1. Introduction
Health systems treat consent as a procedural artifact.
Consent is implemented through documents, configuration flags, access permissions, and institutional policy. These mechanisms regulate visibility and usage, but they do not define authority. As a result, consent is implicit, revocable without trace, and external to the state it governs.
When consent is modeled as policy, authority becomes unstable. Revocation erases causality. Historical assertions become contingent on present permissions. Truth migrates silently to the systems that enforce access.
This paper formalizes consent as a property of canonical state.
2. Authority and Truth
Authority determines who may assert canonical state.
In Paper 001, authority was defined as distinct from access and visibility. That distinction is foundational. This paper extends it by defining how authority is delegated, constrained, and terminated over time.
Authority is not derived from:
- Institutional role
- System ownership
- Data custody
- Compliance obligation
- Network position
Authority exists only when explicitly granted.
Truth in canonical state is a function of valid authority at the time of assertion. Assertions made without authority are undefined.
3. Consent as State
Consent is an assertion about authority.
A consent grant is a canonical assertion that delegates limited authority from an individual to another actor. Like all canonical assertions, consent is immutable once recorded.
Consent is not:
- A document
- A configuration
- A policy rule
- A legal abstraction
Consent is state.
Because consent is state, it is subject to time, provenance, and irreversibility.
4. Delegated Authority
Delegated authority is constrained by construction.
Every delegation is defined along three axes:
4.1 Scope
Scope defines the class of assertions that may be made. Assertions outside this scope are invalid regardless of intent or access.
4.2 Duration
Delegation exists within a defined temporal interval. Assertions made outside this interval are invalid.
4.3 Context
Context defines the conditions under which delegation applies. Context may include interaction boundaries, environments, or explicit triggering conditions.
Delegation that lacks scope, duration, or context is incomplete and undefined.
5. Assertion Validity
An assertion is valid if and only if:
- The asserting entity held delegated authority at assertion time
- The assertion fell within the delegated scope
- The assertion occurred within the delegated duration
- The assertion satisfied the delegated context
Validity is evaluated structurally, not interpretively.
Validity does not imply correctness.
Validity implies admissibility into canonical state.
6. Revocation
Revocation is an assertion that terminates delegated authority.
Revocation:
- Prevents future assertions under the revoked delegation
- Does not invalidate prior assertions
- Does not alter provenance
- Does not rewrite time
Revocation cannot erase historical state. A system that permits revocation to remove past assertions collapses causality and cannot preserve truth under audit.
7. Consent and Access
Consent and access regulate different properties.
Consent governs authority to assert canonical state.
Access governs the ability to view or consume state.
Access may be granted without authority.
Authority may exist without access.
Systems that conflate consent with access cannot enforce accountability. They permit silent reassignment of truth through configuration changes rather than explicit state transitions.
8. Institutional Participation
Institutions participate as delegated actors.
They do not acquire authority through storage, custody, or regulatory responsibility. Institutional outputs are assertions made under delegated authority, not privileged truth.
Institutions may assert state.
They may not redefine authority.
They may not rewrite canonical history.
9. Invariants
The following invariants hold:
- Authority is explicit
- Consent is canonical state
- Delegation is scoped, time-bound, and contextual
- Assertion validity is evaluated structurally
- Revocation affects future authority only
- Consent and access are orthogonal
- Historical assertions are immutable
Violating any invariant collapses individual-anchored truth.
10. Discussion
Modeling consent as state produces stable authority.
Authority becomes inspectable rather than assumed.
Revocation becomes causal rather than destructive.
Historical truth becomes independent of current permissions.
Institutions lose the ability to silently rewrite state.
Consent ceases to be a procedural overlay and becomes a property of the system.