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AAP statement recognizes youths’ input in medical decision-making
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Inclusion of informed consent and decision-making from children and adolescents is recommended for effective and modern ethical pediatric practice, according to an updated policy statement released by the AAP’s Committee on Bioethics.
“As recommended in the 1995 publication [statement on informed consent], this revised statement affirms that patients should participate in decision-making commensurate with their development; they should provide assent to care whenever reasonable,” Aviva L. Katz, MD, FAAP, member of the Committee on Bioethics, and colleagues said in Pediatrics. “Pediatric decision-making continues to evolve in response to changes in information technology, scientific discoveries and legal rulings. Continuing limits on the widespread use of pediatric assent/refusal makes this review and restatement of AAP policy important.”
The statement emphasized that pediatricians should be skilled in using language that is age-appropriate and meets the developmental level of the patient. According to the statement, informed consent relies on three components: disclosure of information to patients and their parents or guardians, an assessment of the patient and parental understanding of the information and their capacity for making medical decisions, and receipt of informed consent before patient care and interventions. Although children and adolescents generally have limited capacity for making a medical decision or are unable to act autonomously, the Committee on Bioethics wrote that the process to obtain informed consent is the same for children and adults because their rights are based on the same principles.
In addition, pediatricians are encouraged to use discussions with their patients as opportunities to gauge their cognitive abilities and developmental maturity, as well their value-based care goals and to determine whether patients can make sound medical decisions. However, the AAP recommends that clinicians intervene with an effective treatment if a patient or family member’s decided treatment is ineffective in the event of serious harm, disability or death is likely to occur.
“Encouraging pediatric patients to actively explore options and to take on a greater role in their health care may promote empowerment and compliance with a treatment plan,” the researchers said. “With this in mind, informed consent/assent should be recognized as an essential part of health care practice.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.
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