What is informed consent, and how does it relate to medical paternalism and shared decision-making?

Informed consent is the minimum of patient autonomy: without it, any medical intervention is a (punishable) bodily injury. Paternalism puts the patient's well-being above their will; shared decision-making combines the doctor's medical knowledge with the patient's own goals and values.

• Informed consent (informierte Einwilligung): from an ethical and legal point of view, the minimum of patient autonomy. Without it, every intervention counts as bodily injury, even a successful one.
• Medical paternalism: a traditional, care-oriented doctor's ethos that has the patient's well-being, not their will, in view. Its most extreme form: deciding on diagnosis or therapy without the patient's knowledge. Clear cases of strong paternalism are almost universally considered morally inadmissible.
• Shared decision-making: doctor and patient bring different knowledge. The doctor knows the diagnostic methods and therapy options; the patient knows their own goals and values. The decision needs both.

The catch: some argue the autonomy principle only applies if minimum conditions of competence (decision-making capacity) are met, which is exactly where cases with dementia, children or unconscious patients become hard.

Also note the difference between professional ethics (Standesethik, the profession's internal rulebook, e.g. a doctors' code) and medical ethics (the broad philosophical debate about what is right and wrong in medicine).

Go deeper:

• Stanford Encyclopedia of Philosophy: Informed Consent — what valid consent requires and why.
• Wikipedia: Shared decision-making in medicine — the model and its evidence base.
• Stanford Encyclopedia of Philosophy: Paternalism — weak vs. strong paternalism.