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RMTs are required to obtain informed consent to treatment. Informed consent supports patient safety, clinical decision-making, and predictable and desired outcomes. Obtaining consent is both a professional obligation, as well as a legal obligation under two BC statutes (the Health Care (Consent) and Care Facility (Admission) Act and Infants Act).

Section 9 of the College’s Code of Ethics requires RMTs to obtain informed consent for therapeutic services. Under section 8 of the Code of Ethics, RMTs must provide complete and accurate information to enable the patient to make an informed decision regarding the need for, and nature of, therapeutic services. This includes providing understandable answers to any questions that the patient may have.

The CMTBC standard of practice on consent will go into effect January 15, 2019. CMTBC’s Bylaws require RMTs to comply with the standard of practice on consent. This standard of practice complements CMTBC’s Code of Ethics and provincial legislation, and defines practice expectations for RMTs in terms of how to obtain consent for delivery of massage therapy.

Below, RMTs will find three types of resources to help them understand and apply the CMTBC standard of practice on consent:

Case studies

Frequently asked questions

The following are some questions that have been posed to the College by RMTs about the new standard of practice on consent, and responses to those questions.

Do existing patients need to sign a consent form?

No. Until the introduction of the new consent standard of practice, which takes effect on January 15, 2019, verbal or written consent to delivery of massage therapy was acceptable.

Under the new standard of practice on consent, written consent (obtained through a signature on a consent form) is only required at a new patient’s initial treatment.

Any subsequent consent may be obtained verbally (and must be documented in the patient’s record).

If an RMT has treated a patient prior to January 15, 2019, that patient is not a new patient and the RMT does not have to request that the patient sign a consent form.  

Do RMTs need to create a new template consent form, and will CMTBC have a sample consent form available?

The new standard of practice on consent states that a consent form should describe the treatment to be provided by the RMT, and should be signed by the patient either with a physical signature or an electronic indication of consent. It does not necessarily require RMTs to create a new template consent form. In most cases, the consent form that an RMT is already using now will continue to be acceptable.

CMTBC has advised registrants that a consent form should include a description of the general framework of a massage therapy treatment (intake, treatment plan, assessment, treatment involving manual, hands-on manipulation and mobilization, and home care). RMTs can consider referring to the scope of practice statement for massage therapy, contained in the Massage Therapists Regulation.

CMTBC will not make sample consent forms available. This is because there are many variations of forms that may be acceptable, and as a regulatory body CMTBC does not want to be overly prescriptive and suggest that there is only one type of form that is acceptable, particularly because RMTs have varied practices with different areas of focus or different preferred population groups.

Can a new patient sign the consent form before arriving at the initial appointment?

No, an RMT should not have a new patient sign a consent form prior to meeting the patient at the initial appointment. This is because a signature by the patient on a consent form does not meet CMTBC’s requirements if the RMT has not discussed the form with the patient and provided the patient with an opportunity to ask questions. 

Does an RMT need to renew consent from a patient at each subsequent treatment?

No. A patient’s written consent must be obtained at the patient’s initial appointment, in accordance with the standard of practice on consent.

The standard requires that an RMT renew consent at a subsequent treatment if necessary. An RMT must renew consent when the treatment approach changes for any reason, and the RMT revises the treatment plan or creates a new one.

How should a patient’s verbal consent be documented in the patient record?

As set out in the application to practice section of the new standard of practice on consent, documentation of verbal consent should reflect the consent process, and include:

  • confirmation that criteria for valid consent were met;
  • when and how consent was obtained;
  • concerns raised during the consent process, and actions taken to address concerns;
  • reason for refusal or withdrawal from massage therapy services; and
  • reasons for determining that a patient was not capable of making an informed decision, and action taken to identify a parent/guardian or substitute decision-maker.

When documenting verbal consent in the patient record, the entry should also outline that an RMT has provided sufficient information to enable the patient to make an informed decision about treatment, as required by the standard of practice on consent (as well as provincial legislation).

Summary of relevant BC legislation

The following is a summary of the relevant legislation: the Health Care (Consent) and Care Facility (Admission) Act (the “Consent Act”) and the Infants Act. It is a summary intended to assist RMTs with their obligation to understand and follow the legal requirements set out in the Consent Act and the Infants Act, as required by the CMTBC standard of practice on consent.

(Note: It is a summary only and cannot be relied on as legal advice.)

Consent Act

The Consent Act applies only to adults (individuals are 19 years of age or older). There are different requirements for individuals under the age of 19 years, which are described under the heading Infants Act below.

Patients’ rights over their own person, and their rights not to have their person interfered with, is considered so important that the RMT must be able to prove that the patient provided consent. Consent can be withdrawn at any time, and the decision must be respected.

Under the Consent Act, the RMT must obtain consent directly from the patient. There are a few exceptions, including:

  1. when an RMT has decided that a patient is incapable of providing consent, and consent is provided by a substitute decision-maker;
  2. when there is an urgent or emergency health care situation; and
  3. when a patient is thought by others to be incapable, and a spouse or relative of the patient gives substitute consent.

Under the Consent Act, valid consent is obtained only if all of the following elements are present:

  1. Consent relates to the proposed massage therapy;
  2. Consent is given voluntarily;
  3. Consent is not obtained through misrepresentation or by fraud;
  4. The patient is capable of making a decision about whether to receive or refuse the proposed health care;
  5. The health care provider informs the patient by providing all information that a reasonable person would require to understand the proposed treatment and to make a decision, including information about:
    1. the condition or impairment for which massage therapy is proposed,
    2. the nature of the proposed treatment (for example, what techniques or modalities is the RMT proposing to use, what do they involve, and how they address the patient’s condition),
    3. the risks and benefits of the proposed treatment that a reasonable person would expect to be told about,
    4. alternatives to the proposed treatment approach, including alternatives available from other professions where expressly indicated; and
  6. The patient has an opportunity to ask questions and receive answers about the proposed treatment.

Point 5, above, refers to the concept of a “reasonable person”. What information would a reasonable person need? The scope of information that must be given varies with each situation. RMTs should make reasonable efforts to find out about the patient’s concerns and personal circumstances that might be relevant to the patient’s information needs, and present information in a manner that is unique to the patient’s circumstances.

Infants Act

The Infants Act sets out different requirements for obtaining consent from an “infant” or minor (legally defined as an individual under the age of 19 years).

While the Infants Act uses the term “infant” to describe all minors, it provides rules to determine who qualifies as “mature” minors and who are entitled to give consent to their own health care. 

Mature minors can consent to their own treatment on the condition that the RMT providing treatment has:

  1. explained the nature, consequences, and reasonably foreseeable benefits and risks of massage therapy,
  2. been satisfied the patient understands these benefits and risks; and
  3. made reasonable efforts to determine that massage therapy and a proposed treatment plan is in the patient’s best interests.

If one or more of these conditions has not been met, the patient is not a mature minor and cannot consent to the patient’s own treatment. There is no set age at which infants can consent to their own health care.

Note: If a mature minor is capable of providing consent, his or her medical information must be kept confidential under the Personal Information Protection Act (PIPA) and cannot be disclosed to anyone, including parents or legal guardians, unless the patient consents to disclosure, or disclosure is allowed under PIPA.

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