750 Assent in Research for Children is Problematic

Abstract

Introduction: Authoritative research guidelines from Europe, USA and Australia suggest that incompetent children ought to assent, when unable to consent. What assent means here is both unclear and morally problematic. I argue that if parents consent (that is choose) the role of the child's assent is unclear.Problems with assent: Firstly, a practical problem arises if parent and child give incompatible responses to consent and assent. The research will either continue or be withheld. If the child can be over-ruled, then assent seems meaningless. Alternatively, if the parents are overruled then this is not consent. But if consent is the authority to proceed, then assent has no role. Secondly, there are other conceptual problems with assent itself. For example, it is emphasised in research, but is largely ignored in medical treatment. Why? In addition, in many descriptions of assent, what is described is lack of dissent. Thirdly, as well as incoherence, the requirement for assent may cause other moral problems. If parents do choose for their children (and ignore the child's views) or if a child's assent contains a veto over the parents' consent, then we may be introducing tensions into the decisionmaking within a family.Some children can consent. Parents of incompetent children must consent (or not) usually consulting with their child. Children should have an input into their parents' decisions but as one component in the decision, not an independent choice.Conclusions: The notion of assent is both flawed and morally problematic. Children's research regulations should be reformed.This Work was Supported by the Wellcome Trust [WT087470MF].