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The law relating to consent for medical interventions in children is complex. Children, when they are old or mature enough can consent for themselves, but the legal rules around this vary by jurisdiction. When they are unable to consent, this must be sought from someone with parental responsibility. This article discusses consent, and its refusal, to medical interventions by children, adolescents and parents. [ABSTRACT FROM AUTHOR]

Despite the promise of oral immunotherapy (OIT) to treat food allergies, this procedure is associated with potential risk. There is no current agreement about what elements should be included in the preparatory or consent process. We developed consensus recommendations about the OIT process considerations and patient-specific factors that should be addressed before initiating OIT and developed a consensus OIT consent process and information form. We convened a 36-member Preparing Patients for Oral Immunotherapy (PPOINT) panel of allergy experts to develop a consensus OIT patient preparation, informed consent process, and framework form. Consensus for themes and statements was reached using Delphi methodology, and the consent information form was developed. The expert panel reached consensus for 4 themes and 103 statements specific to OIT preparatory procedures, of which 76 statements reached consensus for inclusion specific to the following themes: general considerations for counseling patients about OIT; patient- and family-specific factors that should be addressed before initiating OIT and during OIT; indications for initiating OIT; and potential contraindications and precautions for OIT. The panel reached consensus on 9 OIT consent form themes: benefits, risks, outcomes, alternatives, risk mitigation, difficulties/challenges, discontinuation, office policies, and long-term management. From these themes, 219 statements were proposed, of which 189 reached consensus, and 71 were included on the consent information form. We developed consensus recommendations to prepare and counsel patients for safe and effective OIT in clinical practice with evidence-based risk mitigation. Adoption of these recommendations may help standardize clinical care and improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

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This article discusses the principles of performing a thyroidectomy. We review the indications, complications, issues of consent and outline the procedure performed by the senior author. We also briefly discuss how to try and reduce common pitfalls and outline the potential future surgical advances. [ABSTRACT FROM AUTHOR]

L'obtention du consentement aux soins impose à l'oncologue radiothérapeute la délivrance d'une information loyale et l'assurance de sa bonne compréhension par le patient. La preuve d'une telle démarche incombe au praticien. La Société française de radiothérapie oncologique (SFRO) ne recommande pas la signature par le patient d'un formulaire de consentement mais, recommande à l'oncologue radiothérapeute d'être en mesure de fournir tous les éléments démontrant la réalité d'un circuit d'information complet. Obtaining consent to care requires the radiation oncologist to provide loyal information and to ensure that the patient understands it. Proof of such an approach rests with the practitioner. The French Society for Radiation Oncology (SFRO) does not recommend the signature of a consent form by the patient but recommends that the radiation oncologist be able to provide all the elements demonstrating the reality of a complete information circuit. [ABSTRACT FROM AUTHOR]

Notre perception des individus ayant recours aux pratiques sexuelles sadiques a longtemps été influencée par la médiatisation d'infractions sexuelles particulièrement graves, généralement des homicides sexuels sadiques. En effet, la plupart des gens associent le sadisme sexuel à des noms de meurtriers sexuels en série tels que Ted Bundy ou Guy Georges. Toutefois, le profil psychologique et les comportements de ces individus ne sont absolument pas représentatifs du profil des individus qui, dans la population générale, pratiquent les activités sexuelles sadiques dans un cadre consensuel. Au-delà des individus pratiquant des activités sexuelles sadiques, les résultats scientifiques (ex. : enquête populationnelle), mais aussi certains succès de la culture populaire (ex. : livres), mettent en évidence que ce qui pouvait paraître autrefois comme étant stigmatisés et « déviants » l'a peut-être été de manière injustifiée en raison de l'engouement populaire que cette thématique peut susciter. Avec plus de 125 millions d'exemplaires imprimées et électroniques vendus dans le monde en 2015, la trilogie de romans érotiques Fifty Shades of Grey (Cinquante nuances de gris) de E.L. James, qui met en avant les pratiques sexuelles impliquant plusieurs déclinaisons du sadisme, de la servitude et de l'initiation à la soumission sexuelle, est en soi un marqueur intéressant des possibles nuances de sadisme au sein de la population générale. Dans cet entretien avec Jean-Pierre Bouchard, Jonathan James, Alexandre Gauthier, Étienne Garant, Ingrid Ménard et Tamsin Higgs dressent l'état des lieux de cet état du sadisme sexuel, que cela soit notamment en termes de pratiques sexuelles consentantes ou en termes d'intérêt sexuels coercitif sadique. Our perception of individuals who engage in sadistic sexual practices has long been influenced by media coverage of highly severe sexual offenses, typically sadistic sexual homicides. Indeed, most people associate sexual sadism with the names of serial sexual murderers such as Ted Bundy or Guy Georges. However, the psychological profile and behaviors of these individuals are in no way representative of the profile of individuals in the general population who practice sadistic sexual activities in a consensual context. In addition from what seems to be a growing number of individuals engaging in consensual sadistic sexual activities, scientific findings (e.g.: population surveys) and certain popular culture successes (e.g.: books) reflect that what have been stigmatized and "deviant" in the past may have been unjustifiably labeled as such. The tremendous success of E. L. James's Fifty Shades of Grey trilogy of erotic novels, which showcases initiation into sexual practices involving several declinations of sadism, bondage and sexual submission, supports this argument. With over 125 million print and electronic copies sold worldwide in 2015, it is in itself an interesting marker of an interest towards sexual sadism within the general population. In this interview with Jean-Pierre Bouchard, Jonathan James, Alexandre Gauthier, Étienne Garant, Ingrid Ménard and Tamsin Higgs present the current state of knowledge on sexual sadism, both in terms of consensual sadistic sexual practices as well as the engagement in coercive and illegal sadistic sexual behaviors. [ABSTRACT FROM AUTHOR]

While consent is an integral part of respectful maternity care, how this is obtained during labour and birth presents conflicting understandings between midwives' and women's experiences. Midwifery students are well placed to observe interactions between women and midwives during the consent process. The purpose of this study was to explore the observations and experiences of final year midwifery students of how midwives obtain consent during labour and birth. An online survey was distributed via universities and social media to final year midwifery students across Australia. Likert scale questions based on the principles of informed consent (indications, outcomes, risks, alternatives, and voluntariness) were posed for intrapartum care in general and for specific clinical procedures. Students could also record verbal descriptions of their observations via the survey app. Recorded responses were analysed thematically. 225 students responded with 195 completed surveys; 20 students provided audio recorded data. Student's observations suggested that the consent process varied considerably depending on the clinical procedure. Discussions of risks and alternatives during labour were frequently omitted. The student's accounts suggest that in many instances during labour and birth the principles of informed consent are not being applied consistently. Presenting interventions as routine care subverted choice for women in favour of the midwives' preferences. Consent during labour and birth is invalidated by a lack of disclosure of risks and alternatives. Health and education institutions should include information in guidelines, theoretical and practice training on minimum consent standards for specific procedures inclusive of risks and alternatives. [ABSTRACT FROM AUTHOR]

This study aims to analyze parent responses to current strict Oklahoma confidentiality and consent laws in an outpatient subspecialty setting. A consent for treatment form including an explanation of the benefits of qualified confidential care for adolescents was given to parents of patients under 18 years of age. The form asked parents to waive the right to access confidential portions of the medical record, be present for the physical exam, be present for risk behavior discussions, and consent for hormonal contraception including a subdermal implant. Demographic information was collected using patient medical records. Data were analyzed using frequencies, chi-square, and t tests. Of the 507 parent forms, 95% of total parents gave permission for providers to have confidential conversations with the patients, 86% allowed providers to examine the patient alone, 84% of parents allowed providers to prescribe contraception, and 66% gave permission for subdermal implant. New patient status, race, ethnicity, assigned sex at birth, and insurance type did not correlate with parents' willingness to provide permissions. There was a statistically significant difference between patient gender identity and percentage of parents who granted permission for a confidential physical exam. Groups more likely to discuss questions about confidential care with the health care provider included parents of new patients, Native American and Black patients, and cisgender female patients. Despite laws that limit adolescent ability to access confidential care in Oklahoma, the majority of parents who were provided an explanatory document allowed their children the right to access this care. [ABSTRACT FROM AUTHOR]

Consent is one of the essential elements of daily practice for clinicians working in Trauma and Orthopaedics. Autonomy is the right of competent adults to make informed decisions about their care. GMC guidance has placed a professional burden on surgeons to provide informed decision making. The Montgomery v Lanarkshire Health Board (2015) case set a precedent that has driven the modernization of consenting practice, raising the status of shared decision making from guidance to legal requirement. In a post-Montgomery landscape, consent is often the first focus for lawyers and insurers when medico-legal malpractice suit is concerned. Orthopaedic surgeons are at a higher risk of facing malpractice suites (Gould et al., 2003), yet there is a lack of formal training regarding obtaining and documenting informed consent. In this article we discuss the historical context, the current status of consent within UK medical practice, as well as strategies to ensure that consent is legally obtained within Trauma and Orthopaedics. [ABSTRACT FROM AUTHOR]

Consent is a fundamental ethical and legal principle in good medical practice. A patient must have capacity to provide informed consent. There are four key principles that need to be satisfied when establishing if a patient has capacity. For consent to be valid, the patient must be made aware of all associated risks to which they would attach significance. Information provided to patients should be individualized, objective and include all reasonable alternatives. It should be made clear if a procedure is optional, for example, an analgesic regional nerve block. Questions should be encouraged and answered honestly. Patients need adequate time to consider all the information provided. The consent process should be documented but a separate signed consent form is not required for most anaesthetic interventions. Some patients may have an advance care directive or a legally appointed power of attorney and these must be respected. When a patient has not made such arrangements and does not have capacity, treatment should be provided in accordance with their best interests. This must be individualized and consider multiple factors. Specialist advice should be sought in circumstances where there is uncertainty. [ABSTRACT FROM AUTHOR]

Organ donation and transplantation has transformed the lives of many around the world. Despite its place as a treatment option for numerous forms of end-stage organ disease, the need for careful ethical and legal consideration is paramount. In this article we discuss three rules: the Dead Donor Rule, which underpins the use of organs for donation from deceased individuals; the 'Rule of Consent' which includes consideration of both deceased and living donors and the recipients of organs; and finally the 'Fair Transplant Rule', which offers protection from the challenging issues of exploitation and organ allocation fairness. When applied in combination these rules should provide an ethically robust platform on which to deliver organ donation and transplantation. These rules can act universally and are applicable across all jurisdictions. Clinicians are encouraged to see organ donation not as a single event, but as a complex combination of individual ethical and legal activities which require independent consideration specific to the donor patient. [ABSTRACT FROM AUTHOR]

The importance of shared decision making (SDM) for informed consent has been emphasised in the updated regulatory guidelines. Errors of completion, legibility and omission have been associated with paper-based consent forms. We introduced a digital consent process and compared it against a paper-based process for quality and patient reported involvement in shared decision making. 223 patients were included in this multi-site, single centre study. Patient consent documentation was by either a paper consent form or the Concentric digital consent platform. Consent forms were assessed for errors of legibility, completion and accuracy of content. Core risks for 20 orthopaedic operations were pre-defined by a Delphi round of experts and forms analysed for omission of these risks. SDM was determined via the 'collaboRATE Top Score', a validated measure for gold-standard SDM. 72% (n = 78/109) of paper consent forms contained ≥1 error compared to 0% (n = 0/114) of digital forms (P < 0.0001). Core risks were unintentionally omitted in 63% (n = 68/109) of paper-forms compared to less than 2% (n = 2/114) of digital consent forms (P < 0.0001). 72% (n = 82/114) of patients giving consent digitally reported gold-standard SDM compared to 28% (n = 31/109) with paper consent (P < 0.001). Implementation of a digital consent process has been shown to reduce both error rate and the omission of core risks on consent forms whilst increasing the quality of SDM. This novel finding suggests that using digital consent can improve both the quality of informed consent and the patient experience of SDM. • The paper consent process is associated with errors and omissions of core risks. • A digital consent process improved error rate and omission rate of core risks. • Patients reported a higher level of shared decision making with a digital process. • Documentation of consent can be reliably standardised with an electronic record. [ABSTRACT FROM AUTHOR]

The origins of general anaesthesia for dentistry are inextricably linked to the dawn of anaesthesia as a specialty, and the availability of the very first inhalational anaesthetic agents. Its delivery, regulation and safety profile have evolved significantly since then, with its practice now conducted solely by trained anaesthetists in a hospital setting. Dental chair anaesthesia and nasal masks have largely been replaced by more modern techniques and equipment, nevertheless, the patients that necessitate these interventions present their own unique challenges. Restricted mostly to adult patients that lack capacity (special care dentistry) and paediatric patients, these two groups can be demanding both clinically and logistically, requiring specialist knowledge and experience in managing patients undergoing 'shared airway' surgery, navigating complex consent and safeguarding processes, and working in tandem with a varied multidisciplinary team. Meticulous planning and organization are key to achieving the best interaction with healthcare services for these patients that often require repeat attendances. [ABSTRACT FROM AUTHOR]

This article discusses why surgeons get into trouble more than most other specialties. It explores some of the areas that are known to be associated with the highest risk of suspension and malpractice claims, including unacceptable professional behaviour, inadequate consent, documentation and peri-procedural precautions, the introduction of new procedures and devices without adequate training, lack of resources and support, whistleblowing, independent work in the private sector, and medicolegal work as an expert. In each of these areas, pitfalls to avoid are highlighted. The article concludes by emphasizing the importance of teamworking, an adequate workload and support, keeping up-to-date, regular peer review, thorough counselling of patients, meticulous record keeping and attention to detail. [ABSTRACT FROM AUTHOR]

Minor adolescents are often excluded from HIV prevention clinical trials due to unresolved ethical issues. Their under-representation in research leads to delayed access to new HIV prevention approaches. We examine the relationship between consent procedures, trial features, demographic and social characteristics, and minor adolescents' willingness to participate (WTP) in biomedical HIV prevention research. We recruited 14–17-year-olds at risk of HIV for this quasi-experimental study. Adolescents were randomly assigned to (1) self-consent, (2) adult permission required, or (3) parental permission required and underwent simulated consent procedures for two types of HIV prevention trials. They rated likelihood of participating in each study if offered the opportunity and completed a survey with demographic, social, and behavioral measures. One hundred and twenty nine adolescents with diverse identities and socioeconomic status enrolled. Among the 58% of participants who identified as lesbian, gay, bisexual, transgender, or queer (LGBTQ), 76% were out to at least one parent/guardian (outness). Mean WTP was 3.6 (of 5; 5 = definitely would participate) across all participants and both trial types. We found no evidence of an association between WTP and consent condition, LGBTQ identity, or outness. However, medical mistrust, communication with parents, and concern about HIV were associated with WTP. Our results suggest adolescents are willing to participate in HIV prevention trials and parental involvement in the consent process may not be the most important deciding factor. However, variation in WTP within consent groups, and variation in other significant variables, underscores the need for individualized approaches to recruitment and consent for these trials. [ABSTRACT FROM AUTHOR]

Consent conversations in pediatric surgery are essential components of pre-operative care which, when inadequate, can lead to significant adverse consequences for the child, parents, surgeon, and others in the healthcare system. The aim of this study is to explore expert consenting practice from the key stakeholders' perspective. Four senior attending pediatric surgeons obtained consent from a standardized mother of a child requiring surgery in two scenarios: a low-risk elective surgery (inguinal hernia repair – Video 1), and a high-risk emergency surgery (intestinal atresia – Video 2). All sessions were recorded. Families of children who had undergone minor or major surgery, families without medical or surgical background, and healthcare professionals were invited to view and evaluate the videos using a semi-structured questionnaire. Out of 251 distributed surveys, 56 complete responses were received. Thirty two participants (57.1%) evaluated video 1 and 24 (42.9%) evaluated. Overall, 22 (69%) respondents to video 1 and 20 (84%) respondents to video 2 were "very satisfied" with the recorded consent conversation. Qualitative responses shared common themes of valuing surgeon empathy, good surgeon communication, patient engagement, and adequate time and information. Suggestions for improvement included additional resources and visual aids, improved patient engagement, and discussion of post-operative expectations. Our data identifies strengths and gaps in the current consent process from the perspective of patient families and providers. Identified areas for improvement in the informed consent process based on multi-stakeholder input will guide the planned development of a consenting educational video resource. IV. • There is a need for better consent conversations in pediatric surgery informed by parents and healthcare providers. • Patients and families appreciate surgeon empathy, good surgeon communication, patient engagement, and adequate time for discussion and questions in a consent conversation. [ABSTRACT FROM AUTHOR]

Obtaining informed consent is essential for any medical or dental procedure. Dentoalveolar surgery poses numerous risks due to the complex environment and anatomy of the oral cavity. Failure to seek and correctly document consent may lead to claims in negligence, as demonstrated by the increasing litigation in OMFS. We audited dentoalveolar surgery consent forms at two different UK OMFS units and found that many forms failed to document important material risks associated with procedures. In an attempt to improve the consent process, we developed a standardised form containing a list of risks for dentoalveolar surgery that can be affixed to the consent form. We suggest other OMFS units adopt this form to standardise the consent process and optimise patient care while protecting clinicians from medico-legal claims. [ABSTRACT FROM AUTHOR]

An anonymous questionnaire consisting of multiple-choice style questions was created at www.surveymonkey.com to assess physicians' perspectives regarding podiatric resident involvement disclosures in the surgical setting. The survey link was sent to podiatric residency program directors, attendings, residents, and fellows through email, social media outlets, and direct contact. For the purpose of this study, residents and fellows will be grouped together as trainees. A total of 201 participants were surveyed, including 63 program directors, 61 attendings, and 77 trainees. Of the respondents, 89.5% reported that at least 1 resident introduces themselves to the patient as a participant in the case. Additionally, 99% of responses revealed that trainees are performing at least 50% of the case. However, surgeons perceive that only 25% of patients are truly aware of this advanced level of involvement. This study suggests that 89.5% of podiatric physicians do in fact disclose trainee surgical participation. However, it is perceived that patients are still unaware of the extent of trainee involvement. Further studies are warranted which would account for both patient and physician understanding of this controversial topic. [ABSTRACT FROM AUTHOR]

Confidentiality is both a legal and ethical duty for medical professionals, however, it is not absolute. Disclosure of confidential information is permitted in specific circumstances. This article will cover the legal framework around confidential information and its disclosure, with relevant examples that may be encountered by anaesthetic and intensive care medicine practitioners. [ABSTRACT FROM AUTHOR]

La procréation médicalement assistée offre une technique qui permet d'avoir les enfants d'une personne récemment décédée. C'est prévu dans le Code Civil Hellénique. Cet article analyse et critique les conditions de la procréation assistée post-mortem selon le Code Civil Hellénique. Medically assisted reproduction offers a technique that allows to have children of a recently deceased person. This is provided for in the Hellenic Civil Code. This article analyzes and criticizes the conditions of post-mortem assisted reproduction according to the Hellenic Civil Code. [ABSTRACT FROM AUTHOR]

This "2-arm parallel" trial investigated the recall of information pertinent to obtaining informed consent of parents of orthodontic patients using; either written material and verbal support or an animation. Parents of patients, aged 12–18 years, about to undergo fixed applaince treatment, were randomized to either receive information by leaflet or by watching an animation. The parents were asked a series of open-ended questions immediately and one year later. The outcome measure was the total median questionnaire score immediately (T 0) and one year later (T 1). A Mann Whitney U test was performed to test for differences between T 0 and T 1. 31 parents were randomized into the leaflet group and 33 in to the animation group. The median leaflet group score was 81 (IQR = 27) at the time of consent (T 0) and 87 (IQR = 29) a year later (T 1), compared to a median score of 76 (IQR = 23) for the animation group at T 0 and 87 (IQR = 32) at T 1. Statistically, there was no difference in the questionnaire score at (T 0) (p = 0.567) and at (T 1) (p = 0.522). The average time spent with the clinician in the leaflet group was an additional 9 min in the animation group. The use of a leaflet and verbal information or an animation are equivalent in providing information to the parents of orthodontic patients. The use of an animation reduces the clinical time needed to deliver the information. [ABSTRACT FROM AUTHOR]

Background: Establishing healthcare professional's views on optimal consent in complex surgery could guide tailored consent policy, improving the process in challenging scenarios. To date, no studies have established if professionals of differing specialities agree on major aspects of consent in areas such as emergency surgery and cancer surgery.Methods: An anonymous web based survey was distributed to a variety of disciplines in a tertiary referral centre. Questions regarding optimal methods and timing of consent in emergency and cancer surgery were posed. Comparative analyses of quantitative data were performed using chi-squared test.Results: 57 responses were received from doctors and nurses of varying disciplines. Differences were found between doctors of separate specialities and nurses in opinion of optimal timing of consent (p = 0.02), consent validity over time (p < 0.001) and the utility of introducing more specific consent policy (p = 0.01). Almost all respondents agreed that healthcare professionals have differing ideas of what consent is.Conclusions: This study demonstrates differences in opinion regarding optimal consent for cancer and emergency surgery. Consideration should be given to developing consensus among healthcare professionals regarding what consent for complex surgery constitutes. [ABSTRACT FROM AUTHOR]

Après une vingtaine d'années de répit, l'ordonnance rendue le 20 mai 2022 par le juge des référés du Conseil d'État remet sous les feux de l'actualité la question du refus transfusionnel émis par les témoins de Jéhovah. Entre les décisions de 2001 et 2002 et celle de 2022 le corpus législatif et réglementaire a considérablement renforcé les droits des patients, consolidant toujours l'autonomie de la personne. Bien que le refus de traitement soit clairement affirmé, la Haute juridiction administrative n'en maintient pas moins sa position. After a twenty-year hiatus, the issue of transfusion refusal issued by Jehovah's Witnesses comes up in legal news with the decision of May 20, 2022 rendered by the Council of State. During these 20 years the rights of patients and the autonomy of the person have been considerably strengthened. Although the refusal of treatment is clearly stated in the law, the High Administrative Court nevertheless maintains its position. [ABSTRACT FROM AUTHOR]

L'histoire des concepts et des principes éthiques en psychiatrie et leur évolution au cours des temps, de l'Antiquité à nos jours, est passée en revue en mettant en valeur les avancées au niveau des droits des patients. Un nouveau Code d'éthique de la WPA a été élaboré en 2020. Il succède à la Déclaration de Hawaï en 1977 et à celle de Madrid en 1996. Ce Code est divisé en quatre sections qui couvrent l'exercice de la psychiatrie dans la pratique clinique, l'éducation, la recherche et la publication ainsi que la santé mentale publique. Nous discuterons aussi les nouveaux enjeux éthiques que ce Code entraîne. This article reviews the concepts and history of ethical principles in psychiatry and their evolution over time from Antiquity to the present highlighting advances made in patient rights. We also discuss the WPA's new Code of Ethics that was developed in 2020 and which succeeds the Declaration of Hawaii of 1977 and the Declaration of Madrid of 1996. The Code is divided into four sections that cover the practice of psychiatry in clinical practice, education, research and publication as well as in public mental health. We also discuss the new ethical issues that this Code entails. [ABSTRACT FROM AUTHOR]

L'article 388-1 du Code civil en France mentionne que « dans toute procédure le concernant, le mineur capable de discernement peut être entendu par le juge ». Les juges aux affaires familiales ont pour tâche d'évaluer la capacité de discernement du mineur en n'ayant ni définition du discernement ni méthode d'évaluation, et en étant sommés de ne pas utiliser le critère de l'âge. À partir des quelques travaux sur le discernement, nous proposons un schéma présentant les composants du discernement et les facteurs biopsychosociaux pouvant affecter le discernement d'un choix/avis exprimé. L'objectif de cette recherche est d'identifier les éléments pris en compte par des juges aux affaires familiales pour apprécier le discernement chez l'enfant et de confronter ces éléments à ceux du schéma. Trente-deux juges aux affaires familiales ont participé à cette étude. Les juges interrogés rapportent certains facteurs identifiés dans le schéma, d'autres ne sont jamais évoqués. D'un point de vue théorique, cette recherche alimente les recherches et les réflexions autour de l'évaluation du discernement. D'un point de vue pratique, cette recherche permet de donner un cadre de réflexion structuré aux juges aux affaires familiales vis-à-vis de cette notion de discernement. Cette réflexion pourra également servir à d'autres professionnels qui peuvent être amenés, de façon implicite, à estimer le niveau de discernement, par exemple les enquêteurs sociaux, les avocats et les psychologues. Article 388-1 of the French Civil Code states that "in any proceedings concerning him, a minor capable of discernment may be heard by the judge". Family court judges have the task of assessing the minor's capacity of discernment by having neither a definition of discernment nor a method of evaluation and by being ordered not to use the age criterion. Following a review of the literature, we propose a sketch presenting the components of discernment and the biopsychosocial factors that can affect the discernment of an expressed choice/opinion. The objective of this research is to compare the representation of judges' discernment in family cases with this sketch. Thirty-two family judges participated in this study. The results show a partial representation of judgment among the judges surveyed, with some factors being under-represented and others never mentioned. The theoretical and practical implications of this research will be discussed. [ABSTRACT FROM AUTHOR]

The provision of medical care for minors can be complicated. On the one hand, the pattern of the traditional family has changed and many parents are separated while retaining parental authority, which can make the pursuit of parental consent even more complex. In addition, French law, in line with international law, has modified the place of minors in the healthcare relationship, acknowledging the importance of seeking their consent. Such consent is sometimes even required for certain medical procedures. This consent from minors may even allow care to be provided to them without the consent of their parents. [ABSTRACT FROM AUTHOR]

L'adolescent est de plus en plus en quête de chirurgie esthétique. Le mode sociétal actuel favorise cette évolution. Il existe cependant une variété de demandes, depuis la disgrâce majeure invalidante, en passant par le désir de consommation esthétique, jusqu'à la demande injustifiée chez le patient atteint de dysmorphophobie. Information et consentement du patient et des parents sont obligatoires. La chirurgie esthétique est légalement possible chez le mineur mais alors qu'elle est possible pour d'autres décisions thérapeutiques, il n'y a pas de majorité médicale anticipée pour la chirurgie esthétique. Le consentement parental reste obligatoire. Le chirurgien doit lui aussi consentir à réaliser cet acte mais il doit prendre en compte la maturité du patient mineur avant de donner son accord à l'acte opératoire demandé. The teenager is more and more in search of cosmetic surgery. The current societal mode favors this evolution. There are, however, a variety of demands, from disabling major disgrace, through the desire for aesthetic consumption, to unjustified demand in the patient with dysmorphophobia. Information and consent of the patient and parents are mandatory. Cosmetic surgery is legally possible in minors but while it is possible for other therapeutic decisions, there is no anticipated medical majority for cosmetic surgery. Parental consent remains mandatory. The surgeon must also agree to perform this act, but he must take into account the maturity of the minor patient before giving his consent to the requested surgical act. [ABSTRACT FROM AUTHOR]

Adolescent minors in every state can give their own consent for some health care. Although parent consent is generally required for vaccination, there are exceptions in some states. Completion rates are low for recommended adolescent vaccines; allowing adolescents to consent may improve coverage, although more study is needed on barriers to vaccine completion and the feasibility of changes in consent laws. The COVID-19 pandemic highlights the importance of vaccines and related challenges. This policy brief reviews laws governing adolescent consent for health care, including vaccines, and recommends advocacy to support increased adolescent access to vaccines and improved public health. [ABSTRACT FROM AUTHOR]

Patients must trust doctors, their decisions and actions; this confidence extends to how we treat patients' information. Healthcare information should be accurate and securely stored in a readily accessible format. With the digital revolution it is increasingly simple to do this, but it is important to be mindful of just how easy it is to breach confidentiality. There is extensive legislation governing the use of healthcare information and the Caldicott principles describe good practice. All healthcare professions have a moral, ethical, regulatory and legal duty to be familiar with these and ensure adherence in daily practice. [ABSTRACT FROM AUTHOR]

People with aphasia have been systematically excluded from stroke research or included without the necessary modifications, threatening external study validity. In this paper, we propose that 1) the inclusion of people with aphasia should be considered as standard in stroke research irrespective of discipline and that 2) modifications should be made to stroke research procedures to support people with aphasia to achieve meaningful and valid inclusion. We argue that outright exclusion of this heterogenous population from stroke research based purely on a diagnosis of aphasia is rarely required and present a rationale for deliberate inclusion of people with aphasia in stroke research. The purpose of this paper is fourfold: 1) to highlight the issue and implications of excluding people with aphasia from stroke research; 2) to acknowledge the current barriers to including people with aphasia in stroke research; 3) to provide stroke researchers with methods to enable inclusion, including recommendations, resources, and guidance; and 4) to consider research needed to develop aphasia inclusive practices in stroke research. [ABSTRACT FROM AUTHOR]

Background: Given increasing community-based and off-label use of ketamine for psychiatric indications, we examined current informed consent processes from a convenience sample of outpatient ketamine clinics to identify areas of congruence with current evidence and opportunities for growth.Methods: Using a rubric developed from existing practice guidelines, we conducted an exploratory analysis of informed consent documents (IC-Docs) from 23 American clinics offering ketamine as a psychiatric treatment. Domains assessed included clinical content, procedures, and syntax.Results: Participating clinics (23/288) varied widely in their constitution, training, and services provided. We found that IC-Docs addressed a majority of consent elements, though did so variably on an item-level. Areas for improvement included communication around long-term adverse effects, treatment alternatives, medical/psychiatric evaluation prior to treatment, medical/psychological support during treatment, adjunctive psychological interventions, and subjective/dissociative-type effects. All forms were limited by poor readability.Limitations: Our study was limited by convenience sampling along with possible underestimation of verbal consent processes.Conclusions: As ketamine continues to emerge as a psychiatric intervention, both patients and providers will benefit from a deliberate consent process informed by scientific, ethical, and pragmatic factors toward the goal of shared decision-making regarding treatment. [ABSTRACT FROM AUTHOR]

The paper offers an overview of pain intervention procedures which are just one facet of a holistic approach to managing pain. They can have a therapeutic and/or diagnostic focus, at times being useful in terms of guiding the clinician to useful pointers to the source of pain, and at others allowing windows of opportunity of pain relief to allow the patient to engage with other modes of pain management such as physiotherapy or occupational therapy with a common goal of improving level of function. The paper explores the importance of managing patient expectations, providing clear patient information and acquiring appropriate patient consent. It provides a brief overview of different procedures, drugs and other modalities as well as imaging used in their delivery. [ABSTRACT FROM AUTHOR]

Medical consent, the process of agreeing the benefits and risks of a treatment or procedure, has specific challenges in pregnancy and labour. Consent should take the form of a discussion about risk and include the alternatives. It should be an ongoing process with the right to withdraw consent or seek further information if the person chooses. Ideally all risks to which the patient might attach significance should be discussed. To consent, a person must have capacity. It is accepted that while labour can involve stress, pain, and fatigue, and will not infrequently be in a time-critical situation, women will normally retain the capacity to consent. This includes the right to make decisions outside of societal norms or which put at risk the life of herself or unborn child. In rare circumstances where an incapacitated woman requires medical intervention in pregnancy this should be done in accordance with appropriate legislation acting in the best interests of the mother. [ABSTRACT FROM AUTHOR]

Parental decision regret in hypospadias surgery is a recognised source of long-lasting psycho-social morbidity. High parental decision regret after their child's hypospadias repair is reported. The aim of this study is to report on decision regret in Australian parents, who accepted and declined surgery for their son and explore underlying factors for decision-making, satisfaction, and regret. An online anonymous survey was administered to three groups of parents: 1) parents who consented for hypospadias repair, 2) parents who declined repair and 3) a control group who requested circumcision for their child. Operations occurred between 2010 and 2020 in two paediatric hospitals in New South Wales, Australia. The survey included a validated decision regret assessment tool and additional questions to explore the possible basis of the opinions. One hundred and eighteen parents (invited - 381, completed – 116, response rate - 31%) participated in the survey. Decision regret was present in group 1 (n = 89) – 55% (moderate-to-severe 15%), in group 2 (n = 14) – 71% (moderate-to-severe 57%), and in the control group (n = 15) – 15% (moderate-to-severe 8%) of parents. There was a significant difference in the median decision regret score between all three groups. Parents who chose hypospadias repair were mostly concerned about function. The prevalence of decision regret among Australian parents who consented for their son's hypospadias repair was lower compared with the mean decision regret reported in the literature to date (55% vs 65%). Decision regret and its severity were highest among parents who declined hypospadias repair. New strategies are needed to reduce decision regret in parents whether they elect for surgery or not. [Display omitted] [ABSTRACT FROM AUTHOR]

Pain is the most common reason for patients to see a doctor. Socio-economic issues including unemployment and difficulty accessing education are common in such patients. Pain is the third leading cause for absence from work. Patients frequently seek support from their multidisciplinary pain team for welfare support and staying in or returning to employment or education. Pain physicians perform a range of intervention procedures and need to have a clear grasp of the law of consent. They are also called on to give expert evidence in personal injury and medical negligence claims where claimants have been left with chronic pain. This paper explores the legal and social infrastructure, and useful knowledge that should be at the fingertips of all those practising in the field of pain medicine. [ABSTRACT FROM AUTHOR]

Introduction: Fusion remains the gold standard treatment for symptomatic first metatarsophalangeal joint (MTPJ) arthritis. Surgeons have traditionally advised female patients during the consenting process that they would have limitations or be unable to wear heeled footwear following first MTPJ fusion due to the loss of dorsiflexion at the first MTPJ. Anecdotally, surgeons have found that some patients were still able to continue wearing heeled footwear post fusion surgery. Heeled footwear has long been a trendy fashion accessory dating back from ancient Egyptian times and are regularly worn by a significant proportion of women today. Given the lack of literature in this matter, this study was conducted to investigate the effect of first MTPJ fusion surgery on the ability to wear heeled footwear, to aid in the consenting process.Methods: A retrospective review of 50 female patients who have had an isolated first MTPJ fusion between 2004 and 2015 at the authors' institution was undertaken with a follow-up telephone survey which included questions on ability to wear heeled footwear pre and post-operatively, duration, and the height of heels they could wear.Results: This study included 50 patients (62 feet) with a mean age of 63 years (range 43-78 years) at the time of surgery, with a mean follow-up of eight years (range 5-16years) from surgery. Of the 42 patients who wore heeled footwear pre-surgery, 26 (62%) continued wearing them. The majority of them (n = 23, 88%) were able to wear the same height heels. Patients could use heeled footwear from 30 min to eight hours continuously (mean=3 h) and, 88% were able to wear heel heights of 1.5 in. or higher. None of the patients wearing heeled footwear returned to the clinic with midfoot/hindfoot symptoms, one returned for worsening of pre-existing first IPJ (interphalangeal joint) symptoms.Conclusion: This study has important implications for information given to patients during the consent process for this operation. The results have shown that many patients continue to wear heeled footwear following first MTPJ fusion with minimal or no symptoms in neighbouring joints. [ABSTRACT FROM AUTHOR]

The consent process is the foundation of the modern doctor–patient relationship, and can present a challenge to doctors. The consent process can be complex, and often involves the interaction of many different factors, including ethical and legal considerations. A shared decision-making process allows for full consideration of the treatment options available, and takes into account individual patient's concerns and preferences. Ensuring that the patient is fully informed requires a thorough understanding of the risks of an intervention for that particular patient; therefore, individualized risk assessment is of fundamental importance. Using a combination of individual patient information, formalized investigations, and population data, gives the most complete assessment of risk. Communicating that risk information to patients is key, and the doctor should always use clear language and avoid bias. The use of visual aids and information leaflets, and the avoidance of vague language and complex statistical terms, will help the patient to develop a more complete understanding of the risks they face. [ABSTRACT FROM AUTHOR]

The Forensic Databases Advisory Board (FDAB), an independent board that assists the International Society for Forensic Genetics (ISFG), has presented a First Report on ethical aspects of the following Forensic Genetic Frequency Databases (FGFD): EMPOP, STRidER and YHRD. The FDAB designed an ethical framework to evaluate the content of these FGFD, and the factors to be considered for retention and acceptance of submissions. The FDAB framework proposes to categorize submissions according to the risk of having contravened the universal ethical principles outlined by international organizations, and the guidelines adopted by the ISFG. The report has been open to discussion by the scientific community since 2023. Herein we present the conception and development of the First Report along with a summary of its content, with consideration of the feedback received. • Presentation of the Forensic Databases Advisory Board work since its establishment in 2021. • Rationale behind the ethical framework to evaluate the content of the FGFD. • Design of risk categories of submissions to FGFD. • Suggested actions on risk submissions. • Continued debate on emerging challenges is needed. [ABSTRACT FROM AUTHOR]

Genital body image is a highly understudied concept but is important for sexual health and broader body image satisfaction. Effective genital body image interventions for adolescents have been developed, however, parental consent can be a barrier to adolescent participation. The aim of this study was to conduct a novel exploration of parental consent for genital body image education research and factors related to this consent. Participants were 125 parents of adolescents in Australia who completed an online questionnaire including measures of demographic characteristics, personality traits and attitudes, and likelihood of consent for an adolescent son and daughter participating in hypothetical genital body image education research. The vast majority of parents indicated that they definitely would consent to their adolescent sons' and daughters' involvement in this hypothetical research. There was no significant difference in likelihood of consent based on the gender of the adolescent. Parents having more conservative attitudes towards sex was the only factor tested that reduced the likelihood of providing consent. Overall, our results suggest parents are generally supportive of adolescent involvement in genital body image education research. This concept should be included in broader body image educational programs so adolescents gain exposure to this important but neglected topic. • Parental consent can be a barrier to adolescent participation in sensitive research. • Parental attitudes to consent for genital body image research were explored. • Most parents would consent to their adolescent sons and daughters participating. • Parental conservative attitudes to sex reduced likelihood of consent. • Genital body image should be included in broader body image education programs. [ABSTRACT FROM AUTHOR]

In this narrative review, we discuss aspects of study design for research in the surgical treatment of patients with spontaneous acute intracerebral hemorrhage (ICH). We emphasize the importance of carefully defining the primary end point relevant to the intervention under investigation, whether this is technical (i.e., residual hematoma volume) or clinical (i.e., mortality or functional outcome), and the timing of its assessment. Compared with patients with acute ischemic stroke, patients with spontaneous acute ICH may take longer to fully recover. Efficient patient recruitment is essential for all research studies and deferred consent is an option to allow disabled and critically ill patients to be included. Although central concealment of the randomization process, often with a method of stratification to ensure that prognostic variables are balanced between groups, it is often appropriate to undertake analysis of the treatment effect adjusted for various predefined covariables. The definition of minimally invasive surgery, and its use and timing in relation to ICH, requires urgent assessment. Future studies could be better designed and executed as part of a large (inter)national ICH trials consortium, consisting of dedicated interdisciplinary teams of neurologists, neurosurgeons, intensivists, and epidemiologists. We advocate studies to be pragmatic and adhere to the IDEAL recommendations and CONSORT guidelines. [ABSTRACT FROM AUTHOR]

Elite athletes are exposed to an elevated risk of musculoskeletal injury which may present a significant threat to an athlete's livelihood. The perioperative anesthetic plan of care for these injuries in the general population often incorporates regional anesthesia procedures due to several benefits. However, some concern exists regarding the potential for regional anesthesia to adversely impact functional recovery in an elite athlete who may have a lower tolerance for this risk. This article aims to review the data behind this concern, discuss strategies to improve the safety of these procedures and explore the features of consent in this patient population. [ABSTRACT FROM AUTHOR]

Complications of regional anaesthesia can be divided into those specific to central neuraxial blockade, those specific to peripheral nerve blockade, and those that pertain to both. Fortunately, severe complications, namely spinal cord damage, vertebral cord haematoma and epidural abscess, are rare. Here we have given an overview of these complications, with reference to incidences available following the Third National Audit Project of the Royal College of Anaesthetists. A thorough knowledge of anatomy and pharmacology, and a meticulous, unhurried technique are key to reducing the risk of such complications. When considering the use of a regional anaesthetic technique, the risks and benefits for the individual patient should be assessed on a case-by-case basis, and set against the risks and benefits of alternatives. [ABSTRACT FROM AUTHOR]

Obtaining affirmative consent, a hallmark of sexual violence prevention education on college campuses, may influence sexual communication and behaviors such as condom use. This study examined the relationship between self-efficacy to obtain sexual consent with sexual health communication and behaviors among a sample of U.S. college students. Data were from 2,291 students enrolled in a cluster-randomized controlled trial conducted on 28 college campuses from 2015 to 2017. Students reported their self-efficacy to obtain sexual consent, communication about sexual health, and sexual health behaviors. Multivariable logistic regression, adjusted for school clustering, history of violence victimization, and sexually transmitted infection history, estimated odds ratios and 95% confidence intervals (CIs) for sexual consent self-efficacy and sexual health communication. Females (n = 1,150) reported higher self-efficacy to obtain consent than males (b 1 =.32, 95% CI =.23,.41), but lower odds of communication about condom use (adjusted odds ratio [AOR] =.75, 95% CI =.60,.96) and HIV prevention (AOR =.63, 95% CI =.48,.81). Black and other race students reported higher odds of HIV/sexually transmitted infection prevention communication than white students. Odds of consistent condom use were highest among students reporting condom use communication and high self-efficacy to obtain sexual consent (AOR = 1.99, 95% CI = 1.58, 2.51). Campus sexual assault prevention education that focuses narrowly on obtaining sexual consent may be missing an opportunity to enhance sexual health communication broadly, including condom and contraceptive use discussion to promote overall sexual health. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsies are a well-established component of the assessment and treatment pathway for patients with cutaneous melanoma in the UK. Commonly utilised techniques involve the use of blue dye which has an established risk of inducing allergic reactions in patients. Such reactions can be life-threatening, and this risk is important to highlight to patients. We conducted a retrospective review of all patients who had undergone this procedure at our melanoma centre in Cambridge, UK. From a group of 715 patients who received blue dye as part of the procedure, six patients suffered an allergic reaction (0.84%) with one of these treated as anaphylaxis. Our incidence of anaphylaxis is almost ten times greater than that reported in the NAP6 report led by the National Institute of Academic Anaesthesia and significantly higher than reported by others. We propose several reasons why our results differ from previous estimates. This study has focused only on patients undergoing a sentinel node procedure for melanoma, others have focused on such procedures performed on patients with breast cancer and some have combined the two. The administration technique, volume and anatomical distribution of disease all differ significantly from melanoma, possibly influencing rates and severity of allergic reactions. [ABSTRACT FROM AUTHOR]

In emergency, physicians are confronted with obligations that may appear in opposition: assistance to a person in danger and consent to care. Knowing the seriousness of acute coronary syndromes, the cardiologist in front of an ignorant patient should not too quickly resolve himself to accept a refusal. In 2 clinical cases, the different means to obtaining consent are recalled: the evocation of the risks in the absence of care (death, physical incapacity, professional aptitude, heavy treatments) taking into account the psychology of the patient, without him make them lose face, by reassuring them about the steps of the procedure, while explaining the lower effectiveness of other therapies (loss of chance). The participation of all medical and paramedical actors makes it possible to match a psychology adapted to the patient's profile, to prevent an incompatibility of mood leading to death by refusal of care. More than ever, the cardiologist has an "obligation" to implement "all means". If the refusal persists, it will be necessary to find the most effective alternative and to get the patient to return to the optimal strategy by a rapid contact, by involving his family and his attending physicians, who will be informed without delay, with remission of prescriptions. To protect themselves from possible prosecution, the healthcare team will record in detail the course of the events, as well as a detailed document of the refusal of care, signed by the patient who acknowledges having been informed of the risks involved. [ABSTRACT FROM AUTHOR]

The law relating to consent for medical interventions in children is complex. Children, when they are old or mature enough, can consent for themselves. When they are unable to do so, consent must be sought from someone with parental responsibility. This article discusses consent, and its refusal, to medical interventions by children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Informed consent is an ethical and legal requirement that differs from informed decision-making-a collaborative process that fosters participation and provides information to help patients reach treatment decisions. The objective of this study was to measure informed consent and informed decision-making before major surgery.Study Design: We audio-recorded 90 preoperative patient-surgeon conversations before major cardiothoracic, vascular, oncologic, and neurosurgical procedures at 3 centers in the US and Canada. Transcripts were scored for 11 elements of informed consent based on the American College of Surgeons' definition and 9 elements of informed decision-making using Braddock's validated scale. Uni- and bivariate analyses tested associations between decision outcomes as well as patient, consultation, and surgeon characteristics.Results: Overall, surgeons discussed more elements of informed consent than informed decision-making. They most frequently described the nature of the illness, the operation, and potential complications, but were less likely to assess patient understanding. When a final treatment decision was deferred, surgeons were more likely to discuss elements of informed decision-making focusing on uncertainty (50% vs 15%, p = 0.006) and treatment alternatives (63% vs 27%, p = 0.02). Conversely, when surgery was scheduled, surgeons completed more elements of informed consent. These results were not associated with the presence of family, history of previous surgery, location, or surgeon specialty.Conclusions: Surgeons routinely discuss components of informed consent with patients before high-risk surgery. However, surgeons often fail to review elements unique to informed decision-making, such as the patients' role in the decision, their daily life, uncertainty, understanding, or patient preference. [ABSTRACT FROM AUTHOR]