Consent Flashcards
Obtaining consent from a Minor
- no minimum age of consent
- should assume a person is capable unless there is reason to believe they are not
- factors to consider:
age of the minor,
level of maturity,
type of treatment being proposed,
level of risk involved
Requests from Clients to Sign Forms and Documents
e.g. Request for Assessment of Capacity/T2201 Disability Tax Credit Certificate/passport application form
OT carefully review the entire form and consider the following…
1. Risk to the client
- risks and benefits of completing the form
- discussed with the client and obtained consent to proceed
2. What is the information being asked?
- Is the form requesting medical information?
- Will completing the form involve communicating a diagnosis?
- within the scope of OT practice, have the competencies and knowledge
3. Is there a process?
- following a process when reviewing forms and documents.
e.g. speaking to managers or other colleagues to clarify organizational policies and legislation applicable to the practice setting.
4. Signing the form
- Is an occupational therapist designated as one of the professionals allowed to complete the form
- use and display their title appropriately when signing forms
When clients expressly request that specific information not be disclosed to another healthcare provider who is giving them healthcare services
- Developing and implementing policies and procedures for the appropriate
management of restricted information (paper or electronic). - Explaining to clients the potential risks of using the consent directive restriction
- Preventing unauthorized access to all locked information
- if OT believes that disclosure of the information is reasonably **necessary ** for the provision of client services, the occupational therapist must notify the other provider that information has been withheld. However, the content of the withheld information must not be disclosed e.g. reducing or eliminating significant risk of serious harm to an individual or a group of persons.
Circle of Care and Implied Consent
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assume that they have clients’ implied consent to collect, use, or disclose personal health information to another custodian
e.g. hospitals, long-term care, primary care, and home and community care - also apply to the sharing of a client’s personal health information with external healthcare providers —for example, occupational therapists sharing client information with community providers who offer services to the same client e.g. family doctor
- consider carefully whether another healthcare provider is in the circle of care. Employers, insurance companies, educational institutions, and banks are just some examples of third parties who are not in the circle of care –> requires express consent
Secondary Uses of Personal Health Information
e.g. program planning, risk management, quality improvement, research, staff training, and responding to legal proceeding
–> need to obtain client consent
Determine client capacity to provide consent
- Use interpreters or augmentative communication tools
Allow time for clients to understand the information and ask questions before finalizing capacity decisions
Assume that clients are capable of providing consent unless there is information that indicates otherwise. Do not presume incapacity based on:
- Age
- Communication challenges
- Diagnosis of a psychiatric or neurological condition
- Disability
- The fact that a guardian, power of attorney, or substitute decision-maker is in place
- Language differences
- Personal bias about social or cultural structures of marginalized groups or communities
- Refusal of intervention
not have the capacity to provide consent:
1. Explain to or assist the client in exercising their right to have a review of the finding
2. hierarchy of substitute decision-makers to determine who is to provide consent
3. Inform the client that the substitute decision-maker will make decisions regarding occupational therapy services
4. Involve the client in discussions about services whenever possible
Informed consent includes what kind of information?
This information includes:
- Scope and reason for the referral or services
- Purpose and nature of the services
- Expected benefits and risks of proceeding, including any cultural, ecological, or economic considerations
- Likely consequences of not proceeding
- Expected outcomes
- Alternative courses of action
- The right of clients to withdraw consent at any time
- How services will be paid for
Explain each component of the plan, and obtain ongoing consent when moving from one component of services to another.
Obtain consent from clients to involve others in service delivery, such as students and occupational therapy assistants → Clarify their roles and responsibilities
Knowledgeable consent includes what kind of information?
- Explain to clients why information is being collected, used, and shared and with whom
- Make sure that clients understand that they have a right to withdraw consent but that the withdrawal cannot be applied retroactively to information already shared
For third party referrals (for example, independent examinations or expert reports):
Obtain consent for the disclosure of assessment results, reports, and intervention plans to third party payers, other professionals, partners, and interested parties unless exceptions to this disclosure apply under privacy legislation
Obtain consent before reviewing any additional client health information that was provided by the third party after the original assessment services were completed (for example, other medical reports or surveillance material)
Document both informed and knowledgeable consent
- client understood and agreed to all, some, or none?
- Risks, limitations, and benefits of the services discussed?
- Any limits imposed on the collection, use, and disclosure?
- Type of alternative communication methods used?
- Name of the substitute decision-maker. If applicable, include a copy of authorizing documents
Manage withdrawal of consent
Ensure that clients understand their right to withdraw consent and any implications of doing so
If the client withdraws consent, continue the services only if immediate withdrawal poses a serious risk to the health or safety of the client or others. Explain to the client why the withdrawal cannot be immediate.
Ensure that the record includes all services provided before consent was withdrawn and the reasons the clients withdrew consent (if known).
Obtaining informed consent for an incapable client when an SDM is not available
Make a referral to the Public Guardian and Trustee PGT to identify the most appropriate SDM → if said may take some time to obtain informed consent → consider the risk of not having consent vs not giving treatment → proceed treatment while waiting for new informed consent
Consent obtained by a third-party
rely on that consent; however, the third party must be a regulated health professional
If the occupational therapist is uncertain, they should call the parent/guardian themselves and obtain informed consent prior to conducting an occupational therapy assessment with the student
Hierarchy of Substitute Decision-Makers
- Court-appointed guardian
- Attorney for personal care conferred by a written form when the client was capable
- Representative appointed by Consent and Capacity board
- Spouse/Partner
- Children/Parent (when the child is a minor)
- Parent of the incapable person
- Siblings
- Any other relatives
