Considering Consent–A First Step

The role of consent in parenthood is one that I’ve been meaning to discuss in so many different contexts, and yet each time I’ve steered away from it because it seems so tricky to tackle such a broad and variously recurrent issue.   But I suppose there is no time like the present.    Before I deal with any specifics, I want to lay out some big picture points.   That’s what makes this post just a first step.  

 Generally speaking, there is nothing wrong with the idea that autonomous individuals need to give their consent freely before certain sorts of things happen.  People give consent before undergoing surgery, or before having the pictures used to promote products, or before engaging in sex.  

Further, it makes complete sense that in certain contexts individuals should be informed about options/consequences/risks before deciding whether to give consent.    This is particularly true when those consequences are not obvious.   For this reason, informed consent is particularly important when it comes to medical care, although it hasn’t always been that way.    (See The Immortal Life of Henrietta Lacks for a look at a not-so-distant time when informed consent was not understood to be necessary.)    

Some of what goes on in ART is in the nature of medical care and so the need for informed consent is apparent.  I’m thinking here, for instance, of harvesting eggs.    I’ve been thinking about the nature of this consent for some time. 

But not all aspects of ART are medical care–think of collecting sperm.    This doesn’t mean we don’t need to think about consent, however.   And perhaps even informed consent.   If you look back at what I said at the beginning about consent  you ‘ll see that the need to consider consent isn’t limited to procedures identified as medical.    Sexual activity, for example, has to be consensual else it is criminal.    Given that pregnancies are generally the result of either ART or sexual activity, it would seem that issues of consent are universal.         

There is, however, one substantial reason why raising issues of consent make me wary, and that is the way the notion of “informed consent” has been used in abortion debates.   Abortion is clearly a medical procedure and thus, the appropriateness of requiring informed consent at the outset is clear.   But it is equally clear (at least in my view) the people opposed to abortion have used the mechanism of informed consent to prevent women from choosing to have abortions.   Perhaps the least controversial thing I can say is that both the information that must be conveyed to a woman in order to ensure informed consent and the manner in which it is conveyed is hotly debated.    

It’s not my intention to enter into the abortion debate here and am not inclined to post comments directed to this point, just to you know.   I raise the topic because it seems to me that there is a distinct possibility of the same  dynamic recurring in a discussion of informed consent with respect to reproductive matters.   I see, for example, that we might argue about what information must be provided to an egg provider in order to ensure that her consent is properly informed.   Some people may enter this discussion in the hope of improving the outcome for women who provide eggs while the goal of others may be to dissuade all women from providing eggs.      

But ultimately this concern–that others may seek to use informed consent as a vehicle to discourage participation–is not a reason to ignore the subject of consent.  It’s just something to keep in mind–perhaps to watch for–as the discussion gets going

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5 responses to “Considering Consent–A First Step

  1. ART should do more to separate the informed consent given by sperm and egg and embryo providers who voluntarily allow other people to raise their offspring as if they were their own, from customers who have every intention of raising their own offspring and have no intention of relinquishing their parental authority/obligations/rights over their children even if the conception was a laboratory accident with another clinic customer who they’ve never met. Lack of consent needs to count at least as much as consent itself counts in equal but opposite directions. If someone else who gets my point could please say that better than me I’d appreciate it.

  2. Informed consent should give the scientific and legal facts using text book language. People have to draw their own line in the sand about morals and ethics when deciding to do or not do something that is allowed by law.

  3. HA! Informed consent is RARELY practiced and not only in ART. I can’t tell you how many of my patients HAVE ZERO CLUE why they had a cesearean section for example, or what medications they were given, the list goes on.
    (then again, I deal mostly with lower socioeconomic folks so my experience may be skewed….)
    Many people have NO CLUE and never read the consent forms they sign…
    But the official parameters for informed consent are pretty clear. You need to tell the patient the reason for the treatment, the goal, potential adverse effects and risks, risks of NOT accepting treatment, and alternatives to the said treatment. Seems pretty straightforward.

    • When I went to get my flu shot this fall I signed a form which I’m fairly sure was an informed consent. The thing is, I didn’t bother to read the form. I don’t think this is all that unusual. Is there still a point to giving me the paper? Perhaps. I theory I could decide I wanted to be informed. But there is some fiction involved in the idea of informed consent, or even consent more generally.

      • Clearly there is some purpose to it. The doctor has to protect herself/himself from being sued if something goes sideways. I admit to not reading that stuff either, but that is our choice, we had the opportunity, we chose ignorance in order to be expeditious. Someone told me once (which I know is worthless) that if you have to sign something and don’t have time to read it thoroughly you can put the initials U.D. next to your name to indicate that the document was signed under duress so that you could sue saying you did not know. Seems silly to me though, kind of childish. Wonder if its true.

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