Decision-making is a prominent theme in this edition of the Journal of Medical Ethics. Our feature article examines the relationship between trust and informed consent. Informed consent is, of course, central to the decision-making process in medicine. In addition, several articles consider decision-making in medicine from a variety of angles.

Informed consent and trust: Eyal's argument

In our feature article, Nir Eyal attacks attempts by bioethicists including Onora O'Neill, Torbjörn Tännsjö, and Jennifer Jackson to ground the importance of informed consent in its role in safeguarding trust in medical practice (see page 437, Editor's choice). The trust-promotion argument for informed consent, as Eyal terms it, states (1) that trust in medical practice is necessary to ensure that people seek and comply with medical advice and participate in medical research, (2) that as a result it is ‘usually wrong to jeopardise that trust’, (3) that violations of informed consent jeopardise that trust, and (4) that standard informed consent requirements are therefore justified.

Eyal makes explicit that this argument is consequentialist: it takes the value of informed consent to lie in its role in ensuring trust in medical practice; in turn, trust is instrumentally valuable because it promotes health through use of the medical system, compliance with treatment, and participation in research (for brevity, I'll refer to these desirable practices as ‘effective use of medicine’). The consequentialist trust-promotion argument, Eyal observes, differs from deontological trust-based arguments, which defend respecting informed consent requirements with reference to factors such as its being an appropriate way of honouring the trust that patients place in doctors.

Eyal attacks the trust-promotion argument on the ground that it does not account for some commonsense intuitions about informed consent. He argues, to cite one of the many problems he raises, that secret breaches of informed consent—for example, treating patients while they sleep—would …