CONSENT, PATERNALISM AND TRUST

Informed consent cannot, we have argued, serve as an ethical panacea in biomedicine. It is inapplicable where public rather than private goods are to be provided. It fails where individual capacities to consent are not adequate for grasping the relevant information. Even where capacities are adequate, it fails where consent transactions are defective; and consent transactions can fail in many ways. These failures are exacerbated rather than remedied by attempts to set higher and supposedly better standards for consent, for example, by gesturing to excessive and impractical conceptions of ‘fully explicit’ or ‘fully specific’ consent. The difficulties cannot be remedied by invoking implausible or ungrounded conceptions of individual autonomy or of informational privacy.

These realities cast a sobering light on attempts to make informed consent the key to justifiable clinical and research interventions. Where consent transactions fail, any ostensible consent will be bogus; and bogus consent can offer only bogus justification. Even when more limited forms of consent can be sought and given, they will not by themselves provide a sufficient ethical justification. Since consent works by waiving other norms and standards in specific ways for specific purposes, it has to be understood against the background of a wider range of normative standards, including ethical standards. Informed consent is never more than a part of any justification for medical and research interventions.

These are challenging conclusions. If informed consent can play only a limited part in justifying clinical or research practice, we face serious problems.