Consented: A Doctor’s Call to End Medical Violence and Reclaim Patient Autonomy by Dr. Zed Zha offers a comprehensive critique of the way patient autonomy and consent are handled in medical care in the United States and beyond. Over the course of the book, Dr. Zha explores the origins and perpetuation of what she calls “medical rape culture” — the systemic normalization of patients being subjected to medical care to which they have not properly consented. Drawing on the history of medicine, patient experiences, clinical encounters, and her own experiences as a physician, Dr. Zha examines how medical systems can normalize practices that minimize patients’ voices and override their right to make decisions about their own bodies.
Dr. Zha outlines four main forms of problematic consent in medicine: non-consent, forced consent, inadequate consent, and contractual consent. Non-consent reflects the belief that a medical provider inherently knows what is best for their patient. Forced consent occurs when a patient who does not comply with a provider’s recommendations is treated as though they have forfeited their right to choice. Inadequate consent describes situations in which doctors determine for themselves what information a patient does or does not need to know. Contractual consent refers to the idea that a patient loses their right to make choices after signing an agreement or consent form. Together, these ideas challenge the common understanding of consent as something that can be reduced to a signature on a piece of paper.
Each chapter examines a different aspect of this culture, including medical discrimination on the basis of sex, gender, sexuality, and race; the objectification of bodies; medical gaslighting; patient blaming; the trivialization of trauma; and more. The author examines how patients who question their providers or make decisions that differ from medical recommendations can be labeled “difficult” or “non-compliant,” rather than recognized as people with their own knowledge, values, experiences, and reasons for making a particular decision. For each topic, Dr. Zha also proposes ideas for a radically reimagined model of medical care that prioritizes compassion, collaboration, and meaningful consent.
One of the book’s strengths is the way Dr. Zha connects individual patient experiences to the history of medicine and broader, systemic forms of medical violence to effectively “diagnose” the issue of medical rape culture. She consulted more than 900 texts in her research, taking a storied past of policies, practices, and statistics and interweaving them with patients’ stories and the author’s own clinical experiences and reflections to paint a complete picture of medical rape culture. Historical examples, such as the controversial origins of the speculum, are explained clearly and connected to present-day medical practices and attitudes, demonstrating how the ways medicine has historically viewed and treated patients can continue to influence contemporary care, and practices that may seem like isolated or individual failures are connected to much older traditions within medicine.
Rather than treating patients as case studies detached from their humanity, Dr. Zha gives each experience she highlights character and context and treats them with sensitivity and respect. The stories anthologized in Consented also offer a range of medical violations, from overt and extreme abuses of power to experiences that patients themselves may initially believe are too insignificant to warrant concern. This is important because people may minimize their own experiences when they compare them with more dramatic examples of medical harm. By including so many different stories, Consented gives readers the opportunity to recognize themselves in experiences that might otherwise be dismissed as not significant enough to matter.
Dr. Zha also writes openly about her own experiences and about the process of questioning assumptions she had been taught throughout her medical training. Her willingness to examine her own practices and past rather than simply criticizing other providers gives the book a strong sense of sincerity and vulnerability. She challenges the expectation that a provider should simply be “compliant” with established medical practices, and asks providers to consider whether following what has always been taught or what is compliant is necessarily the same thing as providing the most humane or thoughtful care. In doing so, she encourages providers to ask themselves: What are my core values as a provider? What are my biases? Am I truly doing the most I can for my patients, or am I simply complying with what I have been told for years and what has been affirmed by my peers?
Dr. Zha’s dedication to giving patients a voice extends beyond Consented. Through her long-standing Ask the Patient blog and newsletter, she uses patient stories and research to provide information about common medical conditions and to highlight experiences that might otherwise only be discussed in the more sterile context of medical case studies. For readers who are curious about the ideas explored in Consented, Ask the Patient is an accessible starting point for understanding the broader work Dr. Zha has done to bring greater humanity into medicine, and Consented expands upon that work by placing patient experiences within a broader historical and systemic context.
Another particularly interesting aspect of the book is that Dr. Zha does not limit her discussion of autonomy to the patient side of a patient-provider relationship. She also considers the value of provider autonomy and support, and what a healthcare system would look like if it valued providers for the quality of care they provide rather than primarily for their gender identity, revenue generation, or other measures that can have little to do with patient outcomes or experiences. For instance, her proposal of an “organizational compensation algorithm” — compensating providers based on patient complexity, workload, emotional labor, and other factors related to quality of care — suggests that improving patient care also requires changing the structures in which providers work.
In a profit-driven medical system that can often feel as though it has lost its sense of humanity, Consented can offer hope to patients and providers alike. For patients, it can be valuable simply to hear a medical professional articulate that respect for consent extends beyond a signed paper or a one-time affirmation. The book reminds readers that they have a right to speak up when something feels wrong, ask for more information, refuse care they are uncomfortable with, or even seek a different provider when possible. It may encourage patients to be more steadfast in their own judgments and beliefs about their health rather than assuming that questioning a medical professional makes them difficult or non-compliant. For providers, Consented can function either as a reminder or a call to action: a reminder that every patient is a person whose experiences and knowledge matter, or a challenge to reconsider whether the habits and assumptions of medical training are always serving patients as well as they could. Dr. Zha demonstrates by example that becoming a better and more compassionate provider requires not only medical knowledge, but also a willingness to listen, reflect, unlearn, and see the patient as worthy of genuine autonomy. Consented is a reminder that medicine does not have to be cold or transactional, and that there is still room to build a healthcare system in which both patients and providers are treated as human beings.
