Faden and Beauchamp make the claim in “The Concept of Informed Consent” that it is possible to have sense1 of informed consent (autonomous authorization) and fail to have sense2 of informed consent (policies that are enforced in the context of institutions). It is also possible they claim to have the roles reversed, where informed consent in sense2 has been achieved but not sense1. Their argument is valid, however in order to resolve many of the issues they bring up near the end of the selected passage, it is imperative to implement (or atleast strive to do so to the best of one’s ability) both sense1 and sense2 of informed consent at all times in medical practice, so as to protect the doctor/researcher and patients/subjects.
Sense1 of informed consent in medicine emphasizes that a patient must not simply yield to a professional when enrolling in research or commencing a medical program, but rather have the competence to understand disclosed information and freely agree to such a thing. While this does aim to ensure that autonomy is upheld and doctors are not able to implement paternalistic measures, problems are able to arise in practical situations. For example, when a doctor performs surgery on someone who may actually have autonomously authorized verbally said procedure, but when something accidentally goes wrong then sues the doctor for malpractice. In this instance, sense2 of informed consent is necessary to protect the doctor in the court of law.
Conversely, sense2 of informed consent in medicine is defined as authorization deemed to be effective for medical and research settings; it satisfies the rules of an institution and is heavily relied upon in legal situations. Sense2 aims to settle the problem presented when only sense1 is relied upon. However with simply sense2, patients may be unprotected from what they personally view as harm. The legal authorization of research or medical intervention by a patient effectively transfers responsibility and authority to the professional and if the criteria that constitutes the legal authorization (i.e. sense2) does not employ the need of a subject’s competence to understand disclosed information and freely agree to such a thing then other problems arise. Thus reinforcing the fact that sense1 is needed to protect patients.
The authors end the passage by affirming that sense2 should and often is developed with sense1 in mind, but bring up some problems about how to exercise both in practice. I argue that both should be applied at all times, even for minor procedures so that patients and doctors are protected both in terms of general wellness and legal situations.
In her reflection on Faden and Beuachamp’s informed consent, Kaeli lays out a concise summary of the argument made by the authors, as well as providing some insightful perspectives regarding the usage of Sense1 and Sense2 in the patient/doctoral relationship. Kaeli describes “Sense1”, as described by the authors, as a form of informed consent in which the patient must understand and willingly agree to a procedure rather than simply submitting to a doctor recommendation. Conversely, Sense2 is described as a form of informed consent which relies heavily on legal standards and policy driven formal methods such as signing paperwork. Kaeli argues that even though Faden and Beauchamp claim that sense2 is mostly developed with sense1 in mind, both senses must be applied in all situations. Kaeli argues that the reason for this universal application would be to protect uninformed patients from consenting to professional medical situations the makeup of which they don’t fully understand. I agree on this point. When reading both Kaeli’s post and the assigned text reading, it seems crucial to me that crucial points from both senses must be applied to serious medical situations. However, there could be a flaw to this reasoning- it cannot be assumed that a medical professional can always fully educate patients regarding every possible situation. Sense1 is abstract both in concept and in application, and I believe it would be impractical to try to apply this to minor procedures. However, I agree with Kaeli via the lens of major procedures, such as surgery, Overall, Kaeli did a great job analyzing multiple facets of Faden and Beauchamp’s argument, and also provided strong constructive argumentation. However, I believe there is still room to debate regarding the universal application of both forms of informed consent.
I think your argument to apply both sense1 and sense2 informed consent eliminates the cut and dry debate between the philosophical and procedural components that plague this subject. If we just utilize sense1, questions of credibility, reliability, and objectivity would cloud every medical procedure, making the practice of medicine a constant battle of the physicians proving their knowledge. On the other hand, if sense2 was the only requirement, legal battles would distract physicians from their medical practices, further putting their patients at risk due to a potential lack of focus. Though ensuring that both sense1 and sense2 were applied to all situations, may take more time, this mutual sharing on information would help build trust between the patient and physician. Patients might feel calmer if they understand the potential risks and different outcomes, showing that the extra explanations are worth it. Physicians taking time to both explain and understand that their work is being monitored by medical codes and laws may make them hold themselves more accountable, thus limiting the risk of rushed accidents. Utilizing both sense1 and sense2 informed consent benefits both the patients and physicians and allows for safer, more informed medical practices.
Though there are many reasons that both sense1 and sense2 should be utilized, the question of practicality must be addressed. Realistically, would physicians actually take time to sit down and answer questions about minimally invasive procedures that are very low risk? Would they come to resent these discussions so much that they would no longer value these conversations and become frustrated with informed consent? Time is precious, so requiring explanations for everything may not actually be feasible.
(These last few lines didn’t copy and paste right from my GoogleDoc so I just am leaving a second comment to attach the rest of my response!)
Kaeli does a great job of explaining Faden and Beauchamp’s views on informed consent. She starts off by summarizing their two senses of informed consent, sense1 being autonomous authorization of treatment from the patients, and sense2 being institution-enforced policies that protect healthcare providers. Sense1 seeks to protect the patients from harm or paternalism, and sense2 is a way of protecting doctors from a lawsuit. According to Faden and Beauchamp, there are some cases in which sense1 applies but not sense2, and vice versa.
Kaeli challenges this statement by arguing that instead of accepting the fact that there are cases where not both of these senses are applied, it is crucial to at least attempt to implement both senses in any way possible. I agree with this argument because it is only fair to do everything possible in attempts to protect both the patients and the doctors. Patient safety shouldn’t come at the expense of the physicians caring for them, but doctors also can’t deny a patient’s autonomy in order to avoid a malpractice suit.
While I agree with Kaeli that sense1 and sense2 should both be implemented whenever possible, I believe that we must prioritize one over the other. Sense1’s purpose is to protect patients’ health and safety, while sense2 aims to protect doctors’ legal and financial rights. Because one of these senses handles much more life-threatening subject matter, shouldn’t there be an obvious more “important” sense to implement? When it’s impossible to apply both senses, shouldn’t sense1 and a patient’s health take precedence over all other matters?
This post really helped me understand the dichotomy of sense established by the authors. It can be difficult to differentiate the two, since sense2 is often equated and socialized to be understood as truly informed sense1. Being able to separate the social paradigm of sense2 from our analysis of what should be is essential to the conversation revolving around informed consent. The socially established structure of informed consent is, as you said, potentially inefficient within the realms of healthcare. Ensuring that patients understand the contextual information existing around their circumstances is paramount to the ideal of good care. It may be tedious to apply this level of informed consent to all procedures, regardless of intensity and severity, but I agree that it is important to do so. Raising the standard of informed consent to encompass the needs of more patients is a large task for the healthcare industry, but it is a task that is duly necessary in my eyes.