The concept of consent is fundamental in advanced societies such as those of Europe and North America. In my opinion, we can divide it into three main categories: 1. ‘Ordinary’ consent (present in everyday life and in business settings), 2. ‘Recreational’ consent (applicable especially in sexual relations and in sport), and 3. ‘Medical’ or ‘vital’ consent (specific to the medical field and healthcare). Here I will focus on the latter.
Initially, this article was going to be titled ‘(More) Informed Consent’ because I conceived of it as an extension of another work on the same subject published in 2018: ‘(Semi)Informed Consent’. In that piece, I highlighted how, when signing this type of consent form, the information provided to the patient is usually only qualitative, not quantitative, and therefore it is difficult for the patient to make an adequate assessment of the risk they will assume when undergoing certain diagnostic tests or surgical procedures. That information might be something like: ‘Side effects are very rare’ (?).
My reflection on ‘(more) informed consent’ stems from the fact that an essential piece of data is concealed from people who are about to undergo surgery for some medical condition or other: how many patients will the surgeon operate on that day. If the person concerned asks for this piece of information, they will be told that it is an internal matter for the hospital. However, being the first or third is not the same as being the ninth or tenth. That is why I propose that this piece of information be provided to anyone who requests it, so that they can consider, in the event of being among the last, if perhaps it would be better for them to postpone the operation and be among the first at a later appointment, in which the surgeon will be less tired when it comes time to cut into the patient’s body with a scalpel. Regarding this sensitive aspect, we cannot overlook that informed consent must be based on sufficient, truthful and understandable communication.
I am aware that, over the years, I have gone further in my conclusions on this matter. As patients we proceed under ignorance of the real risk we run. Although we are provided with quantitative information on the danger we face, this is given in the form of probability; that is, chance. Probability and chance are not exactly the same, though they closely resemble each other. Both terms are euphemisms for ignorance, since they denote nothing else, albeit to different degrees. Probability is mathematised ignorance, with a certain limit that is expressed by percentages; chance is, prima facie, absolute ignorance due to which it cannot be expressed in any way.
Let's look at an example. If we are informed that the probability of dying as a result of a heart operation is 10%, that means that it is unknown, at the individual level, who will die and who will survive. For the person who is going to be operated on, it is almost the same as not knowing anything. The lack of knowledge, the ignorance is evident but not absolute. Transcending it is a matter of research and time.
The Royal Spanish Academy defines ‘change’, or ‘coincidence’ as follows: ‘A combination of circumstances that cannot be foreseen or avoided.’ On this understanding, if a citizen takes a train, it derails, and he dies, everyone will accept that the accident was due to unforeseeable and unavoidable circumstances, which occurred by chance. However, when a rigorous investigation is conducted, it is discovered that the catastrophe took place because a rail snapped at the same time the line of train cars passed overhead. That broken rail could have been avoided if the necessary checks had been carried out beforehand. This reasoning can be applied to the consequences of any accident or tragedy that may befall us: from the explosion of the Space Shuttle Challenger to property damage and deaths caused by flooding during a DANA storm. All of them due to chance, to ignorance; an ignorance not essential, but remediable.
Because of the phenomena that I have just mentioned, with respect to informed consent I understand that the reader will be able to reach this conclusion: that in the healthcare field it is not possible to base consent on the principle of autonomy of the will because the ‘not-me body’ exerts coercion over the ‘me-being’, on whom our will depends; it is a coercion imposed by the very fact of being embodied and imprisoned within our body, without which the survival of the self is not feasible.
However, at bottom, this conflicting ‘body-being’ dynamic derives from the fact that we have to give our consent not only based on what medical science knows, but also on what it does not know (which is infinitely greater than what it knows). The two aspects together, rather than informing and reassuring us, intimidate us and make it impossible for us to make a free decision, vitiating consent and transforming it into submission.
I'll put it more simply. Those who, with their signature, accept a risky medical act (with ever unforeseeable consequences), do not do so by virtue of the autonomy of their will (that is, out of conviction); on the contrary, they do so by virtue of intimidation: out of fear; therefore, they do not consent, they submit. In the field of health and survival, except in extreme cases, our autonomy of will only acts with total freedom when we deny consent, no matter how informed it may have been.
These are the reasons why I propose changing the name and that ‘informed consent’ be called ‘informed submission’.