World Chiropractic Alliance

Responding to
Eight Chiropractic Issues

Issue 2: Informed Consent

A medical witness in a chiropractic case once testified that:

"When a member of the public consults a chiropractor, there begins a relationship which must have at its core the benefit of the patient above all else. There is a power differential in such a circumstance. A patient is in a dependent position and surrenders her personal agency in trust to the caregiver that the diagnostic and therapeutic procedures employed will be appropriate and safe, and that the nature of the professionalism to be offered will embody a surrender of personal gain priorities by the care giver for that trust afforded by the patient and to her benefit above all else. There is implicitly an assumption that information given in such dependent circumstances will be reliable, up to date and appropriate."

What this witness actually described is an old, outdated model of informed consent that is inherently paternalistic. This "professional" model of informed consent emphasizes what doctors think is important to discuss with patients rather than what the patient wants to discuss or wants disclosed.

This paternalistic professional model urges doctors to practice in accordance with what is accepted as proper by a responsible body of health care providers in the relevant clinical specialty.

The more current model of informed consent to use is known as a patient-centered approach.16 This approach encourages doctors to consider the patients needs and priorities when discussing their healthcare options with them. This patient centered approach demands that doctors ask patients what they want from treatment as they discuss treatment strategies.

In addition to fostering patient autonomy, this approach helps protect patients,

whose objectives may differ from the assumptions made by the doctor. This approach requires doctors to acknowledge patients as partners with different but equal expertise.

Further, it is important to point out that consent is a process that gives patients the opportunity to express concerns about treatment. Inherent in this process is the approach of sharing information with the patient as opposed to disclosing information. This allows a shared partnership between the patient and healthcare professional to develop where the patient and the professional meet as equals but with different expertise.

Patient-centered consent must be founded on the patient's objectives. In order to do this the practitioner must find out about patients' individual needs and priorities since their beliefs, culture, occupation or other factors may have a bearing on the information they need in order to reach a decision. Patient-centered practice requires doctors to offer patients an opportunity to participate in a shared decision making process about treatment options. Doctors can then be guided by what patients want, rather than by professional assumptions about management of a disease.

Ultimately, it is for patients and their doctors to decide if a treatment is appropriate and this forces doctors to be creative in order to respond with appropriate strategies.

Such a process has been taught and encouraged within the chiropractic educational setting for many decades.