The Implicit Assumption in Transplanted Ethics: Informed Consent, Unequal Protective Force, and Accountability Ecology (Preprint)

<sec> <title>UNSTRUCTURED</title> <p>Informed consent remains ethically indispensable, but it is often treated as if the procedures alone deliver equivalent participant protection across research settings. We argue that consent has unequal protective force because its effectiveness depends on two unevenly distributed conditions - the material conditions that make refusal substantively possible and an accountability ecology that converts ethical breakdown into deterrence, remedy, and institutional learning. Focusing on the latter, we identify four components - financial-institutional incentives, legal-adjudicatory recourse, political accountability and public revisability, and public contestability. We illustrate the framework with three cases, Ellen Roche at Johns Hopkins, the Kano/Trovan controversy, and India’s HPV demonstration projects, to show how variation in the latency, density, and enforceability of accountability alters what otherwise similar consent procedures can protect. The result is not a case against consent, but against assuming that transplanted procedures carry equivalent protective force.</p> </sec>