Ethical Pluralism and Informed Consent in Canadian Health Care: Exploring Accommodations and Limitations

Abstract

Vibrant and evolving diversity has become an integral part of Canadian identity. Communities are experiencing an enrichment of new ideas, and unique opportunities to learn about those with whom we share the world. At the same time, we are witness to emerging tensions and value conflicts - especially in the health care system. This has given rise to what some have termed the problem of pluralism: the challenges associated with formulating public policy and shaping health care practices for parties who have deep moral disagreements. It has been proposed that the practice of informed consent in health care is an effective solution to the problem of pluralism, as it allows individuals to make decisions according to their own moral commitments and control the care they receive. In this thesis, I argue that informed consent is not a value-neutral practice. Rather, it is grounded in particular values and beliefs, and reflects a particular understanding of health and illness. Consequently, I argue that the practice may not be able to fully address the problem of pluralism. I begin by exploring the dynamics of ethical pluralism and the structure of the health care system in Canada. I focus, specifically, on the challenges that arise from this complex intersection of ethics and health. Next, I establish the ways in which the practice of informed consent is embedded with particular values. Finally, I discuss strategies for making the practice of informed consent more accommodating of diversity. I argue that there are, however, limits to the possible accommodations that can be made, due to the complexity of the issues and the structure of the health care system in Canada.