Abandoning informed consent?

Editor’s Note: Kirsten Bell was invited to contribute this post based on her recent American Anthropologist article, “Resisting Commensurability: Against Informed Consent as an Anthropological Virtue.”

Kirsten Bell

Department of Anthropology

University of British Columbia

 

There’s a courtroom scene in Rob Reiner’s film A Few Good Men (no, not “you can’t handle the truth”) where a physician has just provided damning testimony against the clients of Lieutenant Daniel Kaffee (Tom Cruise), Lieutenant Commander JoAnne Galloway (Demi Moore) and Lieutenant Sam Weinberg (Kevin Pollack).  Kaffee lodges his objection to the physician’s testimony and the judge overrules it.  Galloway then “strenuously objects”, which merely causes the judge to dig in his heels.  Afterwards, an annoyed Weinberg says to Galloway: “I strenuously object?  Is that how it works?  Hmm?  ‘Objection’.  ‘Overruled’.  ‘Oh no, no, no.  I strenuously object’.  ‘Oh, well, if you strenuously object then I should take some time to reconsider’”.  His point is that the formulation is both redundant and absurd.

In this post I want to consider another absurd redundancy, namely “fully informed consent”.  However, while “strenuously objecting” has never caught on as a legal strategy, “fully informed consent” makes an appearance in everything from the Stanford Encyclopedia of Philosophy to the AAA Code of Ethics (see “be open and honest regarding your work”).  Surely, consent is either informed or it isn’t, so why the qualifier?  In my view, its addition reveals the central problem with the concept itself, namely, that while it seems self-evident and straightforward, the more deeply you look, the murkier it becomes.  That vapid adverbs have been piled on in the hopes of clarifying its meaning (what’s next? “Really, truly informed consent”?) suggests that we are dealing with the fallacy of misplaced concreteness.

It’s worth bearing in mind that “informed consent” is a hypothetical construct.  Even the Belmont Report, the document responsible for enshrining the doctrine as part of a Holy Trinity of universal ethical principles, was hedging its bets on whether it was, in fact, possible.  As others before me have noted, it becomes especially meaningless when applied to anthropological research.  What on earth does it mean to state that, “Anthropologists have an obligation to ensure that research participants have freely granted consent”?  Freely granted consent to what?  To be studied?  To be written about?  (These are not the same thing.)  And how can one share “the expected outcomes [and] anticipated impacts of the research” when these are unknown at the outset?  Again, statements like these might seem self-evident, but upon closer inspection appear to be rather empty.

These are not new concerns.  What is relatively new is the AAA’s embrace of the informed consent doctrine 16 years ago and the lack of debate the concept engendered in the recent online discussions about the proposed revisions to the Code of Ethics