Consent, Refusal, Shared Decision-Making - Pediatric

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The AHRQ outlines 7 elements of a complete informed consent process:

Not every detail needs to be discussed, but all details needed for a reasonable person to make a decision must be provided.$^{5,22-24}$ Therefore, all risks of serious complications, even if they occur very rarely, need to be discussed. Less-serious risks need to be discussed if they occur more commonly.$^{25}$ In addition, the patient or person providing informed consent must be competent and have capacity to make the decision. In the case of a guardian or surrogate providing informed consent, that person must have the legal authority to do so.

While only 1 parent’s consent is needed if they both have legal custody, best practice involves communicating with both parents, even though this is often difficult to navigate in a busy ED. This is especially important in situations of unmarried or divorced parents when there is increased likelihood of disagreement between the parties. If the clinician is made aware of such a situation, we recommend making a good-faith effort to contact the parent not present and documenting these attempts and outcomes. Establishing good rapport with both parents can increase goodwill and decrease the likelihood of conflict later on. Practitioners should check with their institution’s legal counsel regarding their state’s laws on parental guardianship and consent as well as on particular circumstances regarding a patient if legal guardianship is not clear.

To determine capacity, physicians need to assess whether a patient is capable of the following:

Some clinical conditions, such as intoxication, unconsciousness, or other neurologic impairment, can affect a patient’s capacity.

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