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Pediatric Assent in Clinical Practice: A Critical Scoping Review.

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Pediatric assent in medical care is valuable but its meaning, process, and ethical basis remain unclear. Understanding these nuances is crucial for involving children appropriately in their treatment decisions.

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Area of Science:

  • Medical Ethics
  • Pediatric Healthcare
  • Child Development

Background:

  • Pediatric assent is crucial for involving children in medical decisions.
  • Existing research focuses more on assent in research than in clinical care.
  • Therapeutic assent involves balancing child preferences with best interests and parental permission.

Purpose of the Study:

  • To analyze the conceptualization and ethical justification of pediatric assent in clinical settings.
  • To clarify ambiguities surrounding pediatric assent in therapeutic contexts.

Main Methods:

  • Systematic literature search across 11 databases (2010-2020).
  • Screening of articles for relevance to pediatric assent in clinical care with normative claims.
  • Thematic analysis of 29 articles focusing on definitions, temporal aspects, understanding, and ethical justifications.

Main Results:

  • Pediatric assent varies by treatment, patient age, and cultural context.
  • Assent involves two longitudinal processes: preference elicitation and developmental maturation.
  • Ethical justifications for assent are often ambiguous, drawing on both instrumental and intrinsic reasons.

Conclusions:

  • There is broad agreement on the moral value of pediatric assent.
  • Significant ambiguities persist regarding the definition, operationalization, and ethical underpinnings of therapeutic pediatric assent.