Accountability, trust and informed consent in medical practice and research

• Published in: Clinical medicine (London, England) Vol. 4; no. 3; pp. 269 - 276
• Main Author: O’Neill, Onora
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.05.2004; Royal College of Physicians
• Subjects: accountability; bioethics; Biology; Biomedical Research - ethics; Biomedical Research - standards; College Lectures; Delivery of Health Care - standards; General points; History of medicine; History of science and technology; Humans; Hygiene; hospitals; Informed Consent; Life sciences; medical ethics; Medicine; surgery; pharmacy; patient autonomy; Personal Autonomy; professionalism; Public Health; research ethics; Social Responsibility; transparency; Trust; United Kingdom; trust; professionalism; informed consent; medical ethics; bioethics; transparency; patient autonomy; research ethics; accountability; public health; Medicine; Consent; Scientific research; Individualism; Bioethics; Practice; Autonomy; Professionalism; Responsibility; Public health; Truth; Professional Patient Relationship; Biomedical and Behavioral Research
• ISSN: 1470-2118; 1473-4893
• DOI: 10.7861/clinmedicine.4-3-269

During the last 25 years public policy in the UK has aimed to replace ‘club' cultures and their supposedly suspect reliance on trust between professionals and public with a new public culture based on accountability and ‘transparency'. These transformations have changed both clinical practice and public health policy in deep ways. Are the new conceptions of accountability adequate? Are obligations to be ‘transparent' any more than requirements to disclose information which overlook the need for genuine communication? Can demands for ever fuller informed consent improve accountability to individual patients and research subjects? Could we devise more intelligent conceptions of accountability that support more intelligent placing and refusal of trust? What might intelligent conceptions of accountability suggest about proper clinical practice, public health medicine and professional responsibilities?