14 Consent to Medical Care: The Importance of Fiduciary Context

Abstract

Abstract This chapter addresses three of the central challenges in the literature on informed consent to medical treatment. First, how does the nature of the physician-patient relationship, which establishes the context in which medical decisions are made, influence norms of informed consent for medical care? Second, how do the characteristics of the particular decision at hand affect expectations for informed consent? Finally, how can we bridge the persistent gap between the theory and practice of informed consent, and in particular between the robust decision-making rights accorded to patients and the often limited extent to which patients claim decision-making responsibility for themselves? It is argued that progress in resolving these three questions is possible if we take seriously two features of medical relationships and decisions that to date have been neglected in conceptual discussions about informed consent: the complex fiduciary nature of the physician-patient relationship and the notion that some medical decisions involve choices among, or at least substantially impact upon, important ends, whereas others are best understood as choices among means to a settled end.