Ethical aspects of age estimation for forensic purposes in Saudi Arabia / Aspectos éticos de la estimación de la edad para propósitos forenses en Arabia Saudita / Aspectos éticos da estimativa de idade para propósitos forenses na Arábia Saudita

Abstract: In forensic and legal contexts, an assessment of skeletal maturation is required to predict the chronological age in certain circumstances in which the chronological age is undocumented or unable to be proven. Carrying such medical examinations will always pose an ethical concern, especially in cases of assessing sexual maturity as well as examinations involving ionizing radiation. The cultural and religious barriers are also discussed concerning the ethical standards set in Saudi Arabia. Several ethical issues concerning age estimation examinations including issues related to consent forms, privacy, and radiation hazards have been documented. While ethical issues regarding radiation hazards are more likely to be overcome by introducing other imaging modalities without radiation hazards, ethics related to consent forms and privacy are still to be improved.

Resumen: En contextos forenses y legales, se requiere la evaluación de la maduración del esqueleto para predecir la edad cronológica en ciertas circunstancias en que la edad cronológica no está documentada o no es posible de probar. Realizar tales exámenes médicos siempre significa una preocupación ética, especialmente en casos de evaluación de madurez sexual así como en exámenes que involucran radiaciones ionizantes. Se discuten también las barreras culturales y religiosas relacionadas con el contexto de estándares éticos en Arabia Saudita. Entre los varios temas éticos relacionados con la estimación de la edad, se documentan temas relacionados con los formularios de consentimiento, privacidad y riesgos de radiación. Mientras que los temas éticos relacionados con riesgos de radiación pueden ser resueltos al introducir otras modalidades de examen sin radiación, los problemas éticos relacionados con los formularios de consentimiento y privacidad todavía necesitan mejorarse.

Resumo: Em contextos forenses e legais, uma avaliação de maturação esquelética é requerida para predizer a idade cronológica em certas circunstâncias nas quais a idade cronológica não é documentada ou impossível de ser provada. Conduzir tais exames médicos sempre irá suscitar uma preocupação ética, especialmente em casos para avaliar maturidade sexual bem como exames envolvendo radiação ionizante. As barreiras culturais e religiosas também são discutidas no que diz respeito a padrões éticos estabelecidos na Arábia Saudita. Diversos aspectos éticos concernentes a exames de estimativa de idade incluindo aspectos relacionados a formulários de consentimento, privacidade e risco de radiação foram documentados. Ao passo que aspectos éticos que dizem respeito a risco de radiação serem mais provavelmente superáveis pela introdução de outras modalidades de exames de imagem sem risco de radiação, a ética relacionada a formulários de consentimento e privacidade ainda estão por serem melhorados.

Ethical aspects of medical age assessment in the asylum process: a Swedish perspective.

According to European regulations and the legislations of individual member states, children who seek asylum have a different set of rights than adults in a similar position. To protect these rights and ensure rule of law, migration authorities are commonly required to assess the age of asylum seekers who lack reliable documentation, including through various medical methods. However, many healthcare professionals and other commentators consider medical age assessment to be ethically problematic. This paper presents a simplified and amended account of the main findings of a recent ethical analysis of medical age assessment in the asylum process commissioned by the Swedish National Board of Health and Welfare. A number of ethical challenges related to conflicting goals, equality and fairness, autonomy and informed consent, privacy and integrity, and professional values and roles are identified and analysed. It is concluded that most of these challenges can be met, but that this requires a system where the assessment is sufficiently accurate and where adequate safeguards are in place. Two important ethical questions are found to warrant further analysis. The first is whether asylum seekers' consent to the procedure can be considered genuinely voluntary. The second is whether and how medical age assessments could affect negative public attitudes towards asylum seekers or discriminatory societal views more generally.

[The assessment of biological maturation for talent selection - which method can be used?]. / Die Erhebung des biologischen Entwicklungsstandes für die Talentselektion - welche Methode eignet sich?

BACKGROUND: The biological maturity status plays an important role in sports, since it influences the performance level and the talent selection in various types of sport. More mature athletes are favorably selected for regional and national squads. Therefore, the biological maturity status should be considered during the talent selection process. In this context, the relative age effect (RAE), which exists when the relative age quarter distribution of selected sports groups shows a biased distribution with an over-representation of athletes born in the first months after the specific cut-off-date for the competition categories, represents another problem in the talent development. From an ethical point of view, discrimination of young talented kids does exist: the relatively younger athletes have little to no chance of reaching the elite level, despite their talents and efforts. The causal mechanisms behind the RAE are still unclear and have to be assessed. In this context, the biological maturation seems to be a possible influential factor for the existence of a RAE in sport, which has to be examined. Several methods for estimating the biological maturity status exist; however, they are often expensive and not practicable. Consequently, the aim of the present study was to assess the concordance of a simple, yet accurate method of estimating biological maturation (prediction equation of age at peak height velocity, APHV) of Mirwald and co-workers, and the gold standard method of estimating skeletal age (SA, the x-ray of the left wrist). METHODS: In total, 75 Austrian students (40♂, 35♀) aged 10 - 13 years, were examined. Thirty of the participants (17♂, 13♀) were students of a well-known Austrian ski boarding school, and 45 (23♂, 22♀) of a non-sportive secondary modern school of the same region. The participants included in the study had not experienced a rupture of the carpal bones of the left wrist. Parents and participants were informed of the study aims, requirements and risks before providing written informed consent. The study was performed according to the Declaration of Helsinki. The study was approved by the Board for Ethical Questions in Science (Nr.: 2/2014) and the Institutional Ethics Review Boards for Human Research. For the prediction equations, the body height, the body mass and the sitting height were examined 8. The actual CA at time of measurement, and the leg length as the difference between body height and sitting height were calculated. These parameters were used to predict MO as time before or after PHV for boys and girls using the prediction equations of Mirwald et al. 19. According to Malina and Koziel 8, the participants were classified as late, on time (average) or early maturing on the basis of their APHV relative to the sample mean and standard deviation separated by sex. Participants within plus/minus the standard deviation of the mean were considered on time; participants with APHV > mean + standard deviation were classified late, while those with APHV < mean - standard deviation were classified early. An expert in pediatric endocrinology evaluated the x-rays of the left-hand wrist with the Greulich-Pyle-Method for assessing SA, the most widely used method of determining SA 24. The difference between SA and CA were calculated (= difference SA-CA). Consistent with other studies, the participants were divided into three groups according to their maturity status: on time or average maturity status was a SA within ±1 year of CA, late maturating was a SA behind CA of more than 1 year, and early maturating was a SA in advance of CA of more than 1 year 5 19 25. The most accurate method used to compare two methods of measurement is the Bland-Altman plot and the 95 % limits of agreement 26 27 28. Bland-Altman plots of the difference between difference in APHV (from the literature mean) and difference SA-CA (y-axis) and the mean of difference in APHV and difference SA-CA (x-axis) were performed. Approximately 95 % of the points in the plot should lie within the limits; then the concordance between the two methods of measurement is given 28. Additionally, intraclass correlation coefficients (ICC(3,1); two-way-mixed, total agreement) were calculated between difference in APHV and difference SA-CA. Chi²-tests were used to assess the difference in the percentage of pupils classified as on time, early or late maturing between the classifications based on the SA and on APHV, respectively. The level of significance was set at p < 0.05 and for highly significant at p < 0.01. All of the calculations were performed using PASW Statistics V.21.0. RESULTS: Chi²-tests did not show any significant differences (p = 0.404) in the percentage of participants classified as on time, early or late maturing between the two classifications based on SA and on APHV, respectively, neither for the total sample, nor for the two groups ski racers and non-athletes. The Bland-Altman analysis showed that more than 95 % of the points in the plot lie within the limits; consequently, there is concordance between the two methods with regard to estimating biological maturation. The ICC(3,1) statistics showed a highly significant correlation: p = 0.002, ICC (95 % CI) = 0.48 (0.13 - 0.69). CONCLUSIONS: The prediction equations to determine APHV seem to be a valid method of assessing the biological maturity status of youths aged 10 - 13 years. The percentage of pupils classified as on time, early or late maturing did not differ significantly between the classifications based on the two methods. Also the Bland-Altman analysis proved the concordance between the two methods. The RAE could be influenced and strengthened by the biological age in sports in which advantages in maturity parameters are important. Athletes born early in the selection year, who are also at the same time advanced in maturity, might be advantaged in the selection process. However, since the prediction equations seem to be valid, this method can be used in the future in the talent selection process in order to not disadvantage late-maturing athletes, which in turn could result in the reduction of the occurrence of the RAE in various types of sports in the future. In talent selection processes the growth spurt and the implemented changes in proportions between core and the extremities are often not considered; although it was shown that during this period, athletes showed poor performances in physical fitness. Since physical fitness is an important criterion in talent selection processes, athletes who go through their individual peak growth spurt at the time of selection have disadvantages due to the diverse proportions. As a consequence, it seems important to know the athlete's APHV in order to consider the variations in physical performance caused by developmental changes. The prediction equations to determine APHV include the leg length and sitting height in order to consider the diverse proportions between core and extremities; hence, this method seems to be accurate and should be implemented in the talent selection process.

Age estimation for forensic purposes in Italy: ethical issues.

Age assessment in children and young adults is a relevant medicolegal issue due to the gradual increase of persons devoid of proper identification documents in European countries. Because of the illegal immigration and growing crime rates among children and adolescents, age estimation for forensic purposes is often required. The scientific research and the extensive experience of forensic experts in the last decades focused on the use of radiographic methods addressed to evaluate the degree of skeletal or dental development as the most accurate parameters to estimate the chronological age of children and adolescents. This paper analyzes the ethical issues related to age estimation procedures based on radiographic methods, showing how the ethical principles of beneficence, nonmalevolence, justice, and autonomy may be guaranteed during the execution of the age assessment in forensic practice. The procedure might be conducted in accordance with international guidelines and protocols, though they need a higher homogenization and standardization. A strong collaboration between various scientific societies of professionals (forensic odontologists, forensic pathologists, forensic anthropologist, radiologists, pediatricians, and psychologists), who have been involved in age estimation for years, is needed to reach this goal.

Ethics in age estimation of unaccompanied minors.

Children absconding from countries of conflict and war are often not able to document their age. When an age is given, it is frequently untraceable or poorly documented and therefore questioned by immigration authorities. Consequently many countries perform age estimations on these children. Provision of ethical practice during the age estimation investigation of unaccompanied minors is considered from different angles: (1) The UN convention on children's rights, formulating specific rights, protection, support, healthcare and education for unaccompanied minors. (2) Since most age estimation investigations are based on medical examination, the four basic principles of biomedical ethics, namely autonomy, beneficence, non-malevolence, justice. (3) The use of medicine for non treatment purposes. (4) How age estimates with highest accuracy in age prediction can be obtained. Ethical practice in age estimation of unaccompanied minors is achieved when different but related aspects are searched, evaluated, weighted in importance and subsequently combined. However this is not always feasible and unanswered questions remain.

Chacarita Project: conformation and analysis of a modern and documented human osteological collection from Buenos Aires City--theoretical, methodological and ethical aspects.

Osteological reference collections play a key role in bioanthropological research; they allow the development and testing of methods for sexing and ageing individuals using various bone and dental attributes. This paper presents the first stage results of the ongoing Chacarita Research Project, which aims to generate and study a reference collection of adult skeletons representative of the contemporary population of Buenos Aires city. The Chacarita Collection consists of unclaimed human remains of individuals of known nationality, sex, age, cause and date of death from the Chacarita Public Cemetery. Unlike other similar endeavours, this sample has been completely exhumed using archaeological techniques. So far, a total of 146 adult skeletons have been recovered (60 females - 41.1% and 86 males - 58.90%), the majority of which have ages-at-death in the range of 71-90 years. They were born primarily in Argentina (n=133; 91.1%), although other nationalities are also represented. Dates of death range between 1987 and 2000. In the short term, the osteological study of this collection will allow assessment of the performance of classical methods of sex determination and age-at-death estimation in a local setting. A special priority will be given to the study of osteological changes in individuals over 50 years. As the sample is being retrieved by exhumation, the impact of taphonomic agents on the most diagnostic bone structures is also being assessed. In the long term, this osteological collection will be available to generate new population-specific techniques and to develop comparative biological studies.

Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control.

BACKGROUND: Unprecedented changes in both the scale and the complexity of international migration have led to international concern and controversy over the assessment of age in children and young people subject to immigration control or seeking asylum who say they are children yet have no documents to prove their stated age. SOURCES OF DATA: The article reviews the existing evidence on the reliability of medical and non-medical techniques for the assessment of chronological age. AREAS OF AGREEMENT: There is evidence that radiography (X-rays) of bones and teeth, which is increasingly relied upon by immigration authorities, is imprecise, unethical and potentially unlawful, and should not be used for age assessment. AREAS OF CONTROVERSY: Medical techniques including X-rays continue to be relied upon in the absence of an alternative approach resulting in legal challenges and uncertainty for children and young people. AREAS TIMELY FOR DEVELOPING RESEARCH: Further work is needed to establish a process for age assessment based on a 'holistic' multi-disciplinary approach which focuses not on chronological age exclusively but rather on the needs of children and young people subject to immigration control.

Índice de la cavidad coronal pulpar: una herramienta forense para la determinación de la edad en humanos adultos / The Coronal Pulp Cavity Index: A Forensic Tool for Age Determination in Human Adults

La correlación entre la reducción de la cavidadcoronal pulpar y la edad cronológica ha sido estudiada enuna muestra de 846 dientes intactos procedentes de 433individuos de sexo y edad conocidos. La radiografía panorámicaha sido utilizada para medir el largo (mm) de lacorona (CL=coronal length) y el largo (mm) de la cavidadcoronal pulpar. El índice dentario “Tooth coronal index”(TCI) según Ikeda et al. (1985) ha sido calculado por cadadiente para determinar la edad real del individuo con elmétodo de la regresión. Los coeficientes de regresiónvarían de -0.92 (molares, muestra total, lado derecho) a-0.87 (molares femeninos) con un S. E. de estimación de5.88 a 6.66 años. Las correlaciones son más altas en losvarones respecto a las mujeres. Las ecuaciones obtenidaslograron estimar la edad en una muestra de 100 dientes(no utilizados en la regresión) con un error de ± 5 añosen el 81.4% de los casos por los molares masculinos. Elestudio ilustra el valor potencial de un método que puedeser utilizado para estimar la edad en individuos vivos ymaterial esquelético de edad desconocida(AU)

The correlation between the reduction of thecoronal pulp cavity and the chronological age wasexamined in a sample of 846 intact teeth from 433individuals of known age and sex. Panoramic (rotational)radiography was used to measure the length (mm) of thetooth crown (CL=coronal length) and the length (mm) ofthe coronal pulp cavity (CPCL=coronal pulp cavity length).The tooth-coronal index (TCI) after Ikeda et al. (1985) wascomputed for each tooth and regressed on the real age ofthe sample. The correlation coefficients ranged from -0.92(molars, combined sample, right side) to -0.87 (femalemolars), with a S.E. of the estimate ranging from 5.88 to6.66 years. Correlations were slightly higher in males thanfemales. The obtained equations allowed estimation of agein a sample of 100 teeth of both sexes (not used for theregression) with an error of ± 5 years in 81.4% of casesfor the male molars. This study shows the potential valueof a little-known aging method, which can be easily used toestimate age both in living individuals and skeletal materialof unknown age in a forensic context(AU)