This is a presentation for my Medical Ethics course at Bowling Green State University, Summer 2012

1. Informed Consent and
Vulnerable Populations
MEDICAL ETHICS-SUMMER 2012
BOWLING GREEN STATE UNIV.

2. Lecture Goals
 Explain the connection between informed
consent and patient autonomy
 Outline the basic requirements of informed
consent
 Define the concept of a vulnerable population
and explain why it’s more difficult to obtain
informed consent from them.

3. Autonomy and Informed Consent
 Autonomy-the capacity to make choices
about one’s own life, on the basis of one’s
own values and concerns
 Protected by a right
 The requirement that physicians obtain
informed consent ensures (or at least makes
it more likely) that a patient’s choices are
autonomous

4. Why Think Autonomy Matters?
 Mill-In most cases, individuals are the best
judges of what is best for them. Coercion, even
when done for the individual’s own good, is
usually a greater harm .
 Kant-Capacity for autonomy is what makes our
lives valuable. When we cease to have this
capacity, we cease to count as persons in the
morally relevant sense.
 Value Pluralism

5. The Conditions of Informed Consent
 Not all instances of consent count as
informed consent
 Three Conditions
-Competence
-Understanding
-Freely Given or Withheld

6. Competence
 In medical practice, patients are assumed to
be competent.
 Decisions at odds with medical advice are
not, in themselves, evidence of
incompetence.
 Illness, injury, or medication may lead to a
loss of competence.

7. Understanding
 Diagnosis, treatment protocol, risks, benefits, side
effects, aftercare and long-term maintenance, alternatives
 Professional standards tend to emphasize disclosure, rather
than understanding. (Full disclosure, Medical
Community, and Reasonable person)
 Understanding is difficult to measure.
 Difficult to give a neutral presentation of information.
 This can (perhaps) be avoided by explaining the values
which underlie a physician’s recommendation.

8. Freely Given or Withheld
 No such thing as implicit consent in the
medical field.
 Absence of coercion or
manipulation, whether intentional or not.
 Physicians and family members most likely
culprits.

9. Vulnerable Populations
 A group of individuals whose capacity to give
informed consent is impaired or
eliminated, in virtue of their status as
members of that group.
 Examples: Children, disabled, people with
psychological disorders, terminally
ill, prisoners, people who lack a high school
education.

10. Two Common Mistakes
 Race
 Elderly
 These are frequently cited as examples of
vulnerable populations, but they are not.
Nothing about being a member of a
particular race, or being of a certain age, is in
itself an impairment on informed consent.

11. Two Famous Cases
 Willowbrook
Parents of severely disabled children could only
be admitted to the “hepatitis” wing of the
school.
 Tuskegee Syphillis Study
A multi-decade study of syphillis, participants
were all black men living in the rural South.