Cervical spinal manipulative therapy, arterial dissection, and the law: Informed consent and causation in Goldie...

This article examines a recent Canadian case in which a chiropractor is found liable after a patient experienced cervical artery dissection and stroke allegedly linked to cervical spinal manipulation. Two questions dominate: whether informed consent is valid and whether the final treatment caused the injury. Using a clinician-oriented lens applied to the trial reasons, the review maps the courts' reasoning against epidemiology, biomechanics, and contemporary clinical guidance. The trial court finds that the consent disclosure minimizes material risk, and the court of appeal upholds that informed-consent ruling. On causation, the trial court places determinative weight on clinical opinion, treats population-level evidence as "controversial," and frames causation as a binary choice (traumatic or "spontaneous") rather than considering interaction models (latent arterial susceptibility plus trigger). These choices risk oversimplifying a medically complex problem and accepting legal causation where scientific probability remains uncertain. On appeal, the defendant did not seek review of the causation finding.