There is little controversy that individuals generally have an interest against intrusion of or interference with their personal domain, which encompasses one’s person—body and mind1—and property. For example, we typically think that we are entitled to moral complaint when another person pinches us, kisses us, or looks through our phone without our permission. That is to say, we have a moral right against these kinds of unauthorized interactions. Here, a right is understood as “entitlement (not) to perform certain actions, or (not) to be in certain states; or entitlements that others (not) perform certain actions or (not) be in certain states” (Weinar). This is not to say, of course, that all interpersonal interactions are impermissible. One key way in which we facilitate morally permissible interactions on a daily basis is by providing, through verbal or sometimes non-verbal communication, valid consent. Present moral theories of consent identify it as an interpersonal justification for an act upon an agent, the consent-giver, from which they would otherwise have moral protection in the form of a duty of the others not to infringe upon their personal domain. Consent releases the consent-receiver from such duty against intrusion or interference and provides an interpersonal justification for the act within the content of the consent.

 

However, our moral intuition suggests that there is something beyond ordinary, valid consent necessary for an act to be morally permissible when the body is involved, like an invasive procedure or sexual intercourse. Indeed, patients sometimes believe that they are wronged by a medical procedure despite having given legally valid consent, which contributes to the deteriorating patient-physician relationship and growing mistrust (Nie et al.). In these cases, are the patients entitled to such complaint? In this paper, I aim to challenge Tom Dougherty’s theory of consent, presented in his book The Scope of Consent, by attempting to identify a second

 

1. Dougherty does not address the mind in his conception of the personal domain. This paper uses Dougherty’s conception of consent and will not consider intrusions against the mind. Future work can investigate what it means to interfere with or intrude one’s mind and how consent and preference interact with such intrusions.

2

 

condition for moral permissibility in cases involving the body through a series of hypothetical cases. I posit that, besides a consent-based right against bodily intrusion or interference, agents have an additional preference-based right that entitles them to moral complaint, which is not typically present in ordinary cases of consent that do not involve the body.

 

Defining Consent: Expression of Will View

 

Before diving into cases, I will first define consent as it is understood in this paper. Under Dougherty’s Expression of Will View, consent is a deliberate expression of one’s will (Dougherty 2021, 111). Like forfeitures and waivers, consent provides a way for us to give up moral complaints against others for causally contributing to interference with our personal domain, namely, our bodies and property (Dougherty 2021, 102). As such, consent constitutes a justification for how others can interact with or act within the consent-giver’s personal domain. For the purpose of this paper, I accept Dougherty’s Expression of Will View as the working conception of consent that governs interpersonal interactions.

 

As an evidential account of consent, this view emphasizes the role of available reliable evidence and enhanced reliable evidence, both of which define the validity and scope of consent according to the Due Diligence Principle, which states:

 

Due Diligence Principle. At time t, an action A falls within the scope of the consent that X gives to Y if and only if

 

1. at t, X gives consent or, prior to t, X has given consent and has not subsequently revoked this consent;

 

1. at t, the available reliable evidence sufficiently supports the interpretation that X intends their consent-giving behaviour to apply to Y performing A; and

3

 

1. at t, the enhanced reliable evidence also sufficiently supports this interpretation. (Dougherty 2021, 149)

 

According to Dougherty, “the ‘enhanced reliable evidence’ is defined as the available reliable evidence, supplemented by any reliable evidence that the consent-receiver has a duty to acquire2” (Dougherty 2021, 146); the distinction between enhanced reliable evidence (ERE) and available reliable evidence (ARE) will be explored further in this paper. Thus, for consent to be considered valid, the consent-receiver also has to fulfill their duty to acquire additional reliable evidence that is not presently readily available to confirm and clarify the veracity and scope of the consent-giver’s expression of will. Dougherty indicates in the footnote that the definition of enhanced reliable evidence “focuses on actual phenomena” and “not a counterfactual definition of evidence that someone would have” (Dougherty 2021, 146). The duty here is owed to the consent-giver regardless of what the available reliable evidence suggests or what the consent-receiver believes the additional information would indicate. In other words, the consent-receiver should obtain additional evidence even if there is reasonable belief that any additional information that could be obtained would have confirmed that the behavior falls within the scope of consent.3 In all of the cases I present below, we can presume that the Due Diligence Principle is fulfilled when consent is verified with a verbal or written follow-up.

To bring out our moral intuition of the justifying force of consent, let’s consider the following case of ordinary consent.

 

1. Dougherty does not make a clear distinction about what kinds of evidence this entails. Here, I broadly understand enhanced reliable evidence to focus on evidence about consent, including but not limited to the absence of coercion or external pressure, the consent-giver’s soundness of mind at the time of consent, and the absence of revocation. Note that some of these criteria, like coercion and soundness of mind may be considered ARE when overtly displayed. Future work shall work out where to draw this line.

 

1. Note that while Dougherty’s Enhanced Reliable Evidence Principle strictly insists on the acquisition of additional reliable information, it does not say anything about how such information is interpreted. This is because the Expression of Will View is an undemanding Behavioral View, which does not require the successful interpretation of evidence for valid consent.

 

“Control” Case—Consent to Use of Property

 

Landlord signs a legal contract to lease an apartment but prefers not to do so for personal, non-morally significant reasons—e.g. Landlord has a friend visiting that month and would rather use the apartment for that purpose—and presumably expresses such lack of enthusiasm, either with a verbal aside or in the tone of voice.

 

It seems morally permissible for Tenant to move in, since the given consent is valid and deliberately expressed in the form of a legally-binding contract. In other words, Landlord’s lack of underlying preference is not sufficient to render Tenant’s act of renting the apartment morally impermissible.

 

What about when it involves the body?

 

According to Dougherty and US criminal law, there is no complaint if the consent is valid and freely given by an agent who is of sound mind without coercion. For example, suppose a person gives clear and passionate consent to sexual intercourse with their partner of their own volition while sober and uninfluenced. Criminal law and Dougherty’s view both recognize that she is not wronged by the partner unless the consent is undermined. The partner does not wrong her even if she does not like the intercourse during or after it happens so long as she does not indicate in any way that she withdraws consent. Neither is she considered wronged if she is under the false belief that her consent is invalid. Likewise, obtaining voluntary informed consent from a competent patient is a legal and ethical obligation of the medical practitioner as it permits the administration of the intervention in question. We generally consider valid consent to be sufficient when another agent asks to, say, borrow a pen or enter our office. We cannot successfully sue another person for trespassing after knocking and being given permission to come inside our apartment. However, we do not seem to think that it is morally permissible for the consent-receiver to act on the consent or justify their act with the given consent in some cases. To illustrate this, I present a few hypothetical examples below.

 

Let’s consider a first case of a minimally invasive and reversible bodily intrusion.

 

Warm-up case: People Pleaser Gets a Face Tattoo

 

People Pleaser (PP) consents to getting a face tattoo for what we shall term here, extrinsic reasons—reasons that do not come from one’s own internal desires but rather serves to achieve an external goal like garnering praise or receiving an award such as to make Tattoo Artist (TA) think well of them. PP does this freely and not against their will, with no external social pressure like social stigma while of sound mind, and through a deliberate expression of consent, e.g. a verbal yes. In other words, the consent is unambiguously valid according to Dougherty’s Expression of Will View. However, PP has a preference not to receive a face tattoo, of which TA is somehow aware.

 

Is it morally permissible for TA to give PP a face tattoo after consent was given?

 

Let’s stipulate that there is minimal difference in interest for the Tattoo Artist in either outcome scenarios, other than received payment for their services. There is minimal risk of harm for PP—a tattoo is generally minimally invasive and reversible now—even though the tattoo in question is a face tattoo. Here, our moral intuition seems to suggest that it is not morally permissible for TA to proceed because, simply put, PP does not want to have the tattoos and he knows it. It seems, on first pass, that PP’s lack of underlying preference is the necessary but not sufficient condition additional to consent.

 

Dougherty’s Objection—Consent-Centric view of Interpersonal Justification Argument

 

TA has the obligation of Due Diligence to secure both available reliable evidence, e.g. evidence supporting that PP is very clearly sober and of sound mind – i.e. not visibly inebriated or have lost their faculties – when consenting to getting tattooed, and enhanced reliable evidence, i.e. evidence TA has a duty to actively acquire, e.g. a verbal confirmation from PP to clarify that they indeed knowingly and deliberately consent to a tattoo. If TA has sufficiently performed Due Diligence appropriately given the stake of the act—getting a face tattoo—and the cost of acquiring such evidence, the valid consent should justify this act; PP is no longer entitled to a complaint here. This would be analogous to a case in which the consent-giver, PP, falsely believes that their consent is invalid.

 

Dougherty can agree that it is wrong in this case for TA to give PP a face tattoo. However, he would object that, rather than there being something else that makes tattooing PP morally impermissible, it is because the consent is actually not valid. How can that be? Dougherty asserts that consent is invalid when it is given under unjust social pressure like a misogynistic culture that demands unconditional sex from wives (Dougherty 2022). He could appeal that, in this case, PP experiences social pressure, which is “the exertion of influence on a person or group by another person or group” (American Psychology Association). People generally have a right to be free from this kind of pressure or external influence when making decisions, according to Kant’s Principle of Autonomy (Kant G4: 440). Consent is thus invalid in the Dougherty sense when social pressure is present because, like coercion, it denies the agent one or more options that they are entitled to have. Therefore, PP’s consent to receiving a face tattoo is invalid and TA has wronged PP by tattooing them.

However, not all cases of consent for extrinsic reasons involve this unfair denial of options. Here, we would be mistaken to frame PP’s extrinsic reason—people pleasing—as coercion because coercion, by definition, is imposed upon the consenting agent by another agent, which is not present. PP’s “pressure” to consent is self-imposed, which means that this consent is still valid, ceteris paribus.

 

Case 2—Intimate Relations with the Asexual Partner

 

Two individuals, Ace and Bee, initiate a sexual encounter. Ace expresses consent to engage in sexual intercourse with Bee deliberately and freely while sober and of sound mind. However, Ace is asexual and would prefer not to have sex with Bee (or anyone, for that matter). Say, Ace would not mind if the fire alarm goes off as Ace and Bee are about to begin intercourse and interrupts it. Ace simply consents because she prefers not to make Bee think negatively of her. Like in previous cases, Ace’s consent is valid, though there is no underlying preference for the token act.

 

Bee performs Due Diligence to interpret consent based on available reliable evidence and enhanced reliable evidence, which Bee acquires by asking Ace whether she is feeling pressured to consent to sex, to which Ace answers decisively, “No.” Assume that Bee is aware both generally and in this instance that Ace is asexual and prefers not to have sex. Bee proceeds to have sex with Ace because the consent is present and valid.

 

Can we blame Bee for having sex with Ace? Can Ace make a complaint to Bee for acting against her preference? There seems to be something morally unsavory about Bee engaging in sexual intercourse with Ace despite knowing that Ace prefers not to do so even though there is valid, deliberate consent from Ace. Again, valid consent here, though necessary, does not seem sufficient to justify an act of bodily intrusion.

So far, our cases have featured minimal interest and risk of harm on both sides. If underlying preference is indeed a necessary but not sufficient condition for the moral permissibility of acts of bodily intrusion, how would increasing the interest for one or both parties interact with the preference condition? Here, I understand interest as the stakes or concern one has in acting or withholding from acting in a given situation or to achieve a given outcome. For example, a student has an interest in maintaining a good grade point average because it is beneficial for future career or academic opportunities.

Case 3—Obedient Patient’s Minimally Invasive Elective Surgery

 

Obedient Patient (OP) is advised to undergo laser vision correction—a minimally invasive elective procedure otherwise known as LASIK—by their ophthalmologist. The operation has relatively low risk and marginal benefit for the patient. Let’s assume that the ophthalmologist, while board-certified and knowledgeable, does not exert an overwhelming epistemic authority over OP during the treatment process, i.e., OP does not feel epistemically pressured to follow the doctor’s orders. OP, obedient by nature, signs an informed consent form after the ophthalmologist provides a detailed explanation of what the procedure would entail, along with the potential benefits, risks, and side effects. However, OP disprefers to undergo this surgical intervention, all things considered; OP only consents because they do not want to disappoint the ophthalmologist. For OP, the best-case scenario would be if, after consenting, the ophthalmologist informs OP that LASIK would no longer be recommended or is generally canceled. Having obtained verbal confirmation in addition to written consent, the ophthalmologist performs LASIK surgery.

Is this surgery morally permissible? Can OP make a complaint against their ophthalmologist? If valid—and verified—consent were necessary and sufficient for moral permissibility, then the ophthalmologist would have been perfectly justified to perform LASIK, which is not the case. Once again, the violation of the consent-giver’s underlying preference presents a weighty challenge to the moral significance of consent in a case involving bodily intrusion.

 

If the elective surgery case yields ambiguous conclusions, consider the following similar but necessary procedure instead.

 

Case 4—Required Surgery

 

Suppose, now, our Obedient Patient instead consents to cataract surgery, which is required for their health, as they risk losing their vision if they forego the surgery. The procedure is the current standard of care for cataracts, a non-life-threatening but nonetheless serious condition, and OP has been adequately informed of the benefits, potential risks, and side effects such that the Due Diligence principle is fulfilled by the ophthalmologist, the consent-receiver. There is certainly now more interest for OP to comply with medical advice; like any reasonable individual, OP has an interest in preserving—or, in this case, restoring—their vision. However, OP would prefer not to undergo the surgery, all things considered, just like in the elective surgery case. Nonetheless, OP consents to avoid disappointing the ophthalmologist. Given valid and verified consent, and considering the necessity of the procedure to OP’s health and wellbeing, the ophthalmologist proceeds to perform cataract surgery on OP.

 

Is this cataract surgery morally permissible? Can OP now make a complaint against their ophthalmologist? I concede that, to a bystander, OP has every reason to want the surgery, given the overwhelming interest and relatively low risk. Consequentialist theorists would argue that the moral calculus alone is enough to justify the surgery, and consent-centric theorists like Dougherty would cite the valid consent—verified by available reliable evidence and enhanced reliable evidence—to be sufficient for moral permissibility. However, I argue that there is something morally unsavory about disrespecting OP’s underlying preference not to be operated on despite these reasons, as intuitively, we want our preferences to be respected. Simply put, it would be wrong to proceed with the surgery when OP, who is getting the surgery, disprefers the surgery, and OP’s preference should be respected.  Here, valid consent is still insufficient to justify this act of bodily intrusion.

 

If this still does not demonstrate that consent alone is insufficient, consider the post-operation scenario.

 

Case 4.5—Post-Operation

 

Suppose OP finds the surgery unpleasant and is angry afterwards. They say to the surgeon, “You knew I didn’t want that. How could you do that to me? You could easily have said, ‘I know you are only consenting to please me; so, although that consent you gave is valid, I won’t go forward.’ Why didn’t you do that?” The surgeon—who has read up on Dougherty and the legal literature—could respond, “valid consent is all I needed to operate on you. Since I fulfilled my duty to acquire consent as well as additional evidence that your consent was valid while acting in your best interest, I did nothing wrong. I did not wrong you.”

 

If the Due Diligence Principle only cares about available reliable evidence and enhanced reliable evidence for consent, and both indicate that the consent is valid and the procedure is within its scope, then, in the Dougherty sense, there is no moral wrong here. However, does it not feel wrong for the ophthalmologist to insist that no wrong was committed? While the ophthalmologist dutifully obtained and verified OP’s consent, something is missing here: namely, they did not act according to OP’s underlying preferences, which I identify as the other necessary condition for moral permissibility in this case. Note that preference seems to play a weightier role in our intuitive moral judgment of the ophthalmologist’s actions than case 3, where the operation is elective. It would seem that the higher stakes that the patient has in the bodily intrusion they consent to is reflected in a weightier consideration of the preferences of the consent-giver. 

 

To further illustrate this second condition of agent preference in cases of bodily intrusion, I invite the reader to consider the case of Unenthused Organ Donor (UOD).

 

Case 5—Unenthused Organ Donor

 

UOD is a match for a kidney transplant for a patient with end stage renal disease (ESRD). Upon being contacted for the match, UOD is sufficiently informed of the relevant details of the organ donation procedure and understands that there would be little to no risk or harm to their long-term quality of life. UOD understands that there is a great interest for the ESRD patient to receive the transplant and signs the consent form to undergo the procedure. When prompted, they confirm that they indeed consent freely and without external pressure. However, as the name implies, UOD prefers not to have a kidney removed. UOD consents only because it would look bad to refuse to donate. This is not a case of defective consent in Dougherty’s sense because the reason UOD consents—not wanting to look bad—is not an unjust pressure, as it is self-imposed. The consent is still considered valid.

 

Would it be morally permissible for the doctor on the case to remove UOD’s kidney? I don’t think so. UOD’s preferences are clearly violated, so although they gave valid consent, the doctor is not justified to remove UOD’s kidney. Once again, preference clearly matters for the consent-giver, just as I have illustrated in the series of cases involving the body above. For the People Pleaser, preference mattered when a face tattoo was administered. It mattered for Ace, who consented to sexual relations with their partner. It no doubt mattered for Obedient Patient, who really did not want to undergo surgery despite its necessity. This moral significance of preference persists across the spectrum of interest weightings, from a reversible face tattoo to an organ donation operation, meaning that it is not the weight of the interest that matters in addition to the consent but the preference regarding one’s body itself. 

 

Objection—Weightier Interests?

 

So far, I have shown that in cases involving property, like the Landlord case, valid consent suffices for moral permissibility. However, in cases involving the body, it does not. The cases I present posit that underlying preference is the necessary—though not sufficient—condition that makes the difference. One alternative explanation for this difference in the permissibility of consensual interference is that there simply is a weightier interest for the agent when an interaction involves their body. Dougherty would argue that bodily intrusion is more costly for an agent because the body is necessary for survival. It would be intuitive, then, that we should be more prudent when acting on consent that involves the body given the higher stakes for the consenting person. By that logic, individuals may have a similar interest when it comes to their property: there would be a weighty interest in having a large proportion or absolute sum of one’s property interfered with only when they prefer it.

 

If this were true, we would expect to observe an apparent reverse correlation between the cost to the consent-giver and the justifying power of the consent. In minimally intrusive and reversible cases of bodily interference like the face tattoo case, there is minimal interest or harm for People Pleaser to get a face tattoo—it is not too painful, financially costly, does not affect present or future physical or emotional health, assuming we now live in a world where a face tattoo is not deemed socially unacceptable. We would expect that the consent to be asymptotically sufficient for the act’s moral permissibility, which contradicts our initial conclusion. In other words, since interest is low for PP in the tattoo case, we would expect consent-power to be high. Meanwhile, cases of higher-stake bodily intrusion like sexual intercourse or surgery do not minimize the role of valid consent. For example, in the second case of intimate relations, we can generally agree that the stakes are higher than in the face tattoo case, but ultimately, there is still, presumably, little or no risk of physical harm to the consent-giver, Ace. For Bee, there is more interest than in the last case for TA, assuming that allosexual—non-asexual—individuals have some interest in having sexual intercourse with others. The difference in the level of interest for the consent-giver is not reflected in a difference in consent-power in the moral permissibility of the act. Indeed, as the consent-giver’s interest increases, we continually see a restraint on consent’s moral weight in justifying the bodily intrusion. In the LASIK case, OP has a considerable interest in improving their vision, which contributes to their health and well-being. This interest further increases in the cataract surgery case, as delayed intervention could lead to permanent vision damage or even blindness, which OP, like any rational, seeing individual, would want to avoid.

 

On the other hand, while we can acknowledge that the increased interest for the consenting Obedient Patient restricts the justifying force of consent, it does not drown out its role underlying the moral permissibility of the surgery either. OP would not have won a lawsuit, for instance, if they were to sue the surgeon for operating on them with valid consent. OP could only make the case to undermine the validity of the consent on the grounds that their obedience poses a type of pressure akin to coercion, which I have previously shown in the tattoo case to be unsubstantiated. According to Dougherty’s Expression of Will View, OP would have been under the false belief that they gave invalid consent, which does not itself invalidate the consent.

 

If weightier interest were a sufficiently robust explanation for the restriction on consent’s justifying force, we should expect a similar conclusion from the above bodily intrusion cases in a property case. To investigate this hypothesis, I propose a test case involving property in which an agent has weighty interest and compare our moral intuition to the violation of preference with our intuitions regarding previous cases involving the body. 

 

Weighty Property Test Case—Stubborn but Conflict-Avoidant Private Company Owner

 

Suppose an agent J owns a one-person private company. As the only employee and owner,

 

J has sole ownership of this firm, so the company is akin to another form of property. J has

 

a weighty interest in this firm because it is J’s only source of income—it generates present

 

cash flow—and has the potential to continue generating monetary value. Now suppose a

 

local chain offers to acquire J’s firm with attractive conditions: J would not only keep the

 

job but also gain the opportunity to reach more clients, make more money, and potentially

 

take over other departments of this future parent company. J signs the contract and verbally

 

confirms this agreement with the legal representative of the chain company. In other words,

 

in the eyes of the law and according to Dougherty, the acquisition of J’s company is justified. Yet, J is very stubborn and disprefers selling the company. J only consents to avoid conflict with the chain legal representative. The chain company executes the signed and verified contract and acquires J’s firm.

 

It would be utterly absurd for J to make a public complaint against the local chain or the legal presentative and say, “you knew I didn’t want to sign the contract! You have wronged me by executing it and acquiring my company!” If the weight of interest for the consent-giver is the only thing that matters, we would not expect to find J’s complaint absurd. After all, J’s company financially supports J and therefore matters a lot to J! Recall that in the cataract surgery case, it was reasonable for the patient to insist that a wrong had been committed when the surgeon proceeded with the operation with valid consent but no underlying preference. This difference suggests that heightened interest does not sufficiently explain why consent alone is not enough when an agent’s body is interfered with while simultaneously being sufficient in property cases like the case of J’s company. This test case suggests that, when it comes to the body, something else has to be present, namely, preference.

 

Objection—Preference as Consent Revocation?

 

Another possible objection would be to assert that consent is preference-based. The lack of underlying preference would be equivalent to the absence of consent or its revocation, which would render the act no longer justified according to the first condition in Dougherty’s Due Diligence Principle (Dougherty 2021, 149). If the consent is revoked, then performing the token act that the consent is meant to permit would be, again, an intrusion of one’s personal domain. Since preference is a subjective, comparative evaluation (Hansson and Grüne-Yanoff), a conception of consent grounded in or functionally equivalent to preference would be categorized as a mental account, which recognizes that consent consists of a certain mental attitude (Dougherty 2021, 23). In other words, an agent’s mental content determines the scope of the consent. An agent can thus alter the scope of their consent or revoke it simply by changing their mind (Dougherty 2021, 33). Since preference is a kind of mental attitude, changing one’s preference thereby effectively either alters the scope of one’s consent or withdraws it entirely. Therefore, the proponent of the preference account would appeal to the lack of underlying preference as either the absence of consent in the first place or a revocation of consent.

 

There are a few flaws with this objection. Firstly, Dougherty himself rejects the Mental

 

View: in The Scope of Consent, he presents four arguments in favor of the Behavioral View over

 

the Mental View, partly by relating consent to promise, which we generally agree requires public

 

behavior (Dougherty 2021, 56). The Behavioral View thus holds that like promises, consent requires behavior to express the intention to release another individual from the duty not to act in such a way that intrudes in someone’s personal domain (Dougherty 2021, 61).  Dougherty points out the asymmetry between promises and the mental account of consent. The latter can create, reimpose, and eliminate duties with mere intention. The former, by contrast, requires an act that publicly acknowledges the change in duties and how the two or more agents involved relate to each other (Dougherty 2021, 56). Though I in  no way assert that consent is a kind of promise, we can nonetheless intuit from their shared moral currency and role in guiding interpersonal relationships that mere mental attitudes like intentions  or preferences are insufficient in creating valid consent between individuals. Indeed, Dougherty’s own  conception  of  consent—the  Expression  of  Will  view—rejects  the  moral  or  epistemic equivalence between preference and the expression of will; to equivocate these two entirely different concepts would render this objection unsound. Rather, there is something fundamentally different between consent, which, according to Dougherty, is a deliberate expression of will, and preference. The former, while a more undemanding version, remains a Behavior View of consent. The expression of will is a deliberate behavior that authorizes the intrusion of one’s personal domain. It may reflect an underlying preference or it may not. For consent to be valid under this view, preference is not mandatory but behavior is required.

Even if we grant the Mental View, the preference account is still problematic. Dougherty argues that only certain kinds of mental attitudes can ground consent (Dougherty 2021, 27). We can find the motivation behind this view in the Autonomy Argument, which “appeals to the idea that consent is an exercise of an individual’s autonomy” (Dougherty 2021, 25). This is initially attractive given that much of consent literature, at least within the clinical world, arose in the aftermath of inhumane human trials in which subject autonomy was grotesquely violated. Since autonomy is partly reflected in an ability to consciously control our moral boundaries (Dougherty 2021, 25), a mental view of consent, conceptualized to maximize the protection of autonomy, should also be “under our intentional control” (Dougherty 2021, 27). However, preferences, like desires, are not necessarily under our intentional control. An agent can be born with a preference against injection needles without ever being subject to one, which supports the intuition that preferences are not always intentional. Therefore, preferences do not inherently generate a mental account of consent, so we should reject the worry that the lack of underlying preferences would somehow have the same moral significance as the absence or revocation of consent.

 

Upshots

 

Granted, in many cases in real life, the consent-receiver will not be in a position to know whether the preference is present. Indeed, sometimes the consent-giver would not even be aware or certain of their own lack of underlying preference until after the act has begun, as many preferences are nuanced, weak, or unconscious. In such cases, the ignorance of such underlying preference—or the lack thereof—would constitute a blameless ignorance of a morally-relevant fact, which would render the violation of the consent-giver’s personal domain blameless. As Gideon Rosen argues in “Culpability and Ignorance”, an agent is not culpable for an act done from moral ignorance if and only if such ignorance itself is not culpable (Rosen 61). I endorse this view and apply it to what would otherwise be culpable acts of bodily intrusions and concede that they, too, are inculpable if and only if the upstream ignorance of the consent-giver’s preference is not culpable.

 

Moreover, there are cases where the consent-receiver fails to realize that the consent-giver has been wronged. For instance, calling back to our earlier case of LASIK surgery, our patient OP consents to be operated on by the ophthalmologist P. In this case, P has fulfilled Due Diligence, having obtained enhanced reliable evidence, and has OP’s patient profile, which indicates that he disprefers surgery, especially ones that do not involve general anesthesia. Yet, through no fault of P’s own, P fails to connect the dots and realize that OP’s aversions to surgery without general anesthesia would make it wrong for P to proceed with the consent. Again, Rosen would take this case as a kind of inculpable ignorance, which renders P’s intrusion blameless. Even theorists who deny that moral ignorance is exculpatory, like Elizabeth Harman, acknowledge that the failure to realize that the wrong-making features of an action make it morally wrong could sometimes exculpate the offending agent (Harman 2017, 117). Dougherty, too, would excuse this kind of intrusion. Since the Expression of Will View is an undemanding version of the Behavioral View, it does not require successful interpretation or communication for the consent to be considered valid (Dougherty 2021, 32); in fact, Dougherty rejects the Uptake Condition, which states that:

An action A falls within the scope of the consent that X gives to Y only if Y successfully interprets X’s behaviour as motivated by an intention to release Y from their duty not to perform A. (Dougherty 2021, 78)

Therefore, the consent is considered valid even if the consent-receiver is not aware as long as the conditions for validity are met (Dougherty 2021, 79). 

 

Nonetheless, even in these bodily intrusion cases where the preference is unknown or misinterpreted, there is still an issue of objective rightness to which the individual being wronged is entitled. We can concede that the consent-receiver acts blamelessly, but nevertheless unjustifiably. After all, we acknowledge that the consent-giver is still wronged insofar as their preferences are disrespected. Yet, since it is done from inculpable ignorance, as I have established, it is blameless. Such acts, according to Rosen, would call for “agent regret” but not moral blame (Rosen 69).

 

Another account of such unwitting violations of the consenting agent’s preference comes from Elizabeth Harman, who proposes a moral category called morally permissible moral mistake (Harman 2016, 366). According to Harman’s conception, there are acts that one should do, all things considered, for moral reasons, but is not morally obligated to do, such that in failing to do them, one makes a moral mistake that is nonetheless permissible (Harman 2016, 373-374). The failure to perform such an act is a moral mistake because there are moral reasons for the agent to not fail to do it. Meanwhile, failing to perform the act is permissible because one is not obligated to perform it; not performing it is not morally impermissible. If we accept that morally permissible moral mistakes as Harman conceives exist, does proceeding with valid consent for bodily intrusion without the consent-giver’s preference fall under this category? Since I accept that valid consent releases the consent-receiver from the duty not to interfere with the consent-giver’s body, acting on valid consent would be morally permissible like in cases involving property, regardless of whether preference is present. Yet, the absence of preference makes it a moral mistake when it involves the body because, all things considered, there are moral reasons why the consent-receiver should respect the consent-giver’s bodily preferences. For the ophthalmologist, for example, to perform LASIK surgery on the Obedient Patient, would be a morally permissible moral mistake. On the other hand, we cannot say that it is a moral mistake for the Tenant to disrespect Landlord’s preferences against leasing in light of the contract, which makes Tenant’s use of Landlord's Apartment morally permissible. Acting with valid consent but without preference in property cases is not a moral mistake and is simply morally permissible.

 

In either account, we can acknowledge that the consenting individual is still wronged despite the sanction of their valid consent without blaming the consent-receiving actor. In cases of bodily intrusion, we should not be in the business of blame but rather focus on protecting and respecting the moral boundaries and dignity of individuals, which is reflected by their preferences.

 

The Due Diligence Principle, Revisited

 

So what does this mean for Dougherty’s conception of consent? Should we abandon the Due Diligence Principle altogether? Of course not. These cases above have revealed that there is something beyond consent—namely, an agent’s underlying preferences—that should also guide and justify the actions of other individuals interacting with or acting within their personal domain alongside consent, not in place of it. One way to remedy Dougherty’s Due Diligence Principle is to acknowledge that, in cases involving the body, from a reversible tattoo to an invasive medical procedure, there is a further question about the consent-giver’s preference. Such preference should be clearly understood as an additional enhanced reliable evidence that the consent-receiver has a duty to obtain, though not a component of consent itself, such that knowing violations of underlying preference about the body are avoided and inadvertent intrusions are minimized. Note that, since Dougherty rejects the Mental View, and I have established that preference is a kind of mental attitude separate from consent, we can presume that Dougherty’s present conception of the Due Diligence Principle does not include information about preference as a kind of enhanced reliable evidence as I propose. Dougherty’s Expression of Will View does not care about preference. Therefore, my account here is a revision of Dougherty’s Due Diligence Principle, rather than a more generous interpretation.Whether an agent has sufficiently obtained such evidence is, of course, a matter of what is epistemically possible in a given situation, and should be evaluated on a case by case basis, as the Enhanced Reliable Evidence Principle suggests. A helpful metric remains the Reasonable Agent Standard common in the legal literature on intimate relations and medical practice, or Dougherty’s suggestion that it be appropriate given the stakes of the consented act and the cost of acquiring the relevant evidence (Dougherty 2021, 144). The important thing is that such due diligence to obtain evidence for the consenting individual’s underlying preference is carried out before the bodily intrusion is consummated.

 

Conclusion

 

In this paper, I have argued that valid consent alone is not fully dispositive in cases involving the body. Instead, a second preference-based right is another necessary condition for the moral permissibility of the intrusion. I have demonstrated through a series of cases that preference, rather than merely the cost to the agent, matters in addition to valid consent and should be respected. I then addressed the upshots relating to epistemic challenges, including ignorance and the failure to realize certain facts. I also outlined two moral accounts of consensual bodily intrusion without preference: a morally impermissible but blameless account under Rosen’s framework and a morally permissible moral mistake account under Harman’s conception. Lastly, I proposed an addendum to Dougherty’s Due Diligence Principle of consent to include one’s underlying preference. Future work should expand upon the moral significance of preference and provide a more conclusive account of what motivates its relevance in cases involving the body.

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Acknowledgements

 

I would like to thank my advisor, Professor Gideon Rosen, for his guidance and feedback throughout the junior independent work process. I also want to thank family and friends, especially John Wallar, for providing comments and unrelenting support.

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