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A Matter of Consent

Updated: Jul 10, 2023

Consent is one of the fundamental tenets of the relationship between a patient and their healthcare provider. Health professionals have a duty to properly communicate the nature of the proposed intervention, the risks and benefits of the proposed intervention, and any alternatives to the proposed intervention, in order for consent to be valid. Without the obtaining of consent, a health professional is vulnerable to allegations of assault, with serious consequences if found guilty.


Consent is required to be obtained at several stages of the clinical encounter. This includes the physical examination and the undertaking of investigations, such as diagnostic imaging as well as hands-on care. It is important to bear in mind that patients may not have previously attended a chiropractor and therefore will not know what to expect. Ensuring that information about proposed actions is clearly communicated is of paramount importance, especially if it involves the touching of areas that may be regarded as intimate or intrusive.


Patient consent must be voluntary and informed. This means that patients must not be coerced into providing their consent, no matter how important a health provider may think the examination or treatment is. The communication of information must be clear and unambiguous. Patients are often intimidated by the use of medical jargon, so the need to ensure that proposed care is set out in clear terms (using an interpreter if appropriate) is of paramount importance.


A signature on a form does not necessarily mean that informed consent has been obtained. While some jurisdictions demand signed consent from the patient, others, for example in the UK, require that, as a minimum, the fact that consent has been obtained must be documented.



Consent is an ongoing process, not a one-off event. Patients have the right to withdraw their consent at any time and must be informed of this fact. This is particularly important where the circumstances change and a new or different form of care is proposed.


As patients age, or following certain types of trauma, they can suffer from cognitive decline, which mean that they are not always able to understand, weigh up, or retain information that is provided to them. Health professionals have a duty to ensure that a patient has the capacity to provide informed consent. If there is any doubt as to mental capacity, it is recommended that advice is sought.


The law around consent and the assessment and care of children and young people varies from jurisdiction to jurisdiction. Obtaining parental consent is required when a child is to be seen without someone else being present, although there are circumstances where a child may be deemed competent to make their own decisions. As it is a complex area of law, it is again recommend advice be sought where there is uncertainty.


Shared decision making is a fundamental part of the consent process. Ensuring that a patient's wishes are respected and their preferences are clearly understood is vital. In any given interaction, there may be many non-clinical factors at play. Sensitivity, empathy and compassion may often come into play when obtaining consent and ensuring that all questions and concerns are addressed.


Since the case of Montgomery v Lanarkshire Health Board, the law on consent in the United Kingdom requires for the communication of any risks, however remote, to which a reasonable person in the patient's circumstances may attach significance. What this means is that a patient should be told whatever they want to know, rather than what a doctor thinks they ought to be told.


In summary, it is the duty of every chiropractor to ensure that a patient has all the necessary information they need and want prior to commencing care (and during care) and that patients be given support in order to provide valid, informed consent.


Helpful reading:


Richard Brown













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