The support for informed consent in ethical theory is most commonly found in the concept of autonomy, the right of an autonomous agent to make decisions as guided by his or her own reason. The current concept of informed consent in medical practice has roots within both ethical theory and law. The purpose of this technical report is to provide a firm grounding of the concept of informed consent, addressing both the legal and philosophical roots, to provide information on a variety of standards applicable for decision-making by surrogates for pediatric patients and to discuss how issues of assent, refusal, and consent affect the care of children and adolescents in a variety of clinical and research settings. 4, – 6 The discordance between current clinical practice and previously published guidance may reflect the gradual evolution of change within the culture of medicine or perhaps suggests a need to build on the discussion of informed consent, assent, and refusal for children and adolescents.
Despite the long-standing stance of the AAP that older children and adolescents should be involved in the medical decision-making and consent process, there still has not been widespread understanding and endorsement among practitioners of the concept of pediatric assent or refusal. A final use of technology in the demonstration projects is to measure the effectiveness of court actions by compiling data on case outcomes and impacts.Although some aspects of decision-making in pediatrics are evolving in response to changes in information technology, scientific discoveries, and legal rulings, recent reports have noted that change can be slow. All agencies involved in the work of demonstration courts are linked to the information systems needed to make informed and cooperative decisions. The result is that offenders can no longer "play" the system. Also, keeping up-to-date and informative records on all cases handled by the court allows judges to determine whether offenders are complying with court dispositions and thus to intervene to remedy violations and noncompliance.
Bringing information into the courtroom at the earliest stage of the court process is a fundamental principle of each of the Center's experimental projects for example at the Midtown Community Court in New York City, judges, prepared with extensive data on offenders, have been able to sentence selected misdemeanor offenders to long-term drug treatment, which rarely happens in traditional criminal courts. Such information should be an important factor in shaping a disposition or issuing an order of protection. Nor can they know whether any children live in a home where domestic violence is occurring. Most criminal court judges do not know whether the offender appearing before them on a shoplifting charge is on drugs. Information technology has been used in court demonstration projects in three principal ways: to help judges make informed decisions, to enhance the accountability of offenders, and to promote collaboration with old and new partners.
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