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According to Rossi et al. (2003), Assent is definied as "Assent demonstrates respect for the child and his developing autonomy. In order to give meaningful assent, the child must understand that procedures will be performed, voluntarily choose to undergo the procedures, and communicate this choice".

Rossi, W. C., Reynolds, W., & Nelson, R. M. (2003). Child assent and parental permission in pediatric research. Theoretical medicine and bioethics, 24(2), 131–148. https://doi.org/10.1023/a:1024690712019

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Beneficence

Non-maleficence

Veracity

Justice

Autonomy

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1. There are times in which providers may have to treat the child over their objection. There are specific ethical responsibilities the provider must take when doing so. Like still providing a sense of autonomy and apologizing.

2. Assent protects children's rights by giving them the opportunity to express their preferences when appropriate. Recognizing and honoring children's wishes as they develop cognitively and mature is central to the consent requirement, which stems from the principle of individual respect.

3. Minors can't provide consent unless they are at least 18 years of age or emancipated.

4. To ensure that the patient understands, informed assent should be tailored to their age.

5. Children’s preferences about medical treatment ‘always have some moral weight’

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If a child is under the age of 18, his or her parents or legal guardians must provide consent to treatment. In most medical settings, parents or legal guardians have the ability to make medical decisions on behalf of their children and access their medical records.

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1. Beneficence

2. Maleficence

3. Veracity

4. Justice

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1. In the absence of biological or adoptive parents' consent, legal guardians (chosen by the court) may have decision-making authority.

2. Consent from parents or guardians is not required if there is an immediate threat to the child's life, health, or well-being, as determined by the health care professional.

3. Healthcare personnel who treat pediatric patients should be aware of their state's regulations and ensure that organizational policies regarding informed consent for children comply with these laws.

4. However, the requirement for child abuse and neglect laws and processes makes it evident that parents occasionally breach their commitments to their children.

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https://youtu.be/d5zIUCsO8EM?si=oSQAZxOVOICcmVL9

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1. https://www.cirp.org/library/ethics/AAP/

2. https://blog.pcc.com/privacy-consent-and-pediatric-mental-health-what-pediatricians-need-to-know

3. https://www.chp.edu/research/research-excellence/researchers/informed-consent#:~:text=Assent%20%E2%80%93%20Obtaining%20a%20Child's%20Agreement,will%20be%20the%20actual%20participant.

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Informed Consent, Parental Permission, and Assent in Pediatric Practice

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This file contains the American Academy of Pediatrics policy statement on informed consent in pediatric practice.

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14 yo girl with lower abdominal pain, vaginal discharge. Reports sexual intercourse with 1 partner, occasionally uses condoms. No hx pregnancy or STD’s. She is accompanied by her sister, no parent is with her.

In this case, the physician would not need to gain parental consent because depending on the state, some medical services can be provided without parental consent like STD/STI screening. The physician should be mindful of capacity of decision making, assent, financial resposibilitity, and medical records.

Medical conditions based on public health concerns that are exempt from the parental permission requirements

1. STD’s

2. Pregnancy

3. Abortion

4. Alcohol or Drug Abuse

5. Mental Health