Beyond Consent: Ethical Considerations in Informed Permission and Assent in Pediatric Oncology

Informed consent is a guiding principle underpinning medical care. In pediatrics, most patients are unable to provide consent by nature of their age and maturity, and the responsibility for providing informed permission falls to the child's parent or guardian. However, in most circumstances, the child should be involved in discussions about their medical care and sometimes can give assent to their care. In pediatric oncology, where clinical research is often enmeshed in clinical care, the processes of informed consent and assent may be even more complex. Pediatric oncology clinicians must be able to communicate the goals, potential benefits and risks, and anticipated side effects (of both routine care and involvement in research studies), while being attuned to the parents' or guardians' emotional state and understanding. While obtaining consent and assent can be complex and even challenging, familiarity with their ethical rationale is essential for pediatric clinicians.