Health Blog

Osteopaths are bound by law to seek consent for everything they do during an osteopathic consultation – from taking the case history, to examination and treatment. We must explain and justify why we ask certain questions, why we examine an area of the body, why we think certain techniques are more appropriate than others and the risks involved, why we adjust clothing, and so on and so on.

After gathering information from you and from an examination, we must explain what we think is going on and then together we decide the best approach for you. It is imperative we give you all the information so that you can make an informed decision and give consent to the treatment you are having. However, you do have the right to change your mind: You can consent to a course of treatment or a technique, such as manipulating a joint, and then change your mind – either straightaway, five minutes later or during your next visit and say that you do not want that technique. You can withdraw your consent at any time. Consent is therefore an ongoing process, so please forgive us if we keep saying ‘I’m going to do such and such to you now, is that ok?’ or, ‘I’m going to adjust your clothing, is that ok?’  We simply need to make sure you are still consenting. At the same time, you do not have to wait to be asked – you can always tell us and we will not be offended. You have complete control over the treatment you are receiving. You can also decide that you would like to go away and think about how you wish to proceed or you may wish not to have any treatment at all. There is no obligation to have treatment straightaway or in the future.

This is all very straightforward if the patient is an adult with capacity.

‘Capacity’ refers to the ability of a patient to understand and retain information that is relevant to
his or her condition and the treatment that you are proposing.

It also includes the ability of the patient to weigh the various options available (including the consequences of not having treatment)
and to make decisions about his or her treatment.

A person with capacity has the right to refuse treatment. A practitioner must respect this decision
even if they believe treatment would be beneficial to that person.

So, what happens in cases where a patient cannot give consent such as an adult who lacks capacity or a child?
Gaining consent for osteopathic treatment for an adult who lacks capacity

 The law states that your patient will not have capacity if:

a. he or she has an impairment or disturbance (whether temporary

or permanent) that affects the way their mind or brain works

b. that impairment or disturbance means that they are unable to

make a decision at the time it needs to be made.

A patient who is unable to understand and retain information, and unable to communicate their decision, by any means, is deemed to be incapacitated. This may be temporary due to drugs, alcohol, panic, fatigue or medication. In this scenario, it is best to wait until a patient has regained their normal mental state before proceeding.

If the cause of incapacity is permanent, such as dementia, severe learning difficulties, stroke, brain injury or some mental health conditions, another person may be authorised to provide consent, such as

anyone previously named by the patient as someone to be consulted

 anyone caring for or interested in the patient’s welfare

 anyone appointed with Lasting Power of Attorney

 a deputy appointed by the Court of Protection.

This person must act in the best interests of the patient, assisting them in understanding information and making decisions about their treatment, or making the decision for them. They must be present throughout all treatment sessions because, as previously advised, giving consent is an ongoing process. Their presence should also help with gathering information about the presenting symptoms, general health, past medical conditions and medication, which are all required to help treat and advise the patient safely and effectively. Also, they can be helpful after treatment in reminding the patient of what occurred and of any advice that was given.

Gaining consent for osteopathic treatment for children

16 and 17 year old patients can be treated as adults if they have capacity, and sufficient maturity and intelligence to understand information given to them and to make a decision on what treatment they are happy to receive or not. A parent, or chaperone, can be present if they prefer.

For children of 15 years and under, they must always have someone with parental responsibility present and the law is very clear on who this is:

The child’s mother

 The child’s father, if he was married to the mother at the time of birth

 The child’s father if (although not married to the mother at time of birth), he has subsequently obtained a parental responsibility order from the Court or has subsequently married the mother of their child, or if he jointly registered the birth with the child’s mother (from 1 December 2003)

 The child’s legally appointed guardian

 A person in whose favour a Court has made a residence order concerning the child

 A local authority designated in a care order in respect of the child

 A person who has been appointed by the Court as a guardian for a child where there is no parent with parental responsibility

Where the child’s mother was in a civil partnership at the time of treatment for assisted reproduction, e.g. IVF, the other party to the civil partnership is to be treated as a parent of the child.

 Where the child’s mother was in a same sex relationship (but not a civil partnership) at the time of the IVF, the other woman will be a legal parent if the mother consents.

This does not include grandparents, adult siblings, friends, childminders or nannies unless they have obtained a parental responsibility order from the Court. A parent cannot give the ability to consent for their child’s treatment to another person even by a written letter, email or phone call before or during the appointment as consent is ongoing.

We encourage children to be involved in the decision-making from a very young age and would not do anything that they were not happy with.

In conclusion,consent isn’t just ticking a box — it’s a conversation. We make sure you understand your treatment, hear about your concerns, and work with you to decide what’s best. This way, we build a real partnership, so you feel confident and comfortable about the care you and your loved ones receive.

Resources: all information in italics was taken from

Obtaining Consent, a guidance document on General Osteopathic Council website