The Pediatric Patient as a Self-Individual and Decision-Maker

Abstract

The novelty of the pediatric patient as an active participant in the medical decision-making comes from the fact of considering him or her as a subject of rights and as an active citizen. This ethical and legal change regarding children’s rights is recent in the history of surgical ethics. The 1995 statement by the American Academy of Pediatrics highlighted the experience, perspective, and power of children (American Academy of Pediatrics. Committee on Bioethics. Pediatrics 95:314–317, 1995) and, in 2016, recommended the participation in decision-making commensurate with their development providing assent to care whenever possible (Katz, Webb, AAP Committee on Bioethics. Pediatrics. 38:e20161485, 2016).

Besides these new paradigms, new studies on the decision-making process show that before the legal age of majority (in most countries at 18 years), the minor may be ready to make decisions in the same way as an adult; these decisions must be respected and taken seriously since the minor needs to be recognized with an active role in the surgeon-patient relationship.

A new concept has been developed in the health-care scenario: the mature minor. This is especially important in situations of surgical disease and issues related to his/her body and health in general, where the minor should hold a major role as a decision-maker in the process of what is going to be done about him or her. The dynamic medical decision ecosystem shows a multilateral process that is shared and discussed, where three major and relevant actors coexist and participate: the health team, the pediatric patient, and the parents. This new conception of the minor as a subject of rights means that he or she must be offered participation in a progressive way and according to the developed competence to make decisions.