The trouble with consent

Consent is on everyone’s lips.  From media discussion about ‘enthusiastic consent’ to medical requirements for ‘informed consent’, it seems pretty clear there is a problem with ‘consent’.

If consent was what mattered, we would not need to prefix it with a qualifier.  The language we use matters, science communicators spend their time trying to determine the best ways to explain science to the general public.   And the framing is not ‘how do we best communicate science so all may understand’, but rather ‘how do we convince the public to accept what we say without question’.  In medicine this is known as ‘informed consent’.

I got to musing on the word ‘consent’ and I feel great difficultly with the word and all it implies.  Whether we use a medical context or a sexual one, the term ‘consent’ is bandied about as some kind of magic code word.  Both these context involve a power imbalance.  No wonder we have problems with coercion.

Consent is about freeing someone of liability.  To seek consent is to clearly express a desire for a particular action or outcome.  The person seeking consent has the power position.  They are placing someone in a position where it is known they are expected to consent. To not consent is to ‘refuse’ or ‘decline’.  To not consent can be met with repeated asking – pestering – until consent is relented.  It can also be met with increasing pressure and threats.  In some situations consenting to ‘step one’ is treated as consent to any subsequent steps.

In medicine, the legal term is ‘Informed consent’.  The legal role of the person seeking consent is to provide full disclosure of the procedure…and any subsequent ones that may arise.  Most times this consent is sort at the critical moment, under intense stress and pressure.  The ‘informed’ component means “I told you what I was legally required to” not “you know all you need to know to decide what is right for you”.  It does not mean all options were understood or available.

When it comes to pregnancy and birth, it is possible avoid this situation.  This means considering various possibilities in advance, and taking the time to look at the risks and benefits of different options and make an informed decision about the direction to go.  So if ‘consent’ is requested you can give actual informed consent, or you can confidently decline knowing that your decision is solid.

Reflecting on that, replace ‘consent’ with ‘decision’ and the implied yes is removed.  The person seeking consent may still assume or prefer a particular outcome, but when framed as a decision the other possible outcomes become visible.  With ‘consent’, only one outcome is spotlighted.  

In the sexual context, replacing ‘consent’ with ‘decision’ also takes away the implied yes.

Rather than teaching ‘consent’ and the need to ‘check-in’ with a sexual partner to ensure continued ‘consent’, which implies that a certain level of sexual willingness exists in the first place, teaching ‘decision’ opens up other possibilities.

Our society is sex-obsessed.  The sexual revolution, and women’s (sexual) liberation was a double edge sword.  The implied availability of women and assumed willingness means that ‘consent’ is the new starting point.  If we shift that starting point from consent to ‘decision’, the decision to be non-sexual becomes visible.  As it is currently, to be non-consenting could see you labelled unfavourably: to be a prude in this sex-obsessed society is the quickest way to guarantee social exclusion.

To be non-consenting, in medical or sexual contexts, means you are a dissenter.  You are the anomaly.  You are to blame.  You can not simply say NO.   You will be met with hard stares, determined coercive lectures, social exclusion, bullying.  Your ‘NO’, will be met with more negatives.  This is why so many people will consent, despite wanting to say no.  The power play in these situations will force it.  There are those who will use this power play to ensure consent.

And, devastatingly, there are those who don’t bother asking and just go ahead.

This is medical malpractice. This is obstetric violence. This is rape.

You have a Right to DECIDE.  So why are we not framing this is as ‘decision’ rather than ‘consent’.  Why are we encouraged to hand over our autonomy to those perceived as more powerful?




1 thought on “The trouble with consent”

  1. Renske Verheul

    “Consent is the process of thinking about performing a procedure or arranging a test, and being able to explain it to the woman so she’s able, with the right information, to agree to move forward.”

    Edward Morris, Vice President of Clinical Quality, RCOG:

    The woman who posted this quote today on the Dutch Facebook-forum on Human Rights in Childbirth (GeboorteBeweging), said a wise thing: “As if ‘consent’ has any value when the ‘refusal’ is not really an option.”

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