This chapter breaks down the genesis, standards, critiques and questions of ‘informed consent’ in both medical and research contexts in the United States. The notion that patients may direct their care is complex, moulded by legal tests that sometimes frustrate private enforcement through litigation. Often, patients do little more than sign a paper consent form, never having the face-to-face conversation that the form should memorialize. Complicating the possibility of reform, not all patients are alike. Some patients want to be the decision maker; others a passive participant; others still a trusted partner in making medical decisions together with their physician.