Module 4, Lecture 3

Physiotherapy Practice in Canada

Informed Consent

Objectives of this Lecture

1 What is meant by informed consent

2 Outline the different types of consent

Outline the process for properly obtaining

3 informed consent
 Purpose of Informed Consent

The purpose of informed consent is

to provide information that enables
the patient to make an informed
choice or decision about whether
to accept or refuse your proposed
treatment.

Informed Consent - Patient Autonomy

Autonomy means the patient has the

right to make a choice about the
proposed interventions including the
right to refuse treatment, regardless of
potential benefits or harm.
 Informed Consent - Patient Autonomy

Autonomy also means that patients

have the right to change their minds
and subsequently revoke or withdraw
treatment at any time.

Informed Consent - Is an Ongoing Process

Informed consent is an ongoing

exchange of information and
shared-decision making that carries
on throughout the patient’s
treatment
Types of Informed Consent - Express or Implied

Express Implied

Express Consent

Written Verbal
Express Consent - Recommended Standard

Written Verbal

Implied Consent

Implied consent is signalled by some

action from the patient that implies
consent
 Implied Consent - May be OK at Follow-up

Not on first visit OK on follow-up visits

Implied Consent - Embodied and Tacit Consent

Embodied Tacit
 Embodied Consent

Embodied consent is signalled by the

patient’s body language prior to and
during treatment.

Embodied Consent - Not Recommended

Embodied consent is open to

interpretation.
 Tacit Consent

Based on the failure of the patient to

disagree or dissent with the
treatment.

Tacit Consent - Not Recommended

Open to considerable interpretation.

Not recommended.
 Informed Consent - Recommendations

● Obtain express consent for the initial

assessment and treatment planning
and then have ongoing consent
indicated by implied consent.

● During the course of treatment if a

new assessment or treatment is being
introduced then go back and obtain
express consent.

Objectives of this Lecture

1 What is meant by informed consent

2 Outline the different types of consent

Outline the process for properly obtaining

3 informed consent
 Criteria for Obtaining Valid Consent

1 Consent is given voluntarily

2 Patient has capacity to consent

3 Patient receives proper disclosure

4 Patient questions are satisfactorily answered

5 Consent is specific to treatment

1 - Consent is Voluntary

Consent is given without any undue

influence, coercion from others and
misrepresentation of facts.
2 - The Patient Has the Capacity to Consent

The patient giving consent must have

the capacity to do so and be able to
appreciate the implications of their
decision.

3 - The Patient Receives Proper Disclosure

The patient must receive all relevant

information about the nature,
benefits and risks of the proposed
treatment and any alternative courses
of action.
Disclosure of Risk - What is Material Risk?

A risk is considered “material” when

any reasonable person, in the
patient’s position would consent to
treatment knowing all the potential
benefits and risk.

Disclosure - Material Risks

Low risk but High risk but

common uncommon
Disclosure - Risk Can Vary Person to Person

What one person may consider

material another patient may not.

Disclosure - Material Risks

● Some risks that are so serious

they are material to all patients
and so should be included in any
discussion on risks versus
benefits.

● E.g., risk of stroke from upper

cervical manipulation
Disclosure - Provide Information About Alternatives

Provide patients with information

about alternative courses of action
including the consequences of no
treatment.

4 – Patient Questions are Satisfactorily Answered

Allow the patient to ask questions

and take the time to fully answer
their questions
Provide Both Verbal and Written Information

Verbal Info Written Info

5 – Consent is Specific to Treatment

Informed consent must be specific to

each treatment plan.
5 – Consent is Specific to the Physiotherapist

Informed consent is also specific to

the physiotherapist providing care.

Criteria for Obtaining Valid Consent

1 Consent is given voluntarily

2 Patient has capacity to consent

3 Patient receives proper disclosure

4 Patient questions are satisfactorily answered

5 Consent is specific to treatment

 Documenting Informed Consent

Information How Consent was

Disclosed Obtained

Document - Information Disclosed

Document details about what

information was provided to the
patient. Include any written
information.
Document – How Consent Was Obtained

Indicate if consent was given verbally, in

writing, or both

Document - Include Signed Documents

Include the date the consent was

given as well as any signed consent
documents.
 In Review

1 Informed consent is a legal and ethical requirement

1 Informed consent is a legal and ethical requirement

2 Patient autonomy is fundamental to informed consent

1 Informed consent is a legal and ethical requirement

2 Patient autonomy is fundamental to informed consent

3 Informed consent must be given voluntarily

1 Informed consent is a legal and ethical requirement

2 Patient autonomy is fundamental to informed consent

3 Informed consent must be given voluntarily

4 The patient is legally and mentally capable to give consent

1 Informed consent is a legal and ethical requirement

2 Patient autonomy is fundamental to informed consent

3 Informed consent must be given voluntarily

4 The patient is legally and mentally capable to give consent

5 The patient understands the nature, risks and benefits

1 Informed consent is a legal and ethical requirement

2 Patient autonomy is fundamental to informed consent

3 Informed consent must be given voluntarily

4 The patient is legally and mentally capable to give consent

5 The patient understands the nature, risks and benefits

6 Consent is specific to the treatment and physiotherapist

Thank you for listening