Overview for Caregivers - Capacity & Consent

Capacity: A person in incapable of giving or refusing consent to care or medical treatment if he/she is not able to understand the information relevant to the decision or if he/she is not able to appreciate the reasonably foreseeable consequences of such a decision. The health care professional proposing the treatment course of action assesses capacity. (1)

Consent has many elements such as lack of coercion, given by patient or legally authorized substitute decision maker, a reference to the particular administrator and treatment, and comes with full disclosure (e.g. risks, benefits, side effects, alternatives). (1)

Why is it important?

  • The Health Care Consent Act (HCCA) is an Ontario law based on capacity to consent; it governs health practitioners,including physicians (2)
  • Ontario HCCA is also relevant to the Ontario Substitute Decisions Act- a person found to lack capacity for personal care would need a substitute decision maker (3)

Common Causes

  • 73 % of Canadians die from complex chronic diseases and some will be lack capacity; for example, progressive dementing illnesses will affect the person’s decision-making ability at some point (1) (4)

Key Considerations

  • A person will be able to appreciate the consequences of the decision if the following occurs: (1)   
      • Acknowledges that the condition for which treatment is being recommended can affect him/her
      • Understands how proposed action, or lack of action, can effect quality of life
      • Explain why he/she is making a decision in a way that aligns with previously expressed values (e.g. realistic expectations, can communicate choice, can manipulate information rationally (4)
  • If the individual lacks capacity to consent, a substitute decision maker can be used
  • A substitute decision maker can be named in the Power of Attorney-chosen by the patient- and directed by an Advance Directive (a documented expression of wishes written by the patient, when they were capable, with respect to the medical treatment and personal care decisions) (1)
  • It is important to have these conversations earlier on regarding substitute decision makers,  advance directives, advance care planning, treatment options, financial plans etc. with family members, lawyers, and health care professionals

References

1.      Canadian Hospice Palliative Care Association. (2012). Advance Care Planning in Canada: National Framework.
         (2011). Retrieved March 17, 2014 

2.      Service Ontario. (2010). Health Care Consent Act, 1996. Retrieved March 17, 2014 from:
         http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_96h02_e.htm\ServiceOntario_e.htm

3.      ServiceOntario. (2011). Substitute Decisions Act, 1992. Retrieved March 17, 2014 from:
         https://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_92s30_e.htm

4.      The College of Physicians and Surgeons of Ontario. (2007). Determining capacity to consent
          Retrieved March 17, 2014 from: 
          http://www.cpso.on.ca/uploadedFiles/policies/policies/policyitems/capacity_consent_july07dialogue.pdf

Resource Type - Type de Ressources: 
Author/Publisher - Auteur/Éditeur: 
Centre for Studies in Aging and Health
Date Published: 
2014-01