Informed Consent and the Participation of Minors: Legal, Deontological, and Clinical Framework in Italy

Introduction: From the Minor as Object to the Minor as Subject of Rights

The evolution of the concept of informed consent in healthcare and psychological settings reflects a profound cultural and legal transformation in the way minors are perceived. The Italian legal system has progressively moved beyond a paternalistic view in which the child was considered merely an object of protection and decision-making by others, toward recognizing the minor as a subject holding individual rights. This shift aligns with broader developments in family law and health law, which increasingly place the person at the center of care throughout their developmental trajectory. Within this framework, the right to health is no longer managed exclusively by parents, but must take into account the child’s personality, dignity, and evolving capacities. Informed consent thus becomes a participatory process rather than a purely juridical formality. It represents the meeting point between protection, progressive autonomy, and adult responsibility. In psychological practice, this perspective is especially relevant because clinical work is fundamentally relational and grounded in recognition of the subject.

The recognition of the minor’s subjectivity is rooted in both international and national legal sources. The United Nations Convention on the Rights of the Child affirms the child’s right to be heard in all matters affecting them, in accordance with their age and maturity. This principle has been progressively incorporated into Italian legislation and case law, finding clear expression in Law No. 219 of 2017. Within this legal context, informing and listening to the minor become integral components of the care process. The aim is not merely to inform out of obligation, but to acknowledge that the minor’s perspective carries intrinsic value. Even when the child does not hold formal legal authority to consent, their views meaningfully guide clinical decision-making. This approach strengthens the ethical and relational legitimacy of professional interventions.

From a clinical standpoint, recognizing the minor as a subject also requires acknowledging the complexity of how children understand and experience therapy. A child does not interpret care through adult conceptual categories, but rather through images, emotions, fantasies, and personal meanings. Ignoring this dimension risks undermining the effectiveness of the intervention. Conversely, involving the child in an age-appropriate manner fosters a sense of safety and trust. Informed consent, understood as a process, allows for the construction of a therapeutic alliance that includes the minor, the parents, and the professional. In this sense, the time devoted to explanation and listening becomes therapeutic time in its own right. This approach is now widely recognized as both a clinical and deontological best practice.

Legislative Foundations: Law 219/2017 and Constitutional Principles

Law No. 219 of December 22, 2017 represents a turning point in the Italian legal framework governing informed consent. It explicitly states that no healthcare treatment may be initiated or continued without the free and informed consent of the person concerned. Although this principle is often associated with adult patients, the law provides specific provisions for minors as well. Article 3 affirms that minors have the right to receive information about their health in a manner appropriate to their level of understanding. This provision formally recognizes the value of the minor’s participation in healthcare decisions. It imposes a concrete duty of information on healthcare professionals. In doing so, the law integrates the legal and ethical dimensions of care.

The foundations of Law 219/2017 can be traced to core constitutional principles. Article 13 of the Italian Constitution protects personal liberty, while Article 32 recognizes health as a fundamental right of the individual and an interest of the community. Informed consent lies at the intersection of these principles, ensuring that any intervention on the person respects freedom and dignity. These constitutional safeguards also apply to minors, albeit modulated according to their developmental status. Italian constitutional jurisprudence and legal scholarship have repeatedly emphasized that protecting minors must not result in denying their subjectivity. The law thus seeks to place parental authority and the minor’s will in dialogue rather than in opposition. This balance is one of the most delicate and meaningful aspects of the legal framework.

A particularly innovative element of Law 219/2017 is the recognition of the value of communication time. The law states that the time dedicated to communication between the professional and the patient constitutes care time in itself. This principle has significant implications in psychological practice. Informing the minor is not an ancillary task but an integral part of the therapeutic intervention. It requires professional competence, sensitivity, and communicative creativity. The law therefore supports a relational model of care rather than a purely technical one. For minors, this translates into experiencing care as understandable and non-threatening. The norm reinforces the conception of informed consent as a dynamic and shared process.

Parental Responsibility and Consent: Legal Profiles

Despite the increasing recognition of the minor’s voice, Italian law assigns formal authority to provide consent for healthcare treatments to parents or legal guardians. This choice is consistent with the principle of parental responsibility enshrined in the Civil Code. Article 316 of the Italian Civil Code establishes that parental responsibility must be exercised jointly by both parents. Decisions concerning health are classified as matters of major importance in the child’s life. Consequently, they require the consent of both parents, even in cases of separation or divorce. This legal requirement has significant practical implications for healthcare professionals. Careful verification of the family’s legal situation is essential before initiating treatment.

In cases of joint custody, which represents the most common arrangement, neither parent may unilaterally decide on significant healthcare or psychological treatments. Both signatures are therefore required for valid consent. Only in cases of sole custody, formally documented, may one parent provide consent independently. There are also specific circumstances, such as the absence or impediment of one parent, in which the other may exercise parental responsibility alone. Such situations must be adequately documented to protect both the minor and the professional. Procedural clarity is crucial to prevent disputes and interruptions in care. Compliance with legal requirements does not hinder care but provides a secure framework for it.

Law 219/2017 also introduces mechanisms for managing parental conflicts. When parents fail to reach agreement on treatments deemed necessary, care may be suspended unless urgent circumstances apply. In such cases, the matter may be referred to the guardianship judge, who evaluates the child’s best interests. This mechanism underscores that informed consent is not merely a private issue but also one of public relevance. Judicial intervention represents an extreme but necessary safeguard when adult conflict risks harming the minor. Even in these situations, listening to the minor may play a meaningful role. The legal system thus strives, within its limits, to keep the child at the center of decision-making.

The Model of Progressive Enhancement of the Minor’s Capacities

The participation of minors in informed consent follows a model of progressive enhancement rather than a uniform standard. This approach takes into account age, maturity, and cognitive and emotional capacities. In early childhood, consent is entirely parental, yet this does not absolve professionals of the duty to explain what will happen to the child. Even very young children benefit from simple, reassuring explanations. The use of play, metaphors, and storytelling helps reduce anxiety and fosters trust. At this stage, the goal is not to obtain formal consent but to promote a sense of safety. Communication serves as an emotional containment tool.

During the school-age years, approximately between ages seven and thirteen, the child’s involvement becomes more substantial. Children at this stage can understand the general purpose of care and express opinions and preferences. Their views must be heard and taken into account, even though formal consent remains with the parents. Ignoring the child’s perspective may undermine the therapeutic alliance and the effectiveness of the intervention. In this phase, informed consent becomes a dialogical process. Professionals are required to adapt their language and communicative tools accordingly. Respect for the child is also demonstrated by allowing questions and expressions of doubt.

During adolescence, particularly from around the age of fourteen, minors are often considered capable of discernment. Their will must be actively sought, documented, and given serious consideration. In specific areas, such as sexual health or substance use treatment, adolescents may access certain services autonomously. This recognition addresses the need to protect health even in contexts of relational or familial vulnerability. Clinically, adolescents who feel recognized in their autonomy are more likely to engage in therapy. Informed consent thus becomes a space for negotiation and shared responsibility. Progressive enhancement does not eliminate adult involvement but redefines it as accompaniment.

Informed Consent as the Foundation of the Therapeutic Alliance

In clinical practice, informed consent cannot be reduced to a bureaucratic requirement. It constitutes an essential condition for the therapeutic alliance, particularly in work with children. When children understand the scope and meaning of care, they are more likely to engage actively in sessions. Understanding facilitates participation and reduces resistance. Informed consent therefore functions as a clinical tool as well as a legal one. It supports the construction of a relationship based on trust and mutual respect. From this perspective, the alliance is built not only with parents but also with the child. Recognizing the child’s viewpoint strengthens the therapeutic bond.

Explaining to children what will happen during sessions has deep clinical significance. Children have a strong need for predictability, which contributes to their sense of safety. Clear explanations reduce anxiety and prevent misunderstandings or negative fantasies. Knowing why they are seeing a psychologist helps children make sense of the experience. It is essential to clarify that the professional is not there to scold or judge them. Explaining that they are free to talk, play, or draw opens space for authentic expression. Acknowledging their right to ask questions and not disclose everything immediately reinforces their sense of control and respect.

Informed consent, understood in this way, fosters a collaborative climate. The child feels included rather than merely “brought” to therapy. This attitude also has positive effects on treatment continuity. A child who understands and accepts the process is less likely to resist or withdraw. Clinically, this enables deeper and more authentic work. The therapeutic alliance becomes a shared construction involving all participants in the care process. Informed consent thus lies at the interface between the legal and clinical frameworks. It often marks the beginning of a meaningful therapeutic relationship.

Understanding the Child’s Perception of the Psychologist and Therapy

Understanding how the child perceives the psychologist and the therapeutic setting is a central aspect of clinical work. The child’s subjective experience is not secondary but an integral part of the therapeutic process. Children attribute personal meanings to therapy, often different from those assumed by adults. They may perceive the psychologist as an ally, a judge, a helper, or a threatening figure. These representations deeply influence their level of engagement. Asking children how they experience sessions allows access to these meanings. Such attentive listening is itself a therapeutic intervention.

Children do not experience therapy as adults do, nor do they understand it through abstract categories. They rely on images, play, stories, and symbols to make sense of the experience. Adapting the clinical stance to these expressive modalities is essential. The use of games, drawings, photographs, or narratives facilitates communication and emotional expression. Understanding what the child enjoys or fears allows the intervention to be adjusted accordingly. This adaptation is not a concession but a professional skill. It strengthens the child’s sense of safety and competence. Therapy thus becomes a meaningful and inhabitable space.

Seeking the child’s consent also means recognizing their right not to disclose everything about themselves. This principle is central from both clinical and deontological perspectives. No one can be forced to reveal information they are not ready to share. Respecting the child’s timing reinforces trust in the relationship. Informed consent, in this sense, is an ongoing and renegotiable process. It evolves alongside the therapeutic journey. A well-informed child is a child who feels respected and included. Often, this marks the beginning of a solid therapeutic alliance.

The Deontological Framework: Duties and Responsibilities of the Psychologist

The Code of Ethics of Italian Psychologists assigns central importance to informed consent in professional practice. Article 31 establishes that services provided to minors require the consent of those exercising parental responsibility. However, the code goes beyond this formal requirement. It emphasizes the duty to inform the recipient of the intervention in an appropriate manner. Whenever possible, minors themselves must be placed in a position to understand what concerns them. This obligation reflects an ethical conception of the profession. Informed consent thus becomes an expression of respect for the person.

It is essential to distinguish between healthcare informed consent and consent for personal data processing. Although both are required, they serve different purposes. Maintaining separate forms ensures greater transparency and protection for the patient. In psychological practice, confidentiality holds particular importance. With adolescents, psychologists must guarantee the privacy of session contents. Parents may be informed about the general progress of treatment, but not about specific disclosures. This balanced management strengthens the minor’s trust. Respect for professional secrecy is an integral component of the therapeutic alliance.

Seeking the child’s consent means recognizing them as an active subject in therapy. This recognition lays the foundation for a respectful and collaborative therapeutic relationship. In clinical practice, much attention is often devoted to assessment, diagnosis, and framing. In contrast, informed consent as a relational process receives comparatively little focus. Remembering that consent is not a mere administrative formality is essential. It lies at the intersection of legal and clinical frameworks. Informing, obtaining agreement, and respecting rights are therapeutic acts. Informed consent gives meaning to the proposed intervention.

Conclusions: Informed Consent as a Shared Space of Care

Informed consent for minors today represents one of the most significant points of convergence between law, ethics, and clinical practice. It reflects a conception of care centered on the person and on relationships. Respecting the minor’s right to information means recognizing their dignity and value. Italian legislation provides a clear framework while leaving room for professional responsibility. It is in everyday practice that informed consent takes concrete form. How professionals explain, listen, and involve minors makes a tangible difference. Consent thus becomes a living and dynamic process.

From a clinical perspective, informed consent promotes active participation and engagement in therapy. A child who understands and feels respected is more likely to collaborate. Predictability and clarity reduce anxiety and enhance a sense of safety. The therapeutic alliance is built day by day, also through small communicative gestures. Explaining, asking, and respecting are therapeutic actions. Informed consent supports the quality of the relationship. It contributes directly to treatment effectiveness.

In conclusion, informed consent is not merely a legal or deontological obligation. It is a space of encounter between the adult world and the child’s world. It is where the minor can feel seen, heard, and recognized. A well-informed child is a child included in their own care process. Often, this marks the beginning of a strong therapeutic alliance. Investing in consent means investing in the relationship. And it is precisely within the relationship that care finds its deepest meaning.

Bibliographic References 

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