Examining consent within the patient-doctor relationship

The notion of consent which rose to the forefront in biomedical ethics as a n attempt to safeguard patients' autonomy, is relatively new. The notion it self requires qualification, for it precludes neither duress nor ignorance. More seriously, I argue here that consent is redundant except in situation s where paternalism prevails. Paradoxically, these are the very situations where it may be difficult to uphold or to verify voluntary consent. I sugge st that a request-based relationship has the potential to overcome these di fficulties. It enhances patients' participation in decision making, require s that the patients remain in command and avoids their subordination. Reque st is also more conducive to treatments that are representative of patients ' own values and perceptions. In practice, what one wants and what one agre es to, often concur. But these are not conceptually identical issues, and t hey carry important differences of emphasis.