Who Decides? Consent, Assent and Confidentiality in Pediatric Dermatology Practice

Abstract

In pediatrics, decision making must be done with careful consideration of the delicate balance between patient, parent or legal guardian and healthcare provider. Pediatric dermatology is a unique field in which decisions often involve non-emergent procedures. When considering interventions, whether medical or procedural, the best interest of the child must always be considered, in addition to the wants and needs of the patient and guardian. When appropriate, it is important to involve the minor patient in his or her own healthcare decisions in order to establish an environment of trust. In this chapter, we discuss ethical dilemmas arising in cases in which patient or parental desires conflict with the best interest of the patient, and in which parental requests conflict with a child’s desires. Additionally, we discuss management of adolescent patients for whom autonomy is important but from whom unreasonable requests must be handled tactfully.