(Informed) consent

[Paidiske]

This question came up today, and I've been challenged to think through what the Biblical and theological basis might be for an ethical imperative for informed consent (for example, in healthcare, but I guess in general).

It seems to me at first blush that Scripture says little about this, possibly because ancient societies were little concerned with the autonomy and consent of individuals compared to ours, but I'd be curious to see what thoughts others have?

 

[Anthony2019]

In my line of work, I have to follow the principles of the Mental Capacity Act. It presumes that everyone has the capacity to make choices, even ones we disagree with - if they can understand, retain and use information to make a decision. The principle is that we should care for people as individuals, value and understand their life experiences, routines and preferences, and respect their right to self-determination. From a faith perspective, my understanding is that God created us as individuals, with our feelings, fears, hopes and dreams, and people generally live happier, healthier and more productive lives if these characteristics are respected.

 

[Paidiske]

I don't disagree with you, Anthony, but I wonder what Scripture you would use to illustrate that principle?

 

[Quid est Veritas?]

What about Romans 14? Servants stand or fall on their merit before their master, which implies their volition. But do we not just perhaps 'stand' with the Lord?

Just want to point out that medical consent is far from truly informed: the relationship is always weighted toward the practitioner, as he is the acknowledged expert and patients expect him to advise. So you can direct informed consent depending how you present it, and with transference and such, the argument is difficult to decide what is truly 'informed'. For instance, must we inform about horrific, but really really rare, complications? It seems more a legal conceit, and in practice, is more a mix of patient psychology, paternalism, and old-fashioned beneficience and non-maleficence principles.

How much 'consent' one really gives is hard to quantify spirutually, I think. If someone is more predisposed to a certain sin, and struggles against it but occasionally fails, God would know what he was up against. Such an effort is probably more salutary than someone who was never so inclined and thus never committed that specific sin. For instance, an Alcoholic that is mostly sober but fell off the wagon - was that really 'informed' or in spite of what he knows was his best interest? There are more forces at play than merely volition, like genetics or predisposition and the ilk.

 

[Anthony2019]

I don't disagree with you, Anthony, but I wonder what Scripture you would use to illustrate that principle?

One example would be the parable of the prodigal son. The son was given his share of the Father's estate and given complete freedom to choose how he would wish to spend his life. He was free to make decisions, even those which the human mind would find illogical and irrational, such as spending his entire inheritance to the point he had nothing left to live on. He learned through his experience, came to his senses, and made the decision to return to the Father. Often we only realise that we have made a good decision when we have previous experience of what it means to make a wrong one. It increases our wisdom, our faith and our dependence on God.

 

[Tom 1]

I don't disagree with you, Anthony, but I wonder what Scripture you would use to illustrate that principle?

You might be able to build something on the principle of 'each of them should be fully convinced in their own mind' from Romans 14:5. A different context but still a sound principle for decision making, or the importance of using principles for decison making. If you have loads of time you could maybe build something from Job, reduced to such an awful state that his own wife was telling him to get it over with and top himself, but he stayed in the misery because that was his choice.

 

[Paidiske]

What about Romans 14:4? Servants stand or fall on their merit before their master, which implies their volition. But do we not just perhaps 'stand' with the Lord?

Just want to point out that medical consent is far from truly informed: the relationship is always weighted toward the practitioner, as he is the acknowledged expert and patients expect him to advise. So you can direct informed consent depending how you present it, and with transference and such, the argument is difficult to decide what is truly 'informed'. For instance, must we inform about horrific, but really really rare, complications? It seems more a legal conceit, and in practice, is more a mix of patient psychology, paternalism, and old-fashioned beneficience and non-maleficence principles.

How much 'consent' one really gives is hard to quantify spirutually, I think. If someone is more predisposed to a certain sin, and struggles against it but occasionally fails, God would know what he was up against. Such an effort is probably more salutary than someone who was never so inclined and thus never committed that specific sin. For instance, an Alcoholic that is mostly sober but fell off the wagon - was that really 'informed' or in spite of what he knows was his best interest? There are more forces at play than merely volition, like genetics or predisposition and the ilk.

Some good thoughts there, thank you, Quid. I do agree that all sorts of things can interfere in our exercise of otherwise apparently free will.

I wonder whether the "pub test" of whether informed consent is adequate is whether or not the patient feels violated, or feels that they were adequately engaged in the decision making process?

 

[Quid est Veritas?]

Some good thoughts there, thank you, Quid. I do agree that all sorts of things can interfere in our exercise of otherwise apparently free will.

I wonder whether the "pub test" of whether informed consent is adequate is whether or not the patient feels violated, or feels that they were adequately engaged in the decision making process?

That doesn't remain static though. People may feel consent was inadequate when they experience a complication they weren't aware was a possibility, but adequate before such complications occured. If a complication is one in a million, are we really going to inform every single person about it though? Or adequate 2 hours prior, but still so 10 minutes before or just after? Opinions change if there is no standard, just subjective feeling.

For instance, there was a patient in the US who had a prostate resection for presumed benign hypertrophy with no biopsy taken, as evidence suggests the chances of it being carcinoma in his specific subset of symptoms is neglible. He then did get cancer, and decided his informed consent invalid, because he doesn't remember any discussion of this type occuring, about not taking biopsies (of course being a few years later). Was it valid then, or not? Or valid and then invalid? Unfortunately the concept is hopelessly mired in the subjective.

 

[Paidiske]

Unfortunately the concept is hopelessly mired in the subjective.

I agree. I must admit I was thinking of issues to do with giving birth, and how one's capacity to consent can change as that process unfolds; and how many mothers feel traumatised by what happens to them, even when, from a medical perspective, it was absolutely necessary. I don't think there are neat answers.

And yet the principle remains important. And how we - as Christians - think and speak and pray about these principles, and how we enact them in our shared life in the Church, remains important.

Interestingly one of the very few direct reflections on consent that I can find in Scripture is Paul refusing to act in the matter of Onesimus without the consent of his owner. Now there's a tangled web for us to ponder!

 

[Quid est Veritas?]

I agree. I must admit I was thinking of issues to do with giving birth, and how one's capacity to consent can change as that process unfolds; and how many mothers feel traumatised by what happens to them, even when, from a medical perspective, it was absolutely necessary. I don't think there are neat answers.

And yet the principle remains important. And how we - as Christians - think and speak and pray about these principles, and how we enact them in our shared life in the Church, remains important.

Interestingly one of the very few direct reflections on consent that I can find in Scripture is Paul refusing to act in the matter of Onesimus without the consent of his owner. Now there's a tangled web for us to ponder!

One must be careful with Roman concepts of slavery. Runaway slaves were returned to their masters or crucified as an example. Slaves were also branded, and even freedmen remained in a client relationship with their former masters. In general, Roman society was weak on individuals, but strong on webs of patronage and obligation. People didn't carry around papers, so if you travelled away from an area you were known, slave or freedman, it was possible to be confused for a runaway. To send Onesimus back to his master, to reconcile them, was the safest option by far; for even if Onesimus was freed, he would still need to prove it as such on occasion, or risk crucifixion.

 

[Peter J Barban]

This question came up today, and I've been challenged to think through what the Biblical and theological basis might be for an ethical imperative for informed consent (for example, in healthcare, but I guess in general).

It seems to me at first blush that Scripture says little about this, possibly because ancient societies were little concerned with the autonomy and consent of individuals compared to ours, but I'd be curious to see what thoughts others have?

You could look at the prophetic ministry that way:

Acts 21:10After we had been there a number of days, a prophet named Agabus came down from Judea. 11Coming over to us, he took Paul’s belt, tied his own hands and feet with it and said, “The Holy Spirit says, ‘In this way the Jewish leaders in Jerusalem will bind the owner of this belt and will hand him over to the Gentiles.’ ”

12When we heard this, we and the people there pleaded with Paul not to go up to Jerusalem. 13Then Paul answered, “Why are you weeping and breaking my heart? I am ready not only to be bound, but also to die in Jerusalem for the name of the Lord Jesus.” 14When he would not be dissuaded, we gave up and said, “The Lord’s will be done.”

God sent the prophet to Paul warning him about the future result of Paul's plans. The brothers discussed what Paul should do, then Paul made his decision rejecting the advice of others and continued to follow his original plans. The Lord's will be done!

It seems in the Bible that prophecy often works like that.

 

[Gregory Thompson]

This question came up today, and I've been challenged to think through what the Biblical and theological basis might be for an ethical imperative for informed consent (for example, in healthcare, but I guess in general).

It seems to me at first blush that Scripture says little about this, possibly because ancient societies were little concerned with the autonomy and consent of individuals compared to ours, but I'd be curious to see what thoughts others have?

"If there is any other commandment" Romans 13

"Anything that is not of faith is sin" Romans 14

Passages with general principles like that might help.

 

[Snoder]

This question came up today, and I've been challenged to think through what the Biblical and theological basis might be for an ethical imperative for informed consent (for example, in healthcare, but I guess in general).

It seems to me at first blush that Scripture says little about this, possibly because ancient societies were little concerned with the autonomy and consent of individuals compared to ours, but I'd be curious to see what thoughts others have?

Scripture says little about it because the issue did not present itself at the time. I am assuming you mean ethical imperative for informed consent to be offering a patient all information available about the risks and effects so that they can make an informed decision.

We face the opposite situation today in that most patients lack the medical knowledge to make an informed decision based on the information they are provided.

 

[-Sasha-]

This question came up today, and I've been challenged to think through what the Biblical and theological basis might be for an ethical imperative for informed consent (for example, in healthcare, but I guess in general).

It seems to me at first blush that Scripture says little about this, possibly because ancient societies were little concerned with the autonomy and consent of individuals compared to ours, but I'd be curious to see what thoughts others have?

I'm surprised I didn't see it mentioned, but the one thing that immediately comes to mind for me when thinking about "informed consent" is "Father, forgive them, for they know not what they do."