Doctors must weigh both legal and ethical considerations when it comes to allowing children to take part in medical decisions.
Recently the question of when children and adolescents should take part in their own medical decisions has come to the forefront, writes Perri Klass, M.D., a professor of journalism and pediatrics at New York University, in a blog post for The New York Times.
As children get older it presents a host of ethical questions, she writes, from when they should begin participating in medical decisions to how to handle disagreement with doctors or their parents.
The answers aren’t easy but the American Academy of Pediatrics tried to sort out the issues in a new policy statement issued last month that analyzed the issue of informed consent by pediatric patients. The pediatrician’s group also raises the question of assent, suggesting that even a child as young as 7 can express an informed agreement with proposed medical treatment, Klass writes.
The new guidelines encourage doctors to take time and include the child, Aviva Katz, M.D., a pediatric surgeon who is the director of the Ethics Consultation Service at the Children’s Hospital of Pittsburgh and an author of the policy statement and an accompanying report, told Klass. But, she added, doctors must recognize that even children with strong cognitive skills don’t necessarily have mature judgement.
Allowing children to take part in decision-making is best done in stages, according to Katz, with doctors giving them the opportunity to begin making medical decisions and being part of the discussion so they are later prepared as young adults to make their own decisions.