(Disclaimer: these are merely my notes on the Baroness’s lecture, and therefore not necessarily an accurate summary of what was said. This version in the J Med Ethics of a symposium on the limits of informed consent may be more useful >>> click here)

The three traditional concerns of medical ethics described by a medic as referrals, confidentiality & billing! Enormous changes in medicine (technology, budgets, expectations) led to a rejection of self-regulation and calls for accountability.  Important expression of the shift: David Rothman’s Strangers at the Bedside [link to review in Medical History]. A new era of thinking on ethics emerging in the 70s/80s saw a rejection of paternalism as a model for medical practice. The trap of professional capture: whereby the needs of the regulated inevitably win out over those of the public in any system developed by the professionals themselves.

Public accountability has taken over as a principle determining obligations (especially second order ones); an auditing process such that all stakeholders can be satisfied. However, problems arise in relation to patient consent: a almost “mindless” pursuit of anti-paternalism ideals. Patient consent is the goal of the consent procedures, but there are limitations: to protect against coercion, deception, manipulation etc.

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