Toward a Model of Informed
What began as the "doctrine" of informed consent has now become the "problem" of informed consent. The possibility of successfully pursuing the goals and values of informed consent seems to recede just as these goods and values become clearer. Chapter 3 surely affords us no grounds for optimism. Even on a "bits and pieces" model of informed consent, many patients perform only marginally. If we move to the "essay mode" of understanding, we may well wonder how often this ideal is even remotely approached by most patients. And if we then include our reflections on diminished competence, the barriers to informed consent, and the complexities that medical decisions often present, the whole enterprise comes to look quite ill‐ starred.
The option of medical paternalism fares no better, however. As repeatedly noted, it offends against basic aspirations and assumptions of free men and women. The ship wherein physicians exercise unlimited authority over their charges has long since sailed. Further, goods and values that are crucial to the successful treatment of patients are at issue. Trust, acceptance, and understanding are foundational to compliance and cooperation, and the chronically and terminally ill need assistance appreciating profound events in their lives if "treatment" is to be more than a quite temporary and quickly ineffective bandaid.
We may well wonder at this juncture if our "problem" is intractable; that this may be the case can be brought into fuller relief by reflecting further on the ways in which our problem presents both intellectual and practical conundrums.
We should easily be able to imagine any number of extended further debates issuing from the discussions through which one attempts to gain a coherent formulation to solve the problem. The sort of dialectic that took place in chapter 2 could easily start anew. The