By way of conclusion, we need to accomplish three final tasks: (1) provide a basic summary of the argument of this work; (2) make one final point regarding the clinical variables and variable responses that our informed consent intervention must key to, offered under the heading of "the clinician's discretion"; and (3) place this intervention within the broader context of clinician communications with patients.
Our aim has been to develop a sense of informed consent as a useful tool for medical management, an intervention that would change outcomes at the bedside for the better. In chapter 1, we found that the law offered no such implement, focused as it was for all its rhetoric on the ways that tort law might identify actionable departures from minimally adequate informed consents. Whatever minimal goals the law legitimately chose to pursue, it was simply not adequate to the ethical and clinical goods and values that were at stake. Moreover, the law proceeded in terms of a presumption regarding competence and a "bits and pieces" sense of understanding that did not reflect the actual capacities or needs of patients in the situation of illness, nor did it reflect the ways in which such factors varied from situation to situation and patient to patient. Finally, even if one accepted the narrower focus of the law's approach, it failed to provide sufficient operational guidance to determine how to satisfy its requirements—for example, in its standards for disclosure or for the assessment of competence.
The "new ethos of patient autonomy" fared no better, as chapter 2 documents. Along with presuming competence in most patients, with little recognition of or provision for its common diminishments, it proceeded on the basis of a self-stultifying adversarial view of the