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Some people argue there is a further condition. 5. Moral Acceptability Condition: the content of the consent is morally acceptable.
This condition of valid consent says that the content of the consent is morally acceptable. It looks simple and uncontroversial, but that is mere appearance. Part of the role of consent is to change previously wrong things into permissible things.
Ex.1: It is wrong for you to punch me (without consent). However, if I and you consent to having a boxing match, then it becomes permissible for you to punch me during the match. Ex.2: Even if you are a doctor, it is wrong for you to cut me with knife (without consent). However, if I consent to your operating on me with knife, it becomes permissible for you to do so.
Thus, the condition the content of the consent is morally acceptable implies (1) that ones consent to certain things e.g., killing him, enslaving him cannot make them permissible, and (2) that the content of the consent in question is not any of those things. (1) is controversial: is this consistent with respect for ones autonomy, and if not, how can one justify that?
A consent comes from coercion if the consentor makes the consent due to violence or threat by other persons. Ex.: a gravely ill patient is told that unless he agrees to further treatment, other palliative measures to limit his discomfort will be withdrawn. If the patient consents to the further treatment due to this remark, the consent is invalid. (Brock, 117) Threat (as in the above example) must be distinguished from mere warning. To make a threat, one needs to directly or indirectly express the intention to do or allow the unwanted consequences. If a doctor merely informs the patient that the unwanted consequences will come from the patients alternatives, it is only a warning and not a threat. (Brock, 118)
Coercion
Lousy Situations Are Not Coercions (in the Relevant Sense) (Brock, 118)
There are situations where one must consent among unpleasant and unwanted choices between bad alternatives. Ex.: the situation where painful chemotherapy is the only treatment for an otherwise fatal cancer. Some people say that the consent in such a situation is coerced. However, unpleasant and unwanted choices between bad alternatives are not themselves coercive in the relevant sense: they are neither the uses of violence nor treats by other persons. The consent among such choices still reflect the preferences of the consenter, so accepting it as valid will respect the consenters self-determination.
Manipulation: Examples
subliminal advertising posthypnotic suggestions made to non-consenting subjects brainwashing getting someone drunk or drugged before a decision bribes appealing to a persons weaknesses pressing a person for consent when the person is distracted imposing on the persons good nature (e.g., using the pressure from kids, families etc.) playing on a persons neurotic guilt feeling coloring certain options black (or bright) by insinuation
Rewards, offers and encouragements can work as forms of manipulation. Ex.: Medical professionals deal with abnormally weak, dependent and surrender-prone patients, e.g., bedridden patients. Suppose with rewards, offers or encouragement, the professionals contribute to or play on such patients desperation, anxiety, boredom, or other emotions or pandering to their hope of more attention and better care. The professionals eventually get the consent to the medical treatment they recommend from these patients. Is this consent valid? You might find this case unproblematic. However, remember that a main point for giving patients the authority to consent about their medical treatments is that the chosen medical option will probably be the best for them. Attaching rewards, offers and encouragements to some but not all options might well undermine this point.
If a person consents to an apparently crazy thing, e.g., to apparently very bad for him or her, may we judge him or her to be incompetent for this very reason? Brock reject this in medicine on two grounds. 1. If doctors do this, it risks abuse and unwarranted denial of patients self-determination on the pretense for their own good (well-being). 2. The objective theories of well-being is mistaken, and some sort of preference theories is correct. So, we cannot criticize a persons decision about his or her well-being using external or objective standards. As the second ground suggests, this issue partly depends on which theory of well-being is correct.
About the types of consents that every person (with competence) has the authority to give on his or her matter, people who have the information necessary for his or her informed consent are morally obliged to provide the information. The point of this requirement is to enable people to make decisions effectively as well as to protect them from the harms from their uninformed consent. Thus, medical professionals are required to provide patients with the info on the alternatives of their treatments; lawyers are required to provide clients with the info on their legal alternatives; potential lovers are required to provide each other with the info on the expected results of having relations; and so on.
When is it justified to avoid the process of acquiring a valid consent? (124: Q5)
Many argue that there are four situations: 1. (Legitimate) therapeutic privilege is operative. (There is strong evidence that the disclosure of relevant information by itself would cause serious harm to the patient.) 2. The person is incompetent and will not be competent. 3. The person has voluntarily and competently chosen to defer to others (their families or professionals) after being informed that the patient has the authority to give a consent. 4. Emergencies, where failure to make urgent care would likely result in grave consequences, and obtaining the persons consent is either not possible or would delay the rendering of that care.