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Abstract2SLGBTQ+ people face disproportionately high rates of gender-based violence (GBV) compared to cisgender heterosexual people. Scholars have predominantly responded to this violence by reporting on victimization, which homogenizes queer and trans life as misery. To avoid reproducing this joy-deficit, we propose a novel approach that centers queer sexual joy. As rape culture is symptomatic of cisheteronormativity, queer sexual joy is a useful analytic with which to subvert GBV. Drawing on findings from the Queer Sexual Joy project, a mixed-methods study involving 100 young adults from Canada and the US, we introduce six recommendations for a framework to focalize queer and trans sexual joy in GBV prevention education, including: 1) containers for safety; 2) communication strategies; 3) bodily autonomy; 4) trauma-informed, anti-oppression, 5) pleasure; and 6) dissociation and grounding practices. We propose that GBV education rooted in queer sexual joy would reorient all youth from hegemonic sexual scripts and provide a frame for more just sexual cultures. [ABSTRACT FROM AUTHOR]

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The majority of the literature focused on whether consent should be extended to the adolescent population arises from themes adapted from American tort law. In contrast to the USA, Ontario does not delineate an age of consent for medical treatment and relying on American guidelines to guide practice in Ontario is problematic. While the literature is saturated with discussions for and against seeking adolescent consent, there are currently no bioethical guidelines on adolescent consent in the province of Ontario. This paper explores adolescent refusal of care and adolescent request for care in opposition to parental wishes. The paper seeks to answer the following questions: What is the difference between an adolescent and an adult in medical decision-making? What are the barriers to seeking adolescent consent? And, can the neurobiological argument be an accurate guide for obtaining adolescent consent? [ABSTRACT FROM AUTHOR]

Background: Immunological responses to metal ions can occur in people with metal implantable devices. Nevertheless, patients are not routinely asked about metal hypersensitivity nor tested for it prior to surgical procedures. Moreover, we have not identified any published literature on patients' experiences with this condition. We undertook this study to better understand the experiences of patients with metal hypersensitivity and to determine what information would help them make an informed decision about implantable medical devices with metal compositions. Methods: This is a patient-oriented research using an interpretative phenomenological methodology. We enrolled 16 people from five countries (Canada, New Zealand, Spain, the UK, and the USA) who experienced metal hypersensitivity following implantable medical device. We collected data from in-depth, semi-structured interviews focused on pre-procedural patient education and postoperative experiences to elucidate the barriers and opportunities related to metal hypersensitivity. We analyzed the data using interpretative phenomenological analysis. Results: The majority were white biological women between the ages of 34 and 65. None of the participants were informed about immunological responses to metals in implants during the consenting process. They encountered many challenges when symptoms of metal hypersensitivity occurred. The outcomes for the few who had the implants removed were mixed. Conclusion: Hypersensitivity reactions to metal need to be discussed as part of the consenting process, and additional strategies are needed to mitigate this issue in the health system. [ABSTRACT FROM AUTHOR]

The Mental Health Act (1996) is legislation that directs voluntary and involuntary psychiatric treatment for people experiencing mental health issues in British Columbia (BC), Canada. This critical discursive analysis explores how BC's Mental Health Act (1996) and the Guide to the Mental Health Act (2005) structure involuntary psychiatric treatment and illustrates how the discourses within these texts constitute people experiencing mental health issues as passive recipients of care. Understandings of people experiencing mental health issues as pathological, incapable, vulnerable and dangerous justify their need for protection and the protection of others. Protection is identified as a central legitimising discourse in the use of involuntary psychiatric treatment. Further, these texts define the roles and responsibilities of police, physicians and nurses in authorising and implementing involuntary psychiatric treatment. This analysis describes how this legislation erodes consent and entrenches social marginalisation. Alternatively, discourses of equity have potential to transform health care practices and structures that reproduce discourses of deficit, vulnerability and dangerousness, shifting towards promotion of the rights and safety of people experiencing mental health issues and crises. [ABSTRACT FROM AUTHOR]

Background: With the enactment of Bill C-7 in Canada in March 2021, people who are eligible for medical assistance in dying (MAiD), whose death is reasonably foreseeable and are at risk of losing decision-making capacity, may enter into a written agreement with their healthcare provider to waive the final consent requirement at the time of provision. This study explored healthcare providers' perspectives on honouring eligible patients' request for MAiD in the absence of a contemporaneous consent following their loss of decision-making capacity.Method: A critical qualitative methodology, using a feminist ethics theoretical lens with its focus on power and relationality, was used to examine how socio-political and environmental contexts influenced healthcare providers' moral agency and perspectives. Semi-structured interviews were conducted with 30 healthcare providers (13 physicians, six nurse practitioners, nine nurses and two social workers) from across Canada who provide MAiD-related care.Results: Themes identified include; (1) balancing personal values and professional responsibilities, (2) anticipating strengths and limitations of the proposed waiver of final consent amendment, (3) experiencing ethical influences on decisions to enter into written agreements with eligible patients, (4) recognizing barriers to the enactment of MAiD in the absence of a contemporaneous consent and (5) navigating the potential for increased risks and burden.Discussion: To our knowledge, this is the first study in Canada to explore healthcare providers' perspectives on waiving the final consent for MAiD using a written agreement. Most participants supported expanding eligible people's access to MAiD following loss of capacity, as they believed it would improve the patients' comfort and minimize suffering. However, the lack of patients' input at the time of provision and related ethical and legal challenges may impact healthcare providers' moral agency and reduce some patients' access to MAiD. Providers indicated they would enter into written agreements to waive final consent for MAiD on a case-by-case basis. This study highlights the importance of organizational, legal and professional support, adequate resources, clear policies and guidelines for the safety and wellbeing of healthcare providers and to ensure equitable access to MAiD. [ABSTRACT FROM AUTHOR]

Background: Clinicians and their employers, concerned with privacy and liability, are often hesitant to support the recording of clinical encounters. However, many people wish to record encounters with healthcare professionals. It is therefore important to understand how existing law applies to situations where an individual requests to record a clinical encounter. Methods: We searched for and reviewed relevant legal documents that could apply to recording clinical encounters. We limited the scope by purposefully examining relevant law in nine countries: Australia, Brazil, Canada, France, Germany, India, Mexico, the United Kingdom and the United States. We analyzed legal texts for consents needed to record a conversation, whether laws applied to remote or face-to-face conversations and penalties for violations. Findings: Most jurisdictions have case law or statutes, derived from a constitutional right to privacy, or a wiretapping or eavesdropping statute, governing the recording of private conversations. However, little to no guidance exists on how to translate constitutional principles and case law into advice for people seeking to record their medical encounters. Interpretation: The law has not kept pace with people's wish to record clinical interactions, which has been enabled by the arrival of mobile technology. [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]

The recent passing of Bill C-7 has placed Advance Requests for MAID (ARMs) on Canada's legislative agenda. We discuss how ARMs may create ethical and practical challenges for Canadian medical practice. [ABSTRACT FROM AUTHOR]

Advance consent could allow individuals at high risk of stroke to provide consent before they might become eligible for enrollment in acute stroke trials. This survey explores the acceptability of this novel technique to Canadian Research Ethics Board (REB) chairs that review acute stroke trials. Responses from 15 REB chairs showed that majority of respondents expressed comfort approving studies that adopt advance consent. There was no clear preference for advance consent over deferral of consent, although respondents expressed significant concern with broad rather than trial-specific advance consent. These findings shed light on the acceptability of advance consent to Canadian ethics regulators.

The administration of Pre-Mortem Interventions (PMIs) to preserve the opportunity to donate, to assess the eligibility to donate, or to optimize the outcomes of donation and transplantation are controversial as they offer no direct medical benefit and include at least the possibility of harm to the still-living patient. In this article, we describe the legal analysis surrounding consent to PMIs, drawing on existing legal commentary and identifying key legal problems. We provide an overview of the approaches in several jurisdictions that have chosen to explicitly address PMIs within codified law. We then provide, as an example, a detailed exploration of how PMIs are likely to be addressed in one jurisdiction where general medical consent law applies because there is no specific legislation addressing PMIs - the province of Ontario in Canada.

Advance consent presents a potential solution to the challenge of obtaining informed consent for participation in acute stroke trials. Clinicians in stroke prevention clinics are uniquely positioned to identify and seek consent from potential stroke trial participants. To assess the acceptability of advance consent to Canadian stroke clinic physicians, we performed an online survey. We obtained 58 respondents (response rate 35%): the vast majority (82%) expressed comfort with obtaining advance consent and 92% felt that doing so would not be a significant disruption to clinic workflow. These results support further study of advance consent for acute stroke trials.

Public health experts in the US and Canada are increasingly mobilizing molecular-based surveillance techniques in seeking to identify and control HIV. Both countries are also leading in the world to criminalize HIV exposure, transmission and non-disclosure, as well as having pervasive ongoing criminalization regimes toward drug use, sex work and migration. Molecular surveillance aims to rapidly identify 'risk network' clusters of people normally out of reach to public health (e.g. drug taking sexual networks of gay men, rural people living in poverty), in the near real-time, where transmissions are taking place, and to then intervene with enhanced public health approaches. This commentary critically interrogates the seemingly benign new technology that is being presented by leading public health authorities evacuated of social and political context. We outline a series of concerns facing people living with HIV related to molecular surveillance as it intersects with consent and criminalization. [ABSTRACT FROM AUTHOR]

Until recently, conflicts between Indigenous peoples and the Canadian state over land development projects have proceeded without the requirement that the state or companies obtain Indigenous consent. In 2018, this changed when the Government of Canada released a statement identifying 'free, prior, and informed consent' (FPIC) as a requirement of meaningful engagement on projects that implicate Indigenous rights. This article considers the promise of consent within consultation processes. Consent is better than its absence, but conflicts over land development often involve rival claims to authority. The principle of consent cannot alone address the challenges posed by these rival claims nor offer appropriate responses to them. Through organised resistance, communities develop collective agency, forge political alliances, and re-appropriate their authority over territory and resources that are significant to them. The introduction of FPIC clarifies but does not replace the benefits of resistance for some communities. [ABSTRACT FROM AUTHOR]

The problematic presumption that users can control the vast consent and data-management responsibilities associated with big data is referred to as the fallacy of data privacy self-management. Though untenable, this presumption remains fundamental to Canadian privacy law, exemplified in the individual access principle of the Personal Information Protection and Electronic Documents Act governing commercial data management. This article describes the fallacy, critiques the individual access principle, and introduces potential solutions relevant to Canada's digital strategy. [ABSTRACT FROM AUTHOR]

Canada’s reputation as a global champion of human rights has been tarnished by the revelation of the enduring colonial impact and social and economic disparities endured by Indigenous peoples within Canada. While Canada has a strong legal framework for Indigenous rights, its significant and enduring policy and implementation failures are increasingly recognised by both domestic and international bodies. This article addresses Canada’s shifting yet fledgling progress towards the harmonisation of Canadian domestic law and the implementation of the United Nations Declaration on the Rights of Indigenous Peoples. The pathway to reconciliation and sustainable development for Canada is discussed as rights-based resource governance in contrast to Canada’s current imposition of extractive imperialism in both Canada and Latin America. [ABSTRACT FROM AUTHOR]

This paper explores the translation of non-canonised literature from a minority culture (Catalan) into a hegemonic culture (Spanish). In particular, it focuses on the ideological and sociocultural factors which lead the translator to purge the translation of idiosyncratic elements pertaining to the source culture. The aim is to show that the omission of such identifying features not only causes a loss of source culture elements in the target text, but it also legitimates the hegemonic role of the dominant culture. To demonstrate this I will show how specific features from the original are concealed in the target text - in the translators’ deliberate act of making the source culture invisible - so that the translation can be published in the Spanish market. The concepts of hegemony, power, and consent, borrowed from cultural studies, form the theoretical grounds underpinning this study, which also vindicates the relevance of this discipline to understand how translation operates in the asymmetric exchange between Catalan and Spanish cultures. [ABSTRACT FROM AUTHOR]

This paper explores discourses of affirmative consent in sex education curriculum and policy. It traces the ways in which discourses of consent have emerged in sex education debates, focusing first on the activism of two young women in Ontario, Canada who lobbied the provincial government to include discussions of consent in a new Health and Physical Education (HPE) curriculum. Their activism is instructive for the ways in which their lobbying was eventually subsumed into the logics of curriculum, with learning outcomes and lesson plans taming the passion of their protest. As others see in sex education the answer to sexual violence, we cannot forget that sex education is, in part, a defence against passion, and that consent - once swallowed up by HPE - might also work to tame the unruliness of sexuality. Turning to age of consent laws - another arena where discourses of consent discipline the sexuality of young people - I ask how our pedagogical and legal address to sexuality paradoxically refuses its force. This is the central argument of this article - namely, that the concept of consent brings with it, into education, a procedural logic that misrecognises sexuality as a transparent, communicative, and rational experience and mistakes compliance for learning. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this study were to evaluate the frequency with which emergency physicians involved in residency leadership disclose potential malignancy risks from computed tomography (CT), assess comfort with these discussions, and evaluate factors influencing risk disclosure.Methods: We surveyed emergency medicine residency program directors and associate/assistant directors. Primary outcome was the proportion who "almost always" or "most of the time" discussed potential risks.Results: Two hundred and seventy-four (50.6%) of 542 eligible physicians responded. There were 82.1% (95% CI 76.8%, 86.6%) who reported almost always or most of the time discussing potential risks for patients ≤18 years; proportions for adults 19-40, 41-65, and >65 years were 50.6% (95% CI 44.4, 56.7%), 20.7% (95% CI 16.0, 26.0%), and 5.2% (95% CI 2.9, 8.5%), respectively (test for trend, p < 0.001). The proportion reporting being "extremely" or "very" comfortable discussing risks was 57.1% (95% CI 51.1, 63.2%). Patient/family CT request that the physician felt was not indicated was of "very high" or "high" importance for driving risk discussions in 86.4% of respondents. For 75.5%, patient/family query about radiation risks was of "high" or "very high" importance. Among 57.4% of respondents, the patient being elderly and/or having a reduced life expectancy was of "high" or "very high" importance in the decision not to discuss risk.Conclusions: Emergency physicians involved in residency leadership report frequently disclosing potential malignancy risks from CT at frequencies inversely proportional to patient age. About half are comfortable with discussions, and many discussions are driven by patient requests. Opportunities exist to optimize and standardize emergency department CT radiation risk disclosure practices. [ABSTRACT FROM AUTHOR]

Rationale: Recruitment in critical care research differs from other contexts in important ways: patients lack decision-making capacity, uncertainty exists regarding patient prognosis, and critical illnesses are often associated with appreciable morbidity and mortality.Objectives: We aimed to describe the experiences of surrogate decision makers (SDMs) in being approached for consent for critically ill patients to participate in research.Methods: A multicenter, qualitative study involving semistructured interviews with 26 SDMs, who provided or declined surrogate consent for research participation, at 5 Canadian centers nested within a multicenter observational study of research recruitment practices. Transcripts were reviewed by three qualitative researchers, and data were analyzed using grounded theory and a narrative critical analysis.Measurements and Main Results: SDMs were guided by an overarching desire for the patient to live. Surrogate research decision-making involved three sequential stages: (1) being approached; (2) reflecting on participation; and (3) making a decision. In stage 1, SDMs identified factors (their expectations, how they were approached, the attributes of the person approaching, and study risks and benefits) that characterized their consent encounter and affirmed a preference to be approached in person. If SDMs perceived the risk of participation to be too high or felt patients may not benefit from participation, they did not contemplate further. In stage 2, SDMs who knew the patient's wishes or had a deeper understanding of research prioritized the patient's wishes and the perceived benefits of participation. Without this information, SDMs prioritized obtaining more and better care for the patient, considered what was in their mutual best interests, and valued healthcare professional's knowledge. Trust in healthcare professionals was essential to proceeding further. In stage 3, SDMs considered six factors in rendering decisions.Conclusions: SDMs engaged in three sequential stages and considered six factors in making surrogate decisions for research participation. Surrogates' assessments of the risks and benefits of participation and their trust in healthcare professionals were critical factors in research decision-making. By conceptualizing surrogate decision-making for research in stages, future research can develop and test procedures to enhance the surrogate research decision-making process. [ABSTRACT FROM AUTHOR]

Indigenous-led, culturally safe health research and infrastructure are essential to address existing inequities and disparities for Indigenous Peoples globally. Biobanking, genomic research, and self-governance could reduce the existing divide and increase Indigenous participation in health research. While genomic research advances medicine, barriers persist for Indigenous patients to benefit. In northern BC, Canada, the Northern Biobank Initiative (NBI), with guidance from a Northern First Nations Biobank Advisory Committee (NFNBAC), has engaged in consultations with First Nations on biobanking and genomic research. Key informant interviews and focus groups conducted with First Nations leaders, Elders, Knowledge Keepers, and community members established culturally safe ways of biobanking and exploring genomic research. Strong support for a Northern British Columbia First Nations Biobank (NBCFNB) that will promote choice, inclusion, and access to health research opportunities emerged. The acceptance and enthusiasm for the development of this NBCFNB and its governance table highlight the shift towards Indigenous ownership and support of health research and its benefits. With engagement and partnership, community awareness, multigenerational involvement, and support from diverse and experienced healthcare leaders, the NBCFNB will establish this culturally safe, locally driven, and critically important research priority that may serve as an example for diverse Indigenous groups when designing their unique biobanking or genomic research opportunities.

In this article, we report research participants' experiences providing professional bondage, discipline, sadism, masochism (BDSM), and other fetish services in Canada. Like many sexual service providers, professional dominatrices often argue that their work challenges patriarchal and oppressive systems of sexual and gender conformity. These women assert that Canadians misunderstand the range of activities that fall under "BDSM" and the dynamics of power within the provider/client relationship. As a result, misrepresentations and inaccuracies form the basis of Canadian laws, which open professional BDSM practitioners to criminalization and remove provider and client autonomy to consent. The 35 professional dominatrices who participated in our mixed-method study challenge this narrow interpretation of their work, suggesting that Canadian law denying bodily autonomy in this context fails to reflect the realities of professional BDSM. Rather than protection from violence, the mischaracterization of the services as criminal in nature serves to perpetuate marginalization, increase vulnerability to exploitation, and maintain stigmatization of non-normative sexualities., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The primary objective of this commentary is to integrate current neuroscientific research on brain development during adolescence, with existing consent frameworks that do not designate a minimum age for eligibility to consent to, or refuse medical treatment. To reach this objective, the three consent frameworks used in health care settings are outlined: age-based framework; mature minor framework and capacity-based framework. This commentary draws on the Canadian health care system specifically to consider consent frameworks that grant young people with decision-making capacity. Next, a brief review of adolescent brain development findings is presented, particularly pertaining to the decision-making capacity of young people within medical contexts. Ultimately, the question of whether the stage of a young person's brain development impedes their capacity to consent to, or refuse medical treatment is addressed. This commentary provides reassurance as to the compatibility between capacity-based and mature minor frameworks to consent to treatment with current neuroscientific understanding of adolescent brain development. [ABSTRACT FROM AUTHOR]

This article discusses the legal requirements which must be taken into account in providing public online services to individuals with a low level of literacy. It will focus on two aspects: the accessibility and usability of these services. The authors propose a twofold theoretical analysis based on two issues raised by government objectives for improving G2C relations. The first one relates to the accessibility of online public services. This concept is not totally unknown in law, particularly regarding the rights of people with physical or cognitive functional disabilities or limitations. It is nonetheless greatly enriched by the peculiarities of the electronic context, as its scope includes circumstantial constraints, among others, imposed by the software or hardware environment. The authors demonstrate that the legal provisions and the standards promoted to frame the deployment of the immaterial relationship with citizens reflect this expanded vision of accessibility. As a result, by choosing a communication tool that implies minimum reading and comprehension skills, the implementation of these provisions and standards should plainly reflect this vision of accessibility by taking factors such as literacy levels into consideration. Secondly, as usability is a corollary to accessibility, the authors suggest that the strategies supporting the penetration of online public services consider the strong appeals from the private sector and, arguably, feedback from individuals themselves with regard to identification and authentication, which are a prerequisite for the use of these services. Consent to the collection, use or disclosure of personal information is another requirement. Beyond mere compliance with legal obligations, one should consider the conclusions and recommendations of the latest Five-Year Report of the Commission d'accès à l'information du Québec (Quebec access to information commission, hereinafter the 'Access Commission') that introduced the use of pictograms, among other proposals, as an avenue to promote the usability of online public services. In this context, designing the process or formalities for disclosure and consent could take into account the situation of people with low literacy levels and, consequently, be accessible to a significant fringe of the population, in addition to being a model for companies as part of their e-commerce process. [ABSTRACT FROM AUTHOR]

This paper examines the implication of the decision to give 2006 Census respondents the option of letting Statistics Canada access their income tax files rather than answering income-related questions directly. We find that giving respondents the option to share their income tax files (or not) adds a confounding factor when it comes to measuring family-income inequality, particularly for the bottom tail of the distribution. The consent decision does not, however, materially affect the estimation of standard wage equations. [ABSTRACT FROM AUTHOR]

Given the current criminalization trend, the motivating question of this article is whether or not sexual transmission of HIV, without specific consent to the risk of such transmission, should be categorized as an assault or a sexual assault, and what difference that (re)categorization might make. In the argument that follows, the criminalization discourses in Canada and England and Wales that underpin and permeate the debates over HIV transmission will be explored. These jurisdictions have been chosen as examples of two regimes, at almost opposite ends of the criminalization spectrum, in which recent changes have set new benchmarks for criminal responsibility. One (England and Wales) has set rather narrow limits on the criminal law, whilst the other (Canada) has set far broader parameters, and lately has begun to include other sorts of cases (such as deception about the absence of birth control) as analogous to the HIV cases, drawing the boundaries of the criminal law even more widely. Beginning with a brief description of the law in each jurisdiction, this article analyzes the gendered and (hetero)normative role of consent in HIV nondisclosure offenses. Through a comparison with the law on sadomasochism, the article questions whether such offenses are rightly categorized as assaults or as sexual assaults. Following a critical engagement with the reasoning in recent Canadian jurisprudence in the area, the article will conclude by addressing the question of how future HIV transmission cases should be tackled. It is argued that in the absence of a policy that precludes criminalization of nondisclosure, the position in England and Wales is to be preferred. [ABSTRACT FROM AUTHOR]

The author discusses the current state of Canadian legal approaches to sexting, and the conceptual difficulties that continue to trouble the search for appropriate legal responses to malicious forms of sexting. By examining the underlying justifications for existing and proposed criminal offences - child pornography and non-consensual distribution of intimate images - as well as the wrongs that undergird private law causes of action like 'publication of private facts' and 'intentional infliction of emotional distress,' the author aims to clarify what sorts of acts of sexting are or should be considered wrongful in a legal sense. Clarifying the wrongs at issue also serves to clarify the rights of victims at issue when sexting is used to inflict harm on another person: namely, that we all have a right to both protection from sexual victimization and from undue interference with sexual expression. [ABSTRACT FROM AUTHOR]

Australian, New Zealand, English and Canadian courts have made a number of orders, often in the context of parenting disputes, requiring children to be vaccinated. Complementary therapy options have generally not been permitted as an alternative to mainstream vaccination. Debates about parental entitlements to make decisions about such matters have taken place in the context of contested family law litigation during the COVID-19 era. However, by contrast with Ontario Superior Court of Justice decisions in 2022, a series of Australian decisions, including the judgment of Sutherland CJ in Clay & Dallas [2022] FCWA 18, have developed the law further, having regard to both the capacity of a minor to consent to vaccination and reviewing a variety of factors going to children's best interests at different junctures during the pandemic, finding it generally to be in the best interests of children to receive COVID-19 vaccinations. This is likely to flow back into curial decision-making about vaccinations more broadly, as well as cognate matters., Competing Interests: None.

Background: Obtaining a research participant's voluntary and informed consent is the bedrock of sound ethics practice. Greater inclusion of children in research has led to questions about how paediatric consent operates in practice to accord with current and emerging legal and socio-ethical issues, norms, and requirements. Methods: Employing a qualitative thematic content analysis, we examined paediatric consent forms from major academic centres and public organisations across Canada dated from 2008-2011, which were purposively selected to reflect different types of research ethics boards, participants, and studies. The studies included biobanking, longitudinal studies, and gene-environment studies. Our purpose was to explore the following six emerging issues: (1) whether the scope of parental consent allows for a child's assent, dissent, or future consent; (2) whether the concepts of risk and benefit incorporate the child's psychological and social perspective; (3) whether a child's ability to withdraw is respected and to what extent withdrawal is permitted; (4) whether the return of research results includes individual results and/or incidental findings and the processes involved therein; (5) whether privacy and confidentiality concerns adequately address the child's perspective and whether standard data and/or sample identifiability nomenclature is used; and (6) whether retention of and access to paediatric biological samples and associated medical data are addressed. Results: The review suggests gaps and variability in the consent forms with respect to addressing each of the six issues. Many forms did not discuss the possibility of returning research results, be they individual or general/aggregate results. Forms were also divided in terms of the scope of parental consent (specific versus broad), and none discussed a process for resolving disputes that can arise when either the parents or the child wishes to withdraw from the study. Conclusions: The analysis provides valuable insight and evidence into how consent forms address current ethical issues. While we do not thoroughly explore the contexts and reasons behind consent form gaps and variability, we do advocate and formulate the development of best practices for drafting paediatric health research consent forms. This can greatly ameliorate current gaps and facilitate harmonised and yet contextualised approaches to paediatric health research ethics. [ABSTRACT FROM AUTHOR]

This article proposes a rigorous method to map the law on to the facts in the legal analysis of sexual consent using a series of mandatory questions of law designed to eliminate the legal errors often made by decision makers who routinely rely on personal beliefs about and attitudes toward "normal sexual behavior" in screening and deciding cases. In Canada, sexual consent is affirmative consent, the communication by words or conduct of "voluntary agreement" to a specific sexual activity, with a specific person. As in many jurisdictions, however, the sexual assault laws are often not enforced. Reporting is lowest and non-enforcement highest in cases involving the most common type of assailants, those who are not strangers but instead persons the complainant knows, often quite well--acquaintances, supervisors or coworkers, and family members. Reliance on popular narratives about "seduction" and "stranger- danger" leads complainants, police, prosecutors, lawyers, and trial judges to truncate legal analysis of the facts and leap to erroneous conclusions about consent. Wrongful convictions and perverse acquittals, questionable plea bargains and ill-considered decisions not to charge, result. This proposal is designed to curtail the impact of prejudgments, assumptions, and biases in legal reasoning about voluntariness and affirmative agreement and to produce decisions that are legally sound, based on the application of the rule of law to the material facts. Law has long had better tools than the age-old and popular tales of "ravishment" and "seduction. Those tools can and should be used. [ABSTRACT FROM AUTHOR]

Purpose: Consent for research is a difficult and unpredictable process in pediatric critical care populations. The objectives of this study were to describe consent rates in pediatric critical care research and their association with patient, legal guardian, consent process, and study design-related factors. Methods: A prospective, cohort study was conducted from 2009 to 2010 in six tertiary care pediatric intensive care units (PICU) in Canada with legal guardians of patients who were approached for consent for any ongoing PICU research study. Data were recorded on details of the consent process for all consent encounters. Results: We recorded 271 consent encounters. The overall consent rate was 80.1% (217/271). We observed higher consent rates when the research assistant was introduced by a member of the clinical team prior to approaching the family (89.7 vs. 77.7%; P = 0.04). Legal guardians of cardiac surgery patients were less likely to provide consent than those of all other patients (75.3 vs. 86.0%; P = 0.03). There was no difference in consent rates between therapeutic (117/145, 80.7%) versus non-therapeutic studies (100/126, 79.4%; P = 0.88). Conclusion: This study provides future researchers with consent data for determination of recruitment rates, sample sizes, budget estimations, and study timelines. Future pediatric critical care studies should consider incorporating the lower consent rates in cardiac surgery patients and routine introduction of the research assistant to the family by a member of the patient's care team into their study designs. The potential influence of parental factors on consent rates in pediatric critical care studies requires further research. [ABSTRACT FROM AUTHOR]

This article is a comparative study of the law dealing with substitute decision making for incapable patients in end-of-life situations across Canadian provinces. In recent years, this issue has received growing consideration from judicial authorities in Canada and abroad. The article discusses the most significant decisions in Canada, with reference as well to leading cases in the UK, Germany and the US. Future policy and legislative options are discussed as well. [ABSTRACT FROM AUTHOR]

This paper focuses on some of the ethical issues which may arise when conducting research in the context of homelessness. These issues are considered from the viewpoints of researchers, research coordinators and interviewers, drawing from their extensive real world experience. In addition to negotiating the complex context of homelessness, community-based homelessness researchers need to address a number of ethical issues in research conception, design, implementation and dissemination. Although these issues are commonly considered in community-engaged research, research with people who are homeless may raise exceptional challenges. Such challenges include determining the nature of informed consent; protecting research participants and researchers, and determining appropriate compensation for participation. Understanding the context of homelessness to conduct ethical research will require sharing information and joint decision-making, processes that must include members of communities within which the research participants live. Furthermore, researchers should be sensitive to the changing context of homelessness, and vigilant for new ethical challenges. [ABSTRACT FROM AUTHOR]

Drawing from educational research conducted in Canada and Mexico, university researchers explore how culture complicates both the ethics review process and the translation of ethical research principles into practice. University researchers in Canadian contexts seek approval from university Research Ethics Boards to conduct research, following policies outlined in the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. In this article, the authors consider some cross-cultural ethical dilemmas in relation to educational research, which is often qualitative and interpretive in nature and conducted in schooling settings. Drawing from educational research, the authors conduct both in Canada and in an international context an exploration of how culture complicates both the ethics review process and the translation of ethical research principles into practice. As a result of their experiences, the authors focus specifically on issues related to consent, reciprocity, anonymity and confidentiality, and data representation. [ABSTRACT FROM AUTHOR]

The increase in child-centered, participatory research activities with children poses new challenges and responsibilities to policy makers and researchers. This reflective piece is a call for Canadian policy makers and researchers to look more critically at their epistemological and ethical assumptions about their views of children, their competence and decision making in research activities. I draw on sociocultural (VYGOTSKY) and dialogic theories (BAKHTIN) to encourage conversation and dialogue about ethical issues in engaging child participants in human inquiry with particular attention to children who learn and live in diverse, multiple language and cultural contexts. [ABSTRACT FROM AUTHOR]

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Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Biobank participation of children is an ethically complicated process as the vulnerability of this population is a concern throughout the entire process of biobanking. Some ethical issues are more prominent in pediatric biobanking and may not need to be considered in biobanking of adult specimens and data. These include assent, reconsent at the age of majority, capacity to consent, and consequences of genetic results on the child and family members. This article describes current processes and best practices described in the literature as well as our experience at the BC Children's Hospital BioBank, a pediatric institutional biobank in Vancouver, Canada. The focus is on processes more specific to pediatric biobanking, such as assent, as well as topics that affect the pediatric population differently compared to adult biobanking.

Purpose: To examine international approaches to the ethical oversight and regulation of quality improvement and clinical audit in healthcare systems., Data Sources: We searched grey literature including websites of national research and ethics regulatory bodies and health departments of selected countries., Study Selection: National guidance documents were included from six countries: Ireland, England, Australia, New Zealand, the United States of America and Canada., Data Extraction: Data were extracted from 19 documents using an a priori framework developed from the published literature., Results: We organized data under five themes: ethical frameworks; guidance on ethical review; consent, vulnerable groups and personal health data. Quality improvement activity tended to be outside the scope of the ethics frameworks in most countries. Only New Zealand had integrated national ethics standards for both research and quality improvement. Across countries, there is consensus that this activity should not be automatically exempted from ethical review but requires proportionate review or organizational oversight for minimal risk projects. In the majority of countries, there is a lack of guidance on participant consent, use of personal health information and inclusion of vulnerable groups in routine quality improvement., Conclusion: Where countries fail to provide specific ethics frameworks for quality improvement, guidance is dispersed across several organizations which may lack legal certainty. Our review demonstrates a need for appropriate oversight and responsive infrastructure for quality improvement underpinned by ethical frameworks that build equivalence with research oversight. It outlines aspects of good practice, especially The New Zealand framework that integrates research and quality improvement ethics., (© The Author(s) 2020. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Context: Advances in medicine have seen changes in mortality in Western countries. Simultaneously, countries such as Australia, Canada, U.S., New Zealand, U.K., and Germany have encouraged consumer-directed care and advance care plan (ACP) completion, giving patients a voice despite incapacity. Adhering to ACPs relies on the decision-making of treating doctors, making hospital doctors key partners, and their perspectives on ACP adherence critical., Objectives: The aim of this review was to explore and map existing research on factors associated with hospital doctors adhering to adult patients' ACPs., Methods: A scoping review of English language publications within CINAHL, Emcare, Medline, PsycInfo, and Scopus was conducted, following PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. ACPs were defined as adult patient-generated, written health care directions or values statements. Studies of any design, which reported original research associated with hospital doctors adhering to ACPs, were included., Results: Twenty-seven publications were included in the final analysis. Results suggested ACPs were thought potentially useful; however, adherence has been associated with doctors' attributes (e.g., specialty, seniority), attitudes toward ACP (e.g., applicability), and legal knowledge., Conclusion: Current literature suggests doctors hold largely positive attitudes toward ACPs that provide useful patient information that enables doctors to make appropriate treatment decisions. Doctors often perceive limitations to ACP applicability due to legal requirements or ambiguity of patient outcome goals., (Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Severe complicated intra-abdominal sepsis (SCIAS) has high mortality, thought due in part to progressive bio-mediator generation, systemic inflammation, and multiple organ failure. Treatment includes early antibiotics and operative source control. At surgery, open abdomen management with negative-peritoneal-pressure therapy (NPPT) has been hypothesized to mitigate MOF and death, although clinical equipoise for this operative approach exists. The Closed or Open after Laparotomy (COOL) study (https://clinicaltrials.gov/ct2/show/NCT03163095) will prospectively randomize eligible patients intra-operatively to formal abdominal closure or OA with NPTT. We review the ethical basis for conducting research in SCIAS. Main body: Research in critically ill incapacitated patients is important to advance care. Conducting research among SCIAS is complicated due to the severity of illness including delirium, need for emergent interventions, diagnostic criteria confirmed only at laparotomy, and obtundation from anaesthesia. In other circumstances involving critically ill patients, clinical experts have worked closely with ethicists to apply principles that balance the rights of patients whilst simultaneously permitting inclusion in research. In Canada, the Tri-Council Policy Statement-2 (TCPS-2) describes six criteria that permit study enrollment and randomization in such situations: (a) serious threat to the prospective participant requires immediate intervention; (b) either no standard efficacious care exists or the research offers realistic possibility of direct benefit; (c) risks are not greater than that involved in standard care or are clearly justified by prospect for direct benefits; (d) prospective participant is unconscious or lacks capacity to understand the complexities of the research; (e) third-party authorization cannot be secured in sufficient time; and (f) no relevant prior directives are known to exist that preclude participation. TCPS-2 criteria are in principle not dissimilar to other (inter)national criteria. The COOL study will use waiver of consent to initiate enrollment and randomization, followed by surrogate or proxy consent, and finally delayed informed consent in subjects that survive and regain capacity. Conclusions: A delayed consent mechanism is a practical and ethical solution to challenges in research in SCIAS. The ultimate goal of consent is to balance respect for patient participants and to permit participation in new trials with a reasonable opportunity for improved outcome and minimal risk of harm. [ABSTRACT FROM AUTHOR]

RéSUMé: OBJECTIF: L'objectif était d'étudier le déploiement des discours sur la vaccination contre les VPH (VVPH) et leur impact sur les filles, les parents, les infirmiers/infirmières et les médecins canadiens. MéTHODES: Des entrevues ont été réalisées avec des participant(e)s (n = 146) de quatre provinces canadiennes. Une analyse poststructuraliste du discours a permis d'examiner les campagnes de VVPH et les transcriptions d'entrevues pour documenter la façon dont les participant(e)s interprètent les VVPH et se positionnent comme sujets au sein des discours de l'industrie ou des agences de santé publique. RéSULTATS: Les campagnes de VVPH sont sexistes, hétéro-normatives et trompeuses. Émergeant de l'analyse des entrevues est le manque d'information des filles et des parents en ce qui a trait à la VVPH. Les mères se construisent en tant que bio-citoyennes responsables, mais au prix de l'impuissance, de l'anxiété et de la peur ressenties parallèlement à l'impératif d'agir pour minimiser le risque de cancer de leur fille. Quant aux professionnel(le)s de la santé, ils s'approprient les discours dominants sur la VVPH et utilisent la peur comme stratégie pour fabriquer le consentement pour la VVPH. Les occasions de dialogue sur la VVPH et la santé sexuelle des filles sont perdues et les positions en tant que sujets sont problématiques pour tous les types de participant. CONCLUSIONS: Nous nous questionnons à savoir si la santé publique est bien servie quand les discours sur la VVPH transforment des corps en santé en corps « à risque » et quand la peur du cancer est instrumentalisée pour la pharmacologisation de la santé publique.

Background: Mandates abound to share publicly-funded research data for reuse, while data platforms continue to emerge to facilitate such reuse. Birth cohorts (BC) involve longitudinal designs, significant sample sizes and rich and deep datasets. Data sharing benefits include more analyses, greater research complexity, increased opportunities for collaboration, amplification of public contributions, and reduced respondent burdens. Sharing BC data involves significant challenges including consent, privacy, access policies, communication, and vulnerability of the child. Research on these issues is available for biological data, but these findings may not extend to BC data. We lack consensus on how best to approach these challenges in consent, privacy, communication and autonomy when sharing BC data. We require more stakeholder engagement to understand perspectives and generate consensus., Methods: Parents participating in longitudinal birth cohorts completed a web-based survey investigating consent preferences for sharing their, and their child's, non-biological research data. Results from a previous qualitative inquiry informed survey development, and cognitive interviewing methods (n = 9) were used to improve the question quality and comprehension. Recruitment was via personalized email, with email and phone reminders during the 14-day window for survey completion., Results: Three hundred and forty-six of 569 parents completed the survey in September 2014 (60.8%). Participants preferred consent processes for data sharing in future independent research that were less-active (i.e. no consent or opt-out). Parents' consent preferences are associated with their communication preferences. Twenty percent (20.2%) of parents generally agreed that their child should provide consent to continue participating in research at age 12, while 25.6% felt decision-making on sharing non-biological research data should begin at age 18., Conclusions: These finding reflect the parenting population's preference for less project-specific permission when research data is non-biological and de-identified and when governance practices are highly detailed and rigourous. Parents recognize that children should become involved in consent for secondary data use, but there is variability regarding when and how involvement occurs. These findings emphasize governance processes and participant notification rather than project-specific consent for secondary use of de-identified, non-biological data. Ultimately, parents prefer general consent processes for sharing de-identified, non-biological research data with ultimate involvement of the child.

Objective: This interview study explored clinicians' perspectives and parents' decision making about children's participation in Duchenne muscular dystrophy (DMD) clinical trials., Methods: Data from semi-structured interviews conducted with clinicians and parents in U.S. or Canada were assessed using thematic analysis., Results: Eleven clinicians involved in ten trials and fifteen parents involved in six trials were interviewed. Parents described benefit-risk assessments using information from advocacy, peers, professionals, and sponsors. Strong influence was attributed to the progressive nature of DMD. Most expected direct benefit. Few considered the possibility of trial failure. Most made decisions to participate before the informed consent (IC) process, but none-the-less perceived informed choice with little to lose for potential gain. Clinicians described more influence on parental decisions than attributed by parents. Clinicians felt responsible to facilitate IC while maintaining hope. Both clinicians and parents reported criticisms about the IC process and regulatory barriers., Conclusions: The majority of parents described undertaking benefit-risk assessments that led to informed choices that offered psychological and potential disease benefits. Parents' high expectations influenced their decisions while also reflecting optimism. Clinicians felt challenged in balancing parents' expectations and likely outcomes. Prognosis-related pressures coupled with decision making prior to IC suggest an obligation to ensure educational materials are understandable and accurate, and to consider an expanded notion of IC timeframes. Anticipatory guidance about potential trial failure might facilitate parents' deliberations while aiding clinicians in moderating overly-optimistic motivations. Regulators and industry should appreciate special challenges in progressive disorders, where doing nothing was equated with doing harm., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Abstract: Purpose: Reliance on third party consent for patients without decision-making capacity presents unique challenges for critical care research. We compared the attitudes and beliefs of Canadian research ethics boards (REBs) and intensive care unit researchers toward the use of various consent models for a low-risk randomized controlled trial. Materials and Methods: Self-administered, scenario-based survey. Results: Sixty-two percent of eligible REBs (n = 83) and 78% of eligible researchers (n = 124) completed the questionnaire. The REBs were less comfortable endorsing alternative consent models when a substitute decision maker was unavailable, including consent provided by (a) the intensivist involved with the trial (2.0% vs 15.3%; P = .014), (b) the intensivist not involved with the trial (10.0% vs 36.7%; P = .001), (c) 2 physicians (the intensivist and another consultant, neither of whom is involved with the trial) (18.0% vs 54.1%; P < .001), and (d) 2 physicians involved neither with the trial nor the patient''s care (10.2% vs 52.0%; P < .001). In similar circumstances, REBs were less comfortable approving both deferred (8.0% vs 43.3%; P < .001) and waived (4.1% vs 22.4%; P = .005) consent. Conclusions: In this survey of scenarios involving low-risk critical care research, REBs were significantly more conservative in approving alternative consent models compared with investigators. [Copyright &y& Elsevier]