Informed consent is the most discussed, indeed the most hackneyed, theme in bioethics. Yet many widely accepted accounts of informed consent are riddled with problems. They offer justifications that are less than convincing, and set standards that are less than feasible. In this book we have proposed a new way of thinking about informed consent. We believe that our approach offers a more convincing account of informed consent, of reasons why it matters and of standards it should meet.

We looked first at widely accepted accounts of informed consent requirements, and found that they typically propose exaggerated and impractical standards. Unsurprisingly these standards are routinely flouted and ignored in biomedical practice. While some ‘failures’ arise because clinicians and researchers do not live up to standards that they could have met, many arise because the standards advocated propose – or presuppose – inaccurate, excessive or even impossible views of informing and consenting. We identified three possible responses to these mismatches between aspirations and realities.

The first response would be to look for lower, more practicable, standards that could be satisfied either by current practices, or by making feasible changes in those practices. The second would be to reaffirm current standards and continue with current clinical and research practices, in the full knowledge that practice and standards diverge, and that there is no prospect of patching matters up by introducing a few favoured ‘improvements’.