From the Guidelines
Obtaining informed consent for pediatric patients requires a nuanced approach that prioritizes respect for developing autonomy while ensuring appropriate protection, with the most recent guidelines suggesting that children's capacity to consent depends on their ability to understand and weigh up options rather than their age 1. When obtaining informed consent for pediatric patients, it is essential to consider the child's developmental level and involve them in decision-making to the extent possible.
- Children under 18 generally cannot provide legal consent for medical treatment; instead, parents or legal guardians must give informed consent on their behalf.
- However, healthcare providers should still seek assent from children, particularly those over age 7, which acknowledges their preferences and involves them in decision-making appropriate to their developmental level.
- As children mature, particularly adolescents, they should be given increasing involvement in their healthcare decisions. Some exceptions exist where minors can consent independently, including:
- Emergency situations where treatment is necessary to prevent serious harm
- Emancipated minor status
- Mature minor doctrine in some jurisdictions
- Specific treatments protected by state laws (such as reproductive health, mental health services, or substance abuse treatment) The consent process should include:
- Clear explanation of the proposed treatment, alternatives, risks, and benefits
- Language appropriate to both the parent's and child's understanding
- Thorough documentation of consent, including who provided consent and the information discussed As noted in the guidelines for obtaining valid consent for gastrointestinal endoscopy procedures 1, a young person aged 16 or 17 is presumed to be capable of consenting to their own medical treatment, and any ancillary procedures involved in that treatment, such as anaesthetic. Additionally, the concept of Gillick competence 1 suggests that children who have sufficient understanding and intelligence to enable them to understand fully what is involved in a proposed intervention will also have the capacity to consent to that intervention. The most recent and highest quality study 1 emphasizes the importance of assessing the child's capacity to consent carefully in relation to each decision, and using age-appropriate material to assist this process.
From the Research
Guidelines for Obtaining Informed Consent in the Pediatric Population
The guidelines for obtaining informed consent in the pediatric population involve considering the rights and interests of minors, parents, and the state in medical decision making 2.
- Parental consent is generally required for the medical evaluation and treatment of minor children, but there are situations in which a parent or legal guardian is not available to provide consent 3.
- In emergency situations, a medical screening examination and any medical care necessary and likely to prevent imminent and significant harm to the pediatric patient should not be withheld or delayed because of problems obtaining consent 3.
- The state may intervene when a parent acts contrary to the best interests of a child, and the Harm Principle may provide a more appropriate threshold for state intervention than the Best Interest standard 4.
- The American Academy of Pediatrics supports individualized decision making about life-sustaining medical treatment for all children, regardless of age, and these decisions should be jointly made by physicians and parents 5.
Involving Minors in Medical Decision Making
As minors age, they become more capable of participating in the decision-making process, and their involvement may lead them to either accept or refuse proposed care 6.
- Clinicians should consider the minor's capacity to participate in decision making in the context of their age, development, and overall health 6.
- Certain conditions may impact a minor's capacity for participation, but clinicians should avoid categorical presumption that minors of a certain age or with certain conditions are incapable of participating in decisions regarding their care 6.