Ethics in IEMT Practice: Lesson 2.1

Informed Consent and Assessing Capacity

Welcome

Informed consent is the foundation of ethical work with clients. In this lesson we look at what valid consent requires, what you need to tell clients before IEMT begins, how to think about a client's capacity to decide, and how to make sure agreement is freely given. The law described is that of England and Wales.

Learning Objectives

By the end of this lesson, you will be able to:

• Explain what makes consent valid and why it is an ongoing process.
• List the information you should give a client before starting IEMT.
• Apply the Mental Capacity Act test to a client's ability to decide.
• Spot and reduce pressure on a client's decision.
• Record consent properly.

What is informed consent?

Consent is valid when the client:

1. has capacity to make the decision;
2. has enough information to understand what they are agreeing to; and
3. decides voluntarily, without coercion or undue influence.

The Association's Scope of Practice Policy makes the same point and adds that consent is not a one-off event.

Consent is an ongoing process, not a single signature.

The Association for IEMT Practitioners, Scope of Practice Policy, section 7

The legal standard

In England and Wales, an adult has the right to decide what is done to their body and mind. The leading modern statement is in Montgomery v Lanarkshire Health Board [2015] UKSC 11, a Supreme Court case about doctors. It is not a case about complementary practitioners, but it sets out the standard of respect for patient autonomy that any practitioner should aim to meet.

The doctor is therefore under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments.

Lord Kerr and Lord Reed, Montgomery v Lanarkshire Health Board [2015] UKSC 11, paragraph 87

The court described a risk as material if a reasonable person in the client's position would be likely to attach significance to it, or if the practitioner is or should reasonably be aware that this particular client would. In other words, do not decide for the client what they would want to know. Tell them what matters, in terms they can use.

What to tell the client

The Scope of Practice Policy (section 7) and the Standards of Competence (section 4) list what must be explained before IEMT begins. Use this as your checklist:

• Who you are. Your qualifications, your role and its limits, including that you do not diagnose or treat medical or psychiatric conditions.
• What IEMT involves. What the procedure is, and what the client will be asked to do.
• The evidence. That the evidence base is limited and emerging, and that there is uncertainty about how IEMT works and how long any effects last.
• Foreseeable discomfort. Emotional distress, eye strain, headache, dizziness and nausea.
• Alternatives. Including not having IEMT at all, and being referred or signposted elsewhere.
• Practicalities. Fees and cancellation, how records are kept, and confidentiality and its limits.
• Their rights. To pause, decline, withdraw or end the session at any time.
• Feedback and complaints. How to give feedback, make a complaint or report an adverse event.

Check understanding by asking the client to say back, in their own words, what they have understood. Plain language is best. Leave time for questions, and give people the chance to think it over rather than deciding on the spot.

Capacity

In England and Wales the Mental Capacity Act 2005 applies to people aged 16 and over. Its starting point is that adults can make their own decisions.

• Section 1(2): a person must be assumed to have capacity unless it is established that they lack it.
• Section 1(3): a person is not to be treated as unable to make a decision unless all practicable steps to help them do so have been taken without success.
• Section 1(4): a person is not to be treated as unable to make a decision merely because they make an unwise decision.

A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

Mental Capacity Act 2005, section 1(4)

Under section 3, a person is unable to make a decision if they cannot do one or more of the following:

1. understand the information relevant to the decision;
2. retain that information;
3. use or weigh that information as part of the process of making the decision; or
4. communicate their decision, by talking, using sign language or any other means.

Two further points matter in practice. Capacity is specific to the decision and the moment. A person may be able to decide about IEMT on one day and not on another, for example if they are intoxicated, in acute distress or very unwell. And a diagnosis, a label or a disability does not mean someone lacks capacity. Offer support first: explain in a different way, use pictures, involve a trusted person if the client wishes, and choose a calmer time.

Voluntariness: is the choice really free?

IEMT sessions are often short and the practitioner is the expert, so a client may feel an implied obligation to go ahead. Watch for:

• an expectation in a paid arrangement that the session should go ahead once the client has arrived or paid;
• pressure from family, a partner, an employer or the person who referred them;
• authority, urgency or a sense of group expectation, for example in a training or group setting;
• financial pressure, for example a discount that depends on committing to several sessions.

The Standards of Competence say to avoid pressure through authority, urgency, group pressure, interpretation or financial leverage. Reduce it by saying plainly that the client can say no without it affecting your relationship, by offering time to think, and by seeing the client alone for the consent conversation where appropriate.

Recording consent

• Record that consent was given, and what was explained, in writing or in your notes. Many practitioners use a written agreement as well as a conversation.
• Note the date, and any questions the client asked or concerns they raised.
• Reconfirm consent at the start of each session and whenever the plan or goal changes.
• Check consent during the session, for example before a new step or if the client becomes distressed. Remember that consent can be withdrawn at any time.
• If you use an interpreter, use a competent one and deal with confidentiality first.

Children and young people

Module 3 covers consent for under-18s in detail. In brief, people aged 16 and 17 are presumed able to consent, but you must still think about their maturity and circumstances. For anyone under 16, Gillick competence is the legal starting point, but it was developed in a medical context and its application to complementary practice is not settled. The Association's policies do not set a minimum client age. They do say that where capacity or legal consent is uncertain, you must not proceed until the applicable requirements are understood and met (Standards of Competence, section 4), and that your insurance must cover the client group (Scope of Practice Policy, section 2). Module 3 shows how to apply those rules, and your insurer may set conditions of its own.

Self-Reflection Exercise

Think about how you obtain consent now:

• How do you explain IEMT to a new client? Does it include the evidence, the foreseeable discomfort and the alternatives?
• Do you check understanding, or assume it?
• Is there anything about your set-up that might make it hard for clients to say no?
• What would you change after this lesson? Write a short action plan.

Key Takeaways

• Valid consent needs capacity, information and voluntariness, and it is an ongoing process.
• Tell clients who you are, what IEMT involves, what is known about the evidence, the risks and discomfort, the alternatives, the practicalities, their rights and how to complain.
• Assume adults have capacity, support them to decide, and do not treat an unwise decision as lack of capacity.
• If you doubt capacity, pause and take advice rather than proceeding.
• Record consent, and check it again whenever things change.

Next Steps

In Lesson 2.2 we look at boundaries and dual relationships: how to keep the relationship professional and safe.

This ethics series is produced by The Association for IEMT Practitioners and is intended for professional development purposes. It describes law and guidance for England and Wales as at October 2026 and is not legal advice. Always follow your local law, your insurer’s conditions, safeguarding procedures and your professional judgement.