PROFESSIONAL LIABILITY

Professional Liability

Professional Liability

Introduction

Informed or valid consent has a history in law, ethical theory, and clinical and research practice and its defining elements in clinical practice are disclosure of information by the clinician, comprehension and consent from the patient, and preconditions of voluntaries and patient competence. The philosophical theory that underpins informed consent is the idea of autonomy, defined as self-governance or self-rule, a capacity of people to reflect and choose, and freedom to express individual aspirations and preferences.

Case Study

Mary is a 35-year-old secretary with recurring episodes of low back pain over 6 years. She has never been an active person, and she is not skilled at sport. She has uncomfortable memories of being teased as a teenager for her lack of co-ordination and sporting ability. Mary's low back pain is becoming more constant, and she has never been to a physiotherapist before.

Sonia graduated 5 years ago and works in a private practice physiotherapy setting. The idea of patients contributing to their own care and being actively involved in managing their own problems appeals to Sonia. Sonia has always valued fitness and self-motivation. She is a firm believer in the power of self-discipline. Sonia recently attended a course dealing with abdominal muscle stabilization exercises.

Within the treatment, Sonia asks Mary questions related to the nature of the low back pain, including the duration, time of occurrence, severity, and aggravating and easing factors. Sonia assesses Mary's active movements and decides that Mary's problem is caused by too many hours of poor posture sitting at the computer. Sonia explains what she thinks Mary's problem is and how she intends to treat it.

Sonia has decided that Mary is a candidate for treatment using abdominal muscle stabilization exercises. Prior to attending the weekend course, Sonia may have given Mary a different treatment. She may have given Mary manual therapy, consisting of mobilization, massage and some local heat therapy. Sonia explains to Mary the long-term benefits of performing the particular exercises and how they will gradually reduce Mary's pain. She demonstrates the exercises and gives Mary an exercise sheet. Mary arranges an appointment the following week.

To meet disclosure requirements of informed consent, Sonia needs to provide information to Mary about the benefits and risks of abdominal muscle exercises. In Sonia's view, there are only benefits and very few physical risks of this treatment. Sonia notes that Mary is completely competent to understand the treatment and its consequences. She takes notice of Mary's expressions and willingness to proceed, interpreting these as her consent to the treatment. As the treatment involves few risks, Sonia does not believe that a more formal protocol or process should be followed. Sonia is satisfied that she has discharged her legal and ethical duty to obtain informed consent.

Using the philosophical meaning of autonomy as the underlying ethical framework, Sonia starts from a position of respecting and providing opportunities for Mary to exercise choice. Sonia would also be aware of potential barriers that may restrict Mary's ability to make meaningful ...