Obtaining consent is an ongoing communication process, not a onetime event. Its purpose is to provide information to enable patients to make informed decisions/choices about accepting/refusing proposed treatment. The consent process should include an explanation of the diagnosis and recommended treatment including: benefits, risks and other options for treatment. It is important that patients understand the nature/purpose of what is being proposed and have an opportunity to ask questions or get further clarification if required. The process is further helped by communicating to patients in plain, easy to understand language—technical terms or jargon is not recommended.
View the Informed Consent practice guideline as a PDF.
The obligation to obtain informed consent is rooted in the ethical principle of client autonomy, both in professional policy and Canadian law.
- Physiotherapists are ethically and legally bound to communicate with patients so patients can make informed choices regarding their treatment.
- Societal values now reject concept that health professionals always know what is ‘best for the patient.’
Informed consent is an ongoing process and must be based on a careful discussion of relevant information and considerations regarding a proposed treatment.
- Patients must:
- Understand nature/purpose of treatment;
- Be informed why treatment should be performed;
- Be given reasonable and understandable answers to any questions about treatment;
- Be informed of reasonable alternatives to proposed treatment;
- Be advised of treatment’s impact on lifestyle, if any;
- Be informed of any economic considerations of receiving or refusing proposed treatment;
- Be acquainted with potential risks/odds of risk occurring;
- Be advised of consequences of refusing treatment.
- Canadian law requires that patients be informed of the risks (attendant, material and special) associated with a given treatment: Attendant risks - those that are more common. Material risks – those that are less common but serious should they happen. Material risks can differ between patients. Special risks - include probable and possible relevance to a particular person.
- When determining whether informed consent was established, the law asks whether the average, reasonable person in the patient’s position would consent to the treatment knowing the attendant, material and special risks.
- Probable attendant risks, material and special risks should be disclosed.
- Different strategies may be needed to ensure patient understanding including:
- Verbal explanations;
- Visual aids when/where feasible;
- Asking patient what they understood about information presented;
- Consent forms;
- Providing frequent updates/reports while providing the service.
Consent must be given voluntarily:
- Consent is invalid if obtained by coercion, undue influence or by intentional misrepresentation.
- Consent should be given in an environment free of fear and compulsion from others, including family members.
Capacity to give consent:
- Consent is only valid when person consenting has legal capacity to do so.
- Must have the ability to appreciate the nature and consequences of the consent decision.
- If patient is under 18, consent must generally be obtained from both minor and parent/guardian.
- A mature minor under 18, may give consent on their own behalf if they understand the nature and purpose of proposed treatment and consequences of receiving/refusing treatment
- Patients must be mentally competent and able to give informed consent. If not, consent must be given by family member/designate with legal authority to do so, legally-appointed guardian or the court.
- Translators, including sign language interpreters, should be used if any doubt exists about a patient’s ability to understand the implications and nuances of the English language.
Informed consent is treatment specific:
- It is in the physiotherapist and patient’s best interest to understand the limits of patient’s consent.
- If more extensive/different treatment is required, additional informed consent should be obtained.
The treating physiotherapist is the one who obtains consent through a treatment-specific discussion with the patient.
- Informed consent is personal and normally authorises a specific person to carry out a specific treatment.
- Patients have the right to treatment by a health professional with whom they have a relationship.
- Patients can also consent to physiotherapist’s delegation of treatment responsibilities to another.
- Provided there are no significant changes in the nature, expected benefits or risks, a physiotherapist may presume that consent to treatment includes consent to treatment variations/adjustments.
Consent can be expressed or implied:
- Expressed consent - can be written or verbal. As a general rule, the law does not require ‘written consent,’ however; written consent is more precise and prudent and provides clear evidence of consent.
- Implied consent – can be implied from a patient’s words or actions e.g., consent is implied when a patient presents themselves for physiotherapy treatment.
Documentation should reﬂect the consent process and when/how consent is obtained.
- A signed consent form can provide evidence that informed consent was obtained, but cannot replace a detailed discussion of the relevant information.
- Different strategies may and should be used to ensure patient understanding (given the circumstances) including: verbal explanations, handouts, visual aids, consent forms, asking a patient whether they understand the information presented; providing updates and report throughout the course of service.
Patient’s have the right to refuse treatment.
- Mentally competent patients have the right to refuse treatment, regardless of consequences and regardless how beneficial or necessary treatment may be.
- Patients also have the right to change their mind and withdraw previous consent at any time during care. It is important to document a patient’s refusal.