Informed consent in pediatric neurology.
Informed consent remains an important but unpopular topic among physicians. It has the ring of a bothersome legal technicality coupled with a time-consuming, procedural requirement that must be obtained principally to satisfy external agencies and avoid malpractice suits. In fact, consent always has been an essential element in the physician-patient relationship, more important as an ethical duty than as a legal requirement, and continues to represent the most important forum of communication between patients and physicians. To explicate informed consent in pediatric neurology, this article begins with an account of consent in adult medical practice with competent patients. Then consent in incompetent patients is discussed and the standards of surrogate decision-making are defined. Next, the complex situation of consent in pediatrics is considered and the concept of assent and dissent of children and how it differs from consent and refusal in adults is introduced. Legal issues of consent are presented and how to resolve conflicts of assent, consent, and refusal between children and parents is discussed. Then, overriding parental refusals of treatment and consent issues in genetic testing are mentioned. Finally, there is a discussion of consent and assent by children for participation in clinical research studies.
Bernat
James L
JL
Department of Medicine (Neurology), Dartmouth Medical School, Hanover, NH, USA.
D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D007872:Legal Guardians; D009462:Neurology / Q000331:legislation & jurisprudence*; D010372:Pediatrics / Q000331:legislation & jurisprudence*; D010817:Physician-Patient Relations; D014481:United States