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Deciding with children
  1. John Massie
  1. Children's Bioethics Centre, Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia
  1. Correspondence to Dr John Massie, Respiratory Medicine, Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; John.Massie{at}

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In my practice as a paediatric respiratory physician and working with the Children’s Bioethics Centre, I have been reflecting on the way in which children and adolescents are involved in decision-making for their own healthcare. My concern is that children and adolescents are not considered sufficiently in their own medical decisions, even though these decisions clearly affect them and how their lives will go. While paediatricians are good at engaging and acknowledging children and adolescents as young people in general terms, medical decision-making is often negotiated with parents, at the near exclusion of the child. This is in line with the moral and legal recognition of parents as surrogate decision-makers for their child.

This type of decision-making is a nod to shared decision-making but rarely includes the authentic voice of the child who could be more genuinely involved in the shared decision-making experience.1 This type of decision-making also falls under the umbrella of family-centred care, but again the interests of the family are mostly determined by the parents and this model assumes that a child’s interests are completely aligned with those of the family.2 This is not to say that children and adolescents are never included in decision-making, but when they are it is often out of a need to make the consultation or procedure go well. This instrumental involvement is more often for the convenience of the clinician or healthcare system and the comfort of the parents, and not necessarily with the specific needs …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.