The vital role of informed consent in therapy

Informed consent is a fundamental component of chiropractic healthcare law and ethics.^1,2

It influences the doctor-patient relationship and honors the patient’s autonomy in decision-making. As the chiropractic profession integrates techniques, such as dry needling, it is increasingly imperative to maintain the principles of informed consent. This article emphasizes the necessity of obtaining informed permission before any chiropractic intervention, including dry needling.³

The essential importance of informed consent

Informed consent is not merely a procedural formality; it constitutes a continuous dialogue. This methodology is founded on four fundamental ethical principles of medicine: autonomy, beneficence, non-maleficence and fairness. These ideals necessitate transparency and collaboration.^4,5 Autonomy requires patients have the liberty to make informed decisions without coercion. Beneficence necessitates actions that prioritize the patient’s welfare, whereas non-maleficence mandates conduct that avoids inflicting injury. Justice requires objectivity and equitable access to information. These notions are crucial for ensuring informed consent is ethically valid. Legally, informed consent safeguards patients’ rights and diminishes the likelihood of misconduct. Malpractice judgments are gener ally rendered due to insuffcient understanding of hazards, inadequate documentation and a lack of information about alternative therapies. This underscores the importance of maintaining accurate records and educating patients.

Empower patients with information

Informed consent involves providing patients with clear and comprehensible information that is pertinent to them. This information often includes the nature of the treatment, associated risks and benefits, alternative options and anticipated outcomes. Ensuring patients have access to information has
several positive effects:

• Enhanced comprehension: Patients who receive extensive information regarding their treatment are more likely to grasp their condition and the recommended therapies. This knowledge enables your patients to engage in their rehabilitation process actively.
• Making decisions informed by data: Informed patients can make decisions that align with their values and interests. For example, if a patient is aware of their options, they may select a treatment that excludes needles due to their fear of them.
• Reduced anxiety: Understanding what to anticipate during therapy might alleviate the apprehension and trepidation associated with medical procedures. This can consequently enhance the patient’s overall experience and adherence to therapy.
• Enhanced trust: Transparent communication and knowledge improve trust between you and your patients. Patients are more likely to trust healthcare personnel who honor their autonomy and provide truthful and precise information.

Ethical considerations in providing informed consent

Ethical issues are crucial in establishing the practice of informed consent in your endeavors. Healthcare workers must adhere to a framework of principles to ensure the informed consent process is conducted ethically:⁶

• Complete transparency: You are obligated to disclose all pertinent information to your patients. This entails transparency regarding treatment alternatives, associated risks and benefits and other available options.
• Voluntariness: Patients must give their consent willingly, without coercion or deception. You must explicitly inform your patients they have the right to refuse therapy or seek a second opinion.
• Comprehensibility: The information provided throughout the informed consent process must be suffciently clear for your patients to understand. You must consider linguistic barriers, cognitive impairments and other factors that may affect comprehension.
• Continuous consent: Informed consent is not a singular event; it is a perpetual process. Your patients must have the opportunity to ask questions, seek clarification and revise their decisions as their understanding of their condition evolves.

The legal implications of informed consent

Informed consent is essential for ethical and legal considerations. If you fail to obtain informed consent, you may encounter legal issues, including malpractice lawsuits.

1. Safeguard against malpractice allegations: As a DC, you are legally safeguarded by informed consent. You should provide your patients with suffcient information, thereby reducing the likelihood of negligence claims or the inability to make an informed decision.
2. Document: Maintaining accurate documentation of the informed consent process is essential. This documentation includes signed consent forms, records of discussions with the patient and any further signed documents indicating the patient’s acceptance or refusal of treatment.
3. Observe scope of practice: You must remain within professional boundaries when obtaining informed consent. You should exclusively recommend treatments and interventions in which you possess training and expertise.
4. Remember your legal obligation to inform: Legislation in some jurisdictions mandates healthcare providers, including DCs, must disclose treatment alternatives, associated dangers and alternative choices to patients. Failure to adhere to these stipulations may result in legal complications.

Informed consent regarding dry needling

An increasing number of DCs are using dry needling for pain management and myofascial issues. This involves inserting fine needles into anatomic structures for desired physiologic healing. Dry needling may alleviate discomfort and enhance function; nevertheless, it also has risks such as pneumothorax, hemorrhage, nerve injury and post-treatment soreness.^7,8,9

Two recently published articles^10,11 discuss the informed consent process and seek to determine the components and structure of an informed consent risk of harm statement to enhance patient understanding and facilitate informed decision-making. The study utilized four groups—legal experts, policy experts, dry needling specialists and patients—to determine the essential components to include in a dry needling informed consent form. They concluded the risk of harm statement should include identifying hazards and discomforts, articulating various emotions and applying classification to prioritize dangers by severity. A minimum agreement of 80% was required to achieve consensus.

The harm risk statement they created was composed at a seventh-grade reading level so it could be easily understood, and enumerated the various hazards associated with dry needling. Through this process the study determined the essential components of informed consent for dry needling. An example form as discussed can be incorporated into best practices for informed consent, which include:

1. A concise explanation of the procedure: Elucidate the methodology, the focal regions and the subsequent actions to take.
2. Information about potential hazards and advantages: Disclose the potential advantages, such as reduced pain and enhanced functionality, alongside the acknowledged risks, including hemorrhage, infection, nerve injury and post treatment discomfort. One study stated a risk may constitute a potential injury detrimental to the patient’s health.
3. Discussion of alternatives: Encourage your patients to consider alternatives that align with their objectives, including manual therapy, exercise, pharmacological interventions or more injections.
4. Opportunity to inquire: Allow your patients sufficient time to pose inquiries and ensure you provide clear responses. The patient must fully comprehend the information presented to them to weigh their options and offer informed consent. Challenges encompass ensuring patient comprehension and addressing their concerns and expectations. Assess the patient’s health literacy and identify any linguistic or cultural barriers.

Final thoughts

Informed consent is a foundational premise of ethical and patient-centered treatment. It empowers patients, honors their autonomy and facilitates collaborative decision-making. Furthermore, it provides legal protection for you and ensures patients receive therapy aligned with their beliefs and preferences. We must meticulously consider how to address communication issues and emergencies. By staying current on and adhering to the principles of informed consent, you can provide optimal care to your patients while maintaining their dignity and autonomy.

Brian Hortz, PhD, ATC, SFDN, was part of the athletic training staff at Denison University from 1995 to 2019. He served as the head athletic trainer from 1997 to 2010 and the director of sports medicine from 2010 to 2019. Hortz began using dry needling several years ago with his athletes, and it has become a key treatment method for many of the collegiate and high-performance athletes he supports. He has presented at state, national and international conferences on dry needling, athletic training, medical ethics, regulatory issues, health and physical activity. Hortz is an instructor and the director of research and education for Structure & Function Education.

References

1. Wright DS, et al. Patient safety culture research within the chiropractic profession: A scoping review. Chiropr Man Therap. 2025;33(1):46. https://pubmed.ncbi.nlm.nih.gov/41121121/. Accessed January 8, 2026.

2. Simpson JK, Innes S. Informed consent, duty of disclosure and chiropractic: Where are we? Chiropr Man Therap. 2020;28(1):60. https://pubmed.ncbi.nlm.nih.gov/33148281/. Accessed January 8, 2026.

3. Pallocci M, et al. Informed consent: Legal obligation or cornerstone of the care relationship? Int J Environ Res Public Health. 2023;20(3):2118. https://pubmed.ncbi.nlm.nih.gov/36767485/. Accessed January 8, 2026.

4. Giudici-Wach K, et al. Learning from informed consent litigation to improve practices: A systematic review. https://pubmed.ncbi.nlm.nih.gov/34716051/. Accessed January 8, 2026.

5. Lo B, et al. Fundamentals of medical ethics: A new perspective series. N Engl J Med. 2023;389(25):2392-2394. https://pubmed.ncbi.nlm.nih.gov/38118032/. Accessed January 8, 2026.

6. Pietrzykowski T, Smilowska K. The reality of informed consent: Empirical studies on patient comprehension-systematic review. Trials. 2021;22(1):57. https://pubmed.ncbi.nlm.nih.gov/33446265/. Accessed January 8, 2026.

7. Boyce D, et al. Adverse events associated with therapeutic dry needling. Int J Sports Phys Ther. 2020;15(1):103–113. https://pubmed.ncbi.nlm.nih.gov/32089962/. Accessed January 8, 2026.

8. Halle JS, Halle RJ. Pertinent dry needling considerations for minimizing adverse effects: Part one. Int J Sports Phys Ther. 2016;11(4): 651–662. https://pubmed.ncbi.nlm.nih.gov/27525188/. Accessed January 8, 2026.

9. Halle JS, Halle RJ. Pertinent dry needling considerations for minimizing adverse effects: Part two. Int J Sports Phys Ther. 2016;11(5): 810–819. https://pubmed.ncbi.nlm.nih.gov/27757293/. Accessed January 8, 2026.

10. Ickert EC, et al. Identifying which adverse events associated with dry needling should be included for informed consent: A modified e-Delphi study. Physiother Theory Pract. 2024;40(8):1731-1743. https://pubmed.ncbi.nlm.nih.gov/37158676/. Accessed January 8, 2026.

11. Ickert EC, et al. Creation of a risk of harms informed consent form for dry needling: A nominal group technique. Musculoskelet Sci Pract. 2023:66:102778. https://pubmed.ncbi.nlm.nih.gov/37290346/. Accessed January 8, 2026.