Adolescents and Body Modification for Gender Identity Expression

As a matter of ethics and law, adults enjoy wide berth in securing hormonal and surgical interventions to align their bodies with their desired gender appearance. In contrast, the exercise of choice by minors is more constrained, because they can be less well situated to grasp the nature and consequences of interventions having life-long effects. Even so, some minors hope for body modifications prior to adulthood. Starting very young, some minors may assert atypical gender identity: those with female-typical bodies assert a male identity and those with male-typical bodies assert a female identity. This assertion of identity is atypical only in a descriptive sense, because it is uncharacteristic, not because it is normatively unacceptable. Not all minors persist in their atypical gender identities, but some do. For those who do, it is desirable to minimize unwanted secondary sex characteristics and to maximize desired secondary sex characteristics. I outline here a theory of respect for decisions by minors in regard to hormonal and surgical interventions that help align their bodies with their gender identity. Of particular ethical interest here are body modifications for fertility preservation since certain interventions in the body can leave people unable to have genetically related children. In general, I will show that the degree of respect owed to minors in regard to body modifications for gender identity expression should be scaled according to their decision-making capacities, in the context of robust practices of informed consent.

Capitalizing on Scientific Advances to Improve Access to and Quality of Children's Mental Health Care

The majority of mental health problems begin in childhood or adolescence. The potential benefits of early identification and treatment of such problems are well established, and models of effective mental health interventions for children have proliferated in recent decades. However, barriers in access to care and challenges in assuring delivery of high-quality care significantly limit the public health impact of services for children and families. Specifically, the majority of children who need mental health care do not receive it, and when children are in care, many do not receive interventions that are most likely to have the greatest positive impact. A commitment to social justice requires significant improvement in access to care and quality of care to maximize human potential. The purpose of this manuscript is to highlight promising scientific advances in the development of effective mental health services for children and families, as well as the vexing challenges of actually delivering these services to those most in need. Key challenges to be discussed include disparities in access to care and quality of care, including race/ethnic disparities and complexities of navigating the multi-sector mental health service system for children, and difficulties in implementing effective intervention models more consistently in community care. The authors will propose practice and policy reform recommendations to address these challenges. Copyright © 2017 John Wiley & Sons, Ltd.

Ethical Issues in Adolescent Consent for Research

Different opinions are expressed in the literature regarding when children and adolescents can start to make decisions to participate in research and give informed consent. Nurses are frequently involved in research, either as investigators or caregivers, and must therefore have a thorough understanding of consent and related issues. In this article the issues are explored from a Canadian perspective. The argument is put forward that adolescents may be capable of a greater involvement in the research consent process than is the norm. Increasing adolescents’ involvement in research has the potential to enhance their growing autonomy and capabilities. Adolescents appreciate being treated with respect and dignity by adults. This can be achieved in an environment in which protection from harm does not also mean prevention from decision making. The use of empowering processes by nurses to enhance adolescent involvement will provide benefit to adolescents in their transition to adult levels of responsibility.

[Early detection to prevent mental illness during adolescence: ethical and theoretical considerations]

In the face of changes that characterise adolescence, a number of youth experience ill-being, as part of a normal developmental process. For some of them, however, this ill-being may represent early signs of a psychopathological process. Regarding depression and psychosis, such early signs are non-specific, which complicates and delays treatment. In addition, issues such as stigmatization and unfamiliarity with these psychopathologies represent major obstacles to treatment access. Attempts to early detection, which involves identifying risk factors in order to provide support and follow-up, making an effort to take these clinical signs seriously, while at the same time avoiding to mistake a normal developmental process for a pathological condition.

[The contagion of adolescent suicide: cultural, ethical and psychosocial aspects]

Suicide is the second leading cause of death among adolescents. The risk factors are many and varied. The contagion of suicide was raised as a potential cause of youth suicide. In support of this argument, we did a review of the literature on the possible contagion of adolescent suicide. Several types of situations can support this hypothesis : when a youth is faced with the suicide of a relative or close friend, when he lived in a community, through the media or via the Internet. The way suicide is reported in the press shows a correlation with increased incidence of suicide among adolescents. In summary, there is evidence increasingly obvious that the contagion is the source of some youth suicides. For this reason, it seems important that preventive measures are in place. However, although this mechanism has been instrumental in initiating the act, it is important to note that suicide is always the result of several factors including the personal history of the subject.

Making sense of adolescent decision-making: challenge and reality

Few topics in pediatric bioethics are as vexing as decision-making. Decision-making in pediatrics presents challenges for children, parents, and physicians alike. The related, yet distinct, concepts of assent and consent are central to pediatric decision-making. Although informed consent is largely regarded as a worthwhile adult principle, assent has been, and continues to be, mired in debate. Controversial subjects include a meaningful definition of assent; how old children should be to assent; who should be included in the assent process; parental permission; how to resolve disputes between children and their parents; the relationship between assent and consent; the quantity and quality of information to disclose to children and their families; how much and what information children desire and need; the necessity and methods for assessing both children's understanding of disclosed information and of the assent process itself; reconciling ethical and legal attitudes toward assent; and finally, an effective, practical, and realistically applicable decision-making model.

Suicidal attempt of a schoolgirl to demonstrate against the school teacher and try to make her quit the school

A case of a 16-year-old schoolgirl who had admitted a demonstrative suicide attempt against her school teacher thus trying to make the teacher leave the school has been presented. During the observation period in the Emergency Department the nurse taking care of the patient overheard that during her talks with the friends, the girl had been continuously urging them to swallow the same set of tablets, call the ambulance and get admitted to the hospital. The anamnesis revealed that three schoolmates decided to get rid of one of the teacher from their school by accusing her of mental cruelty which had led them to suicidal attempts. It was done mainly because of the bad marks they had got from the teacher. The idea was undertaken by our patient due to many news transmitted in the newspapers and television during last months in which the teachers were blamed for a lot of incidents which had taken place in different schools in Poland. Despite the fact that in many of these events the teachers were both physically and mentally tormented by the pupils the opinions presented by mass-medias were always against them. Our patient said that in such circumstances it was supposed to be an easy way to solve all the problems with unlike teacher.

CONCLUSIONS

The physicians should pay more attention on suicidal attempts causes specially in adolescents. Adolescents possess poor knowledge of the lethal potential of drugs, specially over-the-counter medications. The media have to take more responsibility for transmitting news concerning youth which should be more honest and verified.

Moral competence as a positive youth development construct: conceptual bases and implications for curriculum development

Moral competence refers to the orientation to perform altruistic behavior and the ability to judge moral issues logically, consistently and at an advanced level of development. A brief review of the concepts of altruism and justice is presented. The gender and cultural issues are also discussed. The contents of moral competence program units include four major topics: (1) Fairness, (2) Proper conduct (mainly altruistic and prosocial orientation), (3) Responsibility and altruistic orientation, and (4) Integrity and fairness. The general goal is to help students to develop an altruistic orientation and a judgment structure of a high level of justice. This paper is part of the development of the positive youth development program in Hong Kong.

Moral voices of politically engaged urban youth

The relationship between reflection and action is an enduring question for those interested in promoting moral development among young people. Educators struggle to find effective methods for helping youth reason carefully about moral problems and also to show moral commitment in their everyday lives. One place where reflection and action come together is in youth activism, where young people engage in social action campaigns to improve their schools and communities. What are the moral concerns that urban youth raise when given the opportunity? How do these concerns get translated into action? Drawing on original and secondary sources, this chapter discusses four social action campaigns organized by youth in the San Francisco Bay Area, in which youth combined critical moral judgments with social action. The chapter is not an empirical study, but instead an effort to bring attention to the moral and ethical perspectives that politically engaged youth raise. These social action projects suggest that for youth living in low-income neighborhoods with limited resources, the capacity for critical moral reflection about one's surroundings is an important dimension of healthy development. Helping youth assess and transform their local environments represents a promising direction for moral education and youth development.

Promoting children's ethical development through social and emotional learning

In today's climate of increased emphasis on measuring achievement through high-stakes testing, academic subjects are too often divorced from the social context in which they are taught. We know that learning is a social process. In fact, many educators and other youth development practitioners recognize that social, emotional, and ethical development cannot be ignored in the name of better academic preparation, especially in the face of data showing that students are more disengaged than ever before. Social and emotional learning (SEL) offers educators and other youth development personnel a framework for addressing students' social and emotional needs in systematic way. SEL is the process of acquiring the skills to recognize and manage emotions, develop caring and concern for others, establish positive relationships, make responsible decisions, and handle challenging situations effectively. Research has shown that SEL has an impact on every aspect of children's development: their health, ethical development, citizenship, academic learning, and motivation to achieve. This chapter profiles one school in Illinois that has been implementing SEL programming for a number of years. The authors provide evidence of the impact of SEL on school climate, student behavior, and attitudes. Ultimately the authors see this as fostering the kind of understanding of the larger world that leads young people to make ethical choices. They propose that the lessons learned are applicable to a wide variety of settings, including other schools, after-school programs, and summer camps.

Giving youth the social and emotional skills to succeed

WINGS for Kids is a nonprofit organization based in Charleston, South Carolina, that aims to supply the social and emotional learning (SEL) component into existing programs for school-aged children and thereby assist them to recognize and manage emotions, care about others, make good decisions, behave ethically and responsibly, build satisfying relationships, and avoid negative behaviors. The author, who is the founder and CEO of WINGS, traces the ethos of the organization to her own life experiences as well as her observations of low-income children and families more generally. She describes the strategies and practices that characterize the WINGS approach to SEL. The chapter focuses on the progress made by one boy, who arrived at WINGS at the age of seven, got into disputes from the very first day, and was eventually ejected from the WINGS program but later earned his way back with a commitment to change. He sustained his involvement for a number of years and became an exemplar of what the author states they are trying to accomplish.

Pathways of influence in out-of-school time: a community-university partnership to develop ethics

If we wish to incorporate parents and community members as full partners in building character among youth, then the activities and programs in which youth participate during their out-of-school time are potentially important venues. This chapter describes how numerous agencies in a single community partnered with a university, with the help of the cooperative extension agent, to collect local data on how adolescents used out-of-school time, what they thought about right and wrong, and how well their own behavior comported with their understandings of what was right. Results indicated that surveyed youth characterized themselves as thinking more than acting in ethical ways. For instance, nearly half acknowledged having cheated on a test at least once in the past six months, although the vast majority thought that cheating was wrong. The three pathways the community identified for reaching youth were (1) extracurricular activities at school such as sports, yearbook, and pep club; (2) organized nonschool pursuits such as music, dance, hiking, and biking; and (3) religious activities. They found that nearly 90 percent of high school-aged respondents participated in one or another of these venues.

“I like to treat others as others would treat me”: The development of prosocial selves in an urban youth organization

The development of moral identity is linked to a sense of self that is prosocial and connected to others. Youth organizations, if designed appropriately, may provide a setting for social interactions and relationships in which youth can enact and receive validation for moral behaviors and develop prosocial selves. This chapter reports on findings from a four-year study of identity construction within an urban Boys and Girls Club. The author conducted interviews and photography projects with seventeen youth ages twelve to eighteen, all of whom were active club members. Over half described their race or ethnicity as black or African American, while others were Hispanic, Afro-Latino, white, or other. All of them either lived in the housing project near the club or had close ties to it. Both boys and girls describe themselves as rooted in a rich relational milieu that promoted prosocial identities. The importance of respect emerged as a key theme in the teens' narratives about themselves and their activities. The author found that the club served as a site for the development of prosocial traits in an environment characterized by respectful and supportive relationships.

Internet lives: Social context and moral domain in adolescent development

The author examines the thinking and behavior of adolescents within the digital world. What does all this instant messaging and blogging outside school hours mean? Why do adolescents do it? How much time do they spend doing it? How does it shape their social, emotional, and moral development? Bradley describes the phenomenon and explores some moral development ramifications of a new context of social experience for adolescents. It proposes that the digital world creates its own social context, with a different set of social conventions from the adult-mediated "real" world that adolescents also inhabit. It is a social context that most adults are aware of but do not understand. Adolescents' experiences in the online world influence their experiences in the face-to-face world and play an important role in the development of their social and moral knowledge. This chapter places the discussion within the context of literature on youth ethics that has been developed based on more traditional settings.

The palliative care nurse’s role in supporting the adolescent child of a dying patient

The aim of this article was to critically evaluate the author's role as a hospital-based palliative care nurse in supporting the adolescent child of a dying parent. The approach taken and the resources that were available have been reflected upon. The article explores whether it was possible to adapt the theory of bereavement support for those working with adults within the constraints of a busy acute hospital. It was found that although there were limitations to the amount of support the author could give within her role, there remains a window of opportunity for all healthcare professionals within this field to support parents in preparing their children for bereavement.

Capitalizing on the human-animal bond to teach ethics to youth

The purpose of this study was to evaluate the effectiveness of a livestock ethics curriculum developed for high school students in agricultural education classes. The curriculum was developed in response to numerous unethical occurrences at major livestock shows in recent years. These have included drug violations, physical alteration of animals, and excessive involvement of professional livestock handlers. The curriculum was taught to 305 students enrolled in eight Indiana high school agriculture programs. Data were collected using a pretest and posttest. Eighty-six percent of participants improved their score from the pretest to the posttest. Participants increased their awareness and knowledge of the overall principles involved in making ethical choices when faced with decisions in youth livestock programs. Students improved their understanding of the consequences associated with making unethical choices when faced with decisions in the youth livestock program. Participants were more likely to make an ethical choice when faced with a scenario featuring an ethical dilemma. Participants who had previously been enrolled in 4-H, Future Farmers of America, or an animal project had higher scores than those who had not been previously enrolled, but the amount of change from pre- to posttest was similar for those with and without such prior exposure. Future research should examine whether mastery of this kind of ethics curriculum will lead to better ethical choices in real-life situations.

Toward ethical approaches to the inclusion of peers with disabilities

What would it mean for program leaders and caregivers to shape the thinking of typically developing youth toward their peers with disabilities in a way that we could regard as ethically sound? The author weaves examples from his research in settings such as Girl Scout troops and Boys and Girls Clubs as well as his own parenting experiences to answer this question. He has found that it is commonplace for program leaders, coaches, and others to avoid direct discussion or acknowledgment of the disabilities of children in their groups, in the mistaken belief that this is the best way to demonstrate that all children are equal and to avoid the perception of discrimination. His interpretation is that this is not a product of thoughtlessness but of caring staff and volunteers who believe they are doing the right thing--the ethical thing--by avoiding acknowledgment of individual differences. Disabilities--even when they are readily apparent--are treated as if they were invisible. Rather than giving disabilities the "silent treatment," the author challenges us to go beyond the prevailing ethos and find ways to build on naturally occurring opportunities to learn more about individual needs and supports.

Developing a game plan for good sportsmanship

It is widely believed in the United States that competition is beneficial for youngsters. However, the media are full of examples of players, fans, and coaches whose behavior veers out of control. There have been well-documented examples of youth in livestock competitions illegally medicating show animals to make them appear calmer, officials biasing their rulings toward a team that will take the most fans to a playoff game, and team rivalries that have become so caustic as to be dangerous for competitors and fans. A university extension and its partners created a program called "Great Fans. Great Sports." in order to teach the kinds of behaviors we wish to instill among all who are involved in competitions. It requires entire communities to develop and implement plans for enhancing sportsmanship in music, debate, drama, 4-H, and other arenas, as well as sports. The goal is to make good sportsmanship not the exception but the norm. The authors provide anecdotal evidence that "Great Fans. Great Sports." is having a positive impact on the attitudes and behaviors of competitors, fans, and communities.

Shaping ethics: youth workers matter

The authors propose that youth workers and educators committed to informing and shaping the ethical understandings of young people first need to explore and become aware of their own ethics. This requires front-line staff and caregivers to critically reflect on the impact their day-to-day choices and decisions have on youth. Once they become clearer about their own ethics and the consequences of their decisions, youth workers are then in a position to promote opportunities for youth to make ethical choices. The authors use observations and ideas from their experiences with the Minnesota Youth Work Institute. Their overarching aim is to promote ethical congruence between what is taught, how it is taught, and how it is practiced in daily work with youth.

Incentives for children in research

PURPOSE

To describe the challenges of using incentives for children in research.

ORGANIZING FRAMEWORK

A discussion of incentives in the context of recruitment for research, including a review of the literature, a description of the types of incentives used with children and their families, factors influencing choice of incentives and ethical considerations. Recommendations to guide decisions about incentives are proposed.

CONCLUSIONS

Since the 1997 mandate from the U.S. National Institutes of Health that investigators provide justification for excluding children, researchers have become more willing to include children. Whether all parts of the research process pertain to children without careful consideration and adaptation is unclear. One area lacking clarity is the use of incentives to encourage participation in research. The issue of incentives for children or parents should be considered early in the design of the research proposal, with attention to developmental age, ethical considerations, purpose of the research, and burden to the child and family.

Truth and consequences: ethics, confidentiality, and disclosure in adolescent longitudinal prevention research

PURPOSE

To examine data from a natural experiment resulting from a change made in the confidentiality agreement midway through a randomized, longitudinal, controlled trial to prevent or delay adolescent alcohol use. The investigators explored the impact of the change on adolescents' rates of participation and affirmative responses to a question on suicidal thoughts.

METHODS

Adolescents 12-17 years old were administered a question on suicidal thoughts as part of a confidential exit interview after a general health examination with their primary care provider. After administration to 263 adolescents, the exit interview was made conditionally confidential with the remaining 181 adolescents. The revised consent form and protocol stipulated that researchers would reveal to appropriate professionals and parents any adolescent indicating suicidal thoughts. Prevalence estimates for the suicidal thoughts question and study participation rates were computed for conditions both before and after the change.

RESULTS

Fewer adolescents responded affirmatively to the suicidal thoughts question when they were recruited using the revised (1%) than the original (8%) consent form and protocol (p=.001). The revised confidentiality agreement did not affect participation rates.

CONCLUSIONS

Adolescents who assent to participate in research studies may be less likely to disclose personal information regarding suicidal thoughts if they know that their disclosure may result in a break in confidentiality. Specific guidelines are needed for conditional and unconditional confidentiality agreements to study mental health in adolescent longitudinal prevention research.

Identity processes and the positive youth development of African Americans: an explanatory framework

This chapter presents Spencer's phenomenological variant of ecological systems theory, or PVEST (1995), as a conceptual framework for examining positive youth development. Contextual factors affecting racial and gender identity of African American youth are discussed, with the focus on the influence of schools and religious institutions.