Issues of consent and assent in pediatric neurosurgery

Background Consent and assent are important concepts to understand in the care of pediatric neurosurgery patients. Recently it has been recommended that although pediatric patients generally do not have the legal capacity to make medical decisions, they be encouraged to be involved in their own care. Given the paucity of information on this topic in the neurosurgery community, the objective is to provide pediatric neurosurgeons with recommendations on how to involve their patients in medical decision-making. Methods We review the essential elements and current guidelines of consent and assent for pediatric patients using illustrative neurosurgical case vignettes. Results The pediatric population ranges widely in cognitive and psychological development making the process of consent and assent quite complex. The role of the child or adolescent in medical decision-making, issues associated with obtaining assent or dissent, and informed refusal of treatment are considered. Conclusion The process of obtaining consent and assent represents a critical yet often overlooked aspect to care of pediatric neurosurgical patients. The pediatric neurosurgeon must be able to distill immensely complex and high-risk procedures into simple, understandable terms. Furthermore, they must recognize when the child's dissent or refusal to treatment is acceptable. In general, allowing children to be involved in their neurosurgical care is empowering and gives them both identity and agency, which is the vital first step to a successful neurosurgical intervention.

Automated summary

Understanding the concepts of consent and assent is crucial in caring for pediatric neurosurgery patients, as it is recommended to involve pediatric patients in their own care despite their legal capacity limitations. Obtaining consent and assent in the pediatric population is complex due to varying cognitive and psychological developments, requiring pediatric neurosurgeons to simplify complex procedures and recognize children's dissent or refusal when necessary. Empowering children to be involved in their neurosurgical care is vital for successful interventions.