Consent means a person freely agreeing to something, either participating in something, or having something done to them. Every adult who has the capacity has the right to decide what happens to their own body.
Before any assessment or treatment, you must get consent from the person. Where ongoing treatment is required, the ‘informed consent’ of the person is an ongoing event and not a one-off occurrence.
For consent to be valid:
- The person must have the capacity to decide
- Consent must be given voluntarily, without pressure
- The person must be given all the information they need to make an informed decision
If a person has capacity and refuses treatment, you must respect their choice—even if you disagree with it or think it doesn’t make sense. It can help to talk to other healthcare team members involved in their care, especially if the refusal could affect other parts of their treatment. Be sure to clearly record the person’s decision in their notes.
Types of consent
Explicit: Clearly given by the person, either written or spoken.
Implied: Shown through actions, like rolling up a sleeve for a blood pressure check.
You should be very careful before assuming implied consent because it might be questioned later, especially if your actions are challenged. It’s best to get explicit consent whenever possible.
Oral consent is usually fine if you document it properly.
The CSP recommends written consent for:
- Invasive treatments (like injections or acupuncture)
- Treatments that could cause serious side effects even if done correctly
Written consent should be recorded.
For intimate exams (like vaginal or rectal exams), written consent is not always required, but you should think carefully about the situation and use your professional judgment. Also, consider privacy and whether a chaperone is needed.
The respective Health Departments in each of the Home Countries provide detailed and comprehensive guidance on all matters of consent for specific person groups and you should refer to this guidance for your particular country.
Patients recording physiotherapy sessions
People may choose to record their physiotherapy sessions, either openly or without telling you (covertly), for personal use or to share on social media. While it is best practice for them to ask for your consent, they are not legally required to do so if they are recording themselves.
If you appear in their recording, and they choose to share it, they do not need your permission to post it online, even if you have refused to be filmed. If you’re concerned about being recorded without your consent, speak to your manager or follow your organisation’s policy on managing such situations.
Frequently asked questions about consent
Can I delegate gaining consent to someone else?
Yes, you can ask someone else on the physiotherapy team to explain the treatment and get consent if:
- They are properly trained and qualified.
- They know enough about the treatment to explain the risks, benefits, and options clearly.
- They can answer the person’s questions well enough to help them decide.
- They can perform the treatment themselves.
Even if you delegate this, you are still responsible for making sure the person has enough time and information to make a clear decision before treatment starts.
Can I involve relatives/carers or family in the discussions re consent?
Yes, if the person agrees. You should get their permission, ideally in writing if there’s a chance others might later question it.
Think about involving other healthcare team members or support services if helpful. You can also give out leaflets or suggest advocacy or support groups.
Make sure that people with additional needs are supported to make their own decisions where they have the capacity to do so.
Can a child under the age of 16 consent to their physiotherapy treatment?
Yes, children under 16 can consent to physiotherapy treatment if they are Gillick competent—this means they can:
- Understand the physiotherapy treatment being offered,
- Remember the information,
- Weigh up the benefits and risks,
- And make an informed decision.
If a child has this level of understanding, you do not need consent from a parent or guardian. A parent cannot override a Gillick competent child’s valid consent to physiotherapy.
However, if the child refuses physiotherapy—even if they are Gillick competent—a parent or person with parental responsibility may be able to override that refusal, depending on the situation.
In such cases, consider the reason for the child’s refusal, their best interests and consider seeking advice from your local safeguarding lead.
What should I do if an adult lacks capacity to make decisions about physiotherapy due to a physical condition?
This is governed by the following Acts:
- In England and Wales, follow the Mental Capacity Act 2005
- In Scotland, follow the Adults with Incapacity (Scotland) Act 2000
- In Northern Ireland, decisions are made under the common law duty to act in the person's best interests
You should raise your concerns with the doctors or healthcare team involved in their care. They will assess the person’s capacity and make a ‘best interests’ decision, guided by the appropriate Code of Practice. Always make sure the decision is clearly documented.
Can I take video or photos of a person during physiotherapy sessions?
Yes, but you must get the person’s written consent first.
If the photos or videos are only for their clinical record, let them know that. But if you want to use them for anything else—like teaching, research, or social media—you must explain how, where, when, and why the recordings will be used.
The person has the right to withdraw consent at any time. However, you must tell them upfront that if the footage is shared online or on social media, it might be impossible to fully remove it later, even if they change their mind.