The United Nations Convention on the Rights of the Child (1989) clearly established the importance of children’s right to participate in matters that directly affect them. Children’s participation in healthcare decision-making is seen as leading to positive outcomes such as: increased internal locus of control; decreased fears and concerns, feeling valued, sense of competence, enhanced adaptation and satisfaction with healthcare. Paediatric organisations recommend that children participate in decision making commensurate with their development; children provide assent to care whenever reasonable; and health care providers do not exclude children from decision making without persuasive reasons.1,2 But how is this principle translated into practice and are there any difficulties with implementing this principle? This paper will consider the different philosophical positions on involving children in decision-making. This will provide the backdrop to a discussion of the difficulties with implementing this principle into practice drawing upon a systematic review of the research literature. This paper will suggest an approach to involving children that not only recognises children’s abilities and vulnerabilities and children’s rights, but at the same time, acknowledges and respects parental and professional responsibilities.
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