Abstract
Informed consent is medico-legal orthodoxy and the principal means by which research encounters with the body are regulated in the UK. However, biomedical advancements increasingly frustrate the degree to which informed consent can be practiced, whilst introducing ambiguity into its legal significance. What is more, feminist theory fundamentally disrupts the ideologically liberal foundations of informed consent, exposing it as a potentially inadequate mode of bioethical regulation. This paper explores these critiques by reference to a case study—embryo donation to health research, following fertility treatment, as regulated by the HFEA 1990—and contends that informed consent cannot adequately respond to the material realities of this research encounter. Thereafter, by drawing on feminist theories of vulnerability, this paper proffers an alternative bioethical approach, which calls for structural reform in recognition of the fundamentally bilateral constitution of self and society and a renewed appreciation for the affective/dispositional tenor of lived experience.
Highlights
The problem with informed consent (IC) is that it is premised on a political fiction
When we acknowledge the inherent sociality of the subject, we are forced to conclude that informed consent is a political technology, built to respond to a political fiction, which it subsequently works to sustain
Placing autonomy at the moral centre of biomedical regulation is ethically questionable, because it licences an ideological erasure of context
Summary
The problem with informed consent (IC) is that it is premised on a political fiction. What is notable about relational autonomy theorists is that, whilst they eschew liberal individualism in favour of a more sophisticated treatment of context and relationality, they tend to reaffirm autonomy as a morally central consideration (albeit one amongst others), subsequently reinforcing its bioethical dominance This reaffirmation of autonomy, I would argue, is the consequence of a seeming desire to return participants to a more genuinely autonomous state, albeit often through structural reform. If we take feminist critiques of autonomy seriously, procedural approaches to ethics should be eschewed in favour of more context specific approaches In deference to this observation, I am keen to consider a case-study, which provides a particularised example of how biomedical advancement, the legal codification of IC, and social context constitute spaces of consent, as well as the consenting subject. This is the context in, and through, which health-researchers prevail upon donors to donate embryos
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