The term surrogate comes from the Latin, meaning “put in another’s place." In their important, touchstone work, Deciding for Others, Buchanan and Brock make an extended argument that the primary ethical considerations for surrogate decision making come in the form of three “standards” or “principles” that should be used when making decisions for another: Advance Directive; Substituted Judgment; Best Interests.
What can be culled from these standards is that surrogates, standing “in the place of” the patient should attempt to help extend the patient own voice, his/her autonomy, into a situation where the patient lacks the ability to speak for him/herself, at least to the extent possible. An ethically appropriate “surrogate” healthcare decision-maker for a person who lacks capacity is that person who can bring out the patient’s own expressed wishes and values, where possible.
However, since minors are not (presumptively) autonomous beings, parents do not substitute for or stand in the place of the child. Parents are tasked with shaping the lives of their children. The process of parenting is a kind of authorship that parental authority allows, even requires. The authorship is about the child, and over time becomes with the child, eventually (in ideal cases) leading to by preparing them for a relinquishing of the primary responsibilities over to the child when they reach adulthood.
As such, the norms and practices around pediatric decision making must adhere to different ethical norms, such as those in the reasonable interest framework, not those of Brock and Buchanan.