Purpose: Level of maturity, capacity for thought, and age affect the views and choices of children. In addition, different perspectives exist among medical practitioners regarding children's right to participate in the medical decision-making process. Depending on their personal and professional value systems, beliefs, and perceptions, medical professionals may be reluctant to share their healthcare decision-making power with children. The aim of this study is to examine how medical professionals in Taiwan perceive children's participation, freedom of expression, and decision-making in healthcare settings. Methods: We collected the perspectives of 99 medical professionals who work with child or adolescent patients through qualitative interviews. Results: Among the interviewees, 91% agreed that medical decision-making is a rights concept, while 56% agreed that children possess the ability to participate in healthcare decisions. The most common ethical principles were ＂protection of life＂ and non-maleficence. Although child patients may state their preferences regarding treatment options, their right to choose is not necessarily respected in the family-oriented and paternalistic culture of Taiwan. Based on these findings, the most common barrier to ensuring children's participation in medical settings is the family, followed by conflicts within medical teams regarding the implementation of clinician's decisions. Conclusion: Paternalistic intervention by adults is more likely to be justified and considered moral when a child's right to participate is in conflict with the clinician's decision (e.g., doing no harm and preserving life).
