Informed consent in physiotherapy practice: it is not what is said but how it is said

This paper discusses the concept of informed consent in the context of contemporary
biomedical ethics. A change in UK law regarding what information should be provided to
patients has brought to the fore the role of physiotherapists in the process of gaining informed
consent. It is important that physiotherapists are aware of how this change in the law will affect
their practice.
For an individual to consent, they need to have both the capacity and freedom to exercise
rational thought. These concepts are challenged in contemporary biomedical ethics. An
individual’s ability to make rational decisions has been increasingly questioned by empirical
evidence from behavioural psychology. In addition, the concept of freedom in contemporary
neoliberal societies has also been critically examined. Liberal paternalism has been advocated
by some as a means of helping patients to make better decisions about their care. Actualised as
a ‘nudge’, liberal paternalism has been influential in a number of health policies, and has recently been discussed as a means of gaining consent from patients for assessments and
treatments.
Physiotherapists engage directly with patients and, through this engagement, construct a
therapeutic environment that aims to build mutual trust. This paper questions the legitimacy of
informed consent, and presents the argument that, through communicative actions,
physiotherapists nudge patients into consenting to assessments and treatments.