Making decisions with children

A child's rights to share in health decisions can no longer be ignored

Most health care professionals support the ideal of shared decision making with adult patients. Decisions affecting children and young people are more complex, involving parents as a third party. Children want to be part of the decision making process,1 2 but protective attitudes of paediatricians, and our generally overcautious assessment of children's ability to understand and reason in an environment of traditional adult superiority, have probably contributed to a tendency to overlook the rights of children to express their views. Case law, mostly derived from unusual or extreme cases, has compounded the problems, leading to the present confused and unsatisfactory position regarding children's rights.

The United Nations Convention on the Rights of the Child falls short of recognising children's rights to autonomy; it limits the decision making process to “giving due weight to the views of the child according to age and maturity.”3 The strength of such “participation” …