Background

Consent and assent are important concepts to understand in the care of pediatric neurosurgery patients. Recently it has been recommended that although pediatric patients generally do not have the legal capacity to make medical decisions, they be encouraged to be involved in their own care. Given the paucity of information on this topic in the neurosurgery community, the objective is to provide pediatric neurosurgeons with recommendations on how to involve their patients in medical decision-making.

Methods

We review the essential elements and current guidelines of consent and assent for pediatric patients using illustrative neurosurgical case vignettes.

Results

The pediatric population ranges widely in cognitive and psychological development making the process of consent and assent quite complex. The role of the child or adolescent in medical decision-making, issues associated with obtaining assent or dissent, and informed refusal of treatment are considered.

Conclusion

The process of obtaining consent and assent represents a critical yet often overlooked aspect to care of pediatric neurosurgical patients. The pediatric neurosurgeon must be able to distill immensely complex and high-risk procedures into simple, understandable terms. Furthermore, they must recognize when the child’s dissent or refusal to treatment is acceptable. In general, allowing children to be involved in their neurosurgical care is empowering and gives them both identity and agency, which is the vital first step to a successful neurosurgical intervention.

中文翻译：

---

儿科神经外科的同意和同意问题

背景

同意和同意是在儿科神经外科患者护理中要理解的重要概念。最近，有人建议，尽管儿科患者通常不具有作出医疗决定的法律能力，但应鼓励他们参加自己的护理。鉴于神经外科社区中有关此主题的信息很少，因此目的是向儿科神经外科医师提供有关如何使患者参与医疗决策的建议。

方法

我们使用示例性神经外科病例短片回顾了小儿患者的同意和同意的基本要素和当前准则。

结果

儿科人群的认知和心理发展范围很广，使得同意和同意的过程相当复杂。考虑儿童或青少年在医疗决策中的作用，与获得同意或异议有关的问题以及知情拒绝治疗的问题。

结论

获得同意和同意的过程代表了小儿神经外科患者护理的关键但经常被忽视的方面。儿科神经外科医生必须能够将极其复杂和高风险的过程提炼为简单易懂的术语。此外，他们必须认识到何时可以接受孩子的异议或拒绝接受治疗。通常，允许孩子参与神经外科护理会增强他们的能力，并赋予他们身份和代理权，这是成功进行神经外科干预的至关重要的第一步。