Why is informed consent important?

INFORMED CONSENT AND TRUST: EYAL’S ARGUMENT In our feature article, Nir Eyal attacks attempts by bioethicists including Onora O’Neill, Torbjörn Tännsjö, and Jennifer Jackson to ground the importance of informed consent in its role in safeguarding trust in medical practice (see page 437, Editor’s choice). The trustpromotion argument for informed consent, as Eyal terms it, states (1) that trust in medical practice is necessary to ensure that people seek and comply with medical advice and participate in medical research, (2) that as a result it is ‘usually wrong to jeopardise that trust’, (3) that violations of informed consent jeopardise that trust, and (4) that standard informed consent requirements are therefore justified. Eyal makes explicit that this argument is consequentialist: it takes the value of informed consent to lie in its role in ensuring trust in medical practice; in turn, trust is instrumentally valuable because it promotes health through use of the medical system, compliance with treatment, and participation in research (for brevity, I’ll refer to these desirable practices as ‘effective use of medicine’). The consequentialist trust-promotion argument, Eyal observes, differs from deontological trust-based arguments, which defend respecting informed consent requirements with reference to factors such as its being an appropriate way of honouring the trust that patients place in doctors. Eyal attacks the trust-promotion argument on the ground that it does not account for some commonsense intuitions about informed consent. He argues, to cite one of the many problems he raises, that secret breaches of informed consent —for example, treating patients while they sleep—would not undermine trust in medical practice. Another example: he notes that some of the most distrustful patients are those whom it is generally viewed as acceptable sometimes to treat without their informed consent, such as paranoid schizophrenics. If, as the trustpromotion argument alleges, the importance of informed consent is grounded in its capacity to promote trust, then obtaining informed consent from paranoid schizophrenics and other unusually distrustful patients should be more important than it is in normal cases, not less. Eyal concludes that, despite its initial appeal, the trust-promotion argument fails: the importance of promoting trust in medical practice does not suffice to account for the importance of informed consent.