Simpson J Keith, Innes Stanley
Discipline of Psychology, Exercise Science, Counselling and Chiropractic (PESCC), College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch, Australia.
Chiropr Man Therap. 2020 Nov 4;28(1):60. doi: 10.1186/s12998-020-00342-5.
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.
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.
在新冠疫情期间，基于脊椎半脱位理论的脊椎按摩师提出了一些毫无根据的说法，称脊柱推拿疗法可通过增强人体免疫功能在预防方面发挥作用。我们认为这些说法不专业，且令人不安地显示出对知情同意原则缺乏深刻理解。因此，适时回顾知情同意是如何演变并持续演变的，并讨论其对当代医疗从业者实践的相关影响很有必要。我们回顾了知情同意的起源，并通过四个普通法（判例法）司法管辖区的具有里程碑意义的医疗同意案件，追溯了披露义务和重要性。披露义务已从家长式做法演变为以临床决策中患者自主权至上的做法。随着时间的推移，披露义务已演变为包括可能影响护理提供的非医疗方面。我们认为，患者无法为消除脊椎半脱位提供有效的知情同意。此外，脊椎半脱位护理不符合行为准则标准，因为它缺乏证据基础且以从业者为中心。从业者和监管机构对扩大后的披露义务的接受一直缓慢且不完整。扩大后的披露义务对监管机构、脊椎按摩教育工作者和专业协会具有教育和惩罚意义。我们讨论了从业者和监管机构如何从消费者法等其他来源获取信息。对于监管机构而言，需要审查和更新知情同意要求。对于从业者来说，可能需要披露健康状况、推荐“内部”产品时的利益冲突、参加持续专业发展后的培训近期情况、执业模式、个人利益和纪律处分结果。
最终，此类事项由法院的审议决定。我们认为，一个成熟的职业有责任在这些事项诉诸法庭之前，进行批判性的自我评估，并以患者的最佳利益做出回应。
