Consent Law Research Articles

Minors' Experiences Accessing Confidential Contraception in Texas

PurposeTexas is one of 24 states that restricts minors' ability to obtain contraception without parental consent, unless they access confidential services at federally funded Title X clinics. This study explores Texas minors' reasons for and experiences seeking confidential contraception. MethodsBetween September 2020 and June 2021, we conducted in-depth phone interviews with 28 minors aged 15–17 years. Participants were recruited via the text line and Instagram account of an organization that helps young people navigate Texas' parental consent laws. Interview transcripts were coded and analyzed using inductive and deductive codes in our thematic analysis. ResultsParticipants wanted to be proactive about preventing pregnancy by using more effective contraceptive methods but faced resistance from adults when they initiated conversations about sex and contraception or tried to obtain consent. In the absence of adult support, they turned to online and social media resources for information about types of contraception but encountered challenges finding accurate information about where to obtain methods in Texas without a parent. Only 10 participants were able to attend an appointment for contraception. Parents' increased monitoring of minors' activities during the COVID-19 pandemic, combined with transportation and appointment-scheduling barriers, made it difficult for minors to attend in-person visits, particularly if clinics were farther away. DiscussionMinors in Texas faced a range of barriers to finding accurate information and obtaining confidential contraceptive services, which were exacerbated by the COVID-19 pandemic. Expanding options for accessible confidential contraception, along with repealing parental consent laws, would better support minors' reproductive autonomy.

Are Illinois Contraceptive Providers Comfortable Providing Care to Adolescents? Results From a Statewide Provider Needs Assessment.

Legislation allows adolescents to access comprehensive contraceptive care; however, provider practices remain unclear. We examined predictors of provider knowledge and comfort surrounding the provision of contraceptive care to adolescents. We mailed a survey to Illinois contraceptive providers (n=251). Study outcomes include 1) knowledge of adolescent consent laws, 2) comfort asking for time alone with adolescents, 3) comfort providing contraception to adolescents without parental consent, and 4) comfort providing long-acting reversible contraception (LARC) to adolescents without parental consent. Using multivariable logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Most providers are knowledgeable of consent laws (90%) and report being comfortable asking for time alone with adolescents (94%) and comfortable providing contraception to adolescents without parental consent (88%). Having a large proportion of patients who are eligible for family planning services was associated with increased comfort asking for time alone with adolescents (aOR, 7.03; 95% CI, 1.58-31.3) and providing contraception to adolescents (aOR, 4.0; 95% CI, 1.4-11.1). Only one-half (54%) were comfortable providing LARC methods to adolescents, with higher comfort among providers who: received more than 2days of formal family planning training (aOR, 2.77; 95% CI, 1.2-6.2), specialized in obstetrics-gynecology (aOR, 5.64; 95% CI, 2.1-15.1), and had a patient population with more than 50% patients from minoritized racial/ethnic groups (aOR, 2.9; 95% CI, 1.2-6.6). Although knowledge of consent laws was high, gaps remain. Only one-half of our sample indicated comfort with the provision of LARC methods without parental consent. Additional efforts to increase provider comfort with all contraceptive methods and training on adolescent-centered practices may be required to meet the needs of adolescent patients.

The Regulation of Biotechnology: Ethical, Legal, and Social Implications

This article aims to explore the regulation of biotechnology through the lens of ethical, legal, and social implications. It seeks to identify and analyze the main themes and categories within these implications to provide a comprehensive understanding of the current regulatory landscape and suggest pathways for future policy development. Utilizing a qualitative research design, this study conducted semi-structured interviews with 26 participants from diverse backgrounds, including biotechnologists, legal experts, ethicists, policy makers, and representatives from affected communities. Theoretical saturation was achieved to ensure a robust understanding of the ethical, legal, and social implications of biotechnology regulation. Thematic analysis was employed to categorize the data into main themes and sub-categories. Three main themes emerged from the analysis: Ethical Implications, Legal Implications, and Social Implications. Ethical Implications were subdivided into Consent and Autonomy, Equity and Access, Environmental Ethics, Dual Use and Misuse, Research Ethics, and Moral Boundaries. Legal Implications encompassed Regulatory Frameworks, Intellectual Property, Biosafety and Biosecurity, Consent and Privacy Laws, and Liability and Redress. Social Implications included Public Perception and Trust, Socioeconomic Impacts, Cultural and Religious Perspectives, and Education and Awareness. Each category contained specific concepts highlighting the intricate dynamics within biotechnology regulation. The study concludes that the regulation of biotechnology is a multifaceted issue that requires careful consideration of ethical, legal, and social implications. It underscores the need for a multidisciplinary approach in policy development, emphasizing that future regulations should balance scientific innovation with ethical integrity, legal robustness, and social responsibility. The findings suggest that engaging a broad range of stakeholders and fostering public understanding and trust are crucial for the successful integration of biotechnology into society.

Sexual Consent Perspektif Maqasid Syariah

This article aims to explain the law of sexual consent or sexual consent according to maqasid sharia. Lots of approval and attraction to women, molestation, persecution that causes feelings of oppression and speech. Even in the West there is violence, so that Western women demand the freedom of their body rights. From this sexual agreement, feminism aims to seek justice or benefit for them. In compiling this article, the author uses critical analysis methods to explain the concept of feminism and sexual consent. The results of this study conclude that sexual consent according to Westerners is a solution so that no more treatment is recommended. In fact, Muslims also participate and agree to the concept. This is, which is contrary to maqashid shari'ah or the existence of shari'ah. So that consent and acceptance will only cause harm.

Opportunities to Improve Adolescent Sexual and Reproductive Health Services in Primary Care Clinics.

Primary care providers are well positioned to address the sexual and reproductive health (SRH) needs of adolescents; however, gaps often exist in the delivery of quality SRH services in primary care. Our objective was to identify specific opportunities to improve the delivery of adolescent SRH services in primary care. We conducted in-depth interviews with 25 primary care providers from various disciplines across rural and urban areas of Minnesota and conducted thematic analysis of transcribed data. Participants identified salient opportunities in three areas: (1) training and resources for providers (e.g., related to minor consent laws or addressing sensitive subjects), (2) practices and procedures (e.g., time-alone procedures and policies for confidential screening and sharing test results), and (3) education for adolescents (e.g., knowing their rights and accessing confidential SRH services). Study findings provide actionable opportunities to improve delivery of adolescent SRH services in primary care.

A Bioethics Framework for At-risk Child/Adolescent Access to Key Reproductive Health Services Without Parental Consent

Context: Access of adolescents to key reproductive health services (KRHS) has been emphasized; however, how to provide it has not been addressed. This study aimed to propose a bioethics framework to justify at-risk child/adolescent access to KRHS without parental consent. Evidence Acquisition: First, articles and documents were searched using the age of consent laws, reproductive health, and ethical/legal standards phrases with AND/OR separators in PubMed and Web of Science and also using the Google Scholar search engine in English. After a concise review of the age of consent in child/adolescent-related laws, at-risk child/adolescent access to KRHS without parental consent was justified using major ethical and legal principles and standards. Results: Given the different purposes and nature of harm preventive services, in the first part, the authors argue that considering the age of consent for at-risk adolescents’ access to KRHS is a limiting and inefficient factor, and KRHS could be provided for the at-risk adolescent with his/her own assent. In the second part, the authors argue that in decision-making for at-risk adolescents’ access to KRHS, the best interest standard is applicable on the ground of harm standard. Regarding the sociocultural context of the community, after assessing the seriousness of the harm and the threshold of intervention, practical steps are taken toward reducing or removing harm and choosing the option that best promotes adolescents’ interests. Conclusions: Regarding the existence of restrictive laws, the suggested framework can be applied in different communities as a bioethics policy guide for legislation and appropriate actions of adolescents’ healthcare professionals.

Not just "bodies with vaginas": A Kantian defense of pelvic exam consent laws.

Medical students commonly learn how to administer pelvic exams by practicing on unconscious patients, often without first obtaining explicit consent from patients to do so. While 21 states currently have laws that require teaching hospitals to obtain consent from patients to participate in this educational experience, opposition from the medical community has stymied legislative progress. In this paper, I respond to the two most common reasons offered to opposethe legislation, which appeal to (1) the educational benefits of these examsor (2) protecting institutional autonomy. Kantian ideas about autonomy help to illuminate the problematic ways in which these arguments supplant the importance of women's choices over how their bodies are used while seeking medical treatment. Ultimately, neither argument offers sufficient reason to oppose laws that require explicit consent before administering training pelvic exams.

Abortion Knowledge Among Advanced Practice Clinicians inColorado.

Our objective was to quantify abortion law and care knowledge among Colorado advanced practice clinicians. We conducted a stratified random survey of advanced practice clinicians, oversampling women's health and rural clinicians. We assessed sample characteristics, positions on abortion legality, and knowledge of abortion law and care. Mean knowledge scores were compared by sample characteristics. Survey responses were compared by provision of pregnancy options counseling and positions on abortion legality. Linear regression models were used to examine knowledge scores. A total of 513 participants completed the survey; the response rate was 21%. Abortion law knowledge questions (mean score, 1.7/7.0) ranged from 12% (physician-only law) to 45% (parental consent law) correct. For five of seven questions, "I don't know" was the most frequently chosen response. Abortion care knowledge questions (mean score, 2.8/8.0) ranged from 19% (abortion prevalence) to 60% (no elevated risk of breast cancer) correct. For four of eight questions, "I don't know" was the most frequently chosen response. Practicing in all other areas (e.g., family practice) was associated with lower abortion law and care knowledge than practicing in women's health. Providing options counseling was positively associated with abortion knowledge (law, β=0.44; 95% confidence interval [CI], 0.10-0.78; care, β=0.52; 95% CI, 0.08-0.95). Compared with participants who believe abortion should be legal in all circumstances, those who believe abortion should be illegal in all circumstances had similar abortion law knowledge (β=-0.03; 95% CI, -0.65 to 0.59), but lower abortion care knowledge (β=-1.85; 95% CI, -2.34 to -1.36). Abortion knowledge is low among Colorado advanced practice clinicians and education is needed.

P11.32: Brain Death in Uruguay: 19 Years of Experience

Objetive: Describe the Epidemiology of Brain Death (BD) in 19 years. Material and methods: We studied potential donors reported to the National Registry of Donors diagnosed with BD between 2002 and 2020. We analyzed: total number of communications, age distribution, causes of death, BD diagnostic method, medical contraindications, family refusals, real donors and conversion of BD to real donor. Results: They communicated 2770 BD from all over the country, the age distribution was mainly between 18 and 60 years old, representing 70%. In extreme ages we had the lowest percentage of diagnoses with 2.2% between 1 and 5 years and 2% in those older than 75 years. Taking globally those over 65 years of age, these were 10.1% of BD. There were no differences regarding the months of the year or the days of the week in which the BD were reported. The time of greatest communication was between 1:00 and 6:00 p.m., 36% and from 7:00 to 11:00 p.m. 23%. Causes of death: CVA 51.1% followed by TEC with 23.4%. The diagnosis of BD was clinical and Doppler was used in 20%. Doppler was used as an auxiliary method in 6.8% in 2019 and 9.2% in 2020. The medical contraindications were: sepsis 16%, poor hemodynamics 10.8%, tumor 12%, hypertension/diabetes 16%. The family refusal prior to the implementation of the presumed consent law was 54.4% and of the total communications of BD that had prior expression of donation in the National Registry of Donors, 46.7% were negative. The real donors in this period were 1125. Conversion from BD to Real Donor of 40%. Analyzing the conversion in the years following the implementation of presumed consent, the average conversion was 51.6% 860BD/444 DR. DR over 65 years old were 5.4%, 66 to 70 years old 4.1%, 71 to 75 years old 1.1% and over 75 years old 0.08%. Conclusion: Uruguay has a rich experience in donation and transplants. This analysis of 19 years of BD communications leaves some important conclusions: a decrease in BD in children under 5 years of age, low use of people over 65 years of age as real donors, and a clear benefit of the presumed consent law over the refusal to The donation.

578 Is the Scope of the Physician's Duty to Warn the Patient About the Risks Associated with a Surgery Sufficiently Clear?

Abstract Aim To critically analyze the concepts and cases that led to the seminal rulings in Montgomery and Sidaway Method A medical and legal literature review was performed. Case history was identified and critically analysed to understand the progression of consent law in England. Results The physician's duty to warn the patient about the risk associated with medical intervention has been developed through the cases identified to involve: The process of consent is of chief importance in surgery and yet only a single case (Chester) directly involves consenting during a surgical procedure. Conclusion The definition of material risk is expected to cover a plethora of medical interventions from minor procedures to major surgery. It was generated predominantly from non-surgical cases. The physician's scope to disclose risks to patients is broad and encompasses a skillset that incites core clinical skills of empathy, honesty, and information transfer. It has evolved alongside advances in medical and legal judgement, albeit reactively to cases of inadequate care. With regard to its clarity, one has to consider the acceptable boundary of prescriptivism that both respects patient autonomy and creates a transparent working environment. It can be argued that the current scope is not direct enough for healthcare professionals.

Minor Consent Laws for Sexually Transmitted Infection and HIV Services

This study examines current minor consent laws for sexually transmitted infection/HIV services and related confidentiality protections in all 50 states and the District of Columbia.

From Human Papillomavirus to COVID-19: Adolescent Autonomy and Minor Consent for Vaccines

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

More Than Just a Check-the-Box Form: Informed Consent.

More Than Just a Check-the-Box Form: Informed Consent.

Do age of consent laws decrease teen births?

AbstractThis paper studies two legislative changes that extended legal penalties for sex with minors ages 14 to 16 in Canada and the US. Using differences‐in‐differences and triple‐differences strategies, it presents new evidence that age of consent laws affect teen fertility, especially the rate that teenage girls aged 14 to 15 become pregnant and have children from adult men of ages targeted by the law changes. I find that the 2008 increase in Canada and the 1995 increase in the American state of Georgia led to substantial decreases in the fraction of births arising from partnerships made illegal. These impacts reflect net decreases in births and falling abortions rather than changes in reporting, implying decreased pregnancy rates. Further evidence suggests that the laws deterred relationships between teens and targeted partners altogether and I also uncover a strong response to the law through marriage of teens aged 14 to 15 in Georgia, which then provided a loophole because age of consent laws did not apply to married couples.

State-by-State Variability in Adolescent Privacy Laws.

Health care providers managing the complex health needs of adolescents must comply with state laws governing adolescent consent and right to privacy. However, these laws vary. Our objectives were to summarize consent and privacy laws state-by-state and assess the implications of variation for compliance with the 21st Century Cures Act and with evidence-based guidance on adolescent care. We summarized state laws and regulations on minor consent for the following: health services, substance abuse treatment, prenatal care, mental health care, contraceptive management, immunizations, sexually transmitted infection management, human immunodeficiency viruses testing and treatment, dental care, and sexual assault evaluation. We compared state laws and regulations with American Academy of Pediatrics' evidence-based guidelines to assess consistencies in guidance. We observed notable state-by-state variability in laws governing consent for adolescent patients. No states had identical policies for all services studied. For example, although all states had provisions for consent to management of sexually transmitted infections, there were variable specifications in the age and type of minor, whether this includes human immunodeficiency viruses, and whether confidentiality is protected. Providing confidential care to the adolescent patient has been set as a priority by medical societies; however, guidelines are limited by the need to comply with state laws and regulations. State laws on consent and privacy for adolescents are highly variable, and many do not reflect pediatric professional standards of care. This inconsistency is a barrier to operationalizing a consistent and equitable experience providing evidence-based medical care and ensuring adolescent privacy protection.

Adolescent Consent and Confidentiality: Complexities in Context of the 21st Century Cures Act.

Adolescent Consent and Confidentiality: Complexities in Context of the 21st Century Cures Act.

SARS-CoV-2 Neutralizing Antibody Presence in Infected and Vaccinated Patients

Purpose: To understand persisting knowledge gaps among providers in Maryland regarding HIV prevention for minors and evaluate the providers’ comfort and likelihood of prescribing oral pre-exposure prophylaxis (PrEP), and their perceived barriers and facilitating factors to prescribing PrEP. Methods: Between January 2021 and June 2021, we conducted semistructured, audio-recorded interviews of 18 community health clinicians who provide care to adolescents in Maryland. This qualitative study was well suited as a case study. The theories that served as the primary orienting lens for this research were the theory of planned behavior, and the diffusion of innovation. Results: A total of 18 providers participated in the study. Nine main themes emerged. While reasonable knowledge was noted among most participants regarding the concepts of PrEP, only half (50%) were knowledgeable about the Maryland Minor Consent Law (MMCL) for HIV prevention treatment. In addition, the providers had dissimilar experiences in the prescription of PrEP. Conclusion: Most of the participants were knowledgeable about PrEP, and many were also experienced in prescribing PrEP to eligible adults. Several provider-level barriers to prescribing PrEP were reported. Consequently, the implementation of PrEP in HIV clinics may be challenging without failing to address HIV providers’ concerns.

Are State-Level HIV Testing Policies for Minors Associated With HIV Testing Behavior and Awareness of Home-Based HIV Testing in Young Men Who Have Sex With Men?

PurposeThe objective of this study was to determine whether state-level policies that restrict minors' access to confidential HIV testing without parental consent may suppress HIV testing in young men who have sex with men (YMSM) in the United States. MethodsSecondary data from a national HIV prevention trial among YMSM aged 13–17 years (N= 612) were analyzed to evaluate the association between living in a state with restrictive HIV testing policies for minors and HIV testing behavior, awareness of home-based HIV testing, and confidential interactions with a physician. Multilevel logistic regression models were adjusted for age, parents' education level, race, ethnicity, sexual orientation, being sexually experienced, and health literacy of medical forms and controlled for clustering by state. Age-stratified models by state-level age of consent for HIV testing and a subanalysis (including only sexually experienced participants) were also conducted. ResultsResiding in a state with restrictive HIV testing policies was associated with the lack of awareness of home-based HIV testing (adjusted odds ratio [aOR]: 3.06; 95% confidence intervals [CI]: 1.49, 6.28). No significant associations were found for HIV testing behavior (aOR: 1.81; 95% CI: 0.85, 3.84), speaking privately with a physician (aOR: 1.00; 95% CI: 0.56, 1.79), or discussing confidentiality with a physician (aOR: 0.95; 95% CI: 0.52, 1.71) and HIV testing policies for minors. These results were consistent in both the age-stratified models and subanalysis. DiscussionHIV testing proportions among YMSM did not differ by state-level minor consent laws. However, YMSM living in states with restrictive policies on HIV testing for minors were less likely to be aware of home-based HIV testing.

Consent for Intimate Exams on Unconscious Patients: Sharpening Legislative Efforts.

The practice of nonconsensual intimate exams performed on unconscious patients by medical students during their training has received significant attention in the last several years. Clinicians, medical students, bioethicists, lawyers, and the public have called for explicit and specific consent to take place before all educational intimate examinations of unconscious patients. In response, since January of 2019, dozens of bills have been proposed in more than twenty states, and thirteen of these have been signed into law (in addition to six that passed before 2019). Here, we consider the content of these enacted bills, drawing attention to five variable features and offering these five corresponding legislative recommendations, in hopes of narrowing in on the appropriate ethical scope of consent laws surrounding educational intimate exams: (1) use gender-neutral language; (2) include all intimate exams, not solely pelvic exams; (3) focus on unconscious patients; (4) focus on educational exams; and (5) regulate systems, not individuals.

Film Creation for Education on Concepts Related to Religion, Immigration, and Legislation in the Field of Organ Donation and Transplantation

In education, we can use cinema to create methodologies that develop the critical thinking to acquire knowledge in a collaborative way. Favorable attitudes toward organ donation and transplantation (ODT) is low in adolescents. Working on topics related to ODT, such as religion, immigration, and the law, can help to improve students' knowledge and endear them toward ODT with innovative educational methodologies. This study aims to analyze the change in knowledge about religion, immigration, and legislation on ODT after an educational proposal based on film creation. In this study, 16-year-old students participated in an educational proposal based on ODT education through filmmaking. A total of 543 students participated in the experimental group, and 320 participated in the control group. A validated ODT knowledge form was administered to both groups. Statistical analysis was carried out with SPSS version 21.0 package (SPSS, Inc, Chicago, IL, USA). A descriptive analysis and χ2 test were performed to analyze the differences between the experimental group and control group. P < .05 was considered statistically significant. The study had a 72% participation rate in the experimental group. After receiving the educational proposal, the students presented a greater knowledge with respect to the control group in all aspects: the position of the different religions in relation to organ donation, knowledge of the rights and obligations of immigrants in relation to the ODT, and knowledge of the law of presumed consent in ODT CONCLUSIONS: Working in the classroom on psychosocial aspects such as religion, immigration, and legislation through filmmaking can favorably influence the adolescent's awareness of organ donation.