Abandoning Informed Consent

This paper will defend the thesis that consent is merely a concept. While it emerged in the field as a liberal, innovative, its time may have passed and newer, more enlightened formulations may be. Consent means approval or agreement with the actions or opinions of; terms such as acquiescence and condoning appear in the dictionary. In medicine, the physician or other health care provider will, reviewing the facts of the case and attempting to determine what is in best interest of the patient, propose a course of action for the patient's. While a few decades ago it might have been considered both and innovative to seek the patient's acquiescence in the's clinical judgment, by now that may not be nearly enough. It is clear if one studies the theory of clinical decisionmaking that is no longer any basis for presuming that the clinician can even guess what is in the overall best interest of the patient. If that is true, then model in which the clinician guesses at what he or she believes is best for patient, pausing only to elicit the patient's concurrence, will no longer sufficient. Increasingly we will have to go beyond patient consent to a in which plausible options are presented (perhaps with the's recommendation regarding a personal preference among them, on the professional's personally held beliefs and values), but with no or "professional" basis for even guessing at which one might truly be the patient's best interest. To demonstrate that the concept of consent no longer be adequate for the era of contemporary medicine, some work be in order. After briefly summarizing the emergence of the consent, we will look at what we learn from axiology -- the philosophical of the theory of the good -- that calls into question the adequacy of as a way of legitimating clinical decisions. This, I suggest, will a basis for demonstrating why experts in an area such as medicine not to be expected to be able to guess correctly what course is in the's interest, and therefore should not be able to propose a course to the patient's response is mere consent or refusal.