From Informed Consent to Negotiated Consent1

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Abstract
There is a good reason to believe that the informed consent standard is inadequate for insuring autonomy in long term care. Instead of a conventional opposition between autonomy and paternalism a more complex standard of “negotiated consent” is argued for. The philosophical argument is illuminated by qualitative data gathered from interviews with physicians, nurses, and social workers in nursing homes. In the interviews a continuum of interventions was demonstrated, ranging from advocacy and empowerment to persuasion and making decisions for others.

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