Ethical and Legal Considerations for Sterilization Refusal in Nulliparous Women.

We address the ethical and legal considerations for elective tubal sterilization in young, nulliparous women in Canada, with comparison with the United States and the United Kingdom. Professional guidelines recommend that age and parity should not be obstacles for receiving elective permanent contraception; however, many physicians hesitate to provide this procedure to young women because of the permanence of the procedure and the speculative possibility of regret. At the practice level, this means that there are barriers for young women to access elective sterilization; they are questioned or not taken seriously, or their desire for sterilization is more generally belittled by health care professionals. This article argues for further consideration of these requests and considers the ethical and legal issues that arise when preventing regret is prioritized over autonomy in medical practice. In Canada, there is a paucity of professional guidelines and articles offering practical considerations for handling such requests. Compared with the U.S. and U.K. policy contexts, we propose a patient-centered approach for practice to address requests for tubal sterilization that prioritizes informed consent and respect for patient autonomy. We ultimately aim to assure physicians that when the conditions of informed consent are met and documented, they practice within the limits of the law and in line with best ethical practice by respecting their patients' choice of contraceptive interventions and by ensuring their access to care.

Ethical Issues in Long-term Care in Low-, Middle- and High-Income Countries During the COVID-19 Pandemic.

Long-term care (LTC) centers experienced an unprecedented emergency involving exponential mortality during the COVID-19 pandemic. Individuals residing in long-term care were particularly vulnerable to the effects of COVID-19, placing residents, staff, families, and organizations in a precarious position. Complex issues surrounding how to manage vulnerable populations during the pandemic have highlighted the importance of gathering information on ethical issues that require effective policy and decision-making. This project sought to identify the ethical issues faced in long-term care by residents, families, staff, and organizations from stakeholders themselves. A total of 305 participants from 45 countries responded, highlighting numerous ethical issues in long-term care during COVID-19. While numerous issues were mentioned, there was an overlap in the themes of responses between stakeholders. Visitation, isolation, harm, staff well-being, and the overall enforcement of policies during the pandemic represented the most often discussed issues. As a preliminary study of this issue, future research is necessary in order to effectively guide pandemic policymaking moving forward.

Patients' preferences for distributing limited government-funded IVF cycles.

OBJECTIVE: On December 21, 2015, Ontario began funding one cycle of IVF for each resident with a uterus under the age of 43, but with a program cap that is insufficient to meet the annual demand. Our objective was to determine how fertility patients believe that the limited number of funded IVF cycles should be distributed. METHODS: A survey was distributed to patients attending a university affiliated hospital-based fertility clinic in downtown Toronto, including its associated peripheral satellite clinics. RESULTS: From August 2016 to March 2017, 271 patients responded to the survey, of whom 90.3% were in favour of public funding for IVF. The majority of participants favoured allocating IVF cycles to maximize patients' access to IVF in Ontario rather than targeting funded IVF cycles so as to maximize live births (62.7% vs. 32.8%). Most participants wanted all clinics to adopt the same approach for distributing funded IVF cycles compared to the current system in which each clinic chooses its own criteria for allocation (84.5% vs. 8.5%). Participants favoured distributing IVF by way of a scoring system that took individual patient factors into account. However, the factors that each respondent considered important varied materially. CONCLUSION: Patients overwhelmingly supported public funding for IVF, desired a consistent policy for distribution of limited funded IVF cycles at all clinics, and preferred a method that took individual patient factors into consideration when determining patient priority for funded IVF but there were heterogenous opinions on which factors should be included.

Geometric morphometric analysis for sex determination using lateral cephalograms in Indian population: A preliminary study.

BACKGROUND: Orthodontic science centers primarily on the growth, development and advancement of the craniofacial structures. Geometric morphometrics (GMM) is a new approach for shape identification in forensic sciences. PURPOSE: The aim of this study was to examine the shape variation in the Indian sample in order to assess sexual dimorphism by application of two-dimensional GMM. MATERIALS AND METHODS: The sample comprised a total of 105 lateral cephalograms (54 males-51 females) of Angle's Class I malocclusion patients that were later subjected to principal component (PC) analysis and discriminant analysis. RESULTS: The PC analysis showed over 96% of shape variation. The initial three PCs were statistically significant that depicted as 58.37% of total shape variability, with PC1 represent for the most significant variance 28.48%, PC2 described 18.83% and PC3 11.06%. CONCLUSION: Sex of an individual was clearly associated with occlusion of teeth and showed considerable variation. GMM is an alternative research tool and can be utilized for diagnosing individual characterization and classification of malocclusion.

Patients' perspectives on allocation of publicly funded in vitro fertilization in Ontario: a qualitative study.

BACKGROUND: The aim of this study was to determine consumers' perspectives on fair allocation of publicly funded in vitro fertilization (IVF) in the recently implemented Ontario Fertility Program (OFP). The research questions were as follows: 1) What factors do those who require IVF think are important to consider when distributing funded IVF? and 2) What are the barriers to accessing publicly funded IVF? METHODS: We approached this qualitative study with a social constructivist interpretative framework with grounded theory methodology. Data were obtained via focus group. We recruited participants eligible for the OFP from a tertiary care fertility clinic. Two researchers conducted all interviews, independently reviewed the transcriptions and analyzed the data for open coding, followed by axial coding and then selective coding to determine themes. RESULTS: A total of 13 participants (10 women and 3 men with an average age of 36.4 [range 28-40.7] yr) partook in 4 focus groups. The average duration of infertility was 1.9 (range 0.4-3) years. Three important domains were identified. First, the procedure of distributing funds should be done in a transparent and consistent manner. Second, everyone should have a fair and equal chance to accessing the funds. Participants suggested a combination of first-come, first-served and a scoring system as a method to distribute funds. Lack of communication, associated costs and stress of experiencing infertility were cited as barriers to accessing publicly funded IVF. INTERPRETATION: Ensuring equal and fair access to funds should be prioritized, and information about the process and distribution method to obtain OFP funding should be clearly provided to patients. Transparency, standardization and better communication should be implemented to uphold procedural justice for patients and reduce emotional stress. The findings may be considered by policy-makers to improve the current OFP and when developing similar programs.