How far back does medical consent go? A journey through Ottoman legal records in Ottoman Empire.

Abstract

Tracing the evolution of informed consent from the Hippocratic tradition to the Ottoman Empire reveals its enduring role as a fundamental ethical principle supporting patient autonomy. Spanning diverse medical and cultural landscapes-including Ancient Greece, Byzantium, Islamic medicine and Ottoman legal practices-this historical trajectory uncovers a continuous and evolving dialogue between physicians and patients. It reflects a persistent recognition of the moral and practical necessity for physicians to share medical information and for patients to engage voluntarily in decisions regarding their health. A particularly significant historical juncture is found in the Ottoman Empire. Especially noteworthy are 16th-century and 17th-century court records from Istanbul, which provide some of the earliest concrete examples of formalised patient consent in the Ottoman era. These records, found in qadi (kadı) sicilleri (Ottoman court registers), document patients giving explicit permission-often witnessed and recorded-for surgical procedures. In our study, we employed a methodology that began with a systematic review of relevant national and international literature, followed by the examination of qadi court records from the years 1579 to 1663. Through a concept-based search, 21 documents from the Istanbul Province's kadı registers were located, analysed and evaluated in terms of their informed consent elements. Such documentation demonstrates that informed consent, although not institutionalised in the modern sense, was already being practised as a legally and ethically meaningful process. These examples represent not only a cultural and legal continuity from earlier historical practices but also a key moment in the formal recognition of the patient's voice in medical decision-making. By analysing these sources, the study not only reveals how these legal responsibilities were understood and practised in premodern contexts, but also offers valuable historical insight that enriches contemporary discourse on medical ethics and law. This continuity shows that informed consent is not merely a modern legal formality, but a long-standing ethical commitment embedded across cultures and civilisations.