Alderson, P; Sutcliffe, K; Mendizabal, R; (2019) Dialectic and informed and voluntary consent: the pulse of freedom. Presented at: International Association for Critical Realism (IACR) 22nd Annual Conference, Southampton, UK.

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Abstract

The pulse in the title Dialectic: The Pulse of Freedom (Bhaskar, 2008) suggests a beating heart, and consent is at the heart of freedom. Its absence is at the heart of coercion. From personal to political, marriage to the vote, consent threads through daily interactions. Consent may be respected or not. A mouse click ‘consenting’ to cookies may join thousands of individuals’ clicks used by agencies for advertising or for fixing elections. The agencies may bypass consent when they rely not only on the first uninformed, unthinking click, but also on the half-attentive skimming of messages when readers may scarcely notice how these can alter their beliefs and behaviours. Consent to medical treatment or surgery is a major topic in bioethics, and the topic of our research. Yet we also aim to understand the meaning and purpose of consent more broadly in personal and political contexts. Our paper reviews how critical realism can help to deepen analysis, first of consent and second of why consent matters when it is more than a cerebral or arbitrary choice but expresses powerfully held values. This discussion paper is based on earlier research about parents’ consent to children’s heart surgery (Alderson, 1990) and related current research (Sutcliffe et al., 2019), children’ consent to orthopaedic surgery (Alderson 1993), children’s share in managing diabetes (Alderson et al., 2006; Sutcliffe, 2010) and parents’ decisions about neonatal care (Alderson et al., 2005; Mendizabal, 2017).

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