The Consent Dilemma

 

Image courtesy ICT works

Lately, gentle reader, we've been hearing a great deal about consent.

The discussion has generally been about consent for sex, against the background of a high profile incident in parliament house, the awarding of Australian of the Year to Grace Tame, and school students becoming active about the issue.

But consent operates in a range of other contexts, notable amongst them the use of personal data. How often have you given consent for your information to be shared online, and how much thought do you put into that question? Look at the image above to get a handle on the complications.

Now we're hearing about consent in relation to medical matters, specifically the AstraZeneca vaccine. I had the first dose back in mid-April, with no ill effects. The flu vaccine, on the other hand, left me with a very tender left arm for a few days. 

I needed no persuasion to have either, so consent was not an issue, but in the past, it has been.

Many years ago (1982) my bride and I lost our first baby (full-term) through stillbirth. A post mortem revealed the cause was a cerebral aneurism, the consequence of a minor malformation which meant the baby could not survive the rigours of birth.

We were asked by the obstetrician at a debriefing appointment after my bride's discharge from the hospital whether we were planning to have more children. When we answered in the affirmative, he suggested that future births should be cesareans.

We made no decisions at the time, but went home and discussed the suggestion at length. It was clear that my bride did not want to go down that path, so we went back to the doctor, and asked him to explain simply the dimensions of the risk we were managing. He said that there was an 80% likelihood of safe childbirth.

Put this way, it was easier to make a decision, which was to opt for normal delivery, and four healthy babies later, that worked out well. What the experience did for us, was to highlight the issue of consent, and which player (or players) in the scenario have the right to provide it.

I was reminded of consent again when completing my St John's CPR refresher the other day. The instructor reminded us that first aid cannot be provided to a conscious lucid individual who refuses it. 

I hope I'm never put in that situation.

Now we have National Cabinet deciding that the AstraZeneca vaccine can be provided to people under forty if they give informed consent. Again, that consent needs to be weighed against the background of a risk/benefit analysis. 

Sometimes I think that the medical profession has a problem with allowing consent to be the prerogative of the patient, and I'm sure I understand why. It must be mortifying to know that the decisions the patient makes may not be in his/her long-term interest. It must butt up against the "first do no harm" principle something fierce.

Consent is also a critical factor in any discussion about euthanasia, but maybe I'll look at that another time.

In summary, medicine, whilst a noble profession, runs the risk of assuming a power it does not have. I'm talking about the "playing God" cliche.

I hope my GP brother doesn't read this.