In recent years, the physician-patient relationship has transformed from one of paternalism into an egalitarian and participatory partnership in which patients and physicians work together to make healthcare decisions (Committee on Bioethics, 1995). Today there is general societal acceptance that “patients have a right to know about their health, to know about available diagnostic and treatment options and then” risks and probable benefits, and to choose among the alternatives” (Committee on Bioethics, 1995, p. 315). Informed consent is an essential part of the communication process between physicians and patients. The information provided by physicians about illness and treatment options is vital to patients’ decision-making and influences their psychological well-being (Rushforth, 1999).

Although adults receive considerable encouragement to become active participants in healthcare decisions, children and adolescents often have little voice in decisions about their medical treatment (Kunin, 1997; Lidz et al., 1984). As minors, adolescents often are unable legally to provide informed consent and are granted limited access to confidential medical care. Confusion and mixed messages abound about the abilities and rights of adolescents. The present review examines the developmental literature on children and adolescents’ capacities to make medical decisions that are informed, voluntary, and rational.

In its simplest form, informed consent is the treatment authorization given by a patient to a physician. Legally, it is an intentional authorization in that it must be given knowingly, rationally, with volition, and without coercion (Grisso & Vierling, 1978; King & Cross, 1989; Scott, 1992). By informed, it is meant that the decision must be based on knowledge of the situation and potential consequences. Consent must be voluntary; it must be volitional and not reflect mere acquiescence. Consent also must be rational, implying that it is rendered by an intellectually competent and mature individual.