Consent: Its Practices and Implications in United Kingdom and United States Chiropractic Practice

Langworthy, Jennifer M.; Cambron, Jerrilyn A.

doi:10.1016/j.jmpt.2007.05.002

Cited by 18 publications

(13 citation statements)

References 33 publications

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“…The doctors determined that the safety of chiropractic treatment procedures rendered the routine discussion of major risk unnecessary. 19 Results from this survey suggest that a patient's autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk.…”

Section: Chiropractic Professionmentioning

confidence: 92%

Should the chiropractic profession embrace the doctrine of informed consent?

Lehman

Conwell²,

Sherman

2008

Journal of Chiropractic Medicine

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This commentary provides a narrative review of the literature focusing on the use of a health care informed consent process in the United States. This article reviews the current positions of the World Medical Association, American Medical Association, American Chiropractic Association, Wisconsin and New Jersey State Courts, US Federal Government Office of Health Policy and Clinical Outcomes, and 1 college of chiropractic regarding the doctrine of informed consent. The authors recommend that the chiropractic profession embrace the doctrine of informed consent and promulgate it as a standard of care. The implementation of this doctrine by chiropractic physicians promotes and improves the safety of chiropractic interventions.

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Section: Chiropractic Professionmentioning

confidence: 92%

Should the chiropractic profession embrace the doctrine of informed consent?

Lehman

Conwell²,

Sherman

2008

Journal of Chiropractic Medicine

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“…Recognition and respect for the patient's right to autonomy is fundamental to ethical clinical practice and this is recognised in British Law [4-6]. Furthermore, it has been suggested that patients who actively exercise their autonomy with regard to their health care improve faster and more surely than those who do not [5].…”

Section: Introductionmentioning

confidence: 99%

“…Yet the most significant threat to their autonomy comes from the very practitioner they choose to see, as the clinician's specialist knowledge and training often inhibits patient authority [7]. Within the chiropractic profession, recent studies seem to support this view and suggest that when seeking chiropractic care, a patient's autonomy and right to self-determination may often be compromised [6]. …”

Section: Introductionmentioning

confidence: 99%

“…However, while formal consent is often not obtained, chiropractors have been found to be thorough in explaining procedures. Conversely, it has also been shown that they are reluctant to discuss possible serious adverse effects of treatment [6,9,14]. Reasons for this include the belief that the risk is unproven and minimal and that to inform patients of the possibility of harm, however small, will only serve to cause alarm [6,14].…”

Section: Introductionmentioning

confidence: 99%

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Withdrawal rates as a consequence of disclosure of risk associated with manipulation of the cervical spine

Langworthy

Forrest

2010

Chiropr Man Therap

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BackgroundThe risk associated with cervical manipulation is controversial. Research in this area is widely variable but as yet the risk is not easily quantifiable. This presents a problem when informing the patient of risks when seeking consent and information may be withheld due to the fear of patient withdrawal from care. As yet, there is a lack of research into the frequency of risk disclosure and consequent withdrawal from manipulative treatment as a result. This study seeks to investigate the reality of this and to obtain insight into the attitudes of chiropractors towards informed consent and disclosure.MethodsQuestionnaires were posted to 200 UK chiropractors randomly selected from the register of the General Chiropractic Council.ResultsA response rate of 46% (n = 92) was achieved. Thirty-three per cent (n = 30) respondents were female and the mean number of years in practice was 10. Eighty-eight per cent considered explanation of the risks associated with any recommended treatment important when obtaining informed consent. However, only 45% indicated they always discuss this with patients in need of cervical manipulation. When asked whether they believed discussing the possibility of a serious adverse reaction to cervical manipulation could increase patient anxiety to the extent there was a strong possibility the patient would refuse treatment, 46% said they believed this could happen. Nonetheless, 80% said they believed they had a moral/ethical obligation to disclose risk associated with cervical manipulation despite these concerns. The estimated number of withdrawals throughout respondents' time in practice was estimated at 1 patient withdrawal for every 2 years in practice.ConclusionThe withdrawal rate from cervical manipulation as a direct consequence of the disclosure of associated serious risks appears unfounded. However, notwithstanding legal obligations, reluctance to disclose risk due to fear of increasing patient anxiety still remains, despite acknowledgement of moral and ethical responsibility.

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“…[8][9][10] The use of IC in research and clinical settings eventually extended to the judicial system as legal precedents determined that clinicians who failed to obtain IC before treating patients could face the risk of malpractice due to negligence or even criminal charges related to assault and battery. [10][11][12][13][14][15] This gradually changed the perception of IC, which became viewed by some as a risk management tool for clinicians to absolve themselves of liability and mitigate future litigation. [16][17][18][19] There has been a gradual shift along the spectrum of conceptual decision-making models in health care, from the paternalistic (eg, patient consents to treatment recommended by clinician) to the clinician as agent (eg, clinician incorporates patient preferences into their decision), followed by shared decisions (eg, both process of decision making and decision are shared), and, more recently, IC (eg, clinician provides information but patient decides on treatment).…”

mentioning

confidence: 99%