Week 6 Legal Issues in Nursing: Consent and Capacity

Question 1

Health Care Consent Act

Answer 1

1996

Promoting individual autonomy and communication among patients/practitioners & families

Question 2

Caveat of the HCCA

Answer 2

Health care providers do not have authority to make treatment decisions on behalf of clients except in an emergency when no authorized person is available

Question 3

Principles of Informed Consent (4)

Answer 3

1. Patients right to refuse - regardless of whether that treatment is considered in their ‘best interests’
2. Nurses should always explain treatment or procedure
3. Can be written or verbal
4. Consent is an ongoing process and can be withdrawn at any time

Question 4

Consent: Nursing Responsibilities

Answer 4

Must take “reasonable” steps to get consent.

Consent can be implied.

Question 5

Capacity and Consent (3)

Answer 5

1. Assume that a patient is capable and competent to decide unless there are reasonable grounds to believe otherwise
2. Competence: A person must be capable of understanding the relevant information and appreciating the consequences of consenting/not consenting to the treatment
3. People may be competent to make some decisions but not others, e.g., ADLs vs. understanding health decisions

Question 6

Substitute Decisions Act (SDA)

Answer 6

Focuses on decision-making about personal care or property on behalf of incapable persons

Question 7

Substitute Decision Maker

Answer 7

For people who need decisions made on a continuing basis.

E.g., Power of Attorney, court appointment or guardian/trustee

Question 8

Consent and Capacity Board

Answer 8

Established by and accountable to the government; members are appointed by the government.

Responsibilities:

• review of findings of incapacity
• applications relating to the appointment of a representative
• applications for direction regarding the best interests and wishes of an incapable person

Question 9

Intentional Torts (4)

Answer 9

Assault

Battery

Invasion of Privacy

False imprisonment

Question 10

Negligence

Answer 10

• Unintentional tort
• Conduct that does not meet the standard of care established by law
• Committed by inattention, thoughtlessness or carelessness
  e. g., performing a procedure you are not educated for

Question 11

Common Negligent Acts

Answer 11

• Medication error (not checking ID) resulting in injury
• IV therapy errors - infiltration, phlebitis
• Burns - bathing, spills
• Failure to use aseptic technique
• Failure to give report or giving an incomplete report to incoming shift or HCP
• Failure to monitor a patient’s condition adequately

Question 12

Personal Health Information Protection Act (PHIPA)

Answer 12

2004

Supports and extends CNO standards and CNA ethical guidelines

Balance between client’s rights and HCPs need for information in order to provide effective care

Question 13

Personal Health Information (PHI)

Answer 13

Any identifying information about clients in verbal, written, electronic form

Question 14

Tenets of PHIPA and Consent (2)

Answer 14

1. Personal health information belongs to the client

2. Clients have the right to give, refuse or withdraw their consent to the collection, use and disclosure of PHI

Question 15

Nurses can collect personal health information from someone other than the client without the client’s consent when: (3)

Answer 15

• The client cannot provide it (unconscious)
• Obtaining consent would affect the timeliness of care
• The accuracy of the information is questionable