Decisional capacity to consent to treatment in children and adolescents: A systematic review

Obtaining informed consent in vulnerable populations like children and adolescents, is a relevant issue and raises ethical concerns. Minors are considered unable to consent to treatment, and permission from guardians is required for them. Nevertheless, several studies have been carried out on the competence of pediatric patients, with mixed results. Following PRISMA guidelines, a systematic review was performed to assess children and adolescents’ decisional capacity to consent to treatment. The search strategy identified 2,790 studies, including 10 that survived full-text screening and evaluation. Studies included in the analysis evaluated the decision-making capacity of minors using the MacArthur Competency Assessment Tool - Treatment (MacCAT-T), the Adolescent Psychiatric Patient Competency Questionnaire (CQ-ChP); the Measure of Competency (MOC), the Measure of Competency- Hypothetical (MOCHyp). Overall, minors over the age of 13 showed an acceptable decisional capacity. However, further research, preferably on larger groups, is needed to shed more light on this topic.