Children and bioethics: clarifying consent and assent in medical and research settings

Introduction The concept of consent in the pediatric setting is complex and confusing. Clinicians and researchers want to know whose consent they should obtain, when a child can provide independent consent and how that is determined. The aim of this article is to establish what produces the justification to proceed with medical or research interventions involving children and the role of consent in that. I clarify concepts such as consent, assent, capacity and competence. Source of data Literature review. Areas of agreement Engaging with children and involving them in decisions about matters that affect them is a good thing. Areas of controversy The role of competence or capacity and the question of when a child can provide sole consent. Growing points Flawed assumptions around competence/capacity. Areas for developing research An account of children's well-being that accommodates children's interests during the transition to adulthood.