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Education And Debate

Previous refusal of consent may not be relevant

BMJ 1997; 315 doi: (Published 06 December 1997) Cite this as: BMJ 1997;315:1532
  1. Arthur L Caplan, director (,
  2. John Hansen-Flaschen, chief, pulmonary critical careb
  1. a Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA 19104-3308, USA
  2. b Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
  1. Correspondence to: Dr Caplan


    Over the past three decades informed consent has become an extremely important aspect of the clinical management of patients. Allowing patients to control the nature and extent of the care they are given has become an inviolable moral value. Patient autonomy takes precedence over both professional beneficence and the contrary wishes of others. Any decision to violate a patient's wishes would be condemned as intolerable paternalism at best—and manipulation, coercion, or even assault at worst. Why then does this patient's case pose a moral problem?

    Autonomy and the incapacitated patient

    The moral problem arises because informed consent is often not a reliable guide in the care …

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