Adolescents who are critically, chronically, and terminally ill traditionally have been given little voice in their health care treatment. But over the last three decades attitudes have begun to shift. The legal and medical professions as well as parents and children's advocates have started to recognize that cognitively normal adolescents have decisionmaking capacity and believe these patients ought to have the opportunity to participate in even the toughest of health treatment decisions. Advance directives, if used with sensitivity and care, could (...) prove a valuable means of giving these older pediatric patients a say in their care. (shrink)

To what risks may children participating in research be subjected? Institutional review boards can stand surrogate for parents by filtering out studies whose risk is unacceptably high.

Inconsistency may well be the hallmark of the teenage years. Frequently, teenagers are serious and adult-like, yet just as often, they are callow and unpredictable. Generally, they are all of these things, in no particular order. They studiously observe the adults in their lives, adopting certain values and behaviors, while wholly rejecting others. Their moods shift without warning, leaving entire households with the sensation that they are living on a roller-coaster. As a result, it is not entirely surprising that the (...) legal system has had difficulty deciding how to respond to them. The laws devised to govern teenagers are layered, reflecting society's alternating perceptions of teenagers as adult-like and child-like, and our accompanying impulses to respect as well as to protect this population. Read together, these laws defy any consistent description of adolescent capacity. We have lived with these inconsistencies for so long, though, that they have grown rather familiar to us, and that we hardly recognize the puzzle in the fact that we trust eighteen year olds enough to let them fight and die in the military, but not enough to let them drink alcoholic beverages. (shrink)