Scaffolding Informed Consent

Scaffolding Informed Consent
Extended Essay
Dominic Wilkinson, Neil Levy
Journal of Medical Ethics, 20 December 2024
Abstract
    The principle of respecting patient autonomy underpins the concept and practice of informed consent. Yet current approaches to consent often ignore the ways in which the exercise of autonomy is deeply epistemically dependent.

In this paper, we draw on philosophical descriptions of autonomy ‘scaffolding’ and apply them to informed consent in medicine. We examine how this relates to other models of the doctor–patient relationship and other theories (eg, the notion of relational autonomy). A focus on scaffolding autonomy reframes the justification for existing ways of supporting decisions. In other cases, it suggests a need to rethink how, when and where professionals obtain consent. It may highlight the benefit of technology for supporting decisions.

Finally, we consider the implications for some high-stakes decisions where autonomy is thought to be critical, for example, termination of pregnancy. We argue that such decisions should not be free from all sources of influence—rather they should be protected from undesired influence.

Excerpt
…In what we might call a socially supported model of decision making, individuals make their decisions with input from others. They seek opinions and advice from family and friends, and information from medical professionals, and then attempt to weigh that information in coming to a decision that reflects their own values and outlook. Such socially supported decisions are very plausibly better for the input of others: a broader range of considerations are brought to bear than the individual could marshal on their own. But the final decision-making reflects cognition that is fully the individual’s own. Properly scaffolded models, however, go beyond socially supported models. On the latter, decision-making reflects cognition that is distributed across agents and across the environment. Scaffolded autonomy draws its inspiration from distributed models of cognition…