Niko, a massage therapist with kinesiology and sports massage training, has just been named as the RMT for players in an Under-14 soccer team in his city. The team is part of an elite league; most players have Olympic aspirations. He attends all the games and works with other team personnel to ensure that each player is safe to play.
Ana is 13 years old and a gifted defensive player. She dreams of playing for the Canadian women’s soccer team one day. Recently, during a particularly intense game, Ana badly strained a hamstring on her left leg. She was helped off the field by team personnel who strongly recommended that she receive massage therapy from Niko. Because of her family’s cultural beliefs, Ana is discouraged by her family from having any physical contact with males unrelated to her. She knows that she needs treatment but she tells Niko that her father will not consent to her receiving treatment from him because he is male.
Niko agrees that Ana would need her father’s permission before he could treat her. He says he is sorry about her injury and wishes her good luck. Ana limps off the soccer field, fearful that this injury means the end of her competitive season.
Did Niko’s actions meet the consent standard of practice?
Overall, no. Unfortunately, although massage therapy is indicated for this injury, Niko simply accepts Ana’s concern over her father’s expected refusal and decides not to get involved. He doesn’t review how to establish informed consent with a minor nor does he discuss any other treatment options with her. Rather than engaging Ana with open-ended questions and actively listening, Niko makes no effort to determine if she is capable of understanding the nature of the injury or consenting to treatment as a mature minor. He does not describe the rationale for treatment, the expected positive effects, or any concerns, negative effects, or other considerations. Neither does he invite questions or provide time for Ana to consider her alternatives.
According to the Infants Act, provincial legislation that forms part of the basis for the consent standard of practice, it is not essential that Ana include her father in the informed consent discussion if she is capable of understanding what is proposed. A mature minor’s consent is sufficient if the RMT is satisfied that the minor understands the nature, consequences, and reasonably foreseeable benefits and risks of the proposed health care.
On the other hand, Ana is very concerned about her father’s opinion. Niko could have suggested that they include Ana’s father in a discussion with the coach and other team personnel so that they could inform her father of the nature of proposed treatment, and how it could positively impact her rate of recovery.
Engaging in a careful, deliberate, and thoughtful informed consent conversation may provide an acceptable way for Ana to receive the treatment she needs while at the same time honouring her family dynamics. Establishing informed consent thoroughly and carefully can provide patients with time to determine their best course of action.