It was a white wand — the kind a little girl might have. White ribbon wound round a long straw, at the top of which a double pair of white wings was set. Another more delicate white ribbon looped around the wings, to the front of which was fixed a downy feather, and behind which the ribbon was tied in a bow.
Crusoe was facing her most difficult patient. A man with manic-depressive illness who, when depressed, posed a serious risk of suicide. She had tried all possible medications but none had helped. They seemed, if anything, to make things worse and to prolong the condition. The only thing that had helped in the past was electroconvulsive therapy (ECT) but he was resistant to this. Contemplating what to do, she idly picked up the wand and waved it.
She realized her mistake before he did. She should of course have sought his consent before exposing her patient to any risk. She apologized. He was perplexed; if he wished to get better or she wished to get him better — where was the problem?
“Well,” she said, “It might seem straightforward, but look what happened to Macbeth.”
“But what would I consent to?” he replied. “Do I consent to believing in magic or to your believing in magic or simply to having you wave the wand around?”
“Well in this case,” she said, “simply having me wave the wand around. Look I don’t know whether having the bow or the pom-pom facing you makes a difference, or even whether holding it the right way up or upside down makes a difference. I didn’t chant spells, invoke powers, or connect this manipulation to any belief system, but a wand is a wand. It’s not like reading a horoscope, where your eye might accidentally catch sight of some words but there is no one on the far end of them, and most of us can take or leave these things. I’m on the far end of this.”
“Well,” he said, “whose karma is it that might come back to haunt me — mine or yours? Was Macbeth the victim of the witches or did he undo himself? Makes a difference to any consent form. Actually, you say you didn’t tap into any belief system when waving the wand, but hasn’t mentioning informed consent created the need for informed consent, so that in a sense even before asking me to consent you’d have had to get my consent to having the idea of informed consent raised — but how could you do this?
“If I were elsewhere and you had been idly waving the wand and thinking about me, would you have needed informed consent then or is it just the fact that now that I’ve seen you do it that you need me to indemnify you, as it were?
“And if you’re going to muck around with reality like this, maybe change the structure of the universe, surely you need to get the consent of everyone?”
Crusoe thought about this.
“We’re not talking about turning you into a white rabbit,” she said, “so I can’t see a need to get your wife and family to agree to this. But these days if my employers knew what was going on here, they almost certainly wouldn’t consent — so in this sense getting you to sign a consent form might make my position worse.
“But while you’re most unlikely to end up as a white rabbit, life goes on after this wand is waved, things continue to happen, and waving it just may affect your perception of the sequence of things afterwards. If they go well, fine. But if they go badly, will you begin to wonder about what effect the wand may have had.”
“Now that you’ve mentioned it, I get most of the side effects that are listed in the package inserts. Why haven’t you gotten my consent for all the pills you’ve put me on over the years?” he asked.
“Is there any difference between the way the witches ‘paltered with’ Macbeth ‘in a double sense’ and the way drug companies do with me, or rather with you? At least the witches showed him all the data which is more you can say for the drug companies.”
“I have — I told you about likely problems. You may not have signed a form but by taking them you showed that you agreed.”
“Ah, no you didn’t. You didn’t get me to face the prospect of something going seriously wrong. We both just assumed things would go right, or that we’d be able to manage whatever went wrong. We’re nervous now because we’re not sure we could manage what would happen if the wand went wrong, but it is much more likely that things will go wrong with the pills. All the things that may have been going to happen anyway — things that you’re now worried I might attribute to the wand — would still have happened after the pills, and I’m even more likely to think that they were caused by the pills than by the wand.
“And I don’t just mean things going wrong for me, but waving these pills around you really do produce changes in the fabric of the universe that we can see happening as a consequence of growing pharmaceutical company profits and power — all the women who are going to be persuaded their lives will make sense once their sexual dysfunction is sorted out. Did you get my consent for that?
“And what do I tell my wife about this wand? After all, things only started happening to Macbeth once he told his wife. Will the fact that you’re a woman make a difference to how she views things?”