TY - JOUR

T1 - When is a choice not a choice?

T2 - "sham offers" and the asymmetry of adolescent consent and refusal

AU - Manson, Neil Campbell

N1 - This is the peer reviewed version of the following article: Manson, N. C. (2017), When is a Choice not a Choice? ‘Sham Offers’ and the Asymmetry of Adolescent Consent and Refusal. Bioethics, 31: 296–304. doi:10.1111/bioe.12328 which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/bioe.12328/abstract This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.

PY - 2017/5

Y1 - 2017/5

N2 - In some jurisdictions there is a puzzling asymmetry of consent and refusal, where, for some kinds of treatment, the adolescent patient has the power to permit her own treatment but her refusal does not have the same kind of normative significance as refusal of treatment by a competent adult. In a recent paper in this journal I offered a clarification and defence of this asymmetry. Lawlor (2016) offers a number of objections to this account. Three of his objections can be dealt with quickly. But one of them is much more challenging: the asymmetry of consent and refusal entails a practice of making sham offers (offers that purport to be responsive to the patient's choices, but which, in fact, are not). Genuine offers seem to require a commitment to be symmetrically responsive to whatever decision outcome is reached by the recipient of the offer. When we reflect upon the way that offers can be made in complex social contexts, where different parties have a "say" in what ought to be done, the symmetry of responsiveness need not apply. Offers can be genuine, without being symmetrically responsive. Contrary to the seemingly plausible objection, the asymmetry of consent and refusal does not entail sham offers, or the offer of "sham choices" or some bizarre "asymmetry of choice".

AB - In some jurisdictions there is a puzzling asymmetry of consent and refusal, where, for some kinds of treatment, the adolescent patient has the power to permit her own treatment but her refusal does not have the same kind of normative significance as refusal of treatment by a competent adult. In a recent paper in this journal I offered a clarification and defence of this asymmetry. Lawlor (2016) offers a number of objections to this account. Three of his objections can be dealt with quickly. But one of them is much more challenging: the asymmetry of consent and refusal entails a practice of making sham offers (offers that purport to be responsive to the patient's choices, but which, in fact, are not). Genuine offers seem to require a commitment to be symmetrically responsive to whatever decision outcome is reached by the recipient of the offer. When we reflect upon the way that offers can be made in complex social contexts, where different parties have a "say" in what ought to be done, the symmetry of responsiveness need not apply. Offers can be genuine, without being symmetrically responsive. Contrary to the seemingly plausible objection, the asymmetry of consent and refusal does not entail sham offers, or the offer of "sham choices" or some bizarre "asymmetry of choice".

KW - consent

KW - informed consent

KW - refusal of treatment

KW - adolescent consent

U2 - 10.1111/bioe.12328

DO - 10.1111/bioe.12328

M3 - Journal article

VL - 31

SP - 296

EP - 304

JO - Bioethics

JF - Bioethics

SN - 0269-9702

IS - 4

ER -