"Undoing" Capacity: The Capability Approach in Pediatrics

Area of Science:

• Pediatric Ethics
• Bioethics
• Child Psychology

Background:

• Children's decision-making capacity is not assumed due to developmental factors, unlike adults.
• Child participation in healthcare and research is increasingly advocated, influenced by the UN Convention on the Rights of Children.
• Traditional cognitive assessments of capacity may limit children's involvement, necessitating alternative frameworks.

Purpose of the Study:

• To critique the traditional cognitive approach to children's decision-making capacity.
• To introduce the capability approach as a framework for enhancing child participation in healthcare.
• To promote a patient-centered approach in pediatrics by valuing children's diverse preferences and contexts.

Main Methods:

• Conceptual analysis of decision-making capacity in pediatrics.
• Integration of the capability approach framework into clinical and research contexts for children.
• Examination of socio-familial, cultural, and environmental factors influencing children's participation.

Main Results:

• The capability approach provides a nuanced understanding of children's decision-making capacity.
• It encourages a shift from a deficit-based view to one that fosters children's role in their medical care.
• Acknowledging diverse contexts and preferences supports a more inclusive, patient-centered model.

Conclusions:

• The capability approach offers a valuable alternative to traditional cognitive models for assessing children's decision-making capacity.
• It promotes a more holistic and context-aware approach to child participation in healthcare.
• This framework supports ethical pediatric practice by respecting children's evolving autonomy and preferences.