By Jeridith Lord, LCPC, BCBA
What is consent? What is assent?
Many of us have heard these terms used interchangeably, but they have some important differences! Generally, we can agree that both are important… but how do we assess consent and assent?
Defining the Terms
First things first: Consent, in a basic sense, is the explicit permission for something to happen or an agreement to do something. It is most often used in legal and ethical contexts. Sometimes, consent is not able to be given by the person being cared for and must instead be given by a caretaker.
Assent, on the other hand, is a general agreement to participate. It is not limited to a verbal confirmation, but instead consists of all the verbal and nonverbal communication that could be part of an agreement (or lack thereof). Consent and assent are sometimes used interchangeably, although the difference is important.
An example of these two concepts may be a child whose parents have given consent for him to play on the playground. The child also confirmed that they would like to go outside and play; however, once the child goes outside, he hovers near the classroom door and avoids the equipment and other children. We can see in this example that while consent was secured, the child did not assent to participating. This could be for a whole host of reasons: he decided he didn’t like the heat, he misunderstood what was going to happen outside, he didn’t want to disappoint his friends. The critical element here is that we acknowledge the importance of both.
Consent and Assent in Action
In a working relationship, consent starts with a document called “informed consent.” This will include what to expect from this intervention, risks and benefits, different procedures that may be used, statements of confidentiality, and who can be included in the treatment. There may be other elements, but the goal is to make sure that everyone is on the same page for what treatment can look like. Assent is not typically included in an “informed consent” document, but is no less important.
Consent and assent should be continually assessed. How often this assessment is done formally should be included in the informed consent document; it should also be reviewed whenever a goal is achieved or the treatment plan is changed. Assent may look differently to each individual person so strong rapport is important to making sure that assent is honored.
It is important to remember that both consent and assent are necessary in all decisions throughout the day. They are super important for promoting autonomy. This may look like asking a child before touching them. If this is not an option (consider a situation where safety may be at risk), then the child should be informed of what and why an action is taking place without their permission. Close attention should be paid to their reaction and future decisions should be made with as much of their permission as possible.
About the Author
Jeridith Lord is a practicing clinical counselor and a Board Certified Behavior Analyst. Her passions include research in trauma informed care and compassionate care. She has been fortunate enough to present internationally on topics such as compassionate care in first responders, behavioral training for first responders, adherence to ethical guidelines, traumatic impact and mental health collaboration, and advocacy for domestic violence and sexual assault survivors. Jeridith is a third-year PhD student and an adjunct professor at Endicott College and Southern New Hampshire University.