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From benevolent deception to patient autonomy: a condensed history of consent in medical practice

Year: 2026

Type: article

Abstract: Consent may be implied, such as offering an arm when having a blood test, but other times, it is more explicit, confirmed by a signature after discussion about major surgery. The validity of the process may subsequently be tested in court. Modern consent for surgery assumes the patient's autonomy, and aims to ensure that a patient's dignity and choices are respected. However, this has not always been the case. We conducted a narrative review of the literature, and discuss the evolution of the meaning and application of consent through history. We begin with the earlier days of ‘benevolent deception’, where clinicians knowingly concealed information from patients to protect them from ‘unpleasant news’. We then explore the evolution of consent over the past 100 years, highlighting recent developments in case law. There is rapid change in surgery and some uncertainty about the future, with advancements in artificial intelligence and automated robotic technology. It is likely that we have not reached an end state for consent and our current ethical framework is just a snapshot in a continually evolving paradigm.

Source: Bulletin of The Royal College of Surgeons of England

DOI: 10.1308/rcsbull.2026.77

Authors: L Phelan, M Grela, DN Naumann, S Routley, DM Bowley

Institutions: University Hospitals Birmingham NHS Foundation Trust, Kettering General Hospital, Kettering General Hospital NHS Trust, Aston University

Language: English

Topic: Ethics and bioethics in healthcare

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7162938424

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Cites: 23

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