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In trying to understand the I SUPPORT study, it may be useful to think of contemporary bioethics reform in terms of the principles of consumer protection. The central tendency of that reform (particularly in my own field-the law) has been to employ the model of consumer choice. That model sets as its purpose to allow consumers to choose the kinds of products they prefer. It seeks to accomplish that purpose primarily by supplying consumers the information they need to make choices and by insisting that they are given what they chose. Thus, for example, merchants may be required to reveal the actual terms under which they sell goods on credit, so that customers may decide whether they wish to pay the price. And once the customer has chosen a purchase, the merchant is held to the terms originally agreed upon. In short, the consumer choice model seeks to allow customers to make successful choices by providing them with a market that works in the economist's sense, efficiently. Bioethical reform may be understood along these lines. The doctrine of informed consent is, plainly, intended to provide patients the information they need to make wise choices that express their preferences. The patient is thus to become a consumer well-enough informed to make sensible choices in the market for medical care. The patient's choices are then given more binding effect by, for example, various provisions for advance directives.


Reprinted with the permission of the Hastings Center Report and Wiley-Blackwell.