Patients have a legal and ethical right to decide what happens to their own bodies. This right is protected by common law, the Mental Capacity Act 2005, the Human Rights Act 1998, and is reflected in the General Osteopathic Council’s Osteopathic Practice Standards.

Obtaining valid consent is fundamental to ethical osteopathic practice. Failure to do so may constitute professional misconduct and expose practitioners to allegations of assault or negligence.

This policy sets out the principles, responsibilities, and procedures for obtaining and documenting valid consent for examination and treatment within this clinic.

The purpose of this policy is to ensure that:

• all practitioners understand their legal and professional obligations regarding consent;
• consent is obtained appropriately, lawfully, and consistently;
• patients are supported to make informed decisions about their care.

Consent is valid when the patient:

• has capacity to make the decision;
• has received sufficient, relevant information;
• gives consent voluntarily, without pressure or coercion.

Consent is a process, not a single event, and must be ongoing throughout care.

A patient has capacity if they can:

• understand information relevant to the decision;
• retain that information long enough to make the decision;
• use or weigh that information as part of the decision-making process;
• communicate their decision by any means.

A child under 16 may consent to treatment if they have sufficient maturity and understanding to appreciate what is proposed, including risks and alternatives.

Any examination or treatment involving close proximity to the breasts, genitals, or anus.

Any procedure involving penetration of the skin (e.g. acupuncture, dry needling), or any per rectum (PR) or per vaginal (PV) procedure.

The contemporaneous clinical notes (case history) forming the legal record of care.

• Consent must be obtained before examination or treatment and be specific to what is proposed.
• Oral consent is usually sufficient for non-invasive procedures.
• Consent must be documented in the clinical records.
• The abbreviation “VCO” (Valid Consent Obtained) may be used once per attendance, provided it clearly applies to all procedures undertaken.

Written consent is required:

• for invasive procedures;
• where the examination or treatment is intimate;
• where the patient may be vulnerable or capacity is borderline;
• where a procedure carries material risks that a reasonable patient would want to know.

Written consent must be obtained at or near the time of the procedure, not solely at the start of care.

For PR or PV procedures, patients must be given adequate time (normally at least 24 hours) to consider the information before consenting, unless clinically inappropriate.

A signed consent form is evidence of the consent process, not a binding contract, and consent may be withdrawn at any time.

A patient with capacity may choose not to receive detailed information about risks or alternatives.

• This decision must be clearly documented at the time it is made.
• It must be reconfirmed at each subsequent appointment.
• The abbreviation “WOC” (Waiver of Consent Information) may be used.
• A waiver may be withdrawn at any time.

• Patients aged 16 and over are presumed to have capacity unless assessed otherwise.
• Capacity is decision-specific and may fluctuate.
• Practitioners must not assume lack of capacity due to diagnosis, age, distress, or disability.

• Children under 16 may have Gillick competence, but this should be assessed cautiously and documented.
• Where Gillick competence is not clearly established, consent must be obtained from a person with parental responsibility.

Where an adult lacks capacity:

• Consent may only be given by an attorney under a Lasting Power of Attorney (Health and Welfare) or a court-appointed Deputy, if authorised.
• In the absence of such authority, treatment may be provided in the patient’s best interests, unless a valid and applicable Advance Decision refuses the treatment.

• Consent applies only to the treatment discussed and only at that time.
• Consent may be withdrawn at any stage, including during treatment.
• Patients may refuse treatment even if the practitioner believes it is clinically beneficial.
• Refusals must be respected and documented.
• Patients are not required to justify refusal.

For patients aged 16–17:

• they may consent to treatment themselves;
• refusal may, in limited circumstances, be overridden by a person with parental responsibility, but this should be handled with extreme caution and senior advice.

• Practitioners owe a duty of confidentiality to patients with capacity, including Gillick-competent children and those aged 16–17.
• Parents should be involved where appropriate and with the young person’s consent.
• Where a young person is seen alone, their records must not be disclosed to parents or others without the patient’s consent, unless safeguarding or legal obligations require disclosure.
• Any consent to share information must be documented.

All practitioners are personally responsible for:

• obtaining valid consent;
• ensuring the patient understands what is proposed;
• recognising limits of their own competence;
• documenting consent appropriately.

Responsibility cannot be delegated.

Consent should be integrated naturally into the consultation. This includes:

• explaining the nature and purpose of the proposed examination or treatment;
• discussing material risks, benefits, and alternatives (including no treatment);
• allowing time for questions;
• checking understanding.

For invasive or higher-risk procedures, consent should be obtained only after the patient has had adequate time to consider the information.

Practitioners must provide information that a reasonable person in the patient’s position would want to know, including:

• diagnosis or working diagnosis;
• proposed treatment and likely benefits;
• material risks and side effects;
• alternatives, including no treatment.

Information must be presented clearly, honestly, and without coercion.

• In emergencies where consent cannot be obtained, practitioners may act in the patient’s best interests.
• Any Advance Decisions or DNAR orders must be respected if valid and seen in original form.
• All treatment provided without consent must be fully documented with justification.

• Parental responsibility is held by biological parents, adoptive parents, court-appointed guardians, and others as defined by law.
• It cannot be delegated and is not assumed by step-parents.
• Consent from one person with parental responsibility is sufficient.
• Parental responsibility allows consent for children under 16 and, in limited cases, override of refusal by 16–17-year-olds.