Grace Campbell

From a legal perspective, before a physician engages in a serious medical intervention they must obtain informed consent. In this paper, we argue that there are serious deficits in our processes of obtaining informed consent; it is often seen as just a bureaucratic hurdle, and people agree to interventions without being in an appropriate epistemic state. We explore some possible reasons for this, including ignorance, trust in physicians’ authority, and the minimal time physicians spend with patients. We trace many of these issues to one central cause, which is that in the United States obtaining informed consent is the purview of physicians. We argue that a simple shift in how we obtain informed consent can help to ameliorate these issues. Specifically, we argue that obtaining informed consent should be the responsibility of nurses rather than physicians. While there are several reasons for this, the central ideas are that (1) since nurses are the ones who know the patient, they will be in better position to tell when patients are genuinely informed, and (2) patients will be more comfortable asking questions and admitting ignorance to nurses rather than physicians. While we focus on US law, our conclusions are more broadly applicable.

Character ethics needs a way to account for the role of constitutive moral luck. The character ethics tradition holds agents responsible for acquiring traits that constitute a good moral character; but the circumstances of character formation are not fully in our control. Thus, an agent’s character—and moral status—are at least partly matters of luck. The proposed approach draws from recent work in character ethics to re-think moral agency as inescapably situated in a luck-laden context. A view of agency as situated accounts for luck by attributing moral significance to contingencies that shape character, including hardships and forces outside a person’s control. Assessing an agent’s situatedness can preserve responsibility by emphasizing responses to luck, thereby highlighting areas of choice overlooked in normative ethical theory. The chapter concludes that constitutive moral luck is not a problem for, but an aspect of, situated agency.