A paper in the Journal of Medical Ethics argues that informed consent should be understood as something clinicians help build, not a single moment of disclosure.
A paper in the Journal of Medical Ethics proposes that informed consent should be reframed using the idea of autonomy 'scaffolding', borrowed from philosophy. The authors argue that current consent practices often treat patients as if their reasoning happens in isolation, when in fact good decisions depend on support from others. This reframing, they write, can justify existing ways of helping patients decide, suggest changes to how and when consent is obtained, and point to a role for technology in supporting decisions, including in high-stakes cases such as termination of pregnancy.
The paper is a conceptual analysis: the authors apply philosophical accounts of scaffolded autonomy to medical consent and compare this approach with existing models of the doctor-patient relationship and with relational autonomy theory.
The authors are careful to state what their argument does not mean. They caution that protecting autonomy in difficult decisions should not require removing all outside influence; instead, such decisions should be "protected from undesired influence", a narrower and more workable aim.
For clinicians and students, the practical lesson is to see consent conversations as building decision-making capacity together with the patient, rather than as a one-off exchange of facts, and to ask which influences on a patient's choice are helpful and which are not.
