St Cross Seminar: "I wouldn’t have consented if I’d known that could happen": Consenting without Understanding

There are two features of consenting to medical treatment that have been little explored in the extensive literature on this topic. The first is that the requirement to obtain consent is conditional in the following sense – we only need to obtain consent for those things that are both wrong if done without consent, and that we want or have reason to do. The second is that whilst many patients in their interactions with doctors are initially uninformed, this does not always prevent them from choosing to have, or not to have, possible treatments. In this paper I explore the implications of these two features for the idea that doctors ought to provide information to patients about the treatments they propose. I will argue that these features create a serious problem for the widely held idea that it would be wrong, because it would fail to respect his autonomy, to give a competent patient medical treatment without his valid consent (where this refers to a voluntary and informed agreement to have the treatment). As such the requirement to respect autonomy will not give any reason for doctors to provide information in these cases; in fact on at least some accounts of autonomy the obligation to respect autonomy would give them a reason not to provide that information. The paper then goes on to consider some ways in which the obligation to provide information about potential treatments could be supported.