Bailly D
Service hospitalo-universitaire de psychiatrie, Hôpital Sainte-Marguerite, 270 boulevard de Sainte Marguerite, Marseille, France.
Arch Pediatr. 2010 Feb;17 Suppl 1:S7-15. doi: 10.1016/S0929-693X(10)70003-8.
The process of consent to healthcare decisions in children and adolescents often set physicians difficult problems. From what age is a child able to understand the information given to him or her about illness and treatment? Is an ill child indeed in the capacity to give his or her voluntary consent to treatment? How to define and to assess the capacity of an ill child to take part in treatment decisions? More than the age of the child, it is his or her level of cognitive, emotional and social development and its interactions with illness that will determine his or her degree of involvement in the decision-making process. There is a moral and ethical need to respect the rights and autonomy of every individual, regardless of age. This does not mean viewing children and adolescents as rational and autonomous decision-makers. This implies that we must promote their developmentally appropriate participation in shared decision-making with parents and physicians. Therefore, instead of asking, "should children and adolescents be granted absolute autonomy in decision making?" we ought to ask, "should we treat children and adolescents like people?"
儿童和青少年医疗决策中的同意过程常常给医生带来难题。孩子从几岁起能够理解给予他或她的关于疾病和治疗的信息？患病儿童真的有能力自愿同意接受治疗吗？如何界定和评估患病儿童参与治疗决策的能力？决定其参与决策过程程度的，与其说是孩子的年龄，不如说是其认知、情感和社会发展水平以及这些方面与疾病的相互作用。无论年龄大小，从道德和伦理角度都有必要尊重每个人的权利和自主权。这并不意味着将儿童和青少年视为理性和自主的决策者。这意味着我们必须促进他们在与父母和医生共同决策中进行符合其发育阶段的参与。因此，我们不应问“儿童和青少年在决策中应被赋予绝对自主权吗？”，而应该问“我们应该像对待成年人一样对待儿童和青少年吗？”
