Dare we rethink informed consent?

Malcolm de Roubaix


Current informed consent practices conform to the informed consent paradigm (ICP). Our intention is finally to promote patient autonomy through the provision of information intended to remove the information (i.e. power) differential between doctor and patient. ICP is fundamentally flawed, since it is impossible to comprehensively and explicitly inform. A fundamental problem is our reliance on the container-conduit metaphor of informing. As a linguistic act, this metaphor conceptualises the process of informing as passive, when in reality informing and consequent sense-making are parts of an individualised, personal and active process. The difficulties of the ICP are discussed, as are possible alternative strategies (reverting to paternalism, retaining the illusion of autonomy, and de-linking informing/consent, or the moral and legal aspects of consent). Alternative models are also discussed (e.g. Manson and O’Neill’s notion of informed consent as a transaction). Concluding suggestions include drawing on an ethics of responsibility, incorporating the notion of informed consent as a transaction, debating the issues raised here and promoting the ethical empowerment of practising doctors.

Author's affiliations

Malcolm de Roubaix, Centre for Applied Ethics, Department of Philosophy, Stellenbosch University, Cape Town, South Africa

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Informed consent; paradigm model; metaphors for information transfer; container-conduit model; alternative models of informed consent; paternalism; informed consent as transaction; moral responsibility

Cite this article

South African Journal of Bioethics and Law 2017;10(1):25-28. DOI:10.7196/sajbl.507

Article History

Date submitted: 2016-10-27
Date published: 2017-07-03

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