2. Lecture Goals
Explain the connection between informed
consent and patient autonomy
Outline the basic requirements of informed
consent
Define the concept of a vulnerable population
and explain why it’s more difficult to obtain
informed consent from them.
3. Autonomy and Informed Consent
Autonomy-the capacity to make choices
about one’s own life, on the basis of one’s
own values and concerns
Protected by a right
The requirement that physicians obtain
informed consent ensures (or at least makes
it more likely) that a patient’s choices are
autonomous
4. Why Think Autonomy Matters?
Mill-In most cases, individuals are the best
judges of what is best for them. Coercion, even
when done for the individual’s own good, is
usually a greater harm .
Kant-Capacity for autonomy is what makes our
lives valuable. When we cease to have this
capacity, we cease to count as persons in the
morally relevant sense.
Value Pluralism
5. The Conditions of Informed Consent
Not all instances of consent count as
informed consent
Three Conditions
-Competence
-Understanding
-Freely Given or Withheld
6. Competence
In medical practice, patients are assumed to
be competent.
Decisions at odds with medical advice are
not, in themselves, evidence of
incompetence.
Illness, injury, or medication may lead to a
loss of competence.
7. Understanding
Diagnosis, treatment protocol, risks, benefits, side
effects, aftercare and long-term maintenance, alternatives
Professional standards tend to emphasize disclosure, rather
than understanding. (Full disclosure, Medical
Community, and Reasonable person)
Understanding is difficult to measure.
Difficult to give a neutral presentation of information.
This can (perhaps) be avoided by explaining the values
which underlie a physician’s recommendation.
8. Freely Given or Withheld
No such thing as implicit consent in the
medical field.
Absence of coercion or
manipulation, whether intentional or not.
Physicians and family members most likely
culprits.
9. Vulnerable Populations
A group of individuals whose capacity to give
informed consent is impaired or
eliminated, in virtue of their status as
members of that group.
Examples: Children, disabled, people with
psychological disorders, terminally
ill, prisoners, people who lack a high school
education.
10. Two Common Mistakes
Race
Elderly
These are frequently cited as examples of
vulnerable populations, but they are not.
Nothing about being a member of a
particular race, or being of a certain age, is in
itself an impairment on informed consent.
11. Two Famous Cases
Willowbrook
Parents of severely disabled children could only
be admitted to the “hepatitis” wing of the
school.
Tuskegee Syphillis Study
A multi-decade study of syphillis, participants
were all black men living in the rural South.
