How should clinicians approach an adolescent who refuses treatment but parental consent is allowed?

• A. Proceed with treatment as planned, overriding assent when risk is present.
• B. Ignore the adolescent's preferences if parents consent.
• C. Explore reasons for refusal, maintain assent, involve caregivers, and consider risk.
• D. Only involve caregivers if the adolescent's safety is not at risk.

Answer: (C)

When working with an adolescent who refuses treatment but parental consent is possible, the approach centers on shared decision‑making and the adolescent’s developing autonomy. The clinician should seek the adolescent’s assent and actively explore the reasons behind the refusal, providing clear information about the risks, benefits, and alternatives of the proposed care. Validating the adolescent’s perspective and engaging them in the discussion helps build trust and can improve engagement with any agreed plan.

Involve caregivers as partners in the process, ensuring they understand the adolescent’s views and help support a plan that respects the adolescent’s input while addressing safety and treatment needs. The level of risk matters: if there is real danger to the adolescent’s health or safety, assess capacity and take steps to protect welfare within ethical and legal guidelines, but continue to involve the adolescent in decisions as much as possible. If risk is not imminent, continue to negotiate, revisit the decision over time, and adjust the plan to balance autonomy with safety. This approach respects the adolescent’s emerging autonomy while ensuring appropriate oversight to promote their well-being.