The concept of autonomy in adolescent psychiatry healthcare: A philosophical,legal and medical perspective

French law does not make it obligatory to obtain the consent of minors for suggested treatments. This situation can put the practitioner in difficulty, especially when trying to work on the issue of autonomy with an adolescent. It is not just the adolescent's autonomy that is only partially recognised during their treatment - that of their parents may also be overlooked by the physician in the child's best interest. In this situation, what can the physician do when working on areas related to autonomy, which are of the utmost importance during adolescence, and which become even more important during any treatment for potential psychiatric disorders? This opinion paper provides a focus on the concepts of autonomy, discernment, and the child's best interest, using a triple philosophical, legal, and medical approach, in order to provide guidance to practitioners confronted in their clinical practice with this central, complex and paradoxical issue. The modern-day philosophical approach ties the concept of autonomy to that of vulnerability. The interplay between the free exercise of the subject's rights and their protection is at issue in French law, which proposes to gradually provide new rights, and thus progressive autonomy, to minors, according to an evaluation of their level of discernment. It is similar to clinical practice and biomedical research which tend to objectively evaluate the level of discernment of children and adolescents. This evaluation is partially influenced by the physician's own values, which they need to be conscious of, in order to better accompany patients.     

Exploring Indigenous Traditional Healing programs in Canada,Australia, and New Zealand: A scoping review

ObjectiveTo explore and catalog ways Indigenous Traditional Healing practices are supported within the mainstream healthcare system through policies and programs in Canada, Australia, and New Zealand.Data SourcesA scoping review was conducted, guided by the PRISMA extension for Scoping Reviews. Databases for sources of information include CINAHL, Medline, Embase, Web of Science, Public Health ProQuest, Global Health EBSCO, iPortal, and grey literature.Study Selection2 reviewers screened the titles and abstracts of the studies for inclusion against the selection criteria independently. Studies that met the inclusion criteria were transferred to Covidence for further abstract and full-text review.Data ExtractionOf a total of 2,017 articles identified, 22 met the inclusion criteria for data extraction for this scoping review. Data items extracted include study title, authors, year of publication, publication type, publication source, support policy or program, health system or service, Indigenous Traditional Healing practices, and significant findings.Data Synthesis2 categories emerged from the analysis of the source of evidence. That is, healthcare systems and services with programs and policies supporting Indigenous Traditional Healing practices, and ways Indigenous Traditional Healing was adopted and utilized within the identified support programs.ConclusionsThis study demonstrated the various ways Indigenous Traditional Healing practices are supported within the mainstream healthcare systems in Canada, Australia, and New Zealand. Indigenous Traditional Healing practices can be utilized as either the primary choice of treatment, to support Western biomedical treatment or through the adoption of Indigenous Traditional knowledge within the mainstream healthcare system.     

Maternal healthcare for women with physical disabilities in Northern Vietnam: perspectives of healthcare providers

BackgroundPregnancy among women with physical disabilities is common around the world; however, there are limited qualitative studies that explore the perspectives of healthcare providers toward pregnant women with disabilities outside of the Global North.ObjectiveThis article explores perspectives and experiences of maternal healthcare providers in the delivery of services to women with physical disabilities in Northern Vietnam.MethodsSemi-structured interviews were conducted with 14 healthcare providers who worked in public and/or private healthcare North Vietnamese facilities where maternal services were provided. Data were thematically analyzed.ResultsThe participants included six males and eight females. Ten were obstetricians/gynecologists, one was a doctor specializing in obstetric imaging diagnosis, three were midwives, and one was a midwife/assistant doctor. Four themes were identified. In the first theme, providers attached provisos to the right to motherhood including the view that the women were limited to one child and should undergo prenatal screenings for fetal abnormalities. In the second theme, the providers reported that disability was not incorporated into their education; this led to half of them lacking confidence in providing appropriate maternal healthcare services for women with physical disabilities. The third theme found that although women with physical disabilities were considered as a priority group, decisions around who was seen before others or provided with fee discount/exemption were left in the hands of staff. The fourth theme identified that some providers overlooked their needs for physical accessibility and independence.ConclusionThis study shows that maternal healthcare providers in Vietnam discounted the needs of women with physical disabilities. The needs of women with disabilities should be included in the training of maternal healthcare providers in Vietnam.