Some moral and conceptual issues in informed consent

The present work focuses on some of the central value disputes inherent in informed consent. The Principle of Autonomy is regarded as a preeminent moral position and the cornerstone of the informed consent doctrine. However, there are other key value positions which stand over and against the requirement to respect individual autonomy, two of which are the physical health of the patient and the well-being of society. I attempt to achieve greater balance in our perspective of these disputes by examining what is sacrificed by the strict adherence to the autonomy principle.

First of all, I undertake a historical examination of the various moral, legal, religious, and historical underpinnings of informed consent as we know it today. From these various traditions, evidence suggests that there is no single value position underlying its development. Next, attention is shifted to the relationship between the physician and patient and is analyzed in terms of social class. I argue that because of potential social class gaps, serious deficiencies in communication can occur, often undermining informed consent, as well as much of the intent of respecting individual autonomy.

I then proceed on to develop a conceptual model of informed consent based on an information-processing model from the social sciences. The various conceptual elements are defined so that a precise manner of speaking is possible. They are: two components which presuppose rationality, the physical setting in which informed consent occurs and an information disclosure; and, two components which presuppose competency, the intellectual processing of information and a practical judgment. Thus, a precise language is developed to structure the central value dispute. An attempt is made to identify each value issue and who is in the best position to serve as epistemological judge. The result is a tentative normative epistemological model. Finally, in light of this model, the central value disputes are evaluated and the boundaries of autonomy are clarified.