Informed Consent is crucial in the field of medicine and science so that patients or subjects know of the consequences that could arise from a certain procedure or research. Without this framework of consent put in place to allow patients to be autonomous with their decisions, or at least most of their decisions if they are able to make such a decision, the results could be catastrophic.
In the article “The Concept of Informed Consent” by Ruth Faden and Tom Beauchamp, two very clear views of consent were distinguished. These views include autonomous authorization and informed consent as effective consent, or otherwise known as sense1 and sense2 respectively.
Sense1, or autonomous authorization, takes into effect when a patient provides more than an expressed agreement with, or the patient complies, with an arrangement or proposal. The patient would need to actively authorize the professional to move forward with a procedure or research. Sense1 also contains four acts in which the patient is required to follow. These acts include; (1) Substantial understanding (2) Substantial absence of control by others (3) Intentional compliance (4) authorization of a professional. Without the complete actions of one through four, the consent becomes obsolete and is no longer under the branch of informed consent. A patient may abide by the first three steps, but without the fourth, the consent no longer follows such rules set by autonomous authorization and that is what distinguishes informed consent as a kind of autonomous action.
Sense2, or informed consent as effective consent, stated as a “…policy-oriented sense whose conditions are not derivable solely from analysis of autonomy and authorization…” (Faden and Beauchamp). This sense is based on a legally or institutionally effective authorization, and it focuses on regulating the behavior of the professional and it also establishes rules and procedures for the consent of the patient or subject.
Lastly, the article mentions shared decisionmaking between the professional and the patient, and this form of decisionmaking is unethical. This form is unethical due to the manipulative properties and may distort the patient’s views and decisions causing them to possibly make a decision that was unintentional in the first place. Without the framework of informed consent from both senses, the medical and scientific field would be filled with unethical, and morally questionable, practices, completely demolishing the patient or subject and professional relationship.
Justin, I appreciate your breakdown of the two senses as reading it was a bit confusing to me at first – your explanation really cleared the ideas up. Faden and Beauchamp made the clear distinction that agreement is not equivalent to consent and in the case of Sense 2 ,which you have properly described as based on legality, we tend to overlook these differences in the medical field in order to obtain a signature. Its difficult to avoid prioritizing Sense2 over Sense1 because of the varying degrees of patient medical literacy and understanding. The struggle to not only help someone attain the first 3 acts of Sense1 – actually getting a substantial understanding of complex medical procedures and the limitations of the human body, helping the patient isolate their opinion from that of others, making sure that their complaince is in fact intentional – is incredibly difficult all to allow them to entertaint he fourth act of authorizing a professional. Couple these intricacies with the time contraints placed on doctors and we find ourselves in a society where Sense2 is essentially an inaccurate shortcut.
I’m a big fan of applicable ethics and while we can’t expect every patient to be at the point where full informed concent is a reality, we can attempt to bridge the gap through education and encouragement of patient advocacy. This is found in public health initiatives and policies as obtaining Sense1 for patients cannot be the realistic responsibility of any one doctor. On this note , “shared decision-making” can start as a lone doctor’s attempt at achieving Sense1 but as you’ve pointed out it can definitely lead to coercion or manipulation considering a single physician has extennsive years worth of knowledge far beyond what patients typically manage to google. And as Fraden and Beauchamp pointed out, the decisions made can fail to really be “shared” at all. If the patient gives up their autonomy entirely to the medical professional the decisions made thereafter are unilateral and thus cannot fall under the term “shared decision-making”. Its tricky and I won’t say that the current system is without flaws especially if we stop at Sense2. It’s important distinctions like Sense1 and Sense2 that allow us to keep the practice of medicine ethical.