Issues of consent and assent in pediatric neurosurgery
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REVIEW ARTICLE
Issues of consent and assent in pediatric neurosurgery Rajeev D. Sen 1 & Amy Lee 1,2 & Samuel R. Browd 1,2 & Richard G. Ellenbogen 1,2 & Jason S. Hauptman 1,2 Received: 19 August 2020 / Accepted: 28 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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 decisionmaking. 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. Keywords Pediatric . Consent . Assent . Ethics
Introduction The process of informed consent lies at the heart of the surgeon-patient relationship. By its simplest definition, informed consent is the authorization given by a patient to the physician to perform an intervention. It requires the surgeon to disclose the risks, benefits, and alternatives of the procedure in laymen’s terms while the patient must exhibit capacity by showing appropriate intellectual, psychiatric, and developmental behavior indicating sound judgment. Historically, the physician-patient relationship has transitioned from
* Rajeev D. Sen [email protected] 1
Department of Neurological Surgery, University of Washington, 325 Ninth Ave., Seattle, WA 98104, USA
2
Department of Neurosurgery, Seattle Children’s Hospital, Seattle, WA, USA
paternalistic to egalitarian where the desires of the patient are incorporated into the decision-making process. This transition has been shaped by the major sociopolitical events of the twentieth century such as the Nuremburg trial of Nazi doctors, civil and women’s rights movements, and the overall trend towards individualism. This engagement is straightforward in the adult population; ho
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