Consent

Once you have determined that your patient is capable to consent to treatment, you must ensure that the four elements of consent are achieved.

The following are the elements required for consent to treatment:

Informed consent is based on the concept that every person has the right to determine what will be done to their body. This is the principle of autonomy. Informed consent means that the information relating to the treatment must be received and understood by the patient/client. This may include communication other than speaking. For example, a patient/client with a hearing impairment may need the information provided in writing or by sign language. When a language barrier exists, an interpreter may be needed. It is your responsibility to meet your patient’s/client’s communication needs to the best of your ability. Using plain language in your explanation of the treatment is one way to facilitate understanding and appreciation of the information relayed.

Consent is informed if:

Consent may also be implied or expressed.

Implied consent is determined by the actions of the patient/client. Implied consent may be inferred when you are performing a procedure with minimal risk that the patient/client has consented to previously and acts in a manner that implies their consent. For example, if you inform your patient/client that you would like to auscultate their chest and they unbutton their shirt, it may be reasonable to infer that they consent. If you have any doubt at all, you must ensure that the patient/client or their representative consents.

Expressed consent is more official and may be written or oral. For example, having a signed consent form or, having the patient consent to treatment verbally in front of another health care provider are expressed forms of consent. Unless circumstances dictate otherwise, you may presume that consent to a treatment includes consent to a variation in that treatment, provided that the nature, expected outcome, risks and side effects are not significantly different from the original proposed treatment. This presumption is also appropriate where the treatment is being continued in a different location and there remains no significant changes in the expected benefits, risks, or side effects [HCCA, section 12].

It is important to remember that consent may be withdrawn at any time and depends on the context of the situation (nature of the treatment, time and place) and the patient’s/client’s capacity to consent.

If you have reasonable grounds to believe your patient/client is incapable of giving informed consent you will have to obtain informed consent from a Substitute Decision Maker (SDM). (Please refer to the section on Substitute Decision Makers.)

RTs who are unsure whether or not a patient/client is capable to consent should seek assistance, likely from the prescriber of the treatment. Your employer may set out additional policies and procedures to direct your conduct in circumstances where you believe the patient/client is not capable of giving or withholding consent. Where those policies and procedures require you to refer your concerns to a physician or other health care professional then you may defer the finding of incapacity to that health care provider.

For more information on Capacity Assessments visit the Ministry of The Attorney General’s Capacity Assessment Office.

For more information on Evaluators and Assessors of Capacity in the Health Care Consent Act.

The HCCA does not identify an age at which an individual may give or withhold consent. This is because the capacity to make independent health care decisions is not dependent on age, but more on the ability to understand the relative risks and benefits of a proposed plan of care. As is outlined in the Child and Family Services Act, “consent is an informed process and the patient needs to be able to understand the foreseeable risk of treatment”. Therefore, a determination of capacity must be made for minor children and young adolescents in the same manner as it would be for an adult.