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When Children Have a Say: The Development of Medical Assent

By Leon MoriguchiPublished May 13, 2026Updated May 18, 20266 min read日本語版あり
Audience
Parents of children of any age; people engaged with pediatric healthcare

TL;DR

  • ·Assent — a child's affirmative agreement to a medical procedure — is distinct from parental consent; it is ethically grounded in developmental psychology and clinically meaningful from roughly age seven, when procedural understanding begins to develop
  • ·Decision-making capacity is a gradient, not a switch: research using the MacArthur assessment tool found a developmental inflection point around age 12, below which scores fall substantially short of adult norms
  • ·A child who has been genuinely asked and had their response received seriously — even when dissent does not control the outcome — carries that experience into future healthcare interactions as an adult

Contents

  1. Lead
  2. What Assent Means
  3. Gillick Competence: The UK Standard
  4. The Empirical Research on Assent Capacity
  5. The Context in Japan
  6. What Parents Can Do
  7. Summary
  8. References

Lead

A physician leans toward a school-age child before a procedure and asks: "We're going to do this test — are you okay with that?" The child nods.

What does that nod mean? The parent has already provided legal consent, so nothing about the medical act turns on the child's response. Why ask at all?

The answer is not ceremony. Asking is a practice of treating the child as a person — a participant in what is happening to their own body. Pediatric medical ethics has spent more than 30 years working out what that practice should look like.

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