In the pediatric setting, decision-making generally falls on the shoulders of parents. Often, determination of who makes decisions is guided by the law. However, there is not a clear consensus among lawmakers or health care professionals regarding at what age a person truly becomes capable of making their own decisions. Indeed it is not age specifically that determines capacity for decision-making. Like many other aspects of development, this capacity exists along a continuum, changes over time, develops on a variable timeline, and benefits from practice. The perspective of the child should be included in discussions about health care and care planning. Clinicians should assess a pediatric patient’s ability and desire to participate in health care discussions and decisions and appropriately include the patient.

A fundamental principle of health care ethics is respect for persons. The concept of respect for persons encompasses both the principle of autonomy and the protection of...

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