Informed Consent and the Ick Factor

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Wired News has a fascinating article on face transplants. It contains an interesting statement. Some doctors have suggested that the novelty of the surgery and the lack of certainty on what risks even are make informed consent impossible. I commented on Jonathan Ichikawa's post about this, pointing this out, wondering what they might have meant by that, and his response struck me as equally unusual. He thinks this is an attempt to make a philosophical argument out of an ick factor. Is that really what's going on? What does this statement about informed consent amount to? I have some thoughts, but I really wanted to see what people think about this without my suggesting anything.


Generally speaking, informed consent requires that the patient be capable of making a sound decision, have the moral standing to make the decision, and possess the information and understanding needed to make the decision.

In the case of face transplants, the risks – both physical and psychological -- are so completely unknown that it is impossible to provide adequate information needed to make an informed decision about the treatment. By saying that “informed consent is impossible��? I suspect that they are implying that since the patient is volunteering to be experimented on, there is no real way of knowing whether they are making a rationally informed decision. Essentially, it’s like saying that anyone who would risk the surgery must be crazy, therefore a patient that would consent is not of completely sound mind.

If this is the argument, then I think it's pretty bad. It's never rational to undertake risks when you don't know what the risks are? That seems unduly paternalistic. After all, if I'm not particularly risk-averse, then why shouldn't I go after the possibility that the risk -- and the eventual cost -- turns out to be pretty low?

But doesn't your objection apply to any case where there's putative consent but not rational consent? Someone may be particularly risk-averse by being affected by the date rape drug, for instance. Is that paternalism? Sure. Is it still worth keeping as a moral and legal factor? Why not?

I'm afraid I'm not seeing the point. I agree that if someone's rational faculty is severely compromised, this interferes with his ability to give consent in the relevantly important sense. Do you think that's what's going on in this case? Why?

I thought the claim in the article was that it's not rational consent because you don't have much of a clue what you're consenting to. Maybe that's an exaggeration, because they seem to list in the article itself what some of the risks are. That's not the criticism you're giving, though. You're saying that you can be rational in consenting to something when you don't know much at all of what the risks even are. The thing in common to both cases is that someone isn't able to grasp the nature of what's being consented to, either because of impaired judgment or because of complete lack of information.

Consider a gambling scenario. Leave it open whether high-stakes gambling is rational. I don't happen to think it is. (I don't defend Bill Bennett on everything!) Even if it's rational to consent to it knowing that the risks are high, is it rational to consent to a gamble when you have no idea what the risks are. You don't know how much you're betting. You don't know what the chances of winning and the chances of losing are. For all you know, it could be more money than you have with a chance of winning that's something like one in a trillion. It doesn't seem at all rational to consent to such a gamble, not matter how risk-averse you are.

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