Intentional Learning: The Need for Explicit Informed Consent in Higher Education

Introduction

The idea of informed consent, if not the language and underlying logic, is increasingly taken for granted by patients, research subjects, clients, and even consumers who wish to conduct themselves as autonomous agents in control of their own lives. Such control, using the elements of informed consent, requires access to and understanding of information, and freedom to participate or purchase services or products. The goals of informed consent are self-determination and rational decision making.

The concept of informed consent, however, is not common in undergraduate academic discourse or practice. Faculty may provide information in bulletins and syllabi, for example, but assuring understanding, and explicitly inviting student consent is rare, even in more innovative learning situations. Overall, by emphasizing institutional and faculty control over learning, the culture of academe serves as a continuation of the longstanding and perhaps justifiable paternalism in precollege education. However, the current degree of paternalism in higher education needs to be challenged.

I argue that informed consent would be a welcome addition to other concepts that empower students, is consistent with the meaning of general education, and indeed is necessary if we are trying to form critical learners who fully participate in and give direction to their educational endeavors. The underlying premise is that if general education, and of course the rest of the curriculum and associated methodologies, implies a series of psychological interventions, sometimes threatening, into the learning lives of students, then informed consent about the particulars of these interventions is crucial. Otherwise, individuals cannot be intentional learners, that is, participate freely and with adequate understanding in their own learning. The claim is that learning characterized by informed consent would be better learning and better preparation for assuming civic responsibilities in a democratic society than a more paternalistic approach. In sum, informed consent should be viewed as essential both to the process and to the product of general education. Because of their understanding of liberal learning, faculty in general education should assume a special responsibility for educating students about the concept of informed consent, modeling it in practice, and helping shape institutional culture to be more sensitive to the values associated with this idea.

The first two sections of this paper will sketch the history of growing awareness about the importance of informed consent in medicine, the most important area of development of ethical theory relating to informed consent, and then outline the basic elements of the concept. Developments in research ethics and law have laid the foundation for contemporary understanding of informed consent, but the focus of this paper will be on clinical medicine, which parallels more closely the providing of educational services. The next section describes the common problem of paternalism in health care and higher education. Following sections discuss the current state of awareness about informed consent in higher education and the need for a more explicit use of this procedural tool both in the classroom and in institutional culture. The final section argues that general education faculty have a special responsibility for promoting a more visible commitment to informed consent and demonstrating how this relates to the preparation of students for democratic citizenship.

The Tradition of Informed Consent in Clinical and Research Medicine

Hippocrates' advice to physicians continues to be the most dominant influence in clinical medicine relating to the physician/patient relationship:

Perform [these duties] calmly and adroitly, concealing most things from the patient while you are attending to him. Give necessary orders with cheerfulness and serenity, turning his attention away from what is being done to him; sometimes reprove sharply and emphatically, and sometimes comfort with solicitude and attention, revealing nothing of the patient's future or present condition. (Katz, 1984, p. 1256)

Doing good for the patient and avoiding harm are the key principles in the paternalistic ethics of medicine propounded by Hippocrates. The corollary is that the patient should...