View Of Consent Research Articles

Consenting Under Coercion: The Partial Validity Account

Abstract How is the validity of our consent, and others’ moral permission to act on our consent affected by coercion? Everyone agrees that in cases of two-party coercion—when X coerces Y to do something with or for X—the consent of the coerced is invalid, and the coercer is not permitted to act upon the consent they receive. But coercers and the recipients of consent are not always identical. Sometimes a victim, Y, agrees to do something to, with, or for Z because they are being coerced by X. Recently, several philosophers have argued that consent under third-party coercion can be fully valid. We argue that this view has troubling implications. We develop a novel view of consent in third-party coercion cases, which we call the partial validity account. The core idea is that, under severe coercion, Y’s consent is at most partially valid—it reduces the strength of, but does not completely dissolve, Z’s consent-sensitive duties. We argue that the partial validity account gets the right results in important cases and explains the moral factors at play better than alternative accounts.

“How Will That Consent Play Out?”: Factors Involved in Lesbian, Gay, and Bisexual Individuals’ Understandings of Sexual Consent

Due to a lack of research on sexual consent in sexual minority communities, we know little about how and what individuals who identify as lesbian, gay, or bisexual (LGB) learn about consent. To this end, a convenience sample of 25 LGB adults (N = 25) was interviewed about the factors that have shaped their perceptions and approaches to sexual consent. Data was analyzed using a constant comparative approach wherein data was collected and analyzed simultaneously. Participants identified interpersonal resources, such as past partners, friends, and family, as influential in their views of consent. They also described the lack of inclusive sexual health resources and inadequacies in school-based sexual education as obstacles in the learning process.

Teaching good sex: The limits of consent and the role of the virtues

Abstract I offer an account of sexual ethics, and thus of an education in sexual morality, that tries to make some sense of how a view of consent as central to those ethics might be combined with an education in certain virtues. I do so by exploring what some see as the shortcomings of a standard of consent, namely, how it can deal with instances of prima facie bad sex. I consider and reject various attempts to show that consensuality is sufficient for morally good sex. I then show how a needed supplement to the standard of consent can appeal to a broader view of why consent matters. This in turn connects to those personal and interpersonal virtues that the 2019 Department of Education guidance on relationships and sex education suggests should be taught. Finally, I provide an account of why more than consensuality is needed in the case of sex. In short, I insist on the critical importance of consent but supplement the standard of consent by an appeal to why consent matters and does so especially in the case of sex.

‘I was putting her first’: Birth parents' experiences of ‘consent’ to adoption from care in England

AbstractAdoption is the preferred form of permanence for young children in care in England who are unable to live with their birth family or relatives. However, there have been growing concerns about the use of adoption, particularly in cases where birth parents have not given their consent. Despite concerns, there has been little research into birth parents' views of consent in adoption. This article reports on the experiences of 12 birth mothers and 2 birth fathers whose children were adopted from care in England. Birth parents' views on consent changed throughout the adoption process. They reported that care proceedings could be traumatic, and they did not always understand what was happening. There was a disparity in the quality of legal advice and social work support that birth parents received. The findings raise questions for practice around the level of support birth parents receive during and after care proceedings and highlight the importance of good quality support.

Consent, Communication, and Abandonment

According to the Behavioral View of consent, consent must be expressed in behavior in order to release someone from a duty. By contrast, the Mental View of consent is that normatively efficacious consent is entirely mental. In previous work, I defended a version of the Behavioral View, according to which normatively efficacious ‘consent always requires public behavior, and this behavior must take the form of communication in the case of high-stakes consent’. In this essay, I respond to two arguments by proponents of the Mental View. First, Larry Alexander, Heidi Hurd and Peter Westen have argued that my view has mistaken implications concerning the culpability of different actors. I counter that my version of the view does not have these implications, as it leaves us free to draw moral and legal distinctions between different offences involving non-consensual behavior. Second, Larry Alexander and Kimberly Ferzan have argued for an analogy between consent and abandonment: on the grounds that the normative power to abandon resides in one’s will, Alexander and Ferzan concludes consent does too. I counter that abandonment requires behavior, and call into question the assumption that the ethics of property have much to teach us about the ethics of sexual consent.

Abstract WP307: Patients’ and Surrogates’ Experiences and Views of Consent in Acute Stroke Trials

Introduction: Informed consent for clinical trials in acute stroke is challenging. Enrollment decisions must be made quickly, in stressful situations, and typically by a surrogate. Moreover, trials are complex and unfamiliar. Understanding patients’ and surrogates’ experiences may help maximize respect for them while facilitating important studies. Methods: Telephone interviews were conducted with consented patients or surrogates for patients enrolled in acute stroke trials at 3 US sites between 2011 and 2016. Interviews assessed trial recall, experiences with consent, and preferences regarding consent. Questions were primarily closed-ended. Descriptive statistics were calculated, and bivariate analyses (Fisher’s exact) were conducted to examine predictors of consent preference. Results: Eighty-four respondents (69 surrogates, 15 patients) across 3 sites and 10 trials were interviewed and included in final analysis. Nine did not recall enrollment, and only about half (53%) recalled that the trial involved an intervention. Of 75 respondents who remembered enrolling, 65 (87%) remembered signing a consent form, 52 (80%) of whom said they read at least some of it. Most respondents reported being treated respectfully during consent. Only 12 respondents (16%) wished they had been enrolled in the trial without prospective consent. Individuals with low health literacy were less likely to prefer enrollment without consent (p<0.0007) but more likely to wish they had not had to sign a consent form (p<0.0001). Forty-six (61%) recalled someone talking with them about the study after enrollment. Conclusions: Patients and surrogates in stroke trials reported mostly positive consent experiences and generally appreciated having been asked for consent prior to enrollment. Recall of trial details, however, was low, and post-enrollment contact was recalled to be somewhat infrequent. Further work may help to identify the most context-appropriate strategies.

Patients' views of consent in clinical trials for acute myocardial infarction: impact of trial design

ObjectiveSeeking prospective informed consent is difficult in clinical trials for emergent conditions such as acute myocardial infarction (AMI). Prior data suggest that enrolment decisions of patients are often poorly informed...

Consent ain't anything: dissent, access and the conditions for consent.

I argue against various versions of the 'attitude' view of consent and of the 'action' view of consent: I show that neither an attitude nor an action is either necessary or sufficient for consent. I then put forward a different view of consent based on the idea that, given a legitimate epistemic context, absence of dissent is sufficient for consent: what is crucial is having access to dissent. In the latter part of the paper I illustrate my view of consent by applying it to the case of consenting to being an organ donor.

Abstract 228: Patients’ Views of Consent for STEMI Trials: Are All Trials the Same?

Background: Informed consent for clinical trials in acute MI- especially STEMI- is controversial. Prior data suggest patients want to be asked for permission before enrollment. It is unknown whether trial features affect this desire. This is particularly important in the context of debate about the role of consent in standard of care comparative effectiveness trials. Methods: This interview study included patients admitted with acute MI. Structured, in-depth interviews were conducted in hospital or after discharge. Participants considered 3 scenarios modeled on existing STEMI trials: 1) comparative effectiveness trial of approved antiplatelet drugs; 2) placebo-controlled trial of a novel drug to reduce myocardial injury; and 3) comparative effectiveness trial of intraaortic balloon pump versus medical therapy. Participants were asked their desired involvement in enrollment decisions and willingness to participate in each trial. Results: Thirty patients were interviewed. Most (73-80%) wanted to be asked for permission to be enrolled in all scenarios (Table 1). Willingness to enroll, however, was affected by trial type. For example, 50% vs 20% were unlikely to enroll in scenario 3 vs. scenario 1 (p=0.018). Attitudes regarding enrollment focused on distinctive trial features. Many participants specifically stated they were comfortable with scenario 1 because it involved only approved drugs. Participants split regarding scenario 2 based on whether they viewed the novel agent as a potential benefit or risk, and some had concerns about placebo. The invasive nature of the balloon pump in scenario 3 was the most common basis for not wanting to enroll. For some, this was driven by a desire to receive the intervention; for others, it was driven by a desire to avoid it. Conclusion: In this exploratory study, most patients would prefer to be asked for permission prior to enrollment in 3 different STEMI trial scenarios, including 2 trials evaluating standard of care alternatives. While desire to be involved in enrollment decisions was relatively insensitive to trial features, these features impacted willingness to enroll. This study supports the notion that the form and content of consent processes for STEMI trials should be trial and context specific. Refining these processes requires further study.

Consent Culture and the Forgotten Law of Rape

The need for institutional reform to address the problem of sexual assault, particularly on college campuses, is widely acknowledged. Unnoticed, however, is a profound disconnect between cultural norms around sex and the legal definition of rape. The Model Penal Code and a majority of states still retain a force requirement, effectively consigning most rape — that is, non- stranger rape — to a place beyond law’s reach. Of special concern, the dominant statutory approach misconceives or overlooks entirely the role of consent, which has become central to popular and political discourses around sexual assault. In the midst of increasing moves on campus to codify affirmative consent standards (“yes means yes”), rape law remains mired in an archaic view of consent as rather beside the point. This Article recasts the significance of law’s preoccupation with force by introducing a taxonomy of cases in which force and non-consent tend to diverge. The no-force/no-consent cases raise a question critical to ongoing reform efforts: does the absence of consent make sex rape? Outside of law, this inquiry has for the most part been resolved; what remains is to reconcile competing interpretations of consent’s meaning. In stark contrast, the criminal justice system’s treatment of non- stranger rape reflects a doctrine woefully out of step with modern conceptions of sex. Sexual agency provides the theoretical underpinning needed to close this gap.

Consent, Forced Renegotiation and Expropriation in International Law

Expropriation is evolving. In recent times, host states with a desire to redraw the domestic status quo have demonstrated a tendency not simply to ‘take’ property from foreign investors by decree or proclamation. Rather, they are increasingly carrying out their objectives by murkier means; placing pressure on foreign investors to transfer control of their investments under threat of expropriation – that is, by ‘forced renegotiation’. With the transfer taking place with the apparent consent of the investor, the host state muddies what was once perceived as a clear line between legality and illegality in international law. In this context, scholars and tribunals have failed to define properly the concept of ‘consent’ within the definition of expropriation. This has left considerable doubt hanging over the question of whether forced renegotiation can come within the expropriation paradigm. Determining the existence or absence of consent is vital to determining whether an expropriation exists. After reasserting the importance of ‘consent’, this article identifies two divergent approaches to this much neglected issue. First, the ‘broad’ view of consent requires that a consent procured by duress is nevertheless a consent and prevents expropriation being made out. Alternatively, the ‘narrow’ view demands ‘real and substantive’ consent and rejects any agreement of the parties that is not free and informed. Each approach draws support from different comparative materials. The article concludes that while state practice is consistent with the ‘broad’ view, the trend does appear to be towards adoption of the ‘narrow’ view, both in customary international law and in the BIT context. Nevertheless, even if the ‘broad’ view were to be adopted, the investor would not be left without remedy when subject to illegitimate pressure to vary its contractual arrangements. Investors may look for protection in either the bilateral investment treaty framework, which guarantees fair and equitable treatment and prohibits legally unjustified measures, or in what could be characterised as an emerging doctrine of compensable duress under international law.

The Ontario experience of involuntary treatment of pediatric patients with eating disorders

In this paper, the authors (two clinicians with specialized practices in child and adolescent eating disorders and a lawyer who practices health law in Ontario, Canada) review pertinent aspects of clinical capacity assessment, with elaboration of the specific unique and complex issues which shape that assessment in children and adolescents with eating disorders. The relevant Ontario legislation and institutional framework governing consent and capacity in children and adolescents are reviewed. The literature on involuntary treatment and consent and capacity in patients with eating disorders is reviewed. Specific cases involving child and adolescent patients with eating disorders that have been heard by the Ontario Consent and Capacity Board (OCCB) in the past decade are discussed in order to elucidate the Board's views of consent and capacity in this vulnerable and challenging patient population. Strategies to support clinicians' therapeutic alliances with their patients while both are going through what can be a lengthy and potentially adversarial-seeming legal process are also discussed.

Optimizing the informed consent process with elderly people.

While the avowed purpose of informed consent is to inform, this objective has been shown not to have been met in many situations, particularly with elderly people. The assumption that a single methodology for informed consent would suffice for all people may underlie this failure. The view of consent within a simplistic paradigm of how a person seeks, obtains, and assimilates information in order to make a decision needs to be expanded. This article presents a conceptualization of the informing process and adaptations of the consent process that may help to more completely fulfill the primary goal of informed consent.

The Limits of Consensual Decision

This essay criticizes the ideal of consensual decision as it appears in liberal political theory. A historical survey begins with Locke's view of consent, its criticism and extension by 19th century figures such as Godwin, Calhoun, and Mill, its reappearance in the guise of economic efficiency within the works of Wicksell or Buchanan and Tullock and as moral autonomy in Wolff'sDefense of Anarchy. The paper offers a structural account of political decision making in which vulnerability to the authority of others seems inescapable and in which neither unanimity nor a universal right of consent is possible. On this telling, consensual decision is logically unattainable and misdirects constitutional theory.