J Med Ethics 30:565-569 doi:10.1136/jme.2003.002949
  • Research ethics

The battering of informed consent

  1. M Kottow
  1. Correspondence to:
 Professor M Kottow
 Escuela de Salud Pública Facultad de Medicina University de Chile, Independencia 939, Santiago, Chile;
  • Received 30 January 2003
  • Accepted 16 June 2003
  • Revised 12 March 2003


Autonomy has been hailed as the foremost principle of bioethics, and yet patients’ decisions and research subjects’ voluntary participation are being subjected to frequent restrictions. It has been argued that patient care is best served by a limited form of paternalism because the doctor is better qualified to take critical decisions than the patient, who is distracted by illness. The revival of paternalism is unwarranted on two grounds: firstly, because prejudging that the sick are not fully autonomous is a biased and unsubstantial view; secondly, because the technical knowledge of healthcare professionals does not include the ethical qualifications and prerogative to decide for others.

Clinical research settings are even more prone to erode subjects’ autonomy than clinical settings because of the tendency and temptation to resort to such practices as shading the truth when consent to participation is sought, or waiving consent altogether when research is done in emergency settings.

Instead of supporting such dubious practices with unconvincing arguments, it would seem to be the task of bioethics to insist on reinforcing autonomy.