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 Informed Consent

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This Info guide has been prepared by the Psychiatric Patient Advocate Office in the Ministry of Health and Long-Term Care for general Informational purposes only.  It does not contain legal advice.  If you have a question of would like advice about your specific legal situation, you should contact a lawyer.

 

June 2016

Is decision-making about treatment covered by the law?

  • Yes. The Health Care Consent Act sets out the rules about consent to treatment.

 

What is treatment?

  • Treatment, under the Health Care Consent Act, is anything that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health-related purpose and includes a plan of treatment, a course of treatment or a community treatment plan.
    • Treatment for a mental health issue may include:
    • Administration of medication; 
    •  diagnostic procedure such as an x-ray or blood or urine testing;
    • Psychotherapy;
    • Electro-convulsive therapy;
    • A program to change behavior;
    • A community treatment plan under a community treatment order; and
    • Ancillary or supplementary treatment such as blood tests (for example, if you take certain types of medication, blood testing is necessary to ensure that specific side effects do not exist).
  • The Health Care Consent Act also excludes certain things from the definition of treatment. For example; a capacity assessment, taking of a health history and the admission of a person to a hospital are not “treatments”.

 

What is consent?

  • According to the rules established in the Health Care Consent Act, there are four elements required for consent to treatment:
  • Consent must relate to the treatment;
  • Consent must be informed;
  • Consent must be given voluntarily; and
  • Consent must not be obtained through misrepresentation or fraud.

 

Is consent required before treatment can begin?

  • Yes. Except in certain emergency situations, a health practitioner must not administer a treatment to you unless:
    • If the practitioner is of the opinion that you are capable with respect to the treatment, and you have given consent, or
    • If the practitioner is of the opinion that you are incapable with respect to the treatment, your substitute decision maker has given consent.
  • Under the Health Care Consent Act, a “health practitioner” includes a doctor, a dentist, a chiropractor, a psychologist, a nurse, an occupational therapist and others. For simplicity, in this guide we will sometimes use the term "doctor" in place of health practitioner. If you are receiving treatment from a group of health practitioners, one practitioner, on behalf of all health practitioners involved in your treatment, may propose the plan of treatment, determine your capacity to consent to the treatment and receive your consent or refusal to the treatment.
  • If you are capable, only you can say “yes” or “no’ to the treatment, and you may withdraw your consent at any time. Everyone is presumed capable unless a doctor decides otherwise.
  • If the doctor decides you are incapable of consenting to the treatment, and a Substitute Decision Maker will make treatment decisions for you, you may wish to refer to the Psychiatric Patient Advocate Office Info Guide on “Substitute Decision-Makers.”

 

What is informed consent?

  • One of the requirements for consent to treatment under the Health Care Consent Act is that the consent be informed consent. In order for a person to give informed consent to treatment, the person must receive all the information, including answers to any questions about the treatment, from their health practitioner that a reasonable person would require in order to make a decision about the treatment, including:
    • The nature of the treatment;
    • The expected benefits of the treatment;
    • The material risks of the treatment;
    • The material side effects of the treatment; 
    •  Alternative courses of action; and
    • The likely consequences of not having the treatment.

 

Do I need to give my consent verbally?

  • You can give your consent verbally or in writing. Under some circumstances, your consent can also be understood as being given by your body language and actions. For example, if your doctor proposes to give you an injection and you roll up your sleeve, you are giving your permission to receive the injection. This is often referred to as “implied” consent.

 

What if I do not understand what the doctor is talking about?

  • To give informed consent, it is essential that you understand what your doctor is saying about the proposed treatment. You are entitled to receive additional information about the treatment. You are entitles to receive answers to any questions you have that will help you understand what is being explained to you. You can ask the doctor to use words that are easier for you to understand, instead of technical medical words. You can ask the doctor to provide you with written materials.
  • You can also ask a friend, family member or Patient Advocate (if one is available) to meet with you and the doctor. They may be able to assist you in understanding what the doctor is explaining to you.

 

Can I be forced to say ‘yes’ to a treatment?

  • You have the right to say ‘yes’ or ‘no’ to a treatment that is offered to you if you are capable of making these decisions. Your consent must be voluntary and given of your own free will.

 

Can the doctor change the treatment once I have consented?

  • It is possible that your doctor may make changes or adjustments to the treatment, as long as possible risks or side effects are not much different than the original treatment proposed. For example, your doctor may slightly increase your medication dosage because he or she does not think it is having the desired effects.
  • Your consent to a treatment will continue to apply to the same treatment in a different setting, if there is no significant change in the expected benefits, risks or side effects of the treatment as a result of the change in the setting in which it is administered. For example, you may be discharged to a care home.

 

Are there situations where I may be given medication forcibly and/or without my consent?

  • Where it is necessary to prevent serious bodily harm to you or to others, you may be given medication without your consent when the purpose of the medication is to restrain you. In these circumstances, the medication is not considered to be a treatment – it is a chemical restraint. Please refer to the Psychiatric Patient Advocate Office Info Guide on “Restraints: Your Rights When in a Psychiatric Facility.”
  • You could also be given treatment without your consent in an emergency. This could be done if a doctor thought it was necessary to protect you from severe suffering or serious bodily harm. For example, if you were unconscious and in need of medical attention due to an accident, the law permits emergency treatment without your consent.

 

How should I prepare before meeting with my doctor?

  • Before meeting with your doctor, it is a good idea to write down some of the questions you have about your diagnosis and the proposed treatment. If the doctor is giving new information and you are not ready or able to take it all in, you could ask to schedule another appointment to talk about your concerns. Sometimes you may be able to provide the doctor with a list of questions before you meet. If you have prepared a list of questions, you should ask the doctor how much time he or she has to meet with you to go over your questions; if the doctor does not have a lot of time, arrange to come back and meet again.
  • If you are meeting with a new doctor, it is a good idea to bring a list of your current concerns and medications, if any. You should also bring an interpreter with you if your doctor is not fluent in your language and you may not be able to understand him/her. For example, your doctor may speak English but you may not be fluent in that language.

 

What are some questions I should ask my doctor?

  • The philosophy of the Psychiatric Patient Advocate Office is that a strength-based model of care that enshrines the principles of and commitment to recovery is perhaps the best way to support individuals with mental illness. Individuals should have the opportunity to be active participants in all decisions that affect their care, life and treatment. At the end of this Info Guide is a list of some questions you might want to ask your doctor – you can print the list and take it with you next time you visit your doctor.

 

Questions to ask your doctor about Treatment?

  • (If you are capable, you will say “yes” or “no” to the proposed treatment. If you are incapable, your substitute decision-maker will say “yes” or “no” to the proposed treatment.)

Name of health practitioner: ________________________________

Date: __________________________________________________

o   What health issue are you treating me for?

o   Can you refer me to someone for a second opinion if I would like to have one?

o   Do you have anything I can read about this health issue?

o   What is the proposed treatment? Do you have anything I can read about this treatment?

o   How will this treatment help me?

o   How long it will take before the treatment takes effect?

o   What can I do in the meantime to deal with my symptoms until the treatment starts working?

o   What do I do if I am feeling bad and need to speak to someone immediately?

o   Can this treatment ever cause me discomfort or harm me? If so, how?

o   Can this treatment cause me permanent harm?

o   Are there any side effects to this treatment?

o   Will this treatment be effective if I’m taking other medications or undergoing other treatments?

o   What might happen if I don’t take this treatment?

o   What might happen if I take this treatment for a while and then stop taking this treatment suddenly?

o   Are there any other treatments that might help me?

o   Is there anything else I should know before I leave today?  

 

Questions?

  • If you have questions, contact your local Patient Advocate or Rights Adviser or call the central office of the Psychiatric Patient Advocate Office at 1-800-578-2343.
   

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