The Potential Benefits of
Our inquiry repeatedly tugs us back and forth. The law, rhetorically at least, advanced its doctrine of informed consent in terms of the fundamental principle of self-determination. Unfortunately, the law's specific focus has come to be on torts; and it thus provides little clear, specific guidance regarding how informed consent should actually pursue such self-determination. Concurrently, the law tends to induce behaviors in clinicians that are counterproductive to such a pursuit- for example, the hyperinforming that leads to information overload. The new ethos of patient autonomy, for its part, enjoys broad societal consensus regarding many of its basic prescriptions. Further, like the law, the new ethos seems to presume that certain needs as well as patient abilities are usually present in the same form and degree. But such univocal presumptions regarding patient abilities and needs clearly run afoul of clinical experience and its supporting empirical literature. The icing on the cake is then supplied by reflecting on the diminishment of and barriers to autonomy that are ingredient in the situation of illness and health care, especially when we think of the "essay mode" of understanding, which is surely what we should hope for.
Whether, and in what form and degree, informed consent should be mandated for all clinical encounters thus remains quite unclear. It will probably continue to be legally required in countries like America, given societal attitudes and what now amounts to a strong legal tradition. But such a requirement does not address the issue of what, beyond some self-protective ritual, a conscientious clinician should be pursuing when he offers a given patient informed consent. Clinicians have the right and need to inquire as to what such an intervention might really be worth, why they should bother with it. And if the reply is no more than that the law requires it, or that it is supported by strong societal expectations, then given the preceding critique of the