Week 3: Legislation Flashcards
Why do we need consent?
Legal basis
Ethical basis
What are the different factors within the ethical basis for consent?
Beneficence - do good
Non-maleficence - do no harm
Autonomy - right to determine and act on a self-chosen path
- based on informed choices
Information about the treatment that a reasonable person in the same circumstances would require to make a decision
Informed consent
Informed consent must include these things.
nature of treatment expected benefits material risks and side effects alternative courses of action likely consequences of not having the treatment
What are the laws surrounding consent in Ontario?
Health Care Consent Act
Mental Health Act
What aspects of consent does the HCCA deal with?
Consent to treatment
consent to a care facility
Consent to a personal assistance service
Anything done for a therapeutic, cosmetic or other health-related purpose.
Treatment
A series or sequence of similar treatments administered to a person over a period of time for a particular health problem
Course of treatment
A plan that is developed by one or more HCPs, dealing with one or more of the health problems that a person has an is likely to have. It provides for the administration of various treatments or courses of treatment. It may include the withholding or withdrawal of treatment in light of the person’s health condition
Plan of treatment
Consent is required for any treatment except for this/these cases.
Certain emergency situations
Consent to treatment must involve these things?
Relate to treatment being proposed
Be informed
Be voluntary
Not obtained through misrepresentation or fraud
Who is responsible for taking reasonable steps to ensure that treatment is not administered without consent.
the HCP that proposes the treatment
If consent to admission to a care facility is required by _____, then consent is needed in all cases except?
law
crisis situation
Before CCAC can assess a client for admission to _____, they need consent
LTC
Consent to personal assistance services:
The HCCA does not specify that ______ to a personal service device is _____. However, it does provide that if an evaluator finds a recipient of a personal assistance service incapable of giving consent, and the person providing the service wants to obtain consent, it may be obtained from ______.
consent
required
SDM (as set out by the hierarchy in the act)
What is the minimum age of consent in Ontario?
There is none
A person is able to give consent if he/she?
Understands the information that is relevant to the decision
Appreciates the possible consequences of a decision or lack of a decision
In the case of an incapable person, who is consent obtained from?
Consent obtained from highest ranking SDM from HCCA hierarchy
Treatment in an emergency can be provided immediately if?
Person is capable of giving consent and gives consent
Communication barriers
Person is incapable with respect to the treatment decision, but a SDM gives consent
(same as above point) but it not reasonably feasible to contain consent or refusal from SDM and delay will put the person at risk of sustain serious bodily harm
Situation where the person is experiencing severe suffering or is at risk of sustaining serious bodily harm if the treatment is not administered promptly. An examination or diagnostic procedure that is a treatment may be conducted without consent if it is reasonably necessary to determine if there is an emergency.
Emergency
Admission to a care facility without consent may be authorized if?
the person who has been deemed incapable requires immediate admission as a result of a crisis
And it is not reasonably possible to obtain immediate consent or refusal on the incapable person’s behalf
Refers to the mental or cognitive ability to understand the nature and effects of one’s acts.
Capacity
Capacity is a ______ term; Competence is a _____ term.
functional
legal
Defined as being duly qualified: having sufficient, capacity, ability or authority”
competence
Act dealing with decision-making about personal care or property on behalf of incapable persons.
Substitute decisions Act - SDA
SDA
Decision making about personal care or property on behalf of _______ persons
Concerned with persons who need decisions made on their behalf on a _______ basis
Formal (i.e. legal) appointment of a decision maker:
- (3 things)
incapable continuous Power of attorney document Office of the public guardian and trustee (PGT) Court appointment
Person identified by the HCCA who may make a treatment decision for someone who is incapable of making his/her own decision
SDM
a ____ for personal care is not necessarily required to act as a SDM.
POA
SDM is usually?
spouse, partner or relative
What are the different ways in which a person’s wishes about treatment can be expressed?
orally, in writing, in any other form, or implied
What is the hierarchy of SDMs?
1 - Guardian (court appointed) 2 - PA 3 - Someone appointed as a representative by the Consent and Capacity Board 4 - Spouse, partner or relative - spouse/partner - child if 16+ - custodial parent; or CAS - parent who has only a right of access - Brother or sister - other relative PGT is the SDM of last resort
Legal document in which a capable person gives someone else the authority to make decisions about his/her personal care in the event that he/she becomes incapable. the document could also contain specific instructions about particular treatment decisions.
POA
When must PoA be made?
ahead of time when the person is competent and capable of making decisions
What are some key differences between SDM and PoA?
SDM - can be chosen ahead of time, or NOT
PoA - must be done ahead of time
SDM can be PoA for personal care, but doesnt have to be
Document made and signed by a mentally competent adult which details specific future medical treatments to be administered or withheld.
Advance directive
What are the different admission types to a psychiatric facility?
Voluntary admission
Informal admission
Involuntary admission
Any person who is believed to be in need of the observation, care and treatment in a psychiatric facility, upon recommendation of a physician can agree (Consent) to admission
Voluntary admission
A person who has been admitted to a psychiatric facility on the consent of another person (SDM) in order to get treatment because the person is deemed incapable of consenting or refusing treatment
Informal admission
Gives authority to any person to take the person who suffers from a mental disorder and meets certain criteria to a psychiatric facility
Involuntary admission
The patient is suffering from a mental disorder of a nature or quality that will likely result in:
- serious bodily harm to the patient, to another person
- serious physical impairment of the patient, unless the patient remains in the custody of a psychiatric facility
Involuntary admission
Application for psychiatric assessment
Gives authority to detain, restrain, observe and examine the person for not more than 72 hours
Form 1
Form 1 does not give authority to _____.
- Patient is provided with a notification that they are on a form 1 and why (_____ ___)
treat
Form 42
Gives authority to admit a person who has been assessed by a psychiatrist and found to meet certain criteria as an involuntary patient to a psychiatric facility
Form 3 and 4
Form 3 and 4:
- Still need _____ for treatment
- Patient provided with notice to patient regarding rights advice (_____ __)
consent
form 30
Provides a comprehensive plan of community-based treatment or care and supervision that is less restrictive than being detained in a psychiatric facility
Community treatment orders (CTO)
After how long does a CTO expire?
Renewal?
Non-compliance with the conditions of the CTO may warrant an order for examination (_____ ____)
6 months
renewed indefinitely in 6 month periods
form 47
Patient’s rights:
_______ = the right of a patient not to be subjected to any treatment to which he or she has not given a free and informed consent if mentally capable
_______ = the right to be treated with respect, dignity, and courtesy by all HCPs; guaranteed by professionals who deem these part of their ethical and professional duty
________ = rights enforced by courts
general
moral
legal
Can consent be withdrawn after being given?
Describe how capacity can change.
Consent can be withdrawn at any time
Capacity can change - e.g. due to drugs, confusion, etc.
True or False:
The SDM has the right to access the SAME information that a capable client would be able to access
True
