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Contextualising consent
  1. Michael Dunn, Associate Editor

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No medical ethicist worth their salt would deny that consent is a foundational concept in contemporary medical ethics. Academic ethicists have spent countless hours dissecting consent in extensive theoretical detail: fleshing out its different components, tracing back its moral theoretical heritage, and articulating and defending its boundaries. In medical practice settings, the tendency is to go the other way. Obtaining consent here risks becoming overly proceduralised; a tick box exercise that exists solely to ensure that medical practice is aligned with prevailing professional requirements. In this environment, consent subtly shifts from being used as a noun to being used as a verb. It is common to here doctors and medical students talking about ‘consenting’ their patients as a distinct and abstracted action that previous research suggests can intrude into a healthcare encounter, depersonalising the delivery of care, and decreasing the quality of communication between doctor and patient1.

Writing about the medical research setting, this approach to consent in practice has been described as ‘empty ethics’,2 where the activity of obtaining consent from a research participant is stripped out of the real-world context within which its meaning and value can be made sense of. It must be correct that, whilst we can gain much insight from careful philosophical dissections of consent and its value, our ability to shape practice for the better – and to avoid a regimented approach that treats ‘consenting’ as a mere matter of professional compliance – depends on our ability to take seriously the various contexts in which instances of consent occur. At least in part this is because, stripped bare, consent is about the giving or withholding of a particular type of permission. As they manifest themselves in the world of healthcare, these permissions are embedded in interpersonal interactions, shaped by social context …

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