Informed consent is now seen as fundamental to both to clinical practice and to research on human subjects. Huge literatures advocate supposedly improved consent requirements. Consenting, it is said, should be more explicit; and consent, it is said, should be more specific. These aims are rarely feasible, since the empirical evidence shows that it is extremely hard, and sometimes strictly impossible, to meet either standard even when patients or research subjects have full cognitive competence. There is little ethical merit in advocating impractical or impossible requirements for informed consent, or in pretending that such standards can be met. How might we meet these challenges to contemporary research ethics?

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