Over the past 40 years, the thinking about children and medical decision making has evolved. Whereas at
one time the decision was made for the child without explanation of the illness or consultation, now there is more likely to be a shared decision-making process in which children have more autonomy as they de¬velop greater cognitive maturity. Preschool children are usually considered too young to make clearly ra¬tional decisions, so their parents are asked to make decisions for them based on the best interests’ stan¬dard. When children reach school age, they are usually provided with information about their condition in a manner that they can understand. Although school: age children may express a preference and assent to treatment, parents and healthcare providers usually continue to be the primary decision makers since the child is not thought to have the capacity to make an informed decision yet. In contrast to this common be¬lief and practice, a study by Hinds et al. (2005) found that children as young as 10 years dying from brain tumors could understand the potential treatment op¬tions and recognize that their death could be the con¬sequence of their decision. Hinds et al. (2005) noted that these children usually based their decisions on their relationships with others and the risks that treat¬ment imposed on themselves and others. Once a child enters adolescence, there is less controversy, and the adolescent often has the decision-making capacity of an adult. Harrison et al. (1997) recommend that the decision-making capacity of adolescents be examined in the light of. their