Assent is necessary for a child 7+ years of age, even with consent by the parents.  Family dynamics and maturity level of the teen will definitely factor into the decision. There is typically not a large window of time to debate. Attempting to better understand each parent’s reasoning and also giving the patient a voice in the discussion would be important. If the patient is uncomfortable speaking with the parents’ present, it may be good practice to ask the parents to step out of the room so the patient can feel free to speak his mind. Depending on family dynamics, the patient may not want to contradict one parent over the other and it will be important to stress to the parents that the goal is to provide the patient with the best option possible that align with his goals for his future. If an agreement cannot be reached, it may be necessary to bring in the Bioethics Committee to help navigate what is in the best interest for the patient.

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