The New Ethos of
Informed consent did not spring full-armored like Athena from the head of Zeus. As already noted, it has undergone a long development in Anglo-American law. Equally, though only in more recent years, the doctrine has been appropriated by a broad-based movement to reform medicine in ways felt to be more congruent with the general practices and aspirations of a free society. And it is to this social movement, this "new ethos of patient autonomy" (McCullough and Wear, 1985; Wear, 1991), that we must now refer in order to understand the ethical agendas, insights, and arguments behind the doctrine of informed consent.
Whether we refer to the law, more popular statements, or the writings of its proponents, the new ethos of patient autonomy comes with certain clear and generally espoused principles and agendas. Given the perception that patients have regularly been as uninformed as they are powerless in health care, the basic prescription has been to inform them and alter that power structure. Impeaching all forms of paternalism, at least for competent patients, the new ethos has advanced the doctrines of informed consent and the right to refuse treatment toward enabling and empowering patients to retain control of their lives in health care. The insistence on truth telling is added to this prescription in recognition of both patients' need for information and insight as to whether there are decisions to be made, and the alleged widespread presence of deception within health care. In sum, in any clinical encounter between competent patients and their health care providers, the essential details of the recommended intervention must be presented to the patient, the patient's consent must be obtained before proceeding, the patient has the right to refuse the intervention without prejudice, and any such interaction must proceed honestly without the presence of lies, deception, or coercion.