When an adolescent with parental consent refuses treatment, which approach is appropriate?

• A. Proceed with treatment regardless of refusal.
• B. Involve caregivers, explore reasons for refusal, maintain assent, and assess risk according to legal/ethical guidelines.
• C. Only involve caregivers if risk is present.
• D. Ignore the adolescent's preferences and rely solely on parental consent.

Answer: (D)

Adolescents have a developing capacity to participate in decisions about their care, so the ethical approach is to engage them in the process and honor their assent while also involving caregivers to support understanding and safety. When a teen refuses treatment, the best approach is to sit down with both the adolescent and their caregivers, listen to the reasons behind the refusal, and explore options together. This collaborative discussion helps address concerns, provide information, and consider alternatives that might be acceptable to the teen.

At the same time, a careful risk assessment is essential. If there’s significant risk to the adolescent (or others), the clinician follows legal and ethical guidelines for safety, which may require additional steps to protect the teen while still aiming to respect their preferences as much as possible. If risk is not imminent, continue to support the teen’s participation in decision-making, document the process, and revisit the discussion regularly, adjusting the plan as needed.

In short, combine respect for the adolescent’s growing autonomy with careful involvement of caregivers and a thorough risk-guided plan that follows professional and legal standards.