Proposed: Informed consent standard

Terminology

Must: is where the statement sets a minimum standard that all physiotherapists are obliged to achieve.

Should: is where a statement marked as ‘should’ recognises that in some contexts and situations the physiotherapist requires a degree of flexibility in their response. Guidance is offered by the ‘should’ statement, but it is up to the individual physiotherapist to decide, and be able to justify, by using their professional judgement and/or seeking advice from experienced colleagues.

New Zealand Law

Physiotherapists must be familiar with the law governing this area of practice including, but not limited to, the:

Code of Health and Disability Services Consumers’ Rights (1996)

Care of Children Act 2004 (Section 36)

Health Practitioners Competence Assurance Act 2003

Providing information

A physiotherapist must:

1. Clearly and appropriately inform kiritaki of the purpose and nature of the service being provided (see Aotearoa New Zealand Code of Ethics and Professional Conduct 2026, 2.4). This includes any request to touch kiritaki or when requesting them to remove any items of clothing. 
2. Provide a written summary of the information, if requested by kiritaki.
3. Ensure the information is provided in a form, language and manner that can be understood by kiritaki.
4. Respond appropriately to any questions from kiritaki.
5. Where proposing the involvement or presence of an additional person while services are delivered, clearly and appropriately inform kiritaki:
   • Who is proposed to be present;
   • The reasons for that person’s presence;
   • What their role will be during the service;
   • about rights to give or withhold consent to the presence of the additional person, and to withdraw consent at any point during the consultation.
6. Where undertaking a physiotherapy assessment for a third party, clearly and appropriately inform kiritaki;
   • the purpose of the physiotherapy assessment and the physiotherapist’s role, including an explanation about the differences between the roles of a non‐treating physiotherapist and a treating physiotherapist;
   • that a report will be provided to the referring third party following the assessment and that any aspect of the physiotherapy assessment may be included in the report;
   • they have the right to withdraw consent to the assessment at any time

Commentary: Information should include, but is not limited to, an explanation of:

• the services being provided and what it includes
• why they are being seen by a physiotherapist
• what will happen during the consultation, ensuring kiritaki is informed throughout
• the role of the physiotherapist
• the diagnosis and prognosis the options available
• the expected outcomes, side effects, risks and the possibility of an adverse event
• any proposed participation in teaching or research (including whether the research requires and has received ethical approval)
• the findings of assessments and investigations
• reporting that will follow the consultation
• the costs (fees) for providing the physiotherapy services and alternative options, including public and private.

Where necessary and practicable, a competent interpreter must be supplied, as required by Aotearoa New Zealand Code of Ethics and Professional Conduct (2026), 2.4).

Trained interpreters are less likely to make errors and are more likely to understand confidentiality and improve outcomes. Physiotherapists should give due consideration before using whānau and family to interpret, particularly those under 16 years old, due to potential power, and/or cultural issues, and/or conflicts of interest (except in emergencies).

Kiritaki have the right to have one or more support persons of their choice present (Code of Health and Disability Services Consumers’ Rights (1996), Right 8). The involvement of whānau, family, a carer or other support persons may help kiritaki understand and process information.

Allowing kiritaki the time and opportunity to ask questions, in an environment that enables open, honest, and effective communication, can help them to make an informed choice.

Gaining informed consent

A physiotherapist must:

1. Gain kiritaki informed consent subject to the exceptions in this standard (see 3.2):
   • before providing any services;
   • for any proposed referral to another practitioner;
   • for the recording of an assessment or treatment;
   • for use of digital health tools that require input of personal kiritaki data;
   • for the involvement or presence of an additional person during the assessment or treatment; and
   • for kiritaki participation in education or research.

1. Ensure consent is given freely, without being subject to discrimination, coercion, harassment or exploitation, before proceeding with any services (see Aotearoa New Zealand Code of Ethics and Professional Conduct (2026) 2.4).
2. Seek and gain informed consent for the involvement or presence of an additional person during the service, without the additional person present.
3. Respect the right of kiritaki to refuse services and to withdraw consent that has already been given, without prejudice.
4. If consent to a service is withdrawn after it has been given, cease providing that service.
5. If consent for the involvement or presence of an additional person during the service is withdrawn once the service has commenced:
   • ensure that the additional person ceases to be involved or present; and
   • cease providing services if the involvement or presence of an additional person is required because of a condition on the physiotherapist’s scope of practice.

Commentary: Consent may be valid even where kiritaki are reluctant to proceed or where declining consent may have consequences. The relevant consideration is whether the decision to consent has been undermined by discrimination, harassment, exploitation, or other improper pressure.

Competence to give consent

A physiotherapist must:

1. Assess kiritaki competence and form an opinion on whether they have the capacity to consent to the particular form of service being proposed, including consideration of the following factors:
   • the age of kiritaki
   • the level of understanding of kiritaki, including language and maturity
   • the level of consciousness of kiritaki
   • the degree of risk or complexity associated with the assessment and/or treatment
2. Act in accordance with the law where kiritaki have diminished competence or are unable to consent at the time of the service (see Aotearoa New Zealand Code of Ethics and Professional Conduct 2026, 2.5).

Commentary: Where kiritaki are unable to make an informed choice and consent (for example, a person with severe dementia, or a person who is unconscious), physiotherapy services can still be provided with due considerations and when certain requirements are met, in line with Right 7(4) of the Code of Health and Disability Services Consumers’ Rights (1996).

If the physiotherapist has any doubt regarding kiritaki consent due consideration must be given before proceeding, including consideration of whether a second opinion would be appropriate. Where kiritaki have diminished competence, they must still be provided with information appropriate to their level of ability to understand and they retain the right to make informed choices and give informed consent to the extent appropriate to their level of competence.

The level of competence necessary to consent to treatment that has a high degree of risk or complexity, or may have serious consequences for the consumer, will usually be different from the level of competence required to consent to minor, low‐risk procedures.

Under the Code of Health and Disability Services Consumers’ Rights (1996), every consumer of health services must be presumed to be competent to make an informed choice and give informed consent, unless there are reasonable grounds for believing that the consumer is not competent (Right 7(2)).

Competent kiritaki are those who are able to understand the nature, purpose and possible consequences of the proposed assessment or intervention, as well as the consequences of non‐treatment.

The Code of Health and Disability Services Consumers’ Rights (1996) does not specify an age for consent.

The Care of Children Act 2004 (section 36) states that children over the age of 16 are considered as if they are adults for the purpose of providing consent but are still under guardianship. Section 36 does not automatically prohibit persons under 16 years from consenting treatment and it is not clear whether parental consent is always necessary for (medical) treatment for persons under 16 years.

Informed consent given by a parent or guardian of a child or of an adult with diminished competence does not necessarily imply assent to treatment by kiritaki.

Written consent

A physiotherapist must:

1. Obtain written consent in the following circumstances:
   • the physiotherapist assesses that the severity of a serious adverse event during assessment or treatment is high
   • a student is present
   • kiritaki are to participate in any research

Documenting informed consent

A physiotherapist must:

1. Clearly document an explanation of the information provided and whether informed consent was gained or not gained, ensuring this is dated (see Physiotherapy health records standard).

Commentary: Document informed consent gained at the initial interaction with kiritaki and with any changes to physiotherapy services or providers. 

When documenting written informed consent, include the risks discussed and the options provided, alongside the signature of kiritaki.