Reading #8: Informed Consent in Health Care

In health care, the concept of "informed consent" has two primary applications: Informed Consent in Research and Informed Consent in Treatment.  In any Liberal Society these applications relate to the concept of "Human Agency," or the philosophical questions that underlie what kinds of persons can be held morally responsible for their actions.  There are two conditions: rationality and free will. In health care two questions dominate moral and legal debate. 1.) Was the research subject or patient given enough information to make a rational choice? and 2.) Once provided with this information, does the research subject or patient, have the ability to act "freely" on the basis of that information... in short, does that person possess free will.

There are many conditions that might impede a research subject/patient's ability to process information. First of all: much of the language associated with health care is highly technical and derived from Greek or Roman nomenclature, and therefore most of us do not understand what the researcher or physician is saying. And most researchers/physicians have not been trained in how explain medicine in laymen terms. Therefore, many research subjects/patients are vulnerable, and rely on third-party agents, usually nurses. The most vulnerable classes include: young children, persons suffering from mental diseases, persons with very low IQs, persons with little education, persons that do not speak English, and elderly patients suffering from varying degrees of dementia. In these cases, proxies, or other rational persons must make those rational decisions. But who... family or friends, physicians, lawyers, judges, or juries?  

There are also conditions that might impede a research subject or patient's ability to exercise free will, and consent to serve as a research subject or undergo costly, high-risk, medical treatments. Many potential research subjects/patients tend to defer these decisions to authorities who possess a Ph.D.  or an MD degree. Many research subjects/patients are vulnerable to outside interference because they are desperately seeking to avoid and/or remove pain and or disability. 

Informed consent has become an important moral/legal problem because researchers and physicians often have a stake in securing informed consent from prospective subjects/patients; and therefore may operate under a conflict of interest. Researchers need many research subjects in order to conduct clinical trials. Many researchers are college/university professors seeking tenure and promotion, researchers that are also pursuing lucrative patents for themselves or their respective corporation. Most physicians get paid for their services, and (like everyone else) needs to payoff student loans, feed, clothe, and shelter their families etc. Therefore, researchers and/or physicians might to tempted to misrepresent the known costs and benefits of serving as a  research subject or undergoing an expensive treatment. Sometimes these misrepresentations rise to the level of legal fraud. Sometimes these misrepresentations are paternalistic, and therefore serve the greater interests of the subject or patient, but sometimes these misrepresentations are predatory and serve, primarily the interests of the researcher or physician.  Research subjects may also be bribed into participation in a research project by offering either free health care or monetary reward. At what point does providing an incentive become bribery and/or economic predation (Kant)?