Informed consent

What is informed consent?

Informed consent is consent that only counts once the person giving it knows what they are saying yes to: what happens, what risks are attached, what alternatives exist, and that stopping is always allowed. The concept comes from medical ethics and sets demands on the information beforehand, not on the yes itself.

What informed consent means in practice

Informed consent means that whoever proposes something first explains what it involves, and only then asks whether the other person wants it.

Take a common case. Someone has read about breath control and asks whether that’s possible. A yes to that question is not yet informed consent. It becomes that only once she knows which risks are attached to the practice, what happens if it goes wrong, which milder variant gives roughly the same feeling, and how she stops it at a moment when talking isn’t possible. Four things you wouldn’t look up on your own and that are told in five minutes.

In the consulting room that exact conversation is required by law. Article 7:448 of the Civil Code says the care provider is guided by “what the patient reasonably needs to know” about the nature and purpose of the procedure, the expected consequences and risks, and the other possible methods. In a bedroom that law doesn’t apply. The question underneath is the same.

Where informed consent comes from

From a courtroom, not from the scene.

On 19 August 1947 an American military tribunal in Nuremberg delivered the verdict in the trial of twenty-three German doctors. That verdict contained a list of ten points that became known as the Nuremberg Code. The first point reads: “The voluntary consent of the human subject is absolutely essential.” The elaboration beneath it is what gave the concept of informed consent its content: the person involved must be able to choose freely, without “force, fraud, deceit, duress, over-reaching”, and must have “sufficient knowledge and comprehension of the elements of the subject matter involved”. Point nine added something every safeword arrangement recognizes: the participant must be able to end it at any moment.

After that the concept was sharpened twice more. The Declaration of Helsinki, adopted in 1964 by the World Medical Association and last revised in October 2024, demands that a participant be “adequately informed in plain language” about purpose, method, expected benefits and possible risks, and that they be told they may withdraw at any moment “without reprisal”. The American government’s Belmont Report took informed consent apart in 1979 into three parts: “information, comprehension and voluntariness”. Information, comprehension and voluntariness. Of those three, the second is the hardest, because it’s not about what you told but about what got through.

What informed consent delivers

It makes surrender possible without your having to hope it turns out well.

• For the one undergoing something, informed consent turns the choice from a gamble into a decision. You weigh what can really happen instead of what you hope for.
• For the one taking the lead, the question shifts from “did she say yes” to “did she know what she was saying yes to”. That second answer is the only one that stands up afterward, for her and for you.
• For the two of you together, the conversation surfaces information that would otherwise only come out halfway through, at the worst possible moment.

Informed consent makes nothing safer. It only changes who knows the risk. The kink framework RACK says so plainly: there is no safe or unsafe, only safer and less safe. Someone who does a thing whose risks are on the table is still doing that same thing.

What informed consent is not

“Informed consent and consent are the same.” They’re not. Consent is the permission: voluntary, from everyone, revocable at any moment. Informed consent is the demand on what comes before it. You can say yes entirely voluntarily to something you don’t half know. That’s consent, then, and not informed consent.

“It’s a form.” In research, yes: Helsinki wants the consent recorded in writing or electronically. Outside a research protocol there’s nothing to sign, and a contract doesn’t replace the conversation. The proof sits in what was explained, not in a signature.

“You have to know everything before you can say yes.” No one can. The acronym RACK was proposed in 1999 by Gary Switch on the mailing list of The Eulenspiegel Society, precisely because “safe” is a promise no one can keep. Switch compared BDSM to mountaineering: the risk is part of it and shrinks through study, training and technique. The demand is that you’re well informed about the risks, not that the risks are gone.

What I see myself

I’m Victor, a gigolo, twenty-five years active in BDSM and trained as a psychotherapist. The question I get most is “is that safe?”, and the answer people want to hear is yes.

That answer I don’t give. I tell what can go wrong and how likely that is. Almost no one backs out over it. What does happen is that the tension drops from their shoulders, because they finally have something concrete to think about instead of a vague unease.

The hard part isn’t in the listing. It’s in checking whether it got through, and that is exactly what the Belmont Report means by comprehension. So I regularly ask whether someone will say in her own words what we’re going to do. Anyone who can’t hasn’t heard it, no matter how often she nodded.

What you can do yourself

• Ask what can go wrong, not whether it’s safe. The first question gets you information, the second a reassurance.
• Ask about the milder variant of what you want to try. It almost always exists and makes a fine first time.
• Ask how you stop at a moment when talking isn’t possible, and agree on that gesture before it’s needed.
• Say back in your own words what you understood. If it’s off, that shows now and not halfway through.
• With something you know nothing about, look up one source yourself. Informed consent isn’t a service the other person delivers; you’re allowed to put work into it yourself.

Read more about informed consent

On this site, consent gives the broader frame that informed consent is a condition of, and the article on consent as the backbone of safety and pleasure shows how such a conversation goes in practice. Experience level explains why the same explanation is enough for one person and not for another.

Outside this site, the Belmont Report is still the clearest breakdown of the concept into three parts, and the Declaration of Helsinki shows how extensive the duty to inform has become since 1964.

Where this fits on my site

If you want to try something you know too little about to give an honest yes to, that conversation is the first thing that happens. The page on consent shows what such an explanation looks like with me, and the page on the BDSM date describes what’s possible after it.

Sources

• The Nuremberg Code. United States Holocaust Memorial Museum, with the text from the trial record. Supplies the first of the ten points from the verdict of 19 August 1947 (“The voluntary consent of the human subject is absolutely essential”), the demands of free choice without coercion or deceit and of sufficient knowledge and comprehension of the matter, and point nine on the participant’s right to stop.
• The Belmont Report. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 18 April 1979, published by the American Department of Health. Supplies the breakdown of informed consent into three parts, “information, comprehension and voluntariness”, and the position that the researcher is responsible for establishing that the information was understood.
• WMA Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Participants. World Medical Association, adopted in June 1964 and last revised in October 2024. Supplies the demand that a participant be “adequately informed in plain language” about purpose, method, expected benefits and possible risks, the right to withdraw without reprisal, and the demand that consent be recorded in writing or electronically.
• Civil Code Book 7, articles 448 and 450. Wetten.overheid.nl, text in force. Supplies the Dutch duty to inform (“what the patient reasonably needs to know” about nature and purpose, the expected consequences and risks, also with no treatment, and the other possible methods) and the rule that consent from the patient is required for procedures.
• Informed Consent. Parth Shah, Imani Thornton, Nancy L. Kopitnik & John E. Hipskind, StatPearls, updated 24 November 2024. Supplies the five parts that a recording must cover, including a check of the patient’s comprehension, and the rule that someone must have decision-making capacity to make a voluntary decision.
• Risk-aware consensual kink. Wikipedia. Supplies the origin of RACK (Gary Switch, 1999, mailing list of The Eulenspiegel Society), the comparison with mountaineering, the position that within RACK there is no safe or unsafe but only safer and less safe, and the acronym PRICK for personal responsibility, informed consensual kink.

Related terms

• Consent. What informed consent is a condition of, with the three layers and the Dutch legal frame.
• Consent violation. What it’s called when something steps outside the agreement, and how often that happens.
• The 3 V’s. Safe, sensible and voluntary, the older frame RACK found held too much promise.
• Boundary. The material the agreement is made of once the information is on the table.
• Contract. The written form, which records the conversation but doesn’t replace it.
• Edgeplay. The category where the duty to inform weighs heaviest, and where RACK is the frame.
• Pick-up play. The situation where the information that gives a yes its meaning is precisely what’s missing.
• SSC, RACK and PRICK. The three frames that each give their own answer to how much you have to know before you say yes.

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