Sarah Khan

Dickert et al. (2020) effectively address how factors such as time limitations, stress, and illness severity in acute conditions warrant a deeper evaluation of how current consent processes serve patients. While data suggests that patients “prefer to be asked for permission upfront rather than waiving consent” (2), consent forms themselves “are frequently long and technical, follow rigid templates, and contain language that appears to prioritize institutional protection” (1). Such findings elucidate patients’ valuation of personal agency over settling for the “benefit of the doubt” that physicians and the consent forms they provide are acting in the patients’ best interests. In response, the authors recommend revisions to consent forms in terms of content, structure, and tone to better facilitate patient understanding beyond the mere conveyance of information. We aim to build Dickert et al.’s discussion of how “consent processes serve functions beyond facilitating an informed, autonomous decision” (2), but with a broader focus on an underrecognized purpose of the consent process: namely, reaffirming a patient’s status as a capable, rational agent. Specifically, we argue that patients can exercise this agency when they thoroughly understand the consent process, per Grimm’s (2012) conception of understanding.

The BRAIN 2.0 Neuroethics Report reflects on the ways in which neuroscientific research may inform our understanding of concepts such as consciousness and empathy, and how advances in this understanding might in turn affect practices such as research on non-human animal primates. Generally, the Report calls for “the integration of neuroscience and neuroethics during the remaining years of the BRAIN initiative and beyond” (NIH 2019). In responding to the Report, the articles in this issue grapple with theoretical questions about what the integration of neuroscience and neuroethics might look like, as well as how specific practices might be affected. In this commentary, we don’t grapple with these questions ourselves. Instead, we propose a framework for debates about them. Specifically, we introduce the idea of ‘morally-salient features,’ suggesting that the concept may be helpful in providing a framework for the kinds of questions addressed by the BRAIN 2.0 Neuroethics Report as well as those tackled by the authors of this issue.