Informed consent in allied health: what you should be told

Informed consent is a legal and ethical requirement before any health treatment. It is also, done properly, the part of an appointment that most improves the experience of being a patient — because a practitioner explaining what they intend to do and why is a practitioner you can make a real decision with.

What consent actually requires

Consent is only valid where it is:

Voluntary. Given freely, without pressure. Being told a decision must be made right now, or that declining means treatment cannot continue, undermines this.

Informed. You have been given the information a reasonable person in your position would want, in language you understand.

Specific. Consent to one treatment is not consent to another. Agreeing to have your shoulder treated is not agreement to have your neck manipulated.

Given by someone with capacity. Able to understand the information, weigh it and communicate a decision.

Current. Consent can be withdrawn at any time, including partway through a treatment.

What you should be told before treatment

• What the practitioner thinks is wrong, in plain language
• What they propose to do, described so you can picture it
• What the material risks are — including risks that are rare but serious, and risks that matter specifically to you
• What the alternatives are, including doing nothing and waiting
• What it will cost, and how many sessions are anticipated
• What outcome is realistic, expressed honestly rather than optimistically

The standard Australian courts apply is not “what most practitioners would mention”. It is what a reasonable person in your position would want to know, plus anything the practitioner knows or ought to know that you in particular would attach significance to. If a risk matters to you for a reason specific to your life, saying so obliges them to address it.

Consent for specific techniques

Some treatments warrant explicit, separate consent rather than being folded into a general agreement to be treated:

Cervical spine manipulation. High-velocity manipulation of the neck carries a rare but serious risk, and the discussion about it should be had specifically rather than assumed. You should be told the risk exists, told what alternatives are available — and lower-force techniques for the neck do exist — and asked directly.

Dry needling. Involves needles into muscle. Risks include soreness, bruising and, in specific body regions, more serious risks. Consent should be obtained before the first session rather than as the needle goes in.

Intra-oral treatment for jaw problems. Treatment inside the mouth, with a gloved hand. This should be explained and agreed before it happens, not sprung on someone mid-appointment.

Treatment requiring undressing, or involving sensitive areas. You should be told what needs to be exposed and why, offered draping, and offered the option of a support person present.

Your rights during an appointment

• You can say no to any part of the treatment and continue with the rest
• You can stop at any point, including mid-treatment, and you do not need a reason
• You can ask for a support person to be in the room
• You can ask for a different practitioner, or a different technique
• You can take time to think rather than deciding in the room
• You can ask what happens if you do nothing — a legitimate question with a real answer

None of these should require confidence to exercise. A practitioner who makes it awkward to say no is the problem.

Children and consent

For children, a parent or guardian generally consents. Older children and adolescents may be able to consent themselves depending on their maturity and understanding of the specific decision.

Regardless of who signs, the child should have the treatment explained to them at a level they can understand, and their objection should carry weight rather than being talked over.

When consent has not been properly obtained

Treatment without valid consent can amount to trespass to the person, and is a professional conduct matter for a registered practitioner.

Practical steps, in order:

1. Raise it with the practice. Most cases are communication failures and are better resolved directly.
2. AHPRA, for a registered practitioner — chiropractor, physiotherapist, podiatrist or acupuncturist. AHPRA can investigate conduct and impose conditions.
3. The Health Complaints Commissioner (Victoria), which covers registered and unregistered practitioners — including massage therapists, naturopaths and colonic hydrotherapists.

How this works at Brunswick Health

Practitioners here explain findings in plain language and set out options before treating, including the option of doing nothing. Cervical manipulation, dry needling and intra-oral jaw treatment are consented to specifically rather than assumed.

You are welcome to bring a partner, family member, friend or carer into any consultation, and you can ask for a practitioner of a particular gender when booking rather than raising it in the room.

If you would like to ask about a technique before booking, send the question through — answered within one business day.