Informed consent is held as the ethical and legal bedrock of clinical practice and research involving humans, though there is ongoing debate about the extent to which it is attained. A paradigm of consent focusing on individual autonomy and self-determination is dominant. With increasing numbers of litigation cases and professional guidelines, attention is focused on the question: Has informed consent been achieved? This paper takes an alternative perspective by investigating consent in practice in genetic contexts, exploring how professionals discuss consent and how it unfolds during encounters.

I draw on data from semi-structured interviews with professionals responsible for seeking consent (n = 28) and observations of encounters where consent was sought (n = 27). Rhetorical discourse analysis, involving micro-examination of the discursive devices drawn on by participants in their talk led to the central finding of accountability; that is, how consent is negotiated through often competing discourses of respect for autonomy and the responsibilities of relevant parties. This frequently gave rise to tensions in the accounts, which I will explore in relation to the themes selected for detailed analysis (negotiations of informed consent; constructions of motivations and concerns; handling risk and uncertainty; professional challenges). I argue for a movement away from the impasse in discussions within the dominant paradigm of consent and suggest that opening up a dialogue that conceptualises consent as an interactive process involving complex moral negotiations within relationships is a more fruitful way forward.