Diversity Reading List

Abstract: Many accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy. Unfortunately there are many distinct conceptions of individual autonomy, and their ethical importance varies. A better reason for taking informed consent seriously is that it provides assurance that patients and others are neither deceived nor coerced. Present debates about the relative importance of generic and specific consent (particularly in the use of human tissues for research and in secondary studies) do not address this issue squarely. Consent is a propositional attitude, so intransitive: complete, wholly specific consent is an illusion. Since the point of consent procedures is to limit deception and coercion, they should be designed to give patients and others control over the amount of information they receive and opportunity to rescind consent already given.

Introduction: One might suppose that if political theorists are by now clear about anything at all, they should be clear about the problem of political obligation and the solution to it most commonly offered, the doctrine of consent. The greatest modern political theorists took up this problem and formulated this answer. The resulting theories are deeply imbedded in our American political tradition; as a consequence we are al- ready taught a sort of rudimentary consent theory in high school. And yet I want to suggest that we are not even now clear on what "the problem of political obligation" is, what sorts of "answers" are appropriate to it, what the con- sent answer really says, or whether it is a satis- factory answer. This essay is designed to point up the extent of our confusion, to explore some of the ground anew as best it can, and to invite further effort by others. That such effort is worthwhile, that such political theory is still worth considering and that it can be made genuinely relevant to our world, are the assump- tions on which this essay rests and the larger message it is meant to convey

Introduction: [The doctrine of "hypothetical consent"] teaches that your obligation depends not on any actual act of consenting, past or present, by yourself or your fellow-citizens, but on the character of the government. If it is a good, just government doing what a government should, then you must obey it; if it is a tyrannical, unjust government trying to do what no government may, then you have no such obligation. Or to put it another way, your obligation depends not on whether you have consented but on whether the government is such that you ought to consent to it, whether its actions are in accord with the authority a hypothetical group of rational men in a hypothetical state of nature would have (had) to give to any government they were founding. Having shown how this formulation emerges from Locke's and Tussman's ideas, I want now to defend it as a valid response to what troubles us about political obligation, and as a response more consonant than most with the moral realities of human decisions about obedience and resistance. At the same time the discussion should also demonstrate how many different or even conflicting things that one might want to call "consent" continue to be relevant - a fact which may help to explain the tenacity of traditional consent theory in the face of its manifest difficulties. Such a defense and demonstration, with detailed attention to such decisions, are difficult; the discussion from here on will be more speculative, and will raise more questions than it answers.