Autonomy and informed consent

Source

Onora O’Neill, Autonomy and Trust in Bioethics, 2002 – Chapter 2: Autonomy, individuality and consent

What did I learn from this material?

1. That individual autonomy (IA) has become a key concept in medical ethics. It appears this is through the influence of Thomas Beauchamp and James Childress, and their book Principles of Biomedical Ethics.
2. That IA is linked to naturalism. O’Neill refers often to John Stuart Mill, an English politician and philosopher.
3. Immanuel Kant “saw autonomy as fundamental to morality”.
4. Four principles fundamental to bioethics according to Beauchamp and Childress:
   1. Beneficence
   2. non-maleficence
   3. autonomy
   4. justice
5. These principles are not without controversy – there can be a certain tension between beneficence and autonomy. Do you avoid telling patients about all the nasty stuff that can (but is extremely unlikely to) happen (autonomy and consent) so that they are calm and have a better patient experience (beneficence)? e.g. woman requesting an epidural in labour.
6. O’Neill says that a lot of the debate about IA and informed consent is not about autonomy at all. “What is rather grandly called ‘patient autonomy’ often amounts simply to a right to choose or refuse treatments on offer, and the corresponding obligations of practitioners not to proceed without patients’ consent.”
7. Informed consent might not even be informed – does the patient have capacity to make decisions when under duress? Does the patient have the skill or energy to make such “demanding cognitive tasks?”
8. That the “system” which includes the implementation of informed consent, and the structure of hospitals and complete strangers treating patients, erodes a patient’s reason to trust. “Doctors… (may) conform to regulations rather than to enter relations of trust.”
9. “Consent is a propositional attitude: it has as its object not a procedure or treatment, but rather one or another proposition containing a description of the intended procedure or treatment.” Consent therefore is opaque and can be “quite superficial”.
10. There exists a tension of consent in public health/population interventions.
11. Informed consent, when simplified to a “consumerist ideaology”, has great justification.

What further questions have arisen from this material?

Why do we bother with informed consent in anaesthesia?

Is there such a thing as “fully informed consent”?

Where can I use this?

Everyday practice

When can I use this?

When I am about to treat a patient – consider the beneficience – autonomy trade-off (i.e. with consent to anaesthesia)

Who needs to know this?

Medical practitioners prescribing medications or performing invasive procedures with significant risks. (Then the question is – what is a significant risk?)

Quotations

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