What should an investigator do if a 10-year-old child declines to participate in a study requiring assent?

Honoring the child's decision is paramount in research ethics, particularly when involving minors. Assent recognizes that, while children might not have the legal capacity to give informed consent, they still have a right to express their willingness or unwillingness to participate in a study. If a child declines to participate, it is crucial for the investigator to respect that decision, as coercing or convincing a child to participate could lead to unethical practices and undermine the integrity of the research.

The respect for autonomy is an essential principle in research involving human subjects, and this includes the agency of children in the decision-making process. Facilitating a situation where a child feels safe and understood is important for their well-being and for fostering a trusting relationship in research.

In other potential actions, convincing the child to participate would violate the principle of respect for persons, which includes honoring their feelings and preferences. Reevaluating study criteria could be relevant in different contexts, but the primary ethical stance upon a child's refusal is to honor that choice. Seeking parental consent is important but should occur in line with the child's assent; if the child declines, parental consent alone does not override the child’s decision. Thus, the most appropriate and ethical course of action is to respect the child’s decision not to participate