Democracy and Informed Consent

Dissertation, Michigan State University (1990)
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Abstract

Two aims of this dissertation are: to describe the American experience of informed consent to the Japanese audience whose medical practice, despite its successes in health care, is feudal in terms of physician-patient interaction, and to make an appraisal of informed consent as a part of the theory of participatory democracy. ;Informed consent is a medical practice that requires a physician to disclose necessary information to a patient and obtain consent from the latter with regard to her proposal of a diagnostic or treatment procedure. Consent makes sense only when it is the result of understanding and voluntariness. So, the real message of informed consent is its democratic nature, namely patient's participation in medical decisionmaking against traditional medicine where a physician has been the sole decisionmaker. ;In the first chapter I discuss Japanese medical practice that needs informed consent. The second chapter deals with the American history of informed consent and compares the legal doctrine and ethical idea of informed consent. The third chapter attempts a philosophical reconstruction of informed consent. It deals with the conversation model of informed consent suggested by Jay Katz and the spectrum of understanding from the informational level through the hermeneutical level to the shared decisionmaking stage. The legal doctrine concerns mainly informational understanding. Hermeneutical understanding attains ethical goal of commonality in the fusion of horizons . Democratic understanding is directed to the solution of problems by way of common understanding and shared decisionmaking . Informed consent should mean shared decisionmaking realized only in the conversation model instead of indifferent medicine that informational understanding implies or of hermeneutical medicine where decisionmaking is still in the physician's hands. Consistent claims throughout the dissertation address the efficacy of language use in mutual communication and the idea of participation. The final chapter deals with participatory democracy in which social policies as well as ethical norms are placed in the open, the practice of informed consent being no exception. Our final discussion concerns social conditions that could make informed consent work. It includes proposals for public policy for informed consent

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