Trauma-Informed Care: A Unique Framework for Consent

Abstract: Though ethical and legal requirements to obtain a patient’s consent reflect shifts away from a traditional model of paternalism, healthcare as a system remains primarily authoritative. Thus, efforts to modify a singular process, like consent, through incremental changes in patient autonomy, are likely to falter. Informed consent, opt-in processes, and shared decision making are three contemporary models that redirect some power away from the provider toward the patient. From a feminist bioethical perspective, these models remain incomplete in shifts of decisional authority, realization of individualized care, and consensus on when to use which model. These insufficiencies can lead to patient and provider confusion as to rights and responsibilities qua consent, inviting the default of paternalism to disrupt an ethical maxim of autonomy. One approach to assuage hierarchical influences on the process of consent at both interpersonal and infrastructural levels is trauma-informed care. Trauma-informed care is a patient-centered, strengths-based framework developed through the lived healthcare experiences of survivors of sexual violence and complex trauma. Tenets of the trauma-informed care framework offer unique considerations for consent, including uplifting survivor knowledge, respecting boundaries, and appreciating nonlinear healing, which are not yet recognized in other consent models. This presentation will explore an approach to consent through the framework of trauma-informed care, including feminist and queer ethical insights and critiques into current models of patient decisional autonomy. Through a clinical case example of sexually transmitted infection testing, I highlight the potential for a trauma-informed consent process adaptable to other care scenarios.