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ABSTRACT Objective Design Setting Sample Methods Results Conclusions To understand the experiences of women, birth partners and health professionals of verbal followed by retrospective written consent in a prospective cohort study of a device to manage postpartum haemorrhage (PPH).Grounded Theory.Tertiary facility in North‐West England, UK.We used purposive and theoretical sampling to recruit 51 participants; 12 women, 12 birth partners, 16 obstetricians and 11 midwives.Semi‐structured interviews were conducted, using a topic guide for focus, until data saturation was achieved. Data were analysed using framework analysis technique.Most women wanted sufficient information to make a decision at the time of the event, rather than in advance, and preferred not to be overwhelmed with detail. A key factor in making the decision to participate was a positive and trusting relationship with the attending obstetrician. Obtaining consent for research in emergencies was viewed by obstetricians as requiring a different approach and more challenging than consent for standard procedures in an emergency.This is one of the first studies to explore verbal followed by retrospective written consent processes with women, clinicians and observers. This was acceptable to all, however information needs to be appropriate, and those discussing consent require adequate training (199/200). [ABSTRACT FROM AUTHOR]

Background Study Design and Methods Results Conclusion Some patients express concerns regarding receipt of allogeneic blood transfusions from donors potentially vaccinated against SARS‐CoV‐2 (COVID‐19). However, limited information exists about patients' expression of these concerns or how to address them during the blood transfusion consent process. In this study, we describe our experience of working collaboratively with patients with vaccine‐related transfusion concerns prior to elective surgery, summarizing treatment decisions and clinical outcomes.This observational descriptive study includes patients seen in our Bloodless Medicine and Surgery clinic between June 2022 and June 2024 for vaccine‐related transfusion concerns prior to elective surgery. A shared decision‐making framework was employed to foster conversation, share information, provide reassurance, reconcile conflict, and match preferences with available care options. Patient characteristics, treatment decisions, and surgical outcomes were reviewed and summarized.Thirty‐five patients were included, with median (1st, 3rd quartile) age of 61 (53, 69) years. Cardiac surgery was the most common type of surgery (29%). Twelve patients (34%) were anemic preoperatively, and all received preoperative treatment. After discussion with a Bloodless Medicine specialist, 24 (68.6%) decided to consent to the use of all blood products, 5 (14.3%) accepted only red blood cells, and 6 (17.1%) declined all blood products. Among 28 patients undergoing surgery, only 4 (14%) received allogeneic transfusion perioperatively.Many patients concerned about the vaccination status of blood donors may ultimately consent to allogeneic blood products after shared decision‐making with a Bloodless Medicine specialist, highlighting the importance of patient empowerment and collaborative care. [ABSTRACT FROM AUTHOR]

Human body donors play a crucial role in anatomical education, research, and clinical skills training, and those interested in anatomical donation may bequeath their bodies to body donation programs (BDPs). The purpose of this study was to evaluate the perspective of body donors on the donation process in order to make recommendations for improvement that align with donor values. A survey was administered via email to 2145 individuals that had enrolled in The Ohio State University's BDP and yielded a 40% response rate. Results showed that a majority of registered donors do not place high importance on detailed consent options during the enrollment process, but do value BDP oversight, such as through the use of an oversight committee to supervise the program. Only 9.1% of donors felt that their loved ones should be permitted to make changes to their consent forms after they have passed. Although 96.2% of participants would allow photos/videos to be taken of their donated bodies, females were significantly less likely to consent to this than males (p = 0.001), as well as less likely to allow their donations to be utilized for anatomy outreach (p = 0.023). Racial minorities were significantly less trusting of the university to treat their donation with dignity and respect compared to White registrants (p = 0.034). Suggestions for improving BDP protocols include the implementation of an annual newsletter for registrants, improving methods to spread awareness about donation, increasing transparency during the consent process, and creating resources for donors' families. [ABSTRACT FROM AUTHOR]

Though there has been much debate about whether Abelard's ethics are dangerously subjective or surprisingly absolutist, one thing is unanimous: they are intentionalist. The goal of this article is to parse out what should be meant by this claim, distancing his ethical account from the popular Kantian appraisal. Though much of the secondary literature on Abelard likens him to Kant, I argue that this is mistaken. For Abelard, an agent's intentions are informed by their affections—whether carnal or spiritual. This becomes clear when contextualizing Abelard's use of intentio with a view to his Commentary on Romans. Using the account of intention I suggest—one nuanced by Abelard's own theological commitments and biblical exegesis—it will be clear that Abelard's ethics is not a case for the moral neutrality of the passions nor an ethic of pure reason. [ABSTRACT FROM AUTHOR]

Arranging assent opportunities is an increasingly common strategy for involving clients in therapeutic decisions within behavior analysis. Recent behavior‐analytic articles have helped create a basic behavioral definition and conceptualization of assent, but much more guidance is needed for practitioners and researchers interested in embedding assent into their practices. The purpose of this article is to advance the conceptualization and understanding of assent and assent practices by refining previous definitions and conceptualizations of assent and providing six essential considerations for embedding assent into practice. The six considerations consist of determining the applicability and feasibility of assent, assessing assent‐related skills, arranging assent procedures and teaching assent‐related skills, arranging fair choices, selecting opportunities to assess assent, and informally assessing assent. Following the discussion of the considerations for assent practices, we issue a call for specific topics of research on assent. [ABSTRACT FROM AUTHOR]

Most police searches today are authorized by citizens' consent, rather than probable cause or reasonable suspicion. The main constitutional limitation on so‐called "consent searches" is the voluntariness test: whether a reasonable person would have felt free to refuse the officer's request to conduct the search. We investigate whether this legal inquiry is subject to a systematic bias whereby uninvolved decision‐makers overstate the voluntariness of consent and underestimate the psychological pressure individuals feel to comply. We find evidence for a robust bias extending to requests, tasks, and populations that have not been examined previously. Across three pre‐registered experiments, we approached participants ("Experiencers") with intrusive search requests and measured their behavioral compliance and self‐reported feelings of psychological freedom. Another group of participants ("Forecasters") reported whether they would comply if hypothetically placed in the same situation. Study 1 investigated participants' willingness to allow experimenters access to their unlocked personal smartphones in order to read through the search histories on their web browsers—a private sphere where many individuals feel they have something to hide. Results revealed that whereas 27% of Forecasters reported they would permit such a search, 92% of Experiencers complied when asked. Study 2 replicated this underestimation‐of‐compliance effect when individuals were asked to permit a search of their purses, backpacks, and other bags—traditional searches not eligible for the heightened legal protection extended to digital devices. Study 3 replicated the gap between Forecasters' projections and Experiencers' behavior in a more representative sample, and found it persists even when participants' predictions are incentivized monetarily. [ABSTRACT FROM AUTHOR]

In the context of radiation oncology, radiation exposure from radiation therapy simulation, image guidance, and radiation therapy procedures can have severe adverse biological effects on a developing embryo or fetus. Patients who may be pregnant are screened for the possibility of pregnancy to prevent unnecessary or excessive exposure of radiation in utero. Some radiation therapy patients for whom a pregnancy test is indicated may elect to decline the test. In addition, some patients who are found upon screening to be pregnant may decide, with their attending radiation oncologist, to continue with treatment. A radiation oncology department policy was developed to provide guidelines regarding screening and consent. The policy was designed to prevent unnecessary exposure to patients who may be pregnant, and to limit dose to the embryo or fetus in patients for whom treatment is medically indicated. The policy is presented as an example for physicists intending to develop or revise their own practice's policy regarding patients who may become pregnant. [ABSTRACT FROM AUTHOR]

Stealthing, or non‐consensual condom removal, has become a dark reality for many people, posing risks such as unwanted pregnancy, sexually transmitted diseases, and negative mental health effects. Although stealthing has received prior media coverage, it continues to fly under the legal radar in all but one U.S. jurisdiction. With blogs listing their top 10 tips on stealthing, and memes making light of the issue, it is imperative that the U.S. take action to criminalize stealthing. While the rest of the world amends their laws to include stealthing, the U.S. remains one step behind. Key points for the family court community: An Australian study indicated that roughly 30% of 1189 women respondents had been stealthed.An Australian study indicated that roughly 19% of 1063 men who had sex with men surveyed had been stealthed.A United States study found that 12% of women respondents had experienced stealthing.California is the only American state to enact a civil stealthing law.A study found that among 153 participants, 5.2% reported that they knew what stealthing was. [ABSTRACT FROM AUTHOR]

Every day in EDs, clinicians are faced with situations where they need to decide whether to detain a patient for assessment and treatment. For patients who meet the relevant criteria, provisions of mental health legislation can be used. For other patients, clinicians often rely on so‐called 'duty of care'. This article briefly explores this complex area of law, including the relevant legislation, common law principles and grey areas. It also proposes an approach to decision‐making in this area. [ABSTRACT FROM AUTHOR]

Obtaining medical consent preoperatively is one of the key steps in preparing for surgery, and is an important step in informed decision making with the patient. According to good medical practice guidelines, doctors are required to have the knowledge and skills to treat patients as well as inform them, respect their wishes, and establish trust between themselves and their patients. Valid consent includes elements of competence, disclosure, understanding, and voluntariness. Documentation of these elements is also very important. The International Federation of Gynecology and Obstetrics (FIGO) Education Communication and Advocacy Consortium (ECAC) has realized that the quality of consent varies considerably across the world and has developed simple guidelines regarding consent and procedure‐specific checklists for the most common obstetric and gynecological procedures. Synopsis: To standardize medical care, it is important to understand what constitutes good consent. FIGO has endorsed this guidance for the most common obstetric and gynecological procedures. [ABSTRACT FROM AUTHOR]

With the increased use of technology, the use of medical photography has also increased, especially for secondary purposes. Secondary use only results in a benefit for clinicians and is considered a one‐way process. This, in turn, raises several potential ethical issues, despite the numerous benefits of medical photography. The descriptive cross‐sectional study was conducted with 82 physicians who took medical photos, in Ankara, Turkey. The mean age of the participants was 44.7 years. Of the participants, 95.1% reported using their personal mobile phones for photographing and 84.1% reported taking medical photos for "use in clinical trainings (clinical seminars, student and patient trainings, etc.)". Among physicians who took photos for research purposes, 29.3% reported obtaining only verbal consent. In addition, 53.7% of physicians reported storing medical photos on their personal computers. It seems that there is no consensus among physicians regarding taking, storing, and using medical photos, and these results cause ethical problems. [ABSTRACT FROM AUTHOR]

Context: In vitro fertilisation (IVF) is now a common assisted reproductive technology (ART) procedure globally, with 8 million children alive today having been conceived utilising IVF. For many patients, IVF is a difficult experience with many discontinuing treatment because of emotional, relationship and financial stress, or intolerable physical side effects of hormone treatments. Design and Participants: A qualitative study, in which 31 professionals and 25 patients from the ART sector in Australia were interviewed. The interviews were analysed using codebook thematic analysis. Results: Our data indicates there are 'silences' within the therapeutic relationship of IVF, which may limit the capacity for patients to prepare emotionally, financially, or medically for the procedure, and may contribute to psychological distress and dissatisfaction with care. These 'silences' include what the patient 'is not told' by their clinician or 'does not hear' and what the patient feels they 'cannot say'. Discussion: Drawing upon the work of Jay Katz, Charis Thompson, and Miles Little on 'silences' and performance in clinical practice, we argue that although IVF is a complex and multifaceted procedure that is often conducted in a commercial setting, the clinical and therapeutic relationship between doctor and patient remains pivotal to the experiences of patients. The 'silences' within this relationship may impact negatively on decision‐making, and on the delivery and experience of care. Conclusions: Careful attention to the realities of IVF treatment in the clinic room (and awareness of the performances that hide them) should allow for more present and compassionate care. Such care may leave patients more satisfied with their experience and their choices, regardless of treatment outcomes. Patient or Public Contribution: This article draws on interviews with patients who had undergone or were currently undergoing IVF, as well as a range of representatives from the ART community (including reproductive medicine specialists, general practitioners, fertility nurses, counsellors, administrators in ART businesses and embryologists). [ABSTRACT FROM AUTHOR]

A number of authors criticise opt‐out (or 'deemed consent') systems for failing to secure valid consent to organ donation. Further, several suggest that mandated choice offers a more ethical alternative. This article responds to criticisms that opt‐out does not secure informed consent. If we assume current (low) levels of public awareness, then the explicit consent secured under mandated choice will not be informed either. Conversely, a mandated choice policy might be justifiable if accompanied by a significant public education campaign. However, if this entitles us to assume that members of the public are informed, then an opt‐out system would also be justified in the same circumstances. The alleged advantages of mandated choice seem to rest on an unfair comparison, between mandated choice with a public education campaign and an opt‐out system without one. While it may be that some countries with opt‐out systems should do more to inform their publics, I see no reason to assume that this cannot be done. Indeed, advocates of mandated choice seem committed to thinking it possible to raise awareness. If opt‐out systems adopt the same methods, such as writing to every individual, this should also address concerns about whether consent is informed. [ABSTRACT FROM AUTHOR]

Forced marriage in the United States is a hidden issue for a growing number of children and young people. Being trapped in a marriage severely impacts a person's well‐being, with long‐term psychological and physical ramifications. Forced marriage increases the likelihood of domestic violence and sexual abuse, depriving victims of autonomy. To lessen the number of forced marriages, this Note proposes emulating a United Kingdom statute. The statute provides a comprehensive approach with tailored programs and services to serve the needs of victims of forced marriages. Adopting this statute will create uniform law, making forced marriages illegal federally. Key points for the family court community: An online survey of 7791 individuals estimated an 11% sample prevalence rate of forced marriage in America.There is currently no federal statute outlawing forced marriage.Only nine states and two U.S. jurisdictions have criminal statutes that specifically address the issue of forced marriage.In some states, minors are allowed to marry with parental or judicial consent, or when expecting a child.People use forced marriage as an outlet to alleviate poverty, conceal sexual identity and sexual orientation, provide for a citizenship claim or another person's residence, cover for unplanned pregnancy, or cease criminal or statutory rape investigations. [ABSTRACT FROM AUTHOR]

Researchers agree that the predominant scripts of campus sexual culture, normalizing casual encounters with ambiguous distinctions between hookups and dating, offer contradictory risks and rewards for young adults, particularly young women. The arrival of the novel coronavirus in 2020, however, upended the lives of young adults just as they were shaping sexual and romantic careers. We ask, extending critical intersectional approaches, whether the global pandemic, like a natural experiment, might challenge troubling exclusionary as well as gendered aspects of contemporary sexual culture. In‐depth interviews with 40 "twenty‐somethings" completing undergraduate degrees at a selective university at two points over a year apart found that for most the pandemic offered a needed respite. We suggest: first, many young women used the disruption to prioritize their autonomy, with increased partner churn and detachment. Second, some sexual and racial minority participants, and the few with physical disabilities, reported the pandemic normalized their experience as outsiders, strengthening their self‐development. Finally, the more intentional dating practices one participant named "Covid consent" lessened gendered risks of sexual violence and modeled mutual respect for boundaries. While those without class privilege had less ability to enact such boundaries, pandemic challenges may point to healthier, more inclusive sexual scripts. [ABSTRACT FROM AUTHOR]

A gynaecological ultrasound on an adolescent patient can involve a transabdominal (TAUS), transvaginal (TVUS), trans‐perineal (TPUS) or transrectal (TRUS) approach. Following TAUS a TVUS or TRUS may be suitable on an adolescent patient if they are determined to be a 'mature minor'/Gillick competent and provide informed consent. Legal information on adolescent consent to medical treatment is difficult for sonographers to obtain as current professional guidelines are not sufficiently detailed on the laws of consent to medical treatment and workplace policies are often not specific to adolescent patients. This manuscript provides information on informed consent to medical treatment, 'mature minor'/Gillick competence determination, Australian and New Zealand legislation for 'mature minors' to consent to medical treatment, adolescent psychology and avoiding coercion when obtaining consent. [ABSTRACT FROM AUTHOR]

Researchers agree that the predominant scripts of campus sexual culture, normalizing casual encounters with ambiguous distinctions between hookups and dating, offer contradictory risks and rewards for young adults, particularly young women. The arrival of the novel coronavirus in 2020, however, upended the lives of young adults just as they were shaping sexual and romantic careers. We ask, extending critical intersectional approaches, whether the global pandemic, like a natural experiment, might challenge troubling exclusionary as well as gendered aspects of contemporary sexual culture. In‐depth interviews with 40 "twenty‐somethings" completing undergraduate degrees at a selective university at two points over a year apart found that for most the pandemic offered a needed respite. We suggest: first, many young women used the disruption to prioritize their autonomy, with increased partner churn and detachment. Second, some sexual and racial minority participants, and the few with physical disabilities, reported the pandemic normalized their experience as outsiders, strengthening their self‐development. Finally, the more intentional dating practices one participant named "Covid consent" lessened gendered risks of sexual violence and modeled mutual respect for boundaries. While those without class privilege had less ability to enact such boundaries, pandemic challenges may point to healthier, more inclusive sexual scripts. [ABSTRACT FROM AUTHOR]

Background and Aims: Discharge by personal satisfaction is a condition in which the patient leaves the hospital before completing the care period against medical advice. Thus, this study aims to identify and analyze the reasons for discharge with the personal satisfaction of hospitalized patients. Methods: The study was descriptive‐analytical being performed in 2021. The study population was 2869 discharged inpatients with personal satisfaction. Sampling was done by random and census. The data were collected using a checklist and a researcher‐made questionnaire whose validity and reliability were confirmed. The data were analyzed using SPSS24 by K‐Score test for qualitative and variance for quantitative variables. Results: The discharge rate by personal satisfaction was 7.01%, the average age was 42 years, and the average length of stay was 4 days. Further, 57.1% of patients were female, 63.7% were married, and 21% were babies. A total of 22.77% of the patients were discharged with the father's consent, of which 13.2% were re‐admitted. The most common reasons for the discharge were feeling of recovery (47.2%), the hospital being educational (30%), and dissatisfaction with the services of doctors (51.6%). Discharge with personal satisfaction had a significant relationship with the length of hospitalization (p < 0.001) and type of hospital (p = 0.04). Conclusion: The feeling of recovery, the educational nature of the hospital, and dissatisfaction with the services of doctors were the most common reasons for discharge with personal satisfaction. Therefore, monitoring the provision of services, establishing proper patient‐doctor communication, and increasing the awareness of patients and parents could reduce this type of discharge and its consequences. [ABSTRACT FROM AUTHOR]

This article explores the sexualized nature of the gay tourism industry and examines how 'pink dollar' organizations tacitly encourage incidences of sexual harassment from customers. Drawing on qualitative data from two popular gay tourism destinations, the article shows the embeddedness of sex, as a selling point, in the industry which creates blurred lines between service, sexuality, and sex. This consequently leads to sexual harassment by customers which is accepted and to which workers consent. Consent is driven by the hyper‐sexualization of the workplace and the power imbalance within the service triangle and the interaction with the customer and the precarious nature of the sector. Mirroring Burawoy's (1979) idea of employees consenting (giving in) to organizational norms, we contribute to theory by suggesting that the power imbalance constructed within the service triangle gives high interactive power to the customer to harass workers without evident consequences for their misbehavior, whilst the latter consent and accept this as part of the job, due to the limited support from management. [ABSTRACT FROM AUTHOR]

Within medical ethics, there is widespread agreement that morally valid consent includes an understanding condition. Disagreement centers on what is meant by that understanding condition. Tom Dougherty proposed that this understanding condition should be divided into the two mutually exclusive categories of descriptive information and contextual information. Further, Dougherty argues that each type of information is necessary to satisfy the understanding condition. In contrast, I argue that when the deontic aspect of valid consent is in view, each type of information can be sufficient to satisfy the understanding condition on its own. Moreover, by analyzing delegation, which is conceptually related to consent since both are morally transformative actions, I show that delegation often depends not on descriptive or contextual information but on trust. So, I argue that trustworthiness can also be a type of information that does the same work as descriptive and contextual information in satisfying the understanding condition for valid consent. [ABSTRACT FROM AUTHOR]

Philosophers have become newly interested in the ethics of sex. One promising feature of this new discussion is that it has been broadening our moral lens to include individuals whose sexual interests have historically been denied or ignored. One such group is the elderly. Contrary to popular belief, many elderly people want to have sex and see it as a regular part of their lives. If society harbors ignorance about or prejudice against elderly sexuality, it harbors stronger views against the sexual expression of elderly people with dementia. People with dementia are often prohibited by nursing‐home staff, sometimes in extreme ways, from having sex with their partners. This prohibition is at least partly motivated by the goal of protecting the vulnerable. However, cutting people with dementia off from sex has negative health effects and is a needless restriction of their autonomy. In this article, I argue that the expanding moral lens in sexual ethics should include the sexual expression of elderly individuals with dementia and that their sexual expression should be respected. Specifically, I argue that many people with dementia are competent to consent to sexual activity with their long‐term partners. [ABSTRACT FROM AUTHOR]

In US anatomical gift law, the record on which a person consents to body donation after death is referred to as a document of gift (DG). Due to the lack of legal requirements around minimum information standards, enacted recommendations in the United States, and the unknown variation across extant DGs, a review of publicly‐available DGs from US academic body donation programs were performed to benchmark existing statements and recommend specific foundational content for all US DGs. From 117 body donor programs identified, 93 DGs were downloaded (median length three pages, range 1–20). Statements within the DG were qualitatively categorized into 60 codes within eight themes (Communication, Eligibility, Terms of Use, Logistics, Legal References, Financials, Final Disposition, and Signatures), using existing recommendations of academics, ethicists, and professional associations to guide analysis. Of 60 codes, 12 had high disclosure rates (67%–100% of DGs included; e.g., donor personal information), 22 had moderate rates (34%–66%; e.g., discretion to decline a body), and 26 had low disclosure rates (1%–33%; e.g., testing bodies for disease). Some codes with the lowest disclosure frequency were those previously recommended as necessary. Findings highlighted substantial variation in DG statements, with a higher number of baseline disclosure statements than previously recommended. These results present an opportunity to better understand disclosures that have importance for programs and donors alike. Recommendations suggest minimum standards of informed consent practices for body donation programs in the United States. These include clarity around consent processes, consistency of language, and minimum operational standards for informed consent. [ABSTRACT FROM AUTHOR]

Key content: Clinicians can often face dilemmas in the care of adolescents owing to the lack of understanding over the legal rights and ethical responsibilities involved in their care.A clinician looking after an adolescent should have a good understanding of the principles of adolescent consenting.Often it is necessary to involve the multidisciplinary team and, in extreme circumstances, the court when there is a dispute regarding the competence of the adolescent to consent.Every unit should ensure that they have guidelines for paediatric adolescent gynaecology (PAG) consenting.Areas requiring specific consideration in PAG consent are discussed in this article. Learning objectives: To understand the issues and ethical dilemmas a clinician can face in PAG consent.To understand the current guidance and principles.To develop a problem‐based approach to sharing information with adolescents. Ethical issues: Healthcare professionals must balance the duty of confidentiality with the duties of safeguarding.There can be challenges in influencing the parental authority over the adolescent and balancing this with the child's best interest.Care must be taken in judging the capacity of the adolescent to make decisions. [ABSTRACT FROM AUTHOR]

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for rational choice in alignment with one's values and goals). [ABSTRACT FROM AUTHOR]

Introduction: Engaging adolescents in HIV care and research promotes the development of interventions tailored to their unique needs. Guidelines generally require parental permission for adolescents to receive HIV care/testing or participate in research, with exceptions. Nevertheless, parental permission requirements can restrict adolescent involvement in care and research. To better appreciate prospects for policy reform, we sought to understand the perspectives of stakeholders involved in the development, review and implementation of policies related to adolescents living with HIV. Methods: Semi‐structured individual interviews (IDIs) were conducted from October 2019 to March 2020 with 18 stakeholders with expertise in the (1) development of policy through membership in the Law Society of Kenya or work as a health policy official; (2) review of policy through ethics review committee service; or (3) implementation of policy through involvement in adolescent education. IDIs were conducted in English by Kenyan social scientists, audio‐recorded and transcribed verbatim. We used thematic analysis to identify themes around how policies can be reformed to improve adolescent engagement in HIV care and research. Results: Our analysis identified three major themes. First, policies should be flexible rather than setting an age of consent. Stakeholders noted that adolescents' capacity for engagement in HIV care and research depended on context, perceived risks and benefits, and "maturity"—and that age was a poor proxy for the ability to understand. Second, policies should evolve with changing societal views about adolescent autonomy. Participants recognized a generational shift in how adolescents learn and mature, suggesting the need for a more frequent review of HIV care and research guidelines. Third, adults should empower adolescent decision‐making. Stakeholders felt that caregivers can gradually involve adolescents in decision‐making to equip them to gain ownership over their health and lives, improving their confidence and capacity. Conclusions: Revising relevant laws to consider context, alternative measures of maturity, and evolving societal views about adolescence, along with supporting caregivers to assist in developing adolescent autonomy may promote more equitable and representative participation of adolescents in HIV care and research. Additional research should explore how to support caregivers and other adults to empower adolescents and improve stakeholder engagement in a more routine process of policy reform. [ABSTRACT FROM AUTHOR]

Objective: To present common technical and non‐technical issues leading to medicolegal litigation, illustrated by a series of 54 cases, with the aim of using these examples to prevent harm to patients and to prevent surgeons from having to experience the stress of litigation. Methods: A series of 78 medicolegal litigation cases reviewed by a single expert witness over 13 years from 2008 to 2021 was analysed by two reviewers. Twenty‐nine cases were identified as having a non‐technical learning point and 25 were identified as having a technical learning point. These are discussed using illustrative examples and the steps that could have avoided these issues are considered. Results: All major issues and themes are illustrated with cases demonstrating the errors that lead to litigation and the often‐simple steps that can be taken to avoid them. Out of 29 non‐technical issues, 13 involved consent issues (45%), eight involved delays in treatment (28%) and eight involved failure to provide adequate safeguarding advice (28%). Out of 25 technical issues, 13 cases involved intra‐operative problems (52%) including nine ureteric injuries, eight involved errors or omissions in the immediate preoperative period (32%) and four resulted from decisions around emergency decompression of the obstructed infected kidney. These emergency cases featured complications of amputation (two out of four) and death (one out of four). These decisions are complex and there are many subtleties to these cases, which are discussed in detail. Conclusion: We hope that this case series highlights the potentially catastrophic outcomes of even small errors of judgement, and allows careful stone surgeons to learn from the experiences of those unfortunate others without having to encounter these situations themselves. [ABSTRACT FROM AUTHOR]

Objectives: To present the number and outcomes of urological referrals to the General Medical Council (GMC) and provide a breakdown of the doctors' demographics. Methods: Data were requested and collected from the GMC under the Freedom of Information Act 2000 for all complaints about urologists between 2007 and 2021 (14‐year period). Results: Between 2007 and 2021 a total of 635 urologists were referred to the GMC, totalling 734 referrals (1.15 referrals/doctor). Of these, 50% (364) were closed following a provisional enquiry (PE; 1 month) and another 43% were investigated but no action was taken. Action was taken for only 7% of urologists (49); these urologists were given advice, required to do extra training, suspended from practice, or erased from the medical register. Compared to the current urology workforce, a marginally higher proportion of those referred were international medical graduates or from diverse backgrounds. Conclusion: For urologists unfairly referred to the GMC it is reassuring to know that half of cases are closed at a PE. Of those investigated, only 7% of urologists were given sactions, suspension or given extra training. Reassuringly, our data demonstrate a robust process of GMC investigation, with most doctors going back into work following suitable complaints and, over the last 14 years, only nine urologists received sanctions, two of whom were erased from the medical register. There were only marginal differences when comparing our data to the current urologist population with regard to race and location of primary medical qualification. Conversely, the male‐to‐female split was more heavily weighted towards males being referred to the GMC. [ABSTRACT FROM AUTHOR]

In the debates regarding the ethics of human organoid biobanking, the locus of donor autonomy has been identified in processes of consent. The problem is that, by focusing on consent, biobanking processes preclude adequate engagement with donor autonomy because they are unable to adequately recognize or respond to factors that determine authentic choice. This is particularly problematic in biobanking contexts associated with organoid research or the clinical application of organoids because, given the probability of unforeseen and varying purposes for which a donor's organoids could be employed and given the different ways in which a donor can relate to her biospecimens, a donor can value her organoids differently in different contexts, and her reasons for autonomously permitting use of her cells and tissues in one case may not support an autonomous decision in another. In response, this paper has three aims: first, to make the case for why organoid biobanks ought to respect donor autonomy conceived as authentic choice; second, to explore the autonomy‐respecting limits of established and widely prevalent models of biobank consent; and third, to propose certain conditions that organoid biobanks ought to support or facilitate in order to respect donor autonomy. [ABSTRACT FROM AUTHOR]

Neurointerventions—interventions that cause direct physical, chemical or biological effects on the brain—are sometimes administered to criminal offenders for the purpose of reducing their recidivism risk and promoting their rehabilitation more generally. Ethical debate on this practice (henceforth called 'neurocorrection') has focused on the issue of consent, with some authors defending a consent requirement in neurocorrection and others rejecting this. In this paper, I align with the view that consent might not always be necessary for permissible neurocorrective use, but introduce a qualification I argue ought to inform our ethical and legal analysis of neurocorrection if we are to administer neurocorrectives nonconsensually. I maintain our use of nonconsensual neurocorrection should be constrained by a beneficence requirement—that it should be limited to neurocorrectives that can be expected to benefit those required to undergo them; and my argument is that a beneficence requirement is necessary in order to safeguard against offender abuse. I highlight how we afford a heightened protective role to beneficence in other instances of biomedical intervention where consent is absent or in doubt; and I argue a beneficence requirement is also necessary in the correctional context because alternative candidate protections would provide insufficiently strong safeguards on their own. I then consider whether requiring beneficence in nonconsensual neurocorrection would (a) be incompatible with penal theory, (b) be objectionably paternalistic, or (c) foreclose many fruitful avenues of crime control. I argue in each case that it would not. [ABSTRACT FROM AUTHOR]

Pediatric cancer is accompanied by many ethical challenges, particularly those related to respecting the child's opinion and parental responsibility and consent. Questionnaires were collected from 400 participants, from four equal groups: doctors, nurses, parents and medical students, from three cities in Saudi Arabia, about three problematic issues which revolve around the mandatory consent of one or both parents, the extent of a child's assent, and the acceptable form of consent and assent. Despite the diversity of the participants' cultural backgrounds, most preferred both parents to give consent, followed by either parent without differentiation between parents, which reinforced a trend towards more gender equality. The majority of participants preferred that parental consent forms be detailed enough to obtain the maximum information, while others chose medium‐size consent forms; a large majority preferred that the form seeking to obtain the assent of the child with cancer be short, reflecting their desire not to increase the burden on the child, in addition to the fact that the final decision belongs to the parents rather than the child. Most participants preferred to rely on a child's level of maturity rather than having reached a certain age so that they could give assent, while the rest considered the age of 13‐14 as a suitable age. These findings reflect an increasing ethical awareness regarding parental consent and child assent, and they can be formulated in a recommendation for a more ethical practice in the field of childhood cancer and pediatrics in general. [ABSTRACT FROM AUTHOR]

Adoption is the preferred form of permanence for young children in care in England who are unable to live with their birth family or relatives. However, there have been growing concerns about the use of adoption, particularly in cases where birth parents have not given their consent. Despite concerns, there has been little research into birth parents' views of consent in adoption. This article reports on the experiences of 12 birth mothers and 2 birth fathers whose children were adopted from care in England. Birth parents' views on consent changed throughout the adoption process. They reported that care proceedings could be traumatic, and they did not always understand what was happening. There was a disparity in the quality of legal advice and social work support that birth parents received. The findings raise questions for practice around the level of support birth parents receive during and after care proceedings and highlight the importance of good quality support. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Six years ago, the Supreme Court judgement in Montgomery v Lanarkshire changed medical law. It introduced a new patient‐based standard of care for the communication of treatment risks and alternatives, rejecting the doctor‐based standard that had long governed all aspects of medical negligence. This is the first systematic review to analyse the literature on Montgomery. Our aim is to appraise and synthesize the literature on Montgomery's impact on medicine and the law and to identify areas for further academic enquiry and implications for professional guidance and training. Methods: Searches were run in Medline, Embase, PsycINFO, Web of Science, Scopus, Westlaw UK, HeinOnline, and LexisNexis. Two reviewers screened papers. Extracted data was analysed and discussed by an interdisciplinary team. PRISMA guidelines were followed. Results: Of the 1134 papers identified, 100 met the inclusion criteria. These papers revealed significant disagreement on four core sets of issues, focusing on Montgomery's impact on: (1) legal and professional duties; (2) medical practice; (3) the patient experience; and (4) litigation. The first set addresses whether the case actually changed doctors' legal and professional duties, the relationship between GMC guidance and medical law, and the boundaries of Montgomery. The second explores whether the decision has incentivized defensive medicine, its resource implications, and doctors' knowledge of it. The third concerns whether and how the decision has promoted patient autonomy and involvement in their own care. The fourth focuses on whether the case has caused an increase in litigation. Conclusions: Despite the abundance of legal and medical literature on Montgomery, many issues remain unresolved. Empirical research is required for many of the questions. Doctrinal analysis informed by medical knowledge is also required to assess whether Montgomery may have unrecognized ramifications—for example, whether it will require the disclosure of risks associated with diagnostic uncertainty, where doctors advise patients without performing procedures. [ABSTRACT FROM AUTHOR]

The practice of modern craniomaxillofacial surgery has been defined by emergent technologies allowing for the acquisition, storage, utilization, and transfer of massive amounts of sensitive and identifiable patient data. This alone has thrust providers into an unlikely and unprecedented role as the stewards of vast databases of digital information. This data powers the potent surgical tool of virtual surgical planning, a method by which craniomaxillofacial surgeons plan and simulate procedural outcomes in a digital environment. Further complicating this new terrain is the involvement of third‐party contractors—a necessary presence in bringing raw data to bear in the office, virtual space, and operating room. The individual privileges and responsibilities of patients, providers, and vendors towards data are situated within the most recent U.S. court rulings and regulations. This paper offers guidance for overseeing the safe and responsible transfer to third‐party contractors, and provides suggestions for negotiating the trinary relationship between physicians, their patients, and the vendors offering this transformative technology. [ABSTRACT FROM AUTHOR]

This commentary responds to Samuel Director's article "Dementia and Concurrent Consent to Sexual Relations," in the May‐June 2023 issue of the Hastings Center Report. In the article, Director sets out a set of conditions for sexual consent after one partner in a committed, long‐term relationship develops dementia. While we share Director's view that dementia patients should not be categorically cut off from sexual intimacy, we caution against the use of his approach as a rigid test for allowing sexual activity. Director's analysis does not address the full range of plausibly permissible sexual relationships, which is unfortunate, as intimacy has consistently been linked to physical and psychological well‐being. Moreover, because decisions about sex often carry moral and emotional overtones, we propose that a dementia patient's prior values should sometimes be considered by caregivers in a measured way. [ABSTRACT FROM AUTHOR]

Cosmetic surgery is becoming increasingly popular in Australia with the industry estimated to be worth over 1 billion dollars annually. Regulators both in Australia and internationally have been criticized for not keeping up with the rapidly changing field and keeping patients sufficiently safe in an environment that is problematically entrepreneurial. In this article, we explore the current regulation of and controversies surrounding cosmetic surgery in Australia, including the use of the title 'cosmetic surgeon', consent processes and the phenomenon of medical tourism. Lastly, we review the potential future reforms in Australia and how other countries have regulated the industry to keep patients safe. [ABSTRACT FROM AUTHOR]

A wave of wildcat strikes spread throughout the industrial region of North Rhine Westphalia in 1973. Drawing on a critique of Cedric Robinson's concept of European racialism, Karen Fields and Barbara Fields' work on racism as an ideology, and a Gramscian understanding of hegemonic ideologies from above, I analyse untranslated reports of the failed migrant‐led wildcat strike at the Ford Köln/Niehl plant. An important reason for the unsuccessful strike was the consent building of racial stereotypes against Turkish workers by the press and Ford management. I develop the term "racism from above" to denote the explicit use of racist stereotypes against migrant guest workers to undermine the strike and German‐Turkish solidarity. The reproduction of racism at the workplace demonstrates how consent‐building with racialised (and gendered) capitalist relations of production serves the owning class. Understanding how racism is reproduced in certain spaces will help better counteract attempts to split solidarity from above. [ABSTRACT FROM AUTHOR]

Research ethics oversight systems have traditionally emphasized the informed consent process as the primary means by which to demonstrate respect for prospective subjects. Yet how researchers can best fulfill the ethical obligations of respect for persons in pragmatic clinical trials (PCTs)—particularly those that may alter or waive informed consent—remains unknown. We propose eight dimensions of demonstrating respect in PCTs: (1) engaging patients and communities in research design and execution, (2) promoting transparency and open communication, (3) maximizing agency, (4) minimizing burdens and promoting accessibility, (5) protecting privacy and confidentiality, (6) valuing interpersonal interactions with clinicians and study team members, (7) providing compensation, and (8) maximizing social value. While what respect requires in the context of PCTs will vary based on the nature of the PCT in question, the breadth of these dimensions demonstrates that respect obligations extend beyond informed consent processes. [ABSTRACT FROM AUTHOR]

Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the United Kingdom leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications for fertility treatment and the birth of the resultant child. As the world's first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein. Uterine transplantation warrants a closer look at the legal frameworks on fertility treatment and transplantation in England. Uterine transplantation warrants a closer look at the legal frameworks on fertility treatment and transplantation in England. [ABSTRACT FROM AUTHOR]

Keywords: #metoo; consent; power; sexual harassment EN #metoo consent power sexual harassment 697 702 6 02/15/22 20220301 NES 220301 INTRODUCTION The #metoo movement has cast a renewed focus on sexual harassment and assault in the workplace, "Power & Consent" by Rachel Doyle explores an infamous case from the Australian legal profession and reflects on the phenomenon in Australian society more broadly. Doyle has written a first-person perspective prompted by upheld claims of sexual harassment against a High Court judge, Dyson Heydon. Although the book starts with former High Court Justice Dyson Heydon's sexual harassment case, Doyle asks the critical question, how are sexual harassers are I still i "getting away with it"?. [Extracted from the article]

Objective: Drawing on a feminist framework and social cognitive theory, we examine parental communications about sexual and relationship violence and gendered patterns of communication. Background: Limited research has examined parental communication about sexual and relationship violence, a concern given that parental communication influences children's sexual beliefs in other domains. Method: Participants were 438 university students who responded to three prompts about parental communication regarding sexual and relationship violence (n = 368 who provided responses). A content analysis was performed to categorize responses. Participants also responded to four subscales about parental communication. Results: Most participants reported parent communication about consent, sexual assault, and unhealthy relationships. Women and men reported receiving similar, accurate definitions of consent. Women received messages about monitoring behaviors, help‐seeking, and how to give consent as well as messages that encouraged bodily autonomy, emphasized that sexual assault is not the victim's fault, and deemed physical and emotional abuse unacceptable. Men received messages that sexual assault is wrong, that consent is important, and about how to obtain consent. Conclusions: Collectively, these findings highlight that although parents are communicating important messages about consent, many are also reinforcing gendered sexual scripts. Implications: Implications for education about parental communication and future directions for research are discussed. [ABSTRACT FROM AUTHOR]

In this article, children consenting to a care order proposal is explored as a form of meaningful participation as seen by care‐experienced young people. In contrast to health care and research ethics, almost no research exists on children's consent to child welfare measures. The findings suggest that instead of approaching children as individualistic rights‐holders, a more relational understanding about consenting is required, both conceptually and in practice, to acknowledge the social, emotional and power relations in which children's consent (or objection) becomes topical in child welfare. Without that recognition, consenting may be far from meaningful participation. [ABSTRACT FROM AUTHOR]

The last few decades have witnessed technology progress with leaps and bounds leading to the creation and global adoption of different types of digital devices and platforms that can make personalized recommendations to an individual. One of the consequences of the ubiquity of these devices is the daily generation of data in large quantities. This data includes the sensitive data of an individual as well as multinational organizations and therefore, it must be always kept confidential to prevent its theft and misuse by malicious parties. However, the large volumes of data generated make it difficult to create a robust security solution to safeguard the data from different types of cyberattacks. The paper contributes to the data security industry by consolidating numerous data security algorithms that change with the infrastructure that the data is amid and also outlines the regulations surrounding it. This review paper also aims to highlight the benefits and drawbacks of the security algorithms proposed by researchers to encourage further discussion and consideration of the algorithms for their potential implementation in appropriate domains and also inspire them to develop more powerful and robust security algorithms to cover the drawbacks of the existing ones. [ABSTRACT FROM AUTHOR]

Introduction: This review aims to describe the landscape of pragmatic randomized controlled trials (RCTs) in the context of Alzheimer's disease (AD) and related dementias with respect to ethical considerations. Methods: Searches ofMEDLINE were performed from January 2014 until April 2019. Extracted information included: trial setting, interventions, data collection, study population, and ethical protections (including ethics approvals, capacity assessment, and informed consent). Results:We identified 62 eligible reports. More than two-thirds (69%) included caregivers or health-care professionals as research participants. Fifty-eight (94%) explicitly identified at least one vulnerable group. Two studies did not report ethics approval. Of 57 studies in which patients were participants, 55 (96%) reported that consent was obtained but in 37 studies (67%) no mention was made regarding assessment of the patients' capacity to consent to research participation. Discussion: Few studies reported protections implemented when vulnerable participants were included. Shortcomings remain when reporting consent approaches and capacity assessment. [ABSTRACT FROM AUTHOR]

Introduction: South Africa has one of the highest incidences of HIV among adolescent girls and young women (AGW), ages 15-24, and recent research has focused on developing interventions for HIV prevention. However, the South African National Health Act requires those under 18 years of age to obtain a guardian's permission to participate in research. Limiting research enrolment to AGYW who can obtain guardian consent may lead to non-representative findings. Therefore, innovative, inclusive consent approaches that protect AGYW from the risks of research are needed.Methods: This report details the development and implementation of an approach called the in loco parentis (in place of parent) consent procedure. In loco parentis consent provides a vehicle for adolescent participation that protects adolescents from potential social harms. The in loco parentis consent procedure does not seek to obtain independent minor consent but seeks to obtain permission for the minor to participate in research from a trusted adult who is not a minor's parent or legal guardian. This report also qualitatively explores the experiences of 31 AGYW who were recruited into a behavioral HIV prevention study using this method.Results: Findings suggest that the in loco parentis consent procedure is a feasible and acceptable method to inclusively AGYW in HIV research.Conclusions: The in loco parentis procedure may provide a more inclusive strategy to recruit AGYW for HIV research to increase the generalizability of findings. [ABSTRACT FROM AUTHOR]

Summary: Between 2013 and 2019, there was an increase in the consent rate for organ donation in the UK from 61% to 67%, but this remains lower than many European countries. Data on all family approaches (16,896) for donation in UK intensive care units or emergency departments between April 2014 and March 2019 were extracted from the referral records and the national potential donor audit held by NHS Blood and Transplant. Complete data were available for 15,465 approaches. Consent for donation after brain death was significantly higher than for donation after circulatory death, 70% (4260/6060) vs. 60% (5645/9405), (OR 1.58, 95%CI 1.47–1.69). Patient ethnicity, religious beliefs, sex and socio‐economic status, and knowledge of a patient's donation decision were strongly associated with consent (p < 0.001). These factors should be addressed by medium‐ to long‐term strategies to increase community interventions, encouraging family discussions regarding donation decisions and increasing registration on the organ donor register. The most readily modifiable factor was the involvement of an organ donation specialist nurse at all stages leading up to the approach and the approach itself. If no organ donation specialist nurse was present, the consent rates were significantly lower for donation after brain death (OR 0.31, 95%CI 0.23–0.42) and donation after cardiac death (OR 0.26, 95%CI 0.22–0.31) compared with if a collaborative approach was employed. Other modifiable factors that significantly improved consent rates included less than six relatives present during the formal approach; the time from intensive care unit admission to the approach (less for donation after brain death, more for donation after cardiac death); family not witnessing neurological death tests; and the relationship of the primary consenter to the patient. These modifiable factors should be taken into consideration when planning the best bespoke approach to an individual family to discuss the option of organ donation as an end‐of‐life care choice for the patient. [ABSTRACT FROM AUTHOR]

Across care settings, the practice of lying to or withholding the truth from people living with dementia is common, yet it is objected to by many. Contrary to this common discomfort, I have argued in previous work that respecting members of this group as moral equals sometimes requires deceiving them. In this paper, I test my proposed practice against complex, controversial cases, demonstrating both its theoretical strength and its practical value for those working in social care. [ABSTRACT FROM AUTHOR]

The provision of informed consent for antenatal and intrapartum care remains a contentious issue among healthcare professionals and has been the topic of controversies in the pages of this journal. Recently, the New South Wales (NSW) Department of Health has fundamentally changed the ground rules for the provision of maternity care within the state. In this opinion piece, we try to provide guidance to clinicians to help them deal with the medicolegal environment created by this document which is likely to affect practitioners not just in NSW. [ABSTRACT FROM AUTHOR]

Obtaining assent from potential research participants is an important component of research for reasons related to ethics compliance, self-determination, and choice. However, unique issues arise when working with populations who cannot assent through traditional means, such as individuals with Autism Spectrum Disorder (ASD) and related developmental disabilities (DD). The purpose of this paper is to review and discuss assent practices within behavior-analytic research to identify strategies that can be used to obtain assent from potential participants with ASD and DDs. We began with a descriptive literature review of behavior-analytic articles that included the term "assent" to identify what practices behavior analysts have used to obtain assent from participants. In short, very few articles that clearly addressed assent procedures were identified. Thus, we propose a model for gaining assent when working with individuals with ASD and DDs. [ABSTRACT FROM AUTHOR]

Objective: To look into the urology litigation trends and successful claims in the National Health Service (NHS) over the last 20 years. Methods: We requested data from NHS Resolutions to investigate current litigation numbers, costs and causes for claims. Data collected included the number of claims dating from 1996 to 2019, the total sum of damages paid out each year for urology and the causes for the claims dating from 2009 to 2019. Data from NHS Resolutions were analysed, stratified and categorized by the authors from this information, which was provided as two separate documents. Results: The total cost of damages between 1997 and 2017 was £74.5m (range: £241 325–£7.8m per year). While the number of successful claims was 1653 (range 7–168 per year), the total number of claims was 3341 (range 31–347 per year) and, over time, this has increased almost sevenfold. The cost of damages has increased roughly in line with the number of claims. Over the last 10 years, non‐operative‐related claims accounted for 984 claims, of which the largest subset was for 'the failure to diagnose and/or treat' (n = 639, 65%), with 88 (9%) successful consent‐related claims. There were 226 intra‐operative‐related claims. Of these, wrong‐site surgery, a never‐event, accounted for eight claims and there were six successful claims for failing to supervise juniors. A total of 1129 claims were postoperative claims, with retained foreign body or instrument accounting for 71 (6%) of these. Conclusions: The number and cost of litigation claims have increased year on year. There is a need for continual improvement in patient care, surgical training, counselling, informed consent and early management of complications. The evidence reviewed in this paper suggests that the best approach to this is the combination of rigid adherence to and re‐enforcement of common surgical guidelines and implementation of the national 'Getting it right first time' initiative. [ABSTRACT FROM AUTHOR]