Capacity for Preferences and Pediatric Assent Implications for Pediatric Practice

Area of Science:

• Bioethics
• Pediatric Healthcare
• Medical Decision-Making

Background:

• Clinicians and bioethicists have expanded children's role in medical decisions over 30-40 years.
• The American Academy of Pediatrics (AAP) issued guidance on pediatric assent in 1995, signaling its growing acceptance.
• Current ethical frameworks for pediatric assent, often based on autonomy, may not fully apply to children.

Purpose of the Study:

• To propose a stronger and more stable ethical foundation for pediatric assent.
• To argue that children's treatment preferences themselves are a reason to support pediatric assent.
• To re-evaluate the ethical basis of pediatric assent beyond autonomy and best interests.

Main Methods:

• Conceptual analysis of ethical frameworks for pediatric assent.
• Examination of the concept of "capacity for preferences" in pediatric decision-making.
• Critique of existing policy documents regarding respect for child patients.

Main Results:

• The current ethical foundation for pediatric assent, rooted in autonomy, is insufficient for most cases.
• Children's capacity for preferences provides a distinct moral basis for supporting pediatric assent.
• The moral value of a child patient's preferences is not solely dependent on autonomy or best interests.

Conclusions:

• Pediatric assent requires a robust ethical foundation that acknowledges children's capacity for preferences.
• Respect for child patients can be ethically grounded in their capacity to form preferences, irrespective of full autonomy.
• This approach offers a more stable ethical framework for incorporating children's voices in medical care decisions.