Hobbes and informed consent in medicine

Informed consent has been a central topic in medical ethics for decades. Scholarly discussions have focused on its moral justification as well as its legal status and clinical implementation. Thomas Hobbes’s thought has been surprisingly absent from debates about the moral justification for informed consent, with most of the focus being upon Kant and, to some extent, upon Mill. Some might see this absence of Hobbes within these debates as warranted; perhaps Hobbes has little to add to the resources that are available in Kant or Mill. This paper seeks to place Hobbes’s philosophy in conversation with contemporary views on the moral justification of informed consent in medicine. The paper proceeds in three stages. First, I discuss two moral justifications of informed consent. The first grounds informed consent in autonomy, appealing to Kant (Beauchamp and Childress 2001; Pellegrino and Thomasma 1993, 128-29). The second appeals to a non-Kantian version of autonomy, understanding autonomy as grounded in individuality and drawing upon Mill (O’Neill 2002; 2003). Second, I look to Thomas Hobbes’s Leviathan to provide a conceptual framework for informed consent, founding it in a person’s right to “save himself from death, wounds, and imprisonment.” Third, I argue that in his account of persons and authors in Leviathan XVI Hobbes provides a naturalistic mechanism that makes intelligible what happens when an individual gives consent for a medical procedure.