Possible Worlds, Omission, and Informed Consent: A Model of Nudging, Duping, and Decisional World-Construction in Healthcare
Dr. Antonio Rossini (Arg Studies/CRRAR)Abstract: This paper proposes an original theoretical model of informed consent by integrating selected concepts from Lubomír Doležel’s possible-worlds semantics with the patient-centred legal framework developed by Rachel K. Willsie in her analysis of informed consent in Ontario. Its central argument is that manipulation need not involve affirmative falsehood, coercion, or explicit misinformation: it may also occur through the selective omission of information necessary for patients to construct and compare the possible futures associated with their healthcare decisions. Drawing on the concepts of incompleteness, saturation, and world construction, the paper introduces the notion of necessary decisional properties, defined as those properties whose disclosure is reasonably necessary for a particular patient to evaluate clinically relevant alternatives. It further develops the concept of Omissive Possible-World Manipulation (OPWM) to describe situations in which selective omissions, asymmetric informational saturation, or the exclusion of relevant alternatives directionally structure a patient’s decision-space. Through an examination of Reibl v. Hughes and Willsie’s three-tier framework of legal accountability, the paper distinguishes material non-disclosure, relational failures of communication, and institutional deficiencies from intentional manipulation, while identifying their potentially convergent effects on patient autonomy. The resulting concept of under-constructed consent describes decisions that may be formally voluntary yet emerge from informationally inadequate or asymmetrically represented alternatives. The paper ultimately argues that meaningful informed consent requires more than truthful disclosure and freedom from coercion: it requires fair access to sufficiently constructed, intelligible, and comparatively balanced possible futures. This approach offers a new conceptual foundation for evaluating decisional manipulation, strengthening patient-centred consent practices, and reconsidering the legal and institutional conditions necessary for genuine healthcare autonomy.
November 13, 2026
3:00 p.m.
Windsor Law School
(Faculty Lounge, Room 2200)
All Welcome