Consent or submission? The practice of consent within UK chiropractic

Background: A patient's right to accept or reject proposed treatment is both an ethical and legal tenet. Valid consent is a multifaceted, controversial and often complicated process, yet practitioners are obligated to try to obtain consent from their patients. Its omission is a common basis for malpractice suits and increasing utilization of complementary and alternative services in conventional medical settings is intensifying the focus on medical liability issues. This has important implications for individual professions and their members. Objective: To investigate approaches to consent among a small (n = 150) sample of practicing UK chiropractors. Results: Of 150 randomly selected chiropractic practitioners in the United Kingdom, 55% responded. Of these, 25% report not informing patients of physical examination procedures prior to commencement. By contrast, only 6% do not fully explain proposed treatment, although over one-third do not advise patients of alternative available treatments. Nearly two-thirds of the practitioners report that there are no specific procedures for which they always obtain written consent and 18% that there are no instances in which they document when verbal consent has been obtained. Ninety-three percent said they always discuss minor risk with their patients but only 23% report always discussing serious risk. When treatment carries a possible risk of a major side-effect only 14% of the sample obtain formal written consent. Documentation of patient understanding is omitted by 75% of practitioners in this sample. Conclusion: Results suggest that valid consent procedures are either poorly understood or selectively implemented by UK chiropractors.