Paeds · professional-practice-and-evidence
Consent, parental responsibility and mature-minor frameworks
Also known as Informed consent in paediatrics · Parental permission and assent · Mature minor doctrine · Gillick competence and Fraser guidelines · Decision-making capacity in children · Adolescent consent and refusal · Emergency treatment of children without consent
Fellowship-level approach to consent in paediatrics: parental responsibility, child assent and dissent, decision-making capacity via Appelbaum domains, Gillick/Fraser and mature-minor frameworks, emergency necessity, refusal of life-saving care, and defensible documentation across ANZ, UK, US and Canada.
On this page
Study tools
Your progress
Saved on this device.
Practise this topic
Target exams
Red flags
- Treating chronological age as capacity — a 15-year-old may lack capacity for an irreversible decision
- Proceeding on one parent's authority when local law or policy requires both or a specific holder
- Using a family member as interpreter for high-stakes consent
- Equating silence or quiet cooperation with assent
- Overriding a capable young person's refusal without legal or ethics input
- Delaying emergency treatment while waiting for formal consent when delay risks serious harm
- Promising absolute confidentiality that safeguarding duties will override
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Ethics and professional practice
- Current 2026 PREP curriculum — Learning Objective 1.2.1: Communicate with a child or young person in a way which is appropriate to the position of that child within their own culture
- Current 2026 PREP curriculum — Learning Objective 1.2.2: Communicate with parents or carers
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Renewed curriculum for first-year trainees from 2027 — Learning goal 9: Clinical assessment and management – child safety and maltreatment
- Professional practice: consent, capacity and legal frameworks for children and young people
- Clinical Applications
- Ethics and law in paediatric practice
- Long Cases
- Short Cases
- Communication stations
- 2. Professional skills and knowledge: Communication
- 4. Professional skills and knowledge: Patient management
- 1. Professional values and behaviours
- 9. Safeguarding vulnerable children
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Ethics, consent and law
- Communication
- History
- Clinical
- General Pediatrics Content Outline — Domain 23: Ethics
- General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
- General Pediatrics EPA 10: Leading Interprofessional Teams to Provide Collaborative, Family-Centered Care
- Professionalism and informed permission/assent/consent
- Professionalism 1: Professional Behavior and Ethical Principles
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Patient Care 4: Clinical Reasoning
- Systems-Based Practice: legal and ethical dimensions of care
- Professional
- Communicator
- Pediatrics: Foundations EPA #8 — Communicating assessment findings and management plans to patients and/or families
- Pediatrics: Core EPA #10 — Leading discussions with patients, families and/or other health care professionals in emotionally charged situations
- Consent, capacity and substitute decision-making in paediatrics
Overview & Definition
Picture a six-year-old needing a lumbar puncture. The mother agrees, the child is terrified, and the father is on the phone refusing. Your job is not to pick the loudest voice. It is to work out who holds authority for this decision and how the child's voice fits in. [1]
Four terms do most of the work. Informed consent is a voluntary, understanding agreement to a specific intervention after disclosure of its nature, purpose, material risks and benefits, alternatives including no treatment, and the option to decline. Parental permission is the equivalent authority given by someone holding parental responsibility for a child who cannot yet consent for themselves. Assent is the child's affirmative agreement to participate; mere silence or failure to resist is never assent. Dissent is the child's expressed objection, which deserves weight even when the child lacks legal authority to decide. [1] [2]
Two legal concepts sit underneath all of this. Decision-making capacity is a functional, clinical judgement about whether this person can make this decision now; it is distinct from legal competence, which is what the law assigns by status or age. Parental responsibility is the bundle of rights and duties that lets an adult authorise treatment for a child — and it does not automatically belong to whoever brought the child in today. [1] [3]
[1] [3]References12ShowHide
- [1]COMMITTEE ON BIOETHICS Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456514
- [2]Katz AL, Webb SA Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456510
- [3]Appelbaum PS, Grisso T Assessing patients' capacities to consent to treatment. N Engl J Med, 1988.PMID 3200278
- [4]Hein IM, De Vries MC, Troost PW, Meynen G Informed consent instead of assent is appropriate in children from the age of twelve: Policy implications of new findings on children's competence to consent to clinical research. BMC Med Ethics, 2015.PMID 26553304
- [5]Hein IM, Troost PW, Lindeboom R, Benninga MA Accuracy of the MacArthur competence assessment tool for clinical research (MacCAT-CR) for measuring children's competence to consent to clinical research. JAMA Pediatr, 2014.PMID 25317644
- [6]Grootens-Wiegers P, Hein IM, van den Broek JM, de Vries MC Medical decision-making in children and adolescents: developmental and neuroscientific aspects. BMC Pediatr, 2017.PMID 28482854
- [7]Viner RM, Ozer EM, Denny S, Marmot M Adolescence and the social determinants of health. Lancet, 2012.PMID 22538179
- [8]Diekema DS Parental refusals of medical treatment: the harm principle as threshold for state intervention. Theor Med Bioeth, 2004.PMID 15637945
- [9]Diekema DS Revisiting the best interest standard: uses and misuses. J Clin Ethics, 2011.PMID 21837884
- [10]Freckelton I, McGregor S Refusal of potentially life-saving treatment for minors: The emerging international consensus by courts. J Law Med, 2016.PMID 30136557
- [11]Coyne I, O'Mathúna DP, Gibson F, et al. Interventions for promoting participation in shared decision-making for children with cancer. Cochrane Database Syst Rev, 2016.PMID 27898175
- [12]Levetown M Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics, 2008.PMID 18450887