Autonomy-based informed consent: ethical implications for patient noncompliance

The problems presented by the noncompliant patient are not new to health care professionals, including physical therapists. Although many of the factors that influence the incidence of noncompliance have been studied, important ethical concerns are often overlooked. This fact has led many health care professionals to make the following assumptions: 1) All cases of noncompliance are problems in need of a solution, 2) the solution to the problem of noncompliance is compliance, 3) all instances of compliance are nonproblematical, and 4) the locus of the problem of noncompliance is the patient. In this article, the issue of patient noncompliance is examined based on an analysis of the moral foundations of informed consent. The above assumptions are shown to be problematic from the moral point of view. Three patient cases are presented to highlight some of the implications for physical therapists who encounter noncompliant patients. Understanding the moral foundation of informed consent can help guide therapists in their communication with all patients, and especially in their interactions with noncompliant patients.