ABSTRACT
Preferences for care and consent for treatment emerge best from a process of discussion and feedback. In young children, it is necessary to establish early on who has parental responsibility and who will be the health care proxy/proxy decision makers. In situations where parental responsibility is shared, it is important to establish early on how difficult decisions will be addressed. In many cases, with open discussion, the decisions are clear to the clinical team and the partner, relatives or parents. Even in patients with cognitive impairment, the capacity to make a decision can vary greatly and some are able to make valid advance directives if this is done with someone whom the person knows and trusts. A patient may be competent for one decision, but not for another. The parents' competence must be assessed before they can make decisions on their child's behalf. Regardless of competency, everything should be done to minimize discomfort and distress arising from tests or treatments.
