Euthanasia for children?

<p>Any thought of child euthanasia seems quite shocking on first instinct. However, Belgium forced a flow of international discussion through its extension of euthanasia laws to suffering patients of any age. This essay looks at its possible application in New Zealand, considering the competence of minors, the need for parental consent (or not) and issues of mental suffering. A final conclusion is drawn that euthanasia, if legalised, would be appropriate only for patients 16 years and over. This essay draws analogies with the law around consenting to other medical procedures, abortion, transgender treatment and contraception. For patients under the 16 age threshold, paediatric palliative care is convincingly the safest and most comprehensive option to assist young terminally ill children and their family through the final stages of life.</p>

Euthanasia for children?

<p>Any thought of child euthanasia seems quite shocking on first instinct. However, Belgium forced a flow of international discussion through its extension of euthanasia laws to suffering patients of any age. This essay looks at its possible application in New Zealand, considering the competence of minors, the need for parental consent (or not) and issues of mental suffering. A final conclusion is drawn that euthanasia, if legalised, would be appropriate only for patients 16 years and over. This essay draws analogies with the law around consenting to other medical procedures, abortion, transgender treatment and contraception. For patients under the 16 age threshold, paediatric palliative care is convincingly the safest and most comprehensive option to assist young terminally ill children and their family through the final stages of life.</p>

“Everybody Knows Everybody”: Adolescents’ Perceptions of What Helps Them Succeed in a Rural Title I School

The current study explored adolescents’ perceptions of what contributes to their experiences of success in a rural Title I school through interpretative phenomenological analysis (IPA). Participants included adolescents who were enrolled at a rural Title I Middle/High School in the southern United States. The single campus school district serves approximately 185 students from Prekindergarten to grade 12. Approximately, 73% of the students are identified as At-Risk, 88% of the students are economically disadvantaged, and 100% of the students qualify for free or reduced lunch. Ten students from this school, with assent and parental consent, participated in the current study. Participants’ ages ranged from 13 to 18, and the students represented different genders (seven males, three females) and various racial and ethnic backgrounds (three Black/African American, four Latinx, two White, and one Biracial). Results from the current study suggest low-income adolescents in a rural Title I school perceived (a) school size, (b) family support, and (c) their own internal drive to succeed as contributing to their success at school. These themes, their corresponding subthemes, and representative participant statements are included. Implications for school administrators, teachers, and counselors along with directions for future research are discussed.

Clinical Trials Involving Minors: The Role of the Ethics Consultation in Avoiding Therapeutic Misconception

"Therapeutic Misconception (TM) occurs when clinical trial participants believe that the central purpose of the trial is therapeutic and that they will personally benefit from participation. If individuals who are entitled to consent to participation in a specific clinical trial do not understand that the defining purpose of clinical research is to produce generalizable knowledge, regardless of whether the subjects enrolled may potentially benefit from the intervention under study, this false belief may motivate them to participate, and in extreme cases may disqualify their consent. TM is especially frequent in fields in which the patients are highly vulnerable, such as when they are children and require parental consent. The informed consent is an essential ethical prerequisite before enrolling each and every participant in research that should protect patients through a process of dialog about a planned course of action. We argue that Ethics Consultant’s competencies may be crucial in avoiding TM: The Ethics Consultant should be involved in neonatal and paediatric clinical trials in order to face the unique vulnerability of children as research subjects, and to ensure that parental consent procedures are rigorously managed, enhancing recruitment in research trials in the context of fully understood consent. "

Recruiting pupils for a school-based eye study in Nigeria: Trust and informed consent concerns

School-based research presents ethical challenges, especially with respect to informed consent. The manner in which pupils and their parents respond to an invitation to participate in research is likely to depend on several factors, including the level of trust between them and the researchers. This paper describes our recruitment and consent process for a school-based eye study in Nigeria. In the course of our study, a particular governmental incident helped to fuel public mistrust in governmental programs and posed a potential threat to our recruitment efforts. The recruitment and consent process included series of advocacy visits to stakeholders in the education sector, highly interactive briefing and health talk sessions in schools, use of telephone services as a medium for information dissemination, age-appropriate study information, parental consent, and pupil assent. Of the 6598 pupils provided with study information, 5723 returned parental consent forms. There were 69 cases of pupils who dissented despite having parental consent. The two leading concerns for the parents/guardians were the rumors regarding a military/governmental-sponsored health campaign and the side-effects of the dilating eye-drops. Nevertheless, our high level of recruitment suggests our recruitment and consent process was successful in assuaging fears for the vast majority of pupils and their parents.

Parental consent for the Covid-19 vaccine in children

Parents may not always agree on childhood immunisation and this may also apply to the Covid-19 vaccination. Dr Andrew Power, Medicolegal Consultant at Medical Protection, discusses how to resolve parental disagreement

Adolescents and age of consent to HIV testing: an updated review of national policies in sub-Saharan Africa

ObjectivesIn sub-Saharan Africa (SSA) where HIV burden is highest, access to testing, a key entry point for prevention and treatment, remains low for adolescents (aged 10–19). Access may be hampered by policies requiring parental consent for adolescents to receive HIV testing services (HTS). In 2013, the WHO recommended countries to review HTS age of consent policies. Here, we investigate country progress and policies on age of consent for HIV testing.DesignComprehensive policy review.Data sourcesPolicies addressing HTS were obtained through searching WHO repositories and governmental and non-governmental websites and consulting country and regional experts.Eligibility criteriaHTS policies published by SSA governments before 2019 that included age of consent.Data extraction and synthesisData were extracted on HTS age of consent including exceptions based on risk and maturity. Descriptive analyses of included policies were disaggregated by Eastern and Southern Africa (ESA) and Western and Central Africa (WCA) subregions.ResultsThirty-nine policies were reviewed, 38 were eligible; 19/38 (50%) permitted HTS for adolescents ≤16 years old without parental consent. Of these, six allowed HTS at ≥12 years old, two at ≥13, two at ≥14, five at ≥15 and four at ≥16. In ESA, 71% (n=15/21) allowed those of ≤16 years old to access HTS, while only 24% (n=6/25) of WCA countries allowed the same. Maturity exceptions including marriage, sexual activity, pregnancy or key population were identified in 18 policies. In 2019, 63% (n=19/30) of policies with clear age-based criteria allowed adolescents of 12–16 years old to access HIV testing without parental consent, an increase from 37% (n=14/38) in 2013.ConclusionsWhile many countries in SSA have revised their HTS policies, many do not specify age of consent. Revision of SSA consent to HTS policies, particularly in WCA, remains a priority to achieve the 2025 goal of 95% of people with HIV knowing their status.

Tonsil Riots and Vaccine Hesitancy: A 100-Year Legacy of Medical Mistrust

The “tonsil riots” of 1906 were panics that developed at several public schools in historically immigrant-dominated neighborhoods of New York City (NYC). Per archived newspaper articles, several NYC public schools asked for parental consent to have Board of Health physicians come and perform tonsillectomy and adenoidectomy on their students. When children subsequently returned home from school “drooling mouthfuls of blood and barely able to speak,” mothers reacted with panic and flocked to the schools demanding the safe return of their children. Police, ultimately, had to be called in to manage the crowds, and the events of 1906 largely faded from the public eye. However, these events can offer important lessons in communication and cultural humility as the United States continues its mass vaccination against coronavirus disease 2019.