BAnEthical Perspective ± Consent and Patient Autonomy
Bobbie Farsides
Consent is a moral and legal cornerstone of contemporary health care. Interven-
tions which proceed without the consent of the patient immediately require moral
scrutiny, and even where it is claimed that consent has been given we want to
ensure that this means much more than the mere fact that a form has been signed.
It is important to show that far from being a protective mechanism for health care
professionals, the primary role of consent is to protect patients, and particularly to
protect their status as autonomous individuals who have an interest in remaining
in control of their own lives.
In part A of this chapter, Jean McHale has given a very full account of consent in
alegal context. However, she and other medical lawyers are quick to point out that
the standards set by law are not necessarily those we would wish to reach through
ethical argument. Nor indeed might the legally focused reasons for acquiring
consent fully reveal why we consider it to be ethically important. In ethical terms
consent is important because it demonstrates respect for autonomy, it protects the
autonomous individual from certain harms, and through participating in a
consent process the person's autonomy may be further enhanced [1].
Autonomy is both a prerequisite for consent and a product of it. It is also
representative of a relationship between a patient and a health care professional
which is contractual rather than hierarchical, egalitarian rather than paternalistic,
and patient-centred rather than medically determined. Consent, when properly
conceived, will look something like the concept defined by Raanon Gillon in his
bookPhilosophical Medical Ethics[2]:
`... a voluntary un-coerced decision made by a sufficiently autonomous person
on the basis of adequate information to accept or reject some proposed course of
action that will affect him or her.'This definition offers what we might call a paradigm case or ideal type model, but
Gillon is confident that it can be embraced by health care professionals and
translated into practice. For this to happen, the health care professional must
adopt a particular attitude to patients, and take seriously the duties implied by the
definition.