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Implementation of the Consent Standard of Practice – Update

(Sent as a newsletter on January 16, 2019)

On January 15, 2019, CMTBC introduced a standard of practice on informed consent, aligning it with other BC health regulatory colleges. While the standard itself is new, the legal requirements around informed consent – including the requirements specifically set out in the Consent Act and in the Infants Act – have been in existence for a considerably longer time, and have always applied to RMTs even though there was no College standard on consent. The development and release of the consent standard was therefore intended to support RMTs in the safe and ethical practice of massage therapy, consistent with statutory and other legal requirements, by creating a “one stop” guide and reference to seeking, obtaining and documenting informed consent.

Recently, CMTBC has received communication from some RMTs requesting that CMTBC provide specific guidance as to what would constitute an “acceptable” consent form under the new standard, or that it post a template form, or that it provide approval of a form that the RMT has sent in. Unfortunately, these requests, while understandable, appear to miss the main point of the new consent standard, which is that it is not about creating the perfect consent form, but rather about communicating clearly with the patient to seek, obtain and document the patient’s informed consent to treatment

While documentation of informed consent is important (see paragraph 11 of the consent standard), it is really the final step in this process. Documentation is only of value if it reflects clear and meaningful communication between patient and therapist, leading to consent. The subject matter of the communication is set out in paragraph 4 of the consent standard, and includes (this is a summary only):

  • Determining the patient’s capacity to provide consent
  • Communicating clearly to the patient and describing the proposed treatment
  • Explaining the rationale for and anticipated benefits of the proposed treatment
  • Providing options for disrobing and draping
  • Obtaining and documenting the patient’s consent
  • Renewing consent as necessary as treatment progresses

The RMT’s documentation of this communication with a patient is more important than pre-printed words on a form, because it reflects the RMT’s professional judgment and skillful recording of the patient’s informed consent to treatment.

Documentation of the consent process is a key part of the interaction between RMT and patient. From CMTBC’s regulatory perspective, the main purpose of requiring written consent (a signed consent form) is not to “protect” the RMT against a patient who may later allege improper or non-consensual treatment by the RMT (although documentation of consent may serve that purpose in some cases). Rather, informed patient consent is a critical component of patient-centred health care, in massage therapy as in other health professions.

CMTBC is aware that the Registered Massage Therapists Association of British Columbia (RMTABC) has advised its members to fax their current consent forms to CMTBC for approval. Unfortunately, this was done without consulting or communicating with CMTBC. To be clear, like other health regulators, CMTBC does not approve or comment on specific examples of consent forms. CMTBC also advises that the RMTABC has not been authorized to speak, or to interpret the consent standard, on CMTBC’s behalf (although CMTBC has no issue with the RMTABC providing appropriate patient-centered resources to its members). RMTs who wish to ascertain the CMTBC’s position on this or any issue are welcome to contact CMTBC directly.

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