J Med Ethics 36:61-62 doi:10.1136/jme.2009.031773
  • Paper
  • Teaching and learning ethics

Rights, respect for dignity and end-of-life care: time for a change in the concept of informed consent

  1. J M Freeman
  1. Correspondence to Dr J M Freeman, 1026 Rolandvue Rd, Baltimore, MD 21240, USA; jfreeman{at}
  • Received 18 June 2009
  • Revised 21 August 2009
  • Accepted 8 September 2009


The current concepts of autonomy, surrogate autonomy and informed consent often lead to futile and expensive care at the ends of life. They may impinge on the dignity of the patient as well as subject society to unwarranted expense. In order to provide affordable healthcare for all, these concepts are in need of modification.


  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

  • JMF is the Lederer Professor of Pediatric Epilepsy (Emeritus), Professor Emeritus of Neurology and Pediatrics at the Johns Hopkins Medical Institutions and faculty emeritus of the Berman Bioethics Institute of the Johns Hopkins University, Baltimore.