Competence assessment in minors, illustrated by the case of bariatric surgery for morbidly obese children

Clinicians have to assess children's competence frequently. In order to do justice to children who are competent to make decisions and to protect incompetent children, valid assessment is essential. We address this issue by using bariatric surgery for morbidly obese minors as a case study. Our previous research indicated that opponents of bariatric surgery tend to be sceptical of the competence of adolescents to consent and inclined to set more stringent standards than proponents. Furthermore, there is the concern that minors wanting surgery are less able to make an autonomous decision than minors who do not wish to undergo surgery. Hence, few patients may be qualified as eligible. We argue for a risk-related standard, so that concerns are met, while at the same time preventing to set the bar too high, excluding paediatric patients who are most likely to benefit from surgery. This standard is also applicable in gastroenterology practice.