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Dr. Hannah Shipman
School of English, HKU
When is consent not consent? Medical Ethics-in-Interaction

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.