Saturday, 13 July 2013

Can 'Informed Consent' operationalize the Categorical imperative?

Can  an 'informed consent' procedure- as in Medical practice, where the Doctor has either more information than the patient, or else superior dispassion, thus creating an asymmetry which problematizes a relationist, as opposed to substantivist, Ethics - operationalize the Kantian categorical imperative? Manson & O'Neill say no, but Alasdair Maclean disagrees.
(Vide Autonomy, Informed Consent and Medical Law: A Relational Challenge,  By Alasdair Maclean)

What are the salient features of the Doctor/ Patient game w.r.t Informed Consent?
1) The Doctor, in seeking informed consent for a particular therapy, is- consciously or not-  advancing a particular Scientific Research Program (SRP) in which he has invested all of himself, or indeed borrowed more than he can ever amount to, by reason of an absolute or comparative advantage in specializing in that particular therapeutic practice. This advantage may have arisen by chance or else it might have been acquired through the arduous or aleatory travails of the Doctor's own subjective, Bayesian, trajectory evaluative of different therapies.
By enrolling the patient in a particular therapeutic regimen, a data-set is augmented which privileges the SRP the Doctor himself is professionally invested in. In other words, just by seeking informed consent, a self-regarding element has entered the equation.  To cancel it out would require the Doctor to play Devil's Advocate for alternative therapies, or the null option, at least as well as if he had an acquired, absolute or comparative advantage in each of those therapies and invested exactly the same amount of time and passion on espousing and nurturing each. 
A related point is that it may be the case that different therapies place different weightings on the components of well being and hold different opinions on what symptoms are malign or, indeed, disabling,
This being the case, the very nature of the information/disapassion asymmetry between Doctor & Patient militates for the former's heteronomy. The Kantian Doctor needn't quit Medicine- he could still sign my sick note and prescribe my Viagra- but must give up on seeking 'informed consent' as opposed to simply hanging out his shingle and touting for business like any other tradesman.
2)  The patient's choice of therapist has both a psychological and a physiological effect. It may be that there is a trade-off between short-term dysphoria and long term physiological healing such that the Quack is initially more effective than the Doctor. If the Patient's 'time preference' is an objective datum, does a Kantian Patient have a duty to consult the Quack and tell the Doctor to go hang?  Clearly, 'time preference' itself would be determined by life expectancy. However, the certainty of imminent death might lead to meta-preferences dominating the decision process in an unpredictable way.
Both the 'Doctor's dilemma' & the 'Patient's trilemma'- which relate to hysteresis effects arising from information exchange- militate for a mixed strategy or, what cashes out as the same thing, some internal psycho-drama whose output is stochastic. This means that 'informed consent' looks operationalizable but only at a macro level leaving Kantian relationism pointing mutely at Tardean mimetic heteronomy.

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