Making sense of adolescent decision-making: challenge and reality

Adolesc Med State Art Rev. 2011 Aug;22(2):195-206, vii-viii.


Few topics in pediatric bioethics are as vexing as decision-making. Decision-making in pediatrics presents challenges for children, parents, and physicians alike. The related, yet distinct, concepts of assent and consent are central to pediatric decision-making. Although informed consent is largely regarded as a worthwhile adult principle, assent has been, and continues to be, mired in debate. Controversial subjects include a meaningful definition of assent; how old children should be to assent; who should be included in the assent process; parental permission; how to resolve disputes between children and their parents; the relationship between assent and consent; the quantity and quality of information to disclose to children and their families; how much and what information children desire and need; the necessity and methods for assessing both children's understanding of disclosed information and of the assent process itself; reconciling ethical and legal attitudes toward assent; and finally, an effective, practical, and realistically applicable decision-making model.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adolescent Medicine / ethics
  • Adolescent Medicine / legislation & jurisprudence
  • Decision Making*
  • Disclosure
  • Humans
  • Male
  • Parents*
  • Physician-Patient Relations*
  • Psychology, Adolescent / ethics
  • Psychology, Adolescent / legislation & jurisprudence
  • Public Opinion
  • Testicular Neoplasms / psychology*