HLST 4010 Chapter Notes - Chapter 4: Informed Consent
14 Oct 2020
School
Department
Course
Professor
Week 4 Reading-The impossibility of informed consent?:
Boyd
Thursday, October 01, 2020
12:49 AM
Kenneth Boyd. “The impossibility of informed consent?” Journal of Medical Ethics
2015;41:1 (January 2015): 44-47. Available at York
University Library web site.
The Impossibility of Informed Consent?
• In the research context therefore, the paper concluded, ‘informed consent’ had ‘little or no
meaning’; and it went on to recommend that any request for consent to participation in
clinical research should be preceded by information provided by the investigators, and by
the registration of medical agreement to participation in the study by the potential subject’s
own or nominated doctor. (1)
Surveying the scene: The Law and Ethics of Informed consent to treatment and research:
• Kirby admitted that informed consent was ‘hard to define’ and ‘simply an ideal to which
daily practice can only aim’: it was ‘impossible for the healthcare professional to impart…
every facet of his knowledge and expertise involved in the decision… in the space of a 30-
min consultation’ to patients who ‘vary enormously in their interest in and capacity to
absorb information about medical procedures’.
Fresh insights from psychiatry and philosophy:
• Writing against the background of recent legislative and legal developments in England
(the Mental Health Act 1983 and the 1984 Sidaway case) Dyer and Bloch observed that
while medical paternalism was no longer ethically acceptable, and it was necessary to
respect the autonomy of a patient as a person with human rights, this could be very difficult
if the autonomy of a patient was limited, for example by an acute psychotic condition or
severe dementia. (2)
• This ideal was exemplified in psychotherapy, for which a trusting relationship was essential
if the goal of both partners—‘to understand and clarify the motives of the patient’—was to
be achieved: this however necessarily took time, meaning that informed consent ‘occurs
not once, but repeatedly…as a continuing process’.
• In other words, was the doctor concerned ‘a person of the requisite moral character who
acted with an informed grasp of the situation’? Ultimately the only way for a moral
spectator scrutinising the doctor’s actions to answer these questions, was by trying to
discover, possibly from others among his patients in similar circumstances, ‘the known
practice of the doctor concerned, as materially relevant to the present decision’. If enquiries
into the doctor’s ‘track record’ satisfied the observer that the doctor was ‘a competent
moral judge’ who ‘acted in accordance with adequate principles’, then it should be
accepted that his actions were ‘likely to have been the right thing to do or perhaps a right
thing to do in the situation’
Informed consent requirements in changing contexts:
