Child Participation in Decision-Making: From Adult-Centered to Child-Centered Approaches

Associate Professor of Health Care Ethics
Associate Professor of Pediatrics
Chair, Department of Health Care Ethics
Saint Louis University

Co-Chair, Ethics Committee
SSM Health Cardinal Glennon Children’s Hospital

In pediatric ethics, the practice of “assent” is the primary mechanism for involving children in medical decisions. However, because assent is modeled on adult informed consent, it relies on a “deficit view” of childhood, which defines children by the capacities they lack rather than the unique qualities they possess. This presentation provides an analysis of child involvement practices for patients under age 13, moving beyond the traditional assent framework, by advancing three inter-related arguments. First, it establishes a taxonomy of justifications for child involvement, identifying non-contingent reasons grounded in respect for persons and beneficence. Second, it critiques the AAP’s current assent model, demonstrating how it is adult-centered. Finally, it proposes a child-centered model of engagement that fosters more meaningful participation and respects the dignity of the child, qua child.

Co-hosted with the Department of Pediatrics

Disclaimer: The views expressed herein are those of the presenter, they do not necessarily reflect the views of the contracted organization, department, School of Medicine, nor the University of North Carolina at Chapel Hill.