Abstract
Olszewski and Goldkind argue that children’s participation in medical decision making should be “the default position” and that a stepwise approach is needed to ensure that children are routinely given a voice. They suggest a systematic approach for optimizing such pediatric participation and apply it to two cases concerning terminally ill children: Mary, a 15-year-old girl, and Joe, a 7-year-old boy. The style of argument highlights a generalized problem in bioethical analyses. Authors’ framing of case vignettes is often stylized to illustrate the authors’ central arguments and to support their conclusions. But other facts or emphases might lead us in different directions. Thus, we believe that there is a need to question whether children’s participation in medical decision making is always an unqualified good. As an alternative, we suggest a more flexible approach that we call “personalized decision making.”