Saying no to therapy - am I allowed to?

[Josephine]

It's a matter of consent. Consent is a legal contract between you and your health care professional. It means you give them permission to do certain things such as lay hands on you for therapy and surgeons to perform surgical procedures.

For instance, if you signed a consent form that said you agree to have a knee replacement and 'any other necessary procedure', that last bit is referring to emergency procedures such as using screws and wires if a bone fractured during the surgery. It does NOT mean that if the surgeon spots (for instance) a lump on your thigh that he would be free to decide on a whim to remove it. That would be outside the terms of your consent and would constitute an assault. The same would apply if the surgeon decided you needed a manipulation. He would discuss it with you but could not perform it until you had agreed and signed a written consent and this you are not obliged to do.

This is not an irrevocable contract and you can withdraw consent at any time and without giving a reason.

In regard to PT, you are perfectly entitled to say what you will and won't consent to. So if you want to debar the PT from doing certain things, or all things, then you just need to say "I don't want that done" and that's the end of it. If they argue or attempt to bully you with threats of poor outcomes if you don't comply, angry surgeons and MUAs and so on, you are not required to debate the issue with them or prove your point of view above theirs, just remember that you have said no and leave it at that. You have the final say at all times.

 

[Josephine]

Defining consent
For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision. These terms are explained below:

• Voluntary – the decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure from medical staff, friends or family.
• Informed – the person must be given all of the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments and what might happen if treatment doesn't go ahead.
• Capacity – the person must be capable of giving consent, which means they understand the information given to them, and they can use it to make an informed decision.

If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.

Non-verbal consent can also be given, as long as the patient understands the treatment or examination about to take place – for example, by holding out an arm for a blood test.

Consent should be given to the healthcare professional directly responsible for the person's current treatment, such as:

• a nurse or phlebotomist arranging a blood test
• a GP prescribing new medication
• a surgeon planning an operation or other treatment
  
• a physiotherapist about to commence therapy
• any other medical technician such as a radiographer, physiotherapist/physical therapist, occupational therapist, etc.

If someone is going to have a major medical procedure or treatment, their consent should ideally be secured well in advance, so they have plenty of time to obtain information about the procedure and ask questions.

If they change their mind at any point before (or during the procedure where appropriate), the person is entitled to withdraw their previous consent.

Some findings by the General Medical Council1, NHS Choices1, the British Journal of Medical Practitioners2, NCBI article3

1. A competent patient has the right to refuse treatment and their refusal must be respected, even if it will result in their death. If they change their mind at any point before the procedure (or during where appropriate) the person is fully entitled to withdraw their previous consent.

I'll say that again
A competent patient has the right to refuse treatment
and their refusal must be respected, even if it will result in their death​

2. A patient’s consent to a particular treatment may not be valid if it is given under pressure or duress exerted by another person.

3. Patient has got the right of self-determination. Obtaining consent is not only an ethical obligation, but also a legal compulsion. No doctor can sit in comfort with the belief that the “consent” can certainly avoid legal liability. This is highlighted by the note of The California Supreme Court

This means that if a patient withdraws consent and compliance with a schedule of physio or physical therapy, they must be free to do so without any argument or pressure to change their mind. If a patient chooses to refuse a certain part of therapy, such as having their knee forcibly bent after a TKR, then this too must be respected.

Refusal of consent
NCBI1, BMA2,
1. There is also a legal angle to this concept. No one has the right to even touch, let alone treat another person. Any such act, done without permission, is classified as “battery”or physical assault and is punishable by law.

2. "A doctor who operates without the consent of his patient is guilty of the civil wrong of trespass to the person; he is also guilty of the criminal offence of assault." This also applies to nurses, therapists and technicians of all types and where consent has verbally been withdrawn at the time.

You have a right to decline therapy or parts of therapy that are painful and/or distressing to you.