Consent v. Assent: Getting Permission from a Protected Person
photo credit: Yogendra Singh
One of the hallmark ethical principles for medical providers is “autonomy,” or allowing individuals to freely choose what types of services they receive, or whether they want to receive any type of treatment at all.
Choosing to go into therapy or choosing one’s therapist is extremely important. Choosing whether to have surgery or to undergo chemotherapy: those are huge decisions, too. That is why medical providers rely heavily on the “informed consent” process: they inform patients of the risks and benefits of any type of treatment and then allow the patient to choose whether to engage in that treatment.
The informed consent process becomes murky when the individual is a protected person, meaning they have a Guardian. In all states, an adult generally needs a Guardian when they are unable to make decisions on their own in a safe way. Once a protected person has a Guardian, they lose the right to consent to treatment, to refuse treatment, or even to choose where they live. Someone else is literally in charge of their decision-making process, just like a parent is in charge of a young child’s medical care or living decisions.
The Guardianship process is extremely important: it helps keep vulnerable adults safe. The downside, of course, is that these adults then lose their autonomy. They are no longer able to give or withhold consent for treatment.
In such cases, the law must be respected, and medical providers must obtain consent for treatment from the adult’s legal Guardian. But, it is important for providers to attempt to give the protected person as much autonomy and as much say in their medical case as is possible.
This is where “assent” comes into play. “Consent” is defined as “permission granted by an individual for medical or psychological treatment,” (APA, 2015). “Assent” is defined as “the expression of approval or agreement,” (dictionary.com).
Although consent is a legal construct and can only be given by the protected person’s Guardian, assent is an aspirational concept that can be given by the protected person themself. They may not be able to sign an informed consent form, but they can still be provided with the risks and benefits of the treatment, an explanation of what is involved, and a discussion of the costs of treatment. Ideally, the protected person can then agree as to whether or not the treatment is necessary and can assent to it.
Although necessary in some cases, Guardianship is an intrusive process and it robs the protected person of their decision-making rights. In order to give the protected person as much respect and dignity as possible, psychologists and medical providers should strive to inform them of various treatment issues and attempt to get their assent for these procedures.