What is Sufficient Understanding?

Children's `sufficient understanding' is deemed a critical factor in determining their capacity to consent to treatment or give informed opinions about their future care. However, the concept has remained undefined. We propose that it should refer not only to the child's cognitive development, but also to the influence of personal and interpersonal conflicts. Assessment is through clinical interview, during which the clarity of communication, complexity of the issues and the child's emotional state should also be considered.