Consent: Nuremberg, Helsinki and beyond

Abstract

INTRODUCTION Informed consent has a long and distinguished history in liberal political theory and economic thought that goes back to the great debates of the European Enlightenment. The core of the social contract tradition is the claim that freely given consent legitimates action that would otherwise be unacceptable, and in particular the use of coercive power by governments. The basic arguments for market economics appeal to the moral legitimacy of consensual transactions, and contrast them with illegitimate economic transactions based on force, coercion or fraud, such as theft, confiscation and forced labour. These traditional claims have been reworked and reinvigorated in the last thirty years in influential revivals of liberal contractualism in political philosophy and of market thinking in economics. These debates in politics and economics have been paralleled in biomedical ethics, where informed consent has come to play a larger and larger part, and is now the most discussed theme in Western medical ethics and research ethics. Informed consent procedures have been embedded in clinical and research practice, and in a range of legislative and regulatory regimes that govern the use of personal and medical information and human tissues. Appeals to informed consent and its role in justifying clinical and research practice are now so well entrenched that their presence, indeed their necessity, and their justification are rarely questioned. In this book we raise a number of questions about standard views of the role of informed consent in biomedical ethics.