Informed consent is an essential ethical precondition for any therapeutic intervention. This obviously cannot exclude alternative medicine. Yet, one gets the impression that alternative therapists systematically ignore informed consent. Chiropractors in the UK, for instance, have been shown to often take this issue more than a little light-heartedly.
The General Chiropractic Council (GCC) has issued guidance to its members about informed consent. Here is a passage from their website which I find particularly interesting:
The information you provide to the patient must be clear, accurate and presented in a way that the patient can understand… Patients must be fully informed about their care. You must not rely on a patient to ask questions about their care, the responsibility to fully inform patients about their care lies with you. When discussing with patients the expected outcomes of their care, chiropractors must fully discuss the risks as well as the benefits and explore with the patient what other factors they may see as relevant to making a decision.
When explaining risks, you must provide the patient with clear, accurate and up-to-date information about the risks of the proposed treatment and the risks of any reasonable alternative options, in a way that the patient can understand. You must discuss risks that occur often, those that are serious even if very unlikely and those that a patient is likely to think are important. You must encourage patients to ask questions, so that you can understand whether they have particular concerns that may influence their decision and you must answer honestly.
I have repeatedly written about the fact that, in alternative medicine, informed consent has remained an almost alien concept. Yet, there can be no doubt, it is an ethical imperative in ALL healthcare. The above guideline makes this perfectly clear. Essentially, it proscribes that a chiropractor has to inform each patient who is about to be treated with a spinal manipulation – virtually 100% of all patients consulting chiropractors – that:
- this treatment has not been shown to be effective for non-spinal conditions,
- for back and neck pain, it might help but not better than other conservative therapies,
- in about half of all patients, it leads to mild to moderate adverse effects that typically last 2-3 days and are severe enough to interfere with the patient’s quality of life,
- in an unknown number of patients, it might lead to severe complications, including stroke and death,
- there are other options for your problem that are more effective and/or less harmful.
The chiropractor then has to document the patient’s consent. Only then can he start treatments.
My question to the GCC is: have you tested how many patients would consent under these conditions?
I suspect the answer is No.
And my questions to UK chiropractors is: who is actually following these guidelines?
I suspect the answer is VERY FEW. If that were true, most chiropractors would violate their own ethical guidelines and could therefore be struck of the GCC’s register. Or did I get this wrong?