Frequently Asked Questions > Consent to Treatment


QUESTION — CONSENT TO TREATMENT
  1. What are the necessary conditions of consent to treatment?
  2. What is meant by informed consent?
  3. What are the prerequisites for obtaining informed consent?
  4. What if the patient/client is incapable of consenting to a treatment?
  5. How is informed consent managed when providing treatment as part of a team?
  6. When is consent to treatment not required?
  7. What if the patient/client refuses treatment?
RESPONSE
  1. What are the necessary conditions of consent to treatment?

    The Health Care Consent Act, 1996 (HCCA) includes explicit rules on obtaining consent for treatment, and who can provide consent when the patient/client is incapable of doing so.  Under the HCCA, treatment is defined as anything that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health-related purpose, and includes a course of treatment, plan of treatment or community treatment plan. (Please see HCCA for list of activities that are not considered “treatment”.Informed consent is required for every treatment. The exclusion of some forms of low risk treatment from the HCCA does not mean that informed consent is not required there. Rather it means that the rules for obtaining consent come from the common law and from the professional obligations of each profession.

    The HCCA provides four required elements that must be present in order for consent to treatment to be valid.  The consent must:

    1.       relate to the treatment being proposed;

    2.       be informed;

    3.       be given voluntarily; and

    4.       not be obtained through misrepresentation or fraud.

    The health care practitioner who proposes the treatment is responsible for taking reasonable steps to ensure that the treatment is not administered without consent.

  2. What is meant by informed consent?

    Under the HCCA, consent is informed if, before voluntarily agreeing to the treatment or treatment plan, the patient/client received the information that a reasonable person in the same circumstances would require to make a decision. This information must include details about the nature of the treatment, its expected benefits, its material risks and material side effects, alternative courses of action, and the likely consequences of not having the treatment. Furthermore, if the patient/client requests additional information regarding the proposed treatment or treatment plan, they must receive a response.

  3. What are the prerequisites for obtaining informed consent?

    Under the HCCA , a health practitioner who proposes a treatment shall not administer the treatment unless they are of the opinion that the person is capable with respect to the treatment, and the patient/client has given consent.

    The HCCA provides that a person is capable with respect to a treatment if they are able to understand the information that is relevant to making a decision about the treatment, and able to appreciate the reasonably foreseeable consequences of their decision, or lack of decision.

    A health practitioner is entitled to rely on the presumption of capacity unless he/she has reasonable grounds to believe the patient/client is incapable with respect to the proposed treatment.

  4. What if the patient/client is incapable of consenting to a treatment?

    If a health practitioner is of the opinion that the patient/client is incapable with respect to the treatment, the patient/client’s substitute decision-maker would then be consulted and may provide consent to treatment on the patient/client's behalf. Please see the HCCA ("Consent on Incapable Person's Behalf", beginning with Section 20) for a hierarchal list of individuals/agencies that may give or refuse consent on the client’s/patient’s behalf.

  5. How is informed consent managed when providing treatment as part of a team?

    The HCCA provides that one health care practitioner can propose a plan of treatment, determine the patient's/client's capacity with respect to the treatments referred to in the plan of treatment, and obtain consent or refusal of consent to the treatment plan on behalf of all health care practitioners involved in the plan of treatment.

    The HCCA defines “plan of treatment” as a plan that is developed by one or more health care practitioners, dealing with one or more of the health problems that a patient/client has and/or is likely to have in the future. Furthermore, a plan of treatment provides for the administration of various treatments or courses of treatment, and may include the withholding or withdrawal of treatment in light of the person’s health condition.

    It is important to document that consent to treatment has been obtained. The health practitioner who has obtained consent is advised to note in the patient/client record what went into the decision-making process. Likewise, the health practitioner should document if the patient/client refused or withdraws consent to treatment, and the discussion that took place. For additional details, please refer to the requirements of your profession.

  6. When is consent to treatment not required?

    The HCCA outlines the circumstances whereby an emergency may allow for treatment if one cannot obtain consent. The Act defines an “emergency” as a situation in which the patient/client is experiencing severe suffering or is at risk of sustaining serious bodily harm if the treatment is not administered promptly. Please see the HCCA for further details.

  7. What if the patient/client refuses treatment?

    Patients/Clients are entitled to decide which medical or health care interventions they will accept and which they will not. (This is known as the ethical principle of autonomy.) Health care providers have an obligation to obtain consent and patients/clients have the right to either consent or refuse treatment.

    Patients/Clients are entitled to refuse a treatment recommendation. They also have the right to withdraw consent at any time.

    You should provide a reasonable rationale which reflects a competent approach to your findings and recommendations, and maintain a respectful dialogue with transparent decision-making. It may be helpful to confer with team members or others within your setting to determine how to proceed.

    Ultimately, the patient/client is not bound to comply with the health professional’s recommendation but it will be important to document advice and disagreement.

    It is important to document that consent to treatment has been obtained and what information was provided upon which the patient/client made his or her decision. Likewise, the health practitioner should document if the patient/client refused to consent to treatment, and the discussion that took place. For additional details, please refer to the requirements for your profession.

LINKS

Health Care Consent Act, S.O. 1996, c.2, Schedule A.

Purposes of HCCA 

COLLEGE LINKS
Acupuncturists
Audiologists

Obtaining Consent for Services: Guide for Audiologists and Speech-Language Pathologists

Position Statement on Consent to Provide Screening and Assessment Services

 

Chiropodists
Chiropractors

Standard of Practice S-013: Consent

Dental Hygienists
Dental Technologists
Dentists

Informed Consent in 2001 – Don’t Leave the Office Without It, by Eleanore A. Cronk

Practice Advisory - Informed Consent Issues Including Communication with Minors and with Other Patients Who May Be Incapable of Providing Consent

 

Denturists
Dietitians

Dietetics Health Care Consent Act 

Dietetics Act 

Jurisprudence Handbook for Dietitians in Ontario (Web Edition 2012)

Homeopaths
Kinesiologists
Massage Therapists

Policy: Consent for Treatment

Communication/Public Health Standard 7

Medical Laboratory Technologists

CMLTO Practice Guidelines for Members Regarding the Health Care Consent Act (HCCA)

 

Medical Radiation Technologists

CMRTO Standards of Practice

What you must know about … Health Care Consent Act 

Midwives
Naturopaths
Nurses

Consent Guideline

Consent Learning Module

Occupational Therapists

COTO Standards: Consent

QA Consent Checklist

Opticians
Optometrists
Pharmacists

Expanded Scope of Practice Orientation Manual

Pharmacy Technicians
Physicians and Surgeons

CPSO Policy Statement # 4-05: Consent to Medical Treatment

Physiotherapists

E-Learning Module - Consent

Briefing Note to the Health Care Consent Act

Podiatrists
Psychologists
Psychotherapists
Respiratory Therapists

CRTO Standards of Practice: Therapeutic and Professional Relationships 

CRTO Professional Practice Guideline Responsibilities of Members Under Consent Legislation  

CRTO: A Commitment to Ethical  Practice 

Speech-Language Pathologists

Obtaining Consent for Services: Guide for Audiologists and Speech-Language Pathologists

Position Statement on Consent to Provide Screening and Assessment Services

Reference Guide For the SLP Employed in the School Board Setting

Traditional Chinese Medicine and Acupuncturists