In pediatric end-of-life decisions, assent is best described as ...

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Assent involves the child’s affirmative agreement to participate in the plan of care, reflecting respect for the child’s developing autonomy. It isn’t legal permission; rather, it’s the child’s willingness to be part of the decisions and treatment, explained in an age-appropriate way. Legal consent remains the responsibility of a parent or guardian (and, if the child is capable, the patient themselves), not assent. A formal court permission or any procedural step for parental consent does not define assent. In practice, clinicians seek and document assent by explaining options in understandable terms, checking that the child understands, and inviting questions, while respecting a child’s right to dissent. If the child cannot assent due to age or illness, decisions proceed with parental involvement and best-interest considerations, but assent remains the aim whenever possible to honor the child’s voice.