Capacity for Preferences and Pediatric Assent Implications for Pediatric Practice

The Hastings Center Report
Mark Christopher Navin, Jason Adam Wasserman

Abstract

In the past thirty to forty years, clinicians and bioethicists have expanded the scope for children's participation in decision-making about their medical care, often under the banner of "pediatric assent." The success of this movement was signaled perhaps most strongly by the creation of American Academy of Pediatrics guidance on pediatric assent in 1995. We agree with the AAP that both the best interests of the child patient and the need to respect the child patient are reasons to take seriously children's treatment preferences. However, we argue that the AAP could provide a stronger and more stable ethical foundation for pediatric assent. Current policy documents invoke a conception of respect that is grounded in autonomy and cannot apply in most cases of pediatric assent. We argue that the mere fact that children have treatment preferences is a reason to support pediatric assent. We defend this claim by focusing on the importance of what we have called "capacity for preferences." The notion of capacity for preferences underscores that the moral value of a patient's preferences is not reducible to considerations of either autonomy or best interests.

References

Apr 19, 2002·The Journal of Medicine and Philosophy·Elysa R Koppelman
Apr 26, 2002·Anesthesia and Analgesia·E Joseph Denham, Robert M Nelson
Jan 28, 2004·The American Journal of Bioethics : AJOB·David Wendler, Seema Shah
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Feb 1, 2012·Pediatrics·UNKNOWN COMMITTEE ON HOSPITAL CARE and INSTITUTE FOR PATIENT- AND FAMILY-CENTERED CARE
Nov 22, 2013·The New England Journal of Medicine·Thaddeus Mason Pope
Jan 13, 2016·BMC Medical Ethics·Amanda SibleyMark Sheehan
Jul 28, 2016·Pediatrics·UNKNOWN COMMITTEE ON BIOETHICS
Nov 8, 2017·The American Journal of Bioethics : AJOB·Mark Christopher Navin, Jason Adam Wasserman
Feb 22, 2018·The American Journal of Bioethics : AJOB·Georgiann Davis, Ranita Ray
Feb 22, 2018·The American Journal of Bioethics : AJOB·Maya SabatelloJohn Lantos
Feb 22, 2018·The American Journal of Bioethics : AJOB·Austin Lawrence Dalgo
May 29, 2018·The Hastings Center Report·Nancy Berlinger
May 29, 2018·The Hastings Center Report·Jason Adam Wasserman, Mark Christopher Navin

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Citations

Aug 18, 2020·The American Journal of Bioethics : AJOB·Jason Adam Wasserman, Mark Christopher Navin
May 6, 2021·Paediatric Anaesthesia·John MassieLynn Gillam
Aug 5, 2021·The American Journal of Bioethics : AJOB·Mark Christopher NavinJason Adam Wasserman
Nov 2, 2019·Pediatrics·Jason Adam WassermanChristian John Vercler

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