Argument. The ethical and legal rationale behind the concept of informed consent and its
relevance to nursing practice are examined. In this paper, it is argued that the function of
informed consent is to protect patient autonomy and to promote meaningful decision-
making. Given the potential for nursing care procedures to infringe patient autonomy,
consent is clearly a relevant concept in nursing. Furthermore, in law, any touching
without consent is a potential battery. Informed consent is often associated as a rigid
procedure, only relevant to surgical or research procedures. Consent should be obtained
prior to nursing care procedures whenever patient autonomy is at stake. However,
information-giving should be determined by the needs of the patient and approached in
such a way as to facilitate meaningful decision-making. Given the individual nature of
infringements to patient autonomy, it is difficult to predetermine all those care procedures
that require consent; any list of procedures would fail to be comprehensive.
Conclusions. The principles of informed consent should underpin our approach to nursing
care procedures, which should not be mechanistic but determined by the needs of
Keywords: informed consent, patient centred approach, patient autonomy, nursing care
The requirement to obtain informed consent prior to nursing care procedures is stipulated
in various United Kingdom (UK) nursing policy documents (United Kingdom Central
Council [UKCC] 1996, 2000). The UKCC (2000) requires that all nursing care
procedures are carried out 'within a framework of informed consent' (p. 15). It is
important that nurses understand the ethical and legal rationale behind this requirement so
that the principles of informed consent are applied appropriately and consistently prior to
nursing care procedures. In this paper, the rationale behind the concept of informed
consent and its relevance to nursing practice are examined and the principles of informed
consent are considered from the perspective of nursing practice in the UK. However, it is
likely that the ethical principles of informed consent are internationally relevant.
The history of informed consent -- from nuremberg to nursing
There is evidence of a requirement for a patient to give consent prior to a clinical
procedure as early as the 1700s (Slater v Baker & Stapleton 1767, 95 ER860-863).
However, most accounts of the history and development of the concept of consent start
with attention to the significance of consent prior to medical research, in the wake of
appalling experimentation on human subjects that took place during the Nazi holocaust.
This is important because in these accounts attention is focused on the importance of
consent prior to participation in research (Nuremberg Code 1947). In the Nuremberg
Code, the absolute requirement that a patient should give consent prior to involvement in
clinical research was laid down:
www.notesolution.com The person involved should have the legal capacity to give consent; should be so situated
as to be able to exercise free power of choice, without the intervention of any element of
force, fraud, deceit, duress, overreaching...and should have sufficient knowledge and
comprehension of the subject matter involved as to enable him to make an understanding
and enlightened decision. (Nuremberg Code Rule 1)
At Nuremberg, the requirement of consent was made with specific reference to the
human subject entering medical research. However, since then the concept of consent has
been applied not only prior to research but also prior to clinical procedures, including
nursing care procedures [UKCC 1996, 2000, and General Medical Council (GMC) 1998].
Furthermore, from the general concept of consent, the concept of informed consent has
arisen. An expectation has developed that patients should give their informed consent
prior to clinical procedures in addition to those associated with research, as described by
Beauchamp and Childress (1994):
In recent years, virtually all medical and research codes of ethics have held that
physicians must obtain informed consent of patients before undertaking significant
therapeutic or research procedures. (p. 67)
The components of informed consent will now be examined.
Principles of informed consent
The concept of informed consent is described by Faden and Beauchamp (1986), who
replicate the requirements for consent as outlined in the Nuremberg Code. They define
informed consent as follows:
X is an informed consent by person P to intervention I if and only if:
1. P receives a thorough disclosure regarding I.
2. P comprehends the disclosure.
3. P acts voluntarily in performing X.
4. P is competent to perform X.
5. P consents to I. (Faden & Beauchamp 1986, p. 275).
Faden and Beauchamp (1986,p. 274) define informed consent as the patient's autonomous
authorization and emphasize that autonomous authorization is more than a simple
expressed agreement or acquiescence to the proposal by the patient. They argue that mere
assent to a procedure does not indicate one's consent to it and that it is possible to submit
to or comply with the plan of another without any actual agreement. Instead, they
describe how, in giving consent, a patient 'actively authorizes the proposal in the act of
consent' (p. 278). In order to give such autonomous authorization, a patient should be
informed, be able to comprehend the information and voluntarily consent to the
www.notesolution.comFaden and Beauchamp (1986,p. 275) suggest that the components of informed consent
are largely undisputed in the ethical and philosophical literature. However, there is debate
about the terminology used to define informed consent. Culver and Gurt (1982,p. 42)
suggest that the term 'informed' consent would be better replaced by the term 'valid'
consent. They argue that the information component is just one component of informed
consent; a patient's consent can be 'informed' but not 'voluntary', in which case it would
not constitute 'informed consent' according to the definitions cited above. Furthermore,
McLean and McKay (1981) argue that use of the term informed consent is a tautology
and consent necessarily means that the patient has been adequately informed (p. 98).
These arguments will not be considered further in this paper. Instead, the term informed
consent is used to refer to the specific definitions of informed consent given by Faden
and Beauchamp (1986).
Purpose of informed consent
Those advocating the principles of informed consent argue that its purpose is to protect
patient autonomy or self-determination. Kirby (1983) states:
The fundamental principle underlying consent is said to be the right to self determination:
the principle or value choice of autonomy of the person. (p. 70)
However, there is no agreement as to how autonomy is defined and these varying
definitions are well documented in the literature (Yeide 1992, Beauchamp & Childress
1994). The implications for nursing of th