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It is well known that adolescents delay and avoid sexual health care and fail to disclose necessary information to providers when their confidentiality is not ensured. However, it is not always clear if adolescents are psychosocially, affectively, or cognitively ready for independent decision-making. Whether confidentiality can and should be maintained necessitates that parents and providers have an understanding of adolescents' need for confidentiality. This article explores the concepts of confidentiality and consent in the context of teenage development and behaviors and addresses the complexity of the decision-making triad in adolescent sexual health care.

Few topics in pediatric bioethics are as vexing as decision-making. Decision-making in pediatrics presents challenges for children, parents, and physicians alike. The related, yet distinct, concepts of assent and consent are central to pediatric decision-making. Although informed consent is largely regarded as a worthwhile adult principle, assent has been, and continues to be, mired in debate. Controversial subjects include a meaningful definition of assent; how old children should be to assent; who should be included in the assent process; parental permission; how to resolve disputes between children and their parents; the relationship between assent and consent; the quantity and quality of information to disclose to children and their families; how much and what information children desire and need; the necessity and methods for assessing both children's understanding of disclosed information and of the assent process itself; reconciling ethical and legal attitudes toward assent; and finally, an effective, practical, and realistically applicable decision-making model.