Partnerships with children

Earlier this year a 15 year old girl had her decision to refuse a heart transplant overruled by the High Court,1 highlighting the issue of partnership with children. The case is the latest of several2 that have shown how children's participation in decision making and recognising their autonomy and rationality 3 4 can conflict with the need to protect them from making decisions that are not in their long term interests.5 Court cases dramatically show the problems of involving children in decision making, but they tend to deal with extreme and unusual examples and have led to uncertainty and anxiety about routinely involving children in decision making. Away from the courts a movement is growing to promote children's rights. Proponents have argued from a position of moral obligation and have called for a code of practice which would emphasise children's rights to information, to express views, and to give or withhold consent provided the child is considered competent by a doctor.6 Professional bodies and others concerned with children's wellbeing seem to have accepted many of these principles,7–10 which are based on ethical and moral principles of autonomy, free will, choice, and compassion and have the laudable aim of allowing children's opinions to be voiced, heard, and acted on wherever possible. However, the evidence suggests that partnership with children enjoys only limited success. Children are given little voice in medical consultations 8 11 and are rarely consulted as partners in the evaluation and planning of health services.12 13 The …