Intended for healthcare professionals

Education And Debate

Theories of consent

BMJ 1998; 317 doi: (Published 07 November 1998) Cite this as: BMJ 1998;317:1313
  1. Priscilla Alderson, reader in sociology,
  2. Christopher Goodey, research officer
  1. Social Science Research Unit, Institute of Education, University of London, London WC1H ONS
  1. Correspondence to: Dr Alderson

    This is the third in a series of six articles on the importance of theories and values in health research

    Series editor: Priscilla Alderson

    Consent is understood differently by various disciplines and professions, and also in various theoretical models.1 In this article we review the advantages and limitations of theories about real consent, constructed consent, functionalist and critical consent, and postmodern choice. The article shows how an analysis of theories can clarify practical knowledge about the advantages of and problems in obtaining consent, which will help everyday practice and research.

    Summary points

    Consent is understood and discussed in contradictory ways when people rely on different theoretical models

    Positivism assumes that there is real consent in the factual exchange of medicolegal information

    Social constructionism shows how consent can be a complex, ambiguous process, not a simple event

    Functionalists see consent as a formality, whereas critical theorists see it as a vital protection

    Postmodern theories illuminate the confusions that arise when choice itself is assumed to matter more than any of the options chosen

    Consent is too complex to be explained by any one theoretical model

    Real consent

    Positivism distinguishes factual concepts defined through dichotomies: informed/ignorant, competent/incompetent, free choice/coercion. Medicine, psychology, analytical philosophy, 2 3 and law 4 5 tend to assume positivist concepts of consent. The appropriate information, including percentage risks, for obtaining informed consent is treated almost as a “thing” which doctors give to patients. It is assessed by checking how patients recall and recount standard details of the information they have been given.

    Positivist surveys dominate research about consent; mainly they measure information given. The essence of consent (patients' thoughts, feelings, and values as they evaluate information and make and express their decision) is far harder to observe or record—and too subjective and elusive to count as hard data. Problems in real …

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