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Issues of consent and assent in pediatric neurosurgery
Rajeev D Sen1, Amy Lee2,3, Samuel R Browd2,3
1Department of Neurological Surgery, University of Washington, 325 Ninth Ave., Seattle, WA, 98104, USA. rdsen@uw.edu.
Insights
Pediatric neurosurgeons should involve children in their medical decisions, respecting their developing autonomy. This approach empowers young patients and is crucial for successful neurosurgical care.
Area of Science:
- Pediatric Neurosurgery
- Medical Ethics
- Child Development
Background:
- Involving pediatric patients in their care is increasingly recommended, despite limited legal capacity.
- There is a lack of guidance for neurosurgeons on patient involvement in decision-making.
- This study addresses the need for recommendations in pediatric neurosurgery.
Purpose of the Study:
- To provide pediatric neurosurgeons with recommendations for involving pediatric patients in medical decision-making.
- To enhance the understanding and application of consent and assent principles in pediatric neurosurgery.
Main Methods:
- Review of essential elements and current guidelines for pediatric consent and assent.
- Utilized neurosurgical case vignettes for illustration.
Main Results:
- Pediatric patients' cognitive and psychological development complicates consent and assent processes.
- Consideration of the child's role, assent/dissent, and informed refusal is complex.
- Effective communication of complex procedures is vital for informed decision-making.
Conclusions:
- Obtaining informed consent and assent is critical in pediatric neurosurgery.
- Surgeons must tailor communication to the child's understanding.
- Empowering children in their care fosters identity, agency, and successful outcomes.
Background:
Consent and assent are important concepts to understand in the care of pediatric neurosurgery patients. Recently it has been recommended that although pediatric patients generally do not have the legal capacity to make medical decisions, they be encouraged to be involved in their own care. Given the paucity of information on this topic in the neurosurgery community, the objective is to provide pediatric neurosurgeons with recommendations on how to involve their patients in medical decision-making.
Methods:
We review the essential elements and current guidelines of consent and assent for pediatric patients using illustrative neurosurgical case vignettes.
Results:
The pediatric population ranges widely in cognitive and psychological development making the process of consent and assent quite complex. The role of the child or adolescent in medical decision-making, issues associated with obtaining assent or dissent, and informed refusal of treatment are considered.
Conclusion:
The process of obtaining consent and assent represents a critical yet often overlooked aspect to care of pediatric neurosurgical patients. The pediatric neurosurgeon must be able to distill immensely complex and high-risk procedures into simple, understandable terms. Furthermore, they must recognize when the child's dissent or refusal to treatment is acceptable. In general, allowing children to be involved in their neurosurgical care is empowering and gives them both identity and agency, which is the vital first step to a successful neurosurgical intervention.
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