{"id":4728,"date":"2025-12-13T03:35:52","date_gmt":"2025-12-13T02:35:52","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4728"},"modified":"2025-12-13T03:35:52","modified_gmt":"2025-12-13T02:35:52","slug":"can-unpredictability-undermine-consent-rethinking-the-transformative-experience-objection","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/12\/13\/can-unpredictability-undermine-consent-rethinking-the-transformative-experience-objection\/","title":{"rendered":"Can unpredictability undermine consent? Rethinking the transformative experience objection"},"content":{"rendered":"

By Dr. Johnny Sakr<\/p>\n

Public discussion about abortion often assumes that informed consent works in a straightforward way: a person receives information, weighs risks and benefits, and decides. Joona R\u00e4s\u00e4nen\u2019s recent article challenges this by arguing that abortion is a transformative experience<\/em>, a decision that can fundamentally alter a person\u2019s values, identity, and outlook. If that is right, he suggests, then consent to abortion may be less stable than many assume, because one cannot fully grasp its future significance in advance.<\/p>\n

My response paper challenges that inference and argues that the legal stakes are far more limited than they might first appear. I came to this issue while teaching and researching medical law, where uncertainty and identity change are familiar features of major medical decisions. It struck me that the legal system already handles profound unpredictability, organ donation, high-risk surgery, end-of-life refusals, without treating such uncertainty as a barrier to autonomy. Yet the transformative experience objection seemed to single out abortion as uniquely fragile. Exploring that mismatch led me to ask what the law actually demands of informed consent, and whether this philosophical worry has the implications R\u00e4s\u00e4nen suggests.<\/p>\n

Transformative experiences are not unique to abortion<\/strong><\/p>\n

The idea of a transformative experience, most famously developed by Laurie Paul, describes decisions whose significance cannot be understood until after they are lived. Becoming a parent, migrating, changing religion, or undergoing chemotherapy all fit this category. Abortion may be transformative for some people, but so are continuing a pregnancy, giving birth, or raising a child. If transformative experience undermines autonomy, then virtually every major life decision becomes unstable, an outcome that suggests the problem lies elsewhere.<\/p>\n

What the law actually requires of informed consent<\/strong><\/p>\n

Legal standards for consent are far narrower than philosophical accounts sometimes assume. They require disclosure of material clinical risks, reasonable alternatives, and a voluntary choice. They do not<\/em> require patients, or clinicians, to anticipate how a decision will reshape someone\u2019s values, relationships, or self-conception. People can consent to treatments that alter body image, emotional life, or personal identity without needing predictive insight into their future selves. If such insight were required, almost no major medical decision would meet the legal threshold. The law recognises uncertainty as normal, not as a threat to autonomy.<\/p>\n

The asymmetry problem<\/strong><\/p>\n

A further difficulty with treating abortion as epistemically special is that unpredictability applies equally, often more strongly, to continuing a pregnancy. Childbirth and parenting introduce medical, psychological, and financial consequences that cannot be mapped out in advance, yet society does not demand heightened consent procedures for choosing to give birth. This asymmetry reflects a familiar pattern: claims that abortion requires special caution have historically been used to justify waiting periods and \u201cprotective\u201d counselling. Even if unintended, philosophical arguments can be taken up in ways that disproportionately constrain one option while leaving the other unexamined.<\/p>\n

If transformative experience undermines decision-making, it undermines both sides of the choice. Because that is unworkable, the more plausible conclusion is that autonomy does not depend on perfect foresight.<\/p>\n

Scaffolded consent and scaffolded autonomy<\/strong><\/p>\n

Rather than introducing impossible epistemic demands, recent work in this journal, particularly by Neil Levy and Dominic Wilkinson, develops the idea of scaffolded consent<\/em>: autonomy supported by social and institutional structures that help people navigate uncertainty. My own use of \u201cscaffolded autonomy\u201d builds on and extends this thinking within the specific context of reproductive decision-making. The aim is not to introduce a new concept, but to consider how existing insights about scaffolding can illuminate choices involving deep unpredictability.<\/p>\n

Effective scaffolding includes access to timely medical care, accurate and unbiased information, non-directive counselling, protection from coercion, and the removal of unnecessary procedural barriers. These supports do not eliminate uncertainty. They ensure that uncertainty does not distort or constrain the decision.<\/p>\n

Why uncertainty is not the problem<\/strong><\/p>\n

Informed consent has never required individuals to know exactly who they will become after a major decision. It requires that the relevant clinical<\/em> information is provided, understood, and weighed voluntarily. Uncertainty is built into every significant life choice\u2014the law accommodates it, medicine accommodates it, and everyday reasoning accommodates it. Transformative experience is a feature of human agency, not a flaw in it.<\/p>\n

Conclusion<\/strong><\/p>\n

R\u00e4s\u00e4nen raises an important philosophical question: how do we choose when the future is impossible to fully anticipate? But translating that question into scepticism about abortion consent is unnecessary. Autonomy does not stand or fall on our ability to predict our future identities. It stands on disclosure, voluntariness, and supportive structures that enable meaningful agency. With appropriate scaffolding, of the kind already explored in the literature on scaffolded consent, autonomy remains robust even when the future is uncertain.<\/p>\n

Paper title: Transformative Experience and the Limits of Legal Consent: A Response to R\u00e4s\u00e4nen<\/p>\n

Author<\/strong>: Johnny Sakr<\/p>\n

Affiliations<\/strong>: Prince Sultan University<\/p>\n

Competing Interests<\/strong>: \u00a0None declared.<\/p>\n

Social Media<\/strong>: https:\/\/www.linkedin.com\/in\/dr-johnny\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

By Dr. Johnny Sakr Public discussion about abortion often assumes that informed consent works in a straightforward way: a person receives information, weighs risks and benefits, and decides. Joona R\u00e4s\u00e4nen\u2019s recent article challenges this by arguing that abortion is a transformative experience, a decision that can fundamentally alter a person\u2019s values, identity, and outlook. If […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":522,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8100,8053],"tags":[],"class_list":["post-4728","post","type-post","status-publish","format-standard","hentry","category-autonomy","category-consent"],"yoast_head":"\nCan unpredictability undermine consent? Rethinking the transformative experience objection - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/12\/13\/can-unpredictability-undermine-consent-rethinking-the-transformative-experience-objection\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Can unpredictability undermine consent? 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