Consent Is Not Enough Autonomy, the Ontology of the Patient, and the Vocation of Medicine

Abstract

Informed consent is one of the indispensable moral achievements of modern medicine. It protects patients against coercion, deception, and the unauthorized use of their bodies, while recognizing them as responsible participants in clinical decision-making. Yet consent cannot bear the entire weight of medical morality. It can authorize an intervention, but it cannot by itself establish that the intervention is medically beneficial, morally permissible, or consonant with the physician’s professional vocation.

This essay argues that the elevation of autonomy from a necessary safeguard to the governing norm of medical ethics leaves important questions unanswered. The claim is not that autonomy-based theories intend to provide a complete ontology of the patient. It is that they often rely upon a conception of the patient as an exerciser of choice while lacking the resources to explain equal moral standing when deliberation, communication, memory, or self-determination are diminished or absent.

The argument proceeds in two layers. On philosophical and professional grounds, it distinguishes authorization from justification, decision-making capacity from moral status, and patient choice from the internal goods and responsibilities of medicine. It then offers a Lutheran theological account of the patient as an embodied creature standing coram Deo and of medicine as a vocation ordered toward the health-related good of the neighbor. The theological account is offered as a substantive completion of, not a substitute for, the publicly accessible argument.

Consent is therefore neither rejected nor diminished. It is situated within a richer medical ethics in which patient agency, professional judgment, creaturely vulnerability, justice, and the objective but prudentially discerned goods of medicine mutually constrain one another.