Essay first part

Nowadays, it is widely agreed that decisions about medical care or treatment should not be taken without the patient’s informed consent. However, history abounds with instances of doctors treating patients in ways they might would not have consented to if they had been asked and properly informed. Discuss the circumstances under which non-consensual practice has taken place in the past, and explain how and why this has come to be seen as unacceptable in the present.


The extent to which a person can make an informed decision relies on two key factors. The amount of information available at the time, and the amount of information shared with the person. While a person can be fully informed of any knowledge available, the amount that is known can be limited. In this case, a person may appear to be making an informed choice, but actually is not. Whereas, when a person is not made aware of all available knowledge, then they certainly have not made an informed decision. In terms of consent to treatment, informed consent has become a standard to which all medical practitioners must adhere. However, the extent of information deemed necessary for the patient has changed over the years. As medical knowledge has improved, the dynamic between doctors and patients has changed. The focus of these changes will be from the late eighteenth century until the present day, as accurate medical records from before that time are hard to come by.


In order to understand what non-consensual practice means, it is important to define consensual practice. Consent can be given in a number of ways. It can be implied, expressed directly, and decided upon unanimously for a group by general consensus. The situations these arise within medical practice are covered within this essay. Additionally, in legal terms, some people are deemed unable to give consent. Consent can either be given by others responsible for them, or they are categorically unable to consent to certain acts. This is also covered within. There are situations where a person can give consent but not fully comprehend what they are agreeing to, or what the implications to agreeing entail. This grey area is intertwined within all forms of consent listed above, and as such occurs repeatedly within the changing ideas of consensual practice over the years.


Understanding of the human soma was limited in the later eighteenth century. Patients were considered one entity and all ailments were thought to be solvable in one all-encompassing way. Each patient was viewed as an individual, and no uniformity was recognised between all people. Patients were treated as such. There were many theories, but none were scientific. Patients had full control over who would cure them, and with what methods. Without a proper understanding of human physiology, doctors were forced to prove themselves by “curing” patients in dramatic and obvious ways. Consent was given in the sense of doctors earning a reputation beforehand of creating observable results. Due to the limitations of working knowledge of human physiology, this was as informed as a patient could be.
By the turn of the nineteenth century, the attention had shifted to determining causes for ailments. Practitioners shifted attention from how to cure people, to understanding the different parts of the body, how they relate to each other, and the ailments that occur. Alongside the increased focus on pathological anatomy, patient-doctor dynamics began to change with the accumulating knowledge. As doctors knew more than before, and now much more than the patients, the power to make decisions shifted away from the patients, to the practitioners. Patients had choice, but it was starting to be limited to whether to carry out a procedure or not, not which procedures they wanted undertaken.
Towards the middle of the nineteenth century, the focus of medical understanding had shifted again. Knowledge of the body had been furthered and research had become centred on what made organs work the way they do. Tissues had been broken down and better understood, and these new learnings were combined into the universal, cell theory source. With this the mentality of researchers changed. Patients became subjects for study and no longer individuals. Medical knowledge was strengthening, but at the same time the procedures used by doctors had advanced at a much slower rate. Patients now had very little say on the procedures being used. Many of the known procedures were being shown to be fruitless source. The power of decisions lay ever more so with the researchers and practitioners, and patients options were extremely limited.



Nearing the end of the nineteenth century, more and more surgical procedures began to be attempted. Just as with the developments within the earlier parts of the century, this was a result of increased knowledge of pathology. However, patients began to have more of a say again. Surgery became an option that could be undertaken, but at great risk. Although there were still few options compared to today’s standards, the ability to assess the risk of a life or death decision began resting on the patient.
The dynamics of the relationship between doctors and patients was still shifted towards furthering medical knowledge through research. It became pertinent to continue studies, while getting the consent of patients. Doctors had to be sure to inform patients of the risks, not only due to potential complications, but also the high costs associated with undertaking surgeries.