Informed consent, duty of disclosure and chiropractic: where are we?

Abstract

Background The COVID-19 pandemic has seen the emergence of unsubstantiated claims by vertebral subluxation-based chiropractors that spinal manipulative therapy has a role to play in prevention by enhancing the body’s immune function. We contend that these claims are unprofessional and demonstrate a disturbing lack of insight into the doctrine of informed consent. As such it is timely to review how informed consent has evolved and continues to do so and also to discuss the attendant implications for contemporary health practitioner practice. We review the origins of informed consent and trace the duty of disclosure and materiality through landmark medical consent cases in four common law (case law) jurisdictions. The duty of disclosure has evolved from a patriarchal exercise to one in which patient autonomy in clinical decision making is paramount. Passing time has seen the duty of disclosure evolve to include non-medical aspects that may influence the delivery of care. We argue that a patient cannot provide valid informed consent for the removal of vertebral subluxation. Further, vertebral subluxation care cannot meet code of conduct standards because it lacks an evidence base and is practitioner-centered. The uptake of the expanded duty of disclosure has been slow and incomplete by practitioners and regulators. The expanded duty of disclosure has implications, both educative and punitive for regulators, chiropractic educators and professional associations. We discuss how practitioners and regulators can be informed by other sources such as consumer law. For regulators, reviewing and updating informed consent requirements is required. For practitioners it may necessitate disclosure of health status, conflict of interest when recommending “inhouse” products, recency of training after attending continuing professional development, practice patterns, personal interests and disciplinary findings. Conclusion Ultimately such matters are informed by the deliberations of the courts. It is our opinion that the duty of a mature profession to critically self-evaluate and respond in the best interests of the patient before these matters arrive in court.

"Decreased Dyspnea in Post-COVID Patients After Instrumental Chiropractic Manipulation"

“…The results of the measurements: Oximetry, blood pressure, respiratory, heart rates, and the scores of the ESS questionnaire and the walk test before and after 4 weeks of manipulation are presented in Table 2. Manovacuometry with the values of maximal inspiratory and expiratory pressures before and after they are in Table 3, and in the Table 4 are the domains of the SF-36 questionnaire with the respective results [16][17][18].…”

“…Simpson JK, et al 2020 [17] in their article, state that chiropractic care does not improve the body's immune functions with spinal subluxation adjustments. It turns out that in this study that we did, there was no manipulation in subluxations, we did not use manual chiropractic, and much less had the intention of altering a process as complex as the patient's immune function.…”

A modern way to teach and practice manual therapy

“…We also acknowledge that there is a wider debate about future directions in person-centred care arising from the current evolution of the evidence-based health care movement, which has pointed to the need to learn more about peoples' lived experiences, to redefine the model of the therapeutic relationship. Although beyond the scope of this paper, a full exploration of modern health care provision involves reconsideration of the ethics and legal requirements of communication and shared decisionmaking [156][157][158][159]. The authors envision this paper as a stimulus for self-reflection, stakeholder discussions, and ultimately change that can positively impact outcomes for people who seek manual therapy interventions.…”