Written by: Leah Jeunnette, Ph.D.(c)

Informed consent is a major ethical concept.  It most often is associated with research studies or consent for medications or treatments.  However, informed consent can also be applied to the debate over fast food.  In the past few years, government regulation both at state and federal level has increased the requirements to provide nutritional information.  The justification to pass this regulation is that by providing nutritional information, consumers will make an educated choice regarding what they eat.  They question is though, does providing nutritional information really do that?

The three parts to informed consent can help in this answer and in the public health response to fast food.  The three elements – being fully informed, having capacity to understand, and voluntary participation can all bring about further discussion in how to handle fast food and more importantly unhealthy food.

1.  Being Fully Informed

Being given the full scope of information is crucial to the informed consent process.  It provides all necessary and relevant information in order to provide the individual with not only the big picture, but also the small details.  When applying the element of being fully informed to fast food, there are subtle changes to the concept.  In this case, the information being provided would be the ingredients, its nutrition value, the cooking method, and the portion sizes.  Providing this information allows the consumer to make decisions on what restaurant to go to or what food to order.  In the case of clinical ethics, informed consent is done every time for each procedure or medical intervention.  In the case of fast food, this is not necessarily a practical approach.  While the information should be provided (online or in a pamphlet at the restaurant), it does not have to be reviewed one on one for each consumer every time.  As long as the food remains the same, then having to re-inform an individual seems repetitive and unnecessary.  On the other hand, there is a question as to whether the consumer is ever really fully informed.  Do consumers actually know the information is provided?  Does the business do a satisfactory job of letting consumers know that the information is available?

Nutritional Information and Portion Size

While many fast food restaurants are required by law to post nutritional information about their food, that does not mean that customers take notice.  Some restaurants have their nutritional information posted online, while others have a poster in the restaurant, while still others have pamphlets available to read.  Just because the information is available for the consumer, does not make the consumer fully informed.  In the case of fast food (and many other public health initiatives), the burden is placed upon the consumer to seek out the information.  When a consumer goes through the drive through, the worker does not remind the consumer of the content of fat, or calories of the items they ordered.  Instead, it is assumed that if the consumer is concerned about the nutritional information, that they will ask and seek the information themselves.  Some aspects of the nutritional information is easier to understand than others.  Calories, total fat content, carbohydrates, etc. are not necessarily memorized pieces of information for each item on the menu.  However, because of marketing campaigns, news reports, education reports, many can distinguish which items are healthier than others.  Many fast food restaurants also feature healthy options that the company has identified.  This does not solve the dilemma though. Some pieces of nutritional information remain in a consumer’s knowledge base, other times concepts like portion sizes just further confuse the individual.  In the United States, there is a discrepancy between the portion size and the amount of food that is served at a fast food restaurant.  Many assume that when they order an item, what they are given is one serving.  However serving size and the portion served usually does not match up at fast food restaurants. Consumers, even if they seek out the information, are not fully informed as to which size of the food they should order to stay within nutritional guidelines.

2.  Having Capacity to Understand

The second element to informed consent is having the capacity to understand.   It determines whether the patient is capable of making a decision and the ability to understand the information provided.  In the fast food industry, no one questions the capacity of the consumer to understand the health information or effect of the food on the consumer.  Employees at fast food restaurants do not consider the mental capacity of the customer.  It is also assumed, that if the customers are able to come in (or drive thru) for the fast food, that the consumers have the capacity to decide for themselves.  Furthermore, the consumers are assumed to have the capacity to understand the difference in their menu items in order to make their own selection.  However, should public health consider whether or not the consumer truly understands the effect that certain foods can have on the body and health.  Many understand that unhealthy foods eaten in large amounts for a continued period of time can cause health detriments.  But is the average consumer able to understand what the true impact is?  And should this impact the fast food?

3.  Voluntary Participation

The third element of informed consent is voluntary participation.  The idea of voluntariness is rooted in the assumption that the individual is given the full information; has the capacity to understand; and therefore chooses whether or not to participate.  It is also known that a patient can refuse at any point.  In the concern over fast food, voluntary consumption of the food makes for an interesting discussion.  Food (and more importantly the energy taken from food) is required to sustain life and therefore not eating is unsafe.  At the same time, choosing what types of food to eat is a voluntary process.  However, there are some who are in a vulnerable state and have less control over their food selection.  The availability of healthy options and fast food should be considered for the individual.  Even more compelling is the cost of healthy options and fast food for those whose money is tight.  Finally, the time constraints that an individual faces are also important.

So the next time you eat at a fast food restaurant, consider if you are really practicing informed consent on the food you are consuming.  Do you know if you are fully informed about nutritional information and portion sizes?  Is your capacity where it should be to understand the health issues associated with fast food or are you happy to know that something is unhealthy, but not understand the why?  And finally, are you voluntarily choosing fast food or doing so out of necessity from your circumstance or environment?  And even more specifically, are the items you order the healthier options on the menu? Think about it the next time you order fast food.