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Added by: Chris Blake-TurnerAbstract: Although informed consent models for prescribing hormone replacement therapy are becoming increasingly prevalent, many physicians continue to require an assessment and referral letter from a mental health professional prior to prescription. Drawing on personal and communal experience, the author argues that assessment and referral requirements are dehumanising and unethical, foregrounding the ways in which these requirements evidence a mistrust of trans people, suppress the diversity of their experiences and sustain an unjustified double standard in contrast to other forms of clinical care. Physicians should abandon this unethical requirement in favour of an informed consent approach to transgender care.
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Added by: Rochelle DuFordAbstract: Informed consent is increasingly heralded as an ethical panacea, a tool to counter autocratic and paternalistic medical practices. Debate about the implementation of informed consent is constricted and polarised, centring on the right of individuals to be fully informed and to freely choose versus an autocratic, paternalistic practice that negates individual choice. A bioethical framework, based on a principle-led form of reductive/deductive reasoning, dominates the current model of informed consent. Such a model tends to abstract the process of consent from its clinical and social setting. By fleshing out the social process involved when patients and healthy volunteer subjects consent to take part in clinical drug trials, this paper attempts to address the problem arising from the current 'empty ethics' model. My arguments are substantiated by qualitative interview data drawn from a study I conducted on the process of consent as experienced by participants in clinical drug trials.
Comment: This text is a clear critique of the use of informed consent as a medical-ethical panacea (it could be taught alongside O'neill's "Paternalism and Partial Autonomy" for a more accessible and applied look at the problem of informed consent). It would be useful as a contrast at the end of a unit on informed consent for medical treatment or a unit on clinical research ethics. It is especially good for use in a biomedical ethics or research ethics course aimed at students interested in the health professions.
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Added by: Rochelle DuFordAbstract: Patient competence is an essential element of every doctor-patient relationship. In this paper I provide a case report involving an older Korean man in a Hawaiian hospital who refused treatment on the basis of mistaken facts or beliefs about his doctors and treatment. I discuss the case as it relates to competency and extends it to informed consent, autonomy and paternalism. I suggest and argue firstly, that the older Korean man is not fully competent, and secondly, that if he is not fully competent, then soft and weak paternalism may be justified in his case and in cases similar to his.
Comment: This text presents an introduction to the relationship between competance, informed consent, and autonomy in medical contexts through the use of a case study. As such, it would be a good text for an introductory course in health care ethics or biomedical ethics within a unit on autonomy or culturally-specific applications of medical ethical principles.
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Added by: Chris Howard, Contributed by: Simon FoktPublisher's Note: Onora O'Neill suggests that the conceptions of individual autonomy (so widely relied on in bioethics) are philosophically and ethically inadequate; they undermine rather than support relationships based on trust. Her arguments are illustrated by issues raised by such practices as the use of genetic information by the police, research using human tissues, new reproductive technologies, and media practices for reporting on science, medicine, and technology. The study appeals to a wide range of readers in ethics, bioethics, and related disciplines.
Comment: Parts of this book are an excellent supplement to units on autonomy and informed consent in an intermediate-advanced level medical ethics course. In particular, chapters 1, 2, and 4 would be excellent additions to a unit on autonomy, and chapter 7 would be a similarly excellent addition to a unit on informed consent.
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Added by: Simon FoktAbstract: Prenatal screening, consisting of maternal serum screening and nuchal translucency screening, is on the verge of expansion, both by being offered to more pregnant women and by screening for more conditions. The Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists have each recently recommended that screening be extended to all pregnant women regardless of age, disease history, or risk status. This screening is commonly justified by appeal to the value of autonomy, or women's choice. In this paper, I critically examine the value of autonomy in the context of prenatal screening to determine whether it justifies the routine offer of screening and the expansion of screening services. I argue that in the vast majority of cases the option of prenatal screening does not promote or protect women's autonomy. Both a narrow conception of choice as informed consent and a broad conception of choice as relational reveal difficulties in achieving adequate standards of free informed choice. While there are reasons to worry that women's autonomy is not being protected or promoted within the limited scope of current practice, we should hesitate before normalizing it as part of standard prenatal care for all.
Comment: The text introduces the notion of relational autonomy and argues that an increase in pre-natal screening can in fact act so as to restrict the autonomy of pregnant women. It is best used in teaching applied ethics modules on procreation and autonomy, and as a further reading offering a critique of approaches which do not take into account contextual features of particular situations in their moral assessment.
Comment (from this Blueprint): Ashley draws on their own experiences as a trans person, as well as that of the trans community more broadly, to argue against assessment and referral requirements for hormone-replacement therapy (HRT). Ashley argues instead for an informed consent model, on which providers of HRT are not gatekeepers of transness, but facilitators of thoughtful decision-making.