The values underlying informed consent—autonomy and concern for individual well-being—are deeply embedded in American culture, in our religious traditions, and in Western moral philosophy. It is not surprising that informed consent is a cornerstone doctrine of contemporary medical ethics and health law in the United States. There is widespread agreement about the importance of the concept, goals, and practice of informed consent. Even when there are differences of opinion about the best way to implement informed consent in clinical practice, or when there is debate about the core meaning of the concept, the attention paid to these controversies only reinforces recognition of the importance of informed consent in contemporary health care and medical research. The concept of informed consent has multiple meanings and draws its ethical justification from several sources. Some consider informed consent to be synonymous with the ideal of shared decision making between physician and patient, or at least to embody this ideal (1). Others emphasize that informed consent is a particular sort of decision made by a particular sort of decision maker (2). Still others focus on informed consent as a norm-governed social practice that is embedded in social institutions, specifically law and medicine. This chapter discusses these different but often overlapping conceptions of informed consent. From a patient’s perspective, informed consent appears to be a right, while from the physician’s viewpoint, it is a duty or obligation. In fact, informed consent imposes responsibilities on both patient and physician. The relationship between ethical rights and duties, as well as the possibility of conflict between them, form another topic of this chapter. In this chapter we also discuss the ethical values and goals that underlie informed consent. Informed consent is grounded in some of the ethical values most prized in American society and Western ethical thought, especially autonomy— auto from the Greek word for self, and nomos from the Greek for rule—literally “self-rule.” It is interesting to observe how the fundamental goals of informed consent usually coincide, but sometimes conflict, both in theory and as manifest in particular cases.
THE PRINCIPLE OF NON-INTERFERENCE OF POWER AND ITS ETHICAL JUSTIFICATION IN THE WORK OF HANS-HERMANN HOPPE
