Objective Paediatric ethics has focused predominantly on debating treatment decision-making authority between parents and physicians. These debates have been important in identifying the issues surrounding “who should decide?” and have given rise to decisional models that are congruent with the social roles attributed to parents and physicians in different countries. A commonly underacknowledged issue is the significance that should be accorded to the voice of the child undergoing medical treatment. Children’s treatment wishes are generally disregarded until they can demonstrate adult-like decision-making capacities.

Methods and Results This paper highlights three major problems associated with typical practices regarding children’s participation in treatment decision-making: (1) children’s decisional capacities are commonly underestimated (ie, young adolescents demonstrate decision-making judgement resembling that of adults); (2) children (including very young children) have moral viewpoints that are unique and quite distinctive from those of adults that are morally meaningful to them, yet typically disregarded by adults and (3) adults deciding on behalf of children’s best interests usually have their own adult interests that can conflict with those of the children.

Conclusion In an attempt to overcome these barriers to “hearing” the voices of children in treatment decisions, I will argue for a stronger recognition of children’s assent to treatment.