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LEARNING OBJECTIVES – BACK TO THE BASICS:

• the fundamentals of health care consent, relevant Ontario legislation, and your professional and legal obligations

• the connection between health care consent, advance care planning and treatment

“The problem with learning from experience is that you get

the test before the lesson.”

Mad Magazine’s Alfred E. Neuman

PERSONAL REFLECTION:

Imagine that in 5 minutes you will be assessed to be mentally incapable of making personal care decisions.

PERSONAL REFLECTION:

Imagine that in 5 minutes you will be assessed to be mentally incapable of making personal care decisions.

What are some of the things in your life that give you joy, happiness, peace, a sense of belonging?

PERSONAL REFLECTION:

Imagine that in 5 minutes you will be assessed to be mentally incapable of making personal care decisions.

What are some of the things in your life that give you joy, happiness, peace, a sense of belonging?

What does ‘Quality of Life” mean to you?

PERSONAL REFLECTION:

Imagine that in 5 minutes you will be assessed to be mentally incapable of making personal care decisions.

What are some of the things in your life that give you joy, happiness, peace, a sense of belonging?

What does ‘Quality of Life” mean to you?

Who will speak for you if you are no longer able to do so?

PERSONAL REFLECTION:

Imagine that in 5 minutes you will be assessed to be mentally incapable of making personal care decisions.

What are some of the things in your life that give you joy, happiness, peace, a sense of belonging?

What does ‘Quality of Life” mean to you?

Who will speak for you if you are no longer able to do so?

Does this person/people know about your thoughts/values/beliefs and wishes for the future?

Have you discussed with them what you might want your treatment/care plan to include or not include?

• “In some respects, this century’s scientific and medical advances have made living easier and dying harder”

Approaching Death: Improving Care at the End of Life The Institute of Medicine, Washington, D.C., 1997.

THE COUNTRY SINGERS ARE WAY AHEAD OF US!

•Tim McGrawLive like you were dying

•Garth BrooksIf Tomorrow never comes

WHAT ARE THE BENEFITS HAVING THESE DISCUSSIONS?

• Personal wishes are more likely to be respected and acted upon.

• Provides comfort and a sense of control at end-of-life care.

• Enhances a sense of independence.• Reduces stress and anxiety for those

making difficult decisions• Decreases potential for conflict among

family members/friends• Increased satisfaction with care • Higher quality of life and death

BENEFITS OF ADVANCE CARE PLANNING

Wright et al found that: • The absence of ACP, in all its forms, was associated with: worse

patient ratings of quality of life in the terminal phase of the illness, and worse ratings of satisfaction by the family during the terminal illness or in the months that follow death.

• End-of-life conversations between patients and physicians were associated with fewer life-sustaining procedures and lower rates of intensive care unit (ICU) admissions.

Wright, AA., et al. Associations between end-of-life discussions, health care expenditures. JAMA. 2008; 300(14):1665

Zhang et al found that:

• Patients with advanced cancer who had end-of-life conversations with physicians had significantly lower health care costs in their final week of life.

• Higher costs were associated with worse quality of death.

Zhang, B., et al. Health care costs in the last week of life. Arch Intern Med 2009; 169(3): 480-488.

ER TransfersICU Admissions

Unwanted proceduresMedication and chemotherapy

DiagnosticsALC beds

Impact ? Improved Quality of Life and Decreased costs of healthcare

DOCUMENTED GOALS OF CARE ARE DISCORDANT WITH PATIENT PREFERENCES 63% OF THE TIME

0

5

10

15

20

25

30

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Patient's preferences Goal

% of patients

Comfort Missing OtherCPR Full med, no CPR

Mix Unsure

Did the healthcare team …

Ask about prior discussions/documents

Discuss your prognosis

Provide information about comfort care

Provide information about supportive care

Ask what is important to you

Discuss risks and benefits of CPR, etc

Make a decision about use or non-use of CPR, etc

11.1%

12.8%

25.3%

41.8%

17.2%

13.7%

40.3%

End of Life

WHO SHOULD WE INITIATE THESE CONVERSATIONS WITH?

• Absolutely:Capable Adults with advanced-stage disease (life expectancy less than 12 months)

• Imperative With:Capable adults with chronic diseases along the illness trajectory or prior to a procedure with associated risk

• Ideally:Healthy capable adults to create awareness

Normalize discussions around Health Care Consent and Advance Care Planning.

Begin the culture change!

Diagnosis

A Established

Disease

A Terminal Chronic Disease

At Risk Death

Bereavement

Self Management Stabilized Treatment

Health Complications Pain & Symptom

Management

Interdisciplinary primary team

CHILD & ADULT HOSPICE PALLIATIVE CARE - CHRONIC DISEASE CONTINUUM MODEL

Last Year of Life

Time

Modified (2011) from the Canadian Hospice Palliative Care Association, A Model to Guide Hospice Palliative Care, 2002

By the Care Pathing Across the Continuum of CDM Working Group,

Primary Care Investigations

Specialists

Generally Intensity Increases in Time based on the Individual and their Family’s Needs and Goals

Last Days and Hours of Life

End-of-Life Care

Generally Intensity Diminishes in Time based on the Individual and their Family’s Needs and Goals

A Controlled Chronic Disease

A Advanced Chronic Disease

Extended inter-professional team and common care plan

Advance Care/Life Planning Options Psychosocial-Spiritual Support

Specialized HPC Team-based therapy to relieve suffering

and/or improve quality of life

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ADVANCE CARE PLANNING

• Only capable people can express wishes about future health care

• Wishes are speculative and out of context

• Wishes can be expressed in writing, verbally or by any other form of communication

• Later wishes, however communicated, expressed while client is capable, prevail over earlier wishes even if the previous wishes were in writing and the later wishes are oral

• When a person has expressed wishes about a potential future health condition:

• consent has not been acquired• if the patient is incapable when the time comes to provide

consent, consent must still be acquired from a substitute decision-maker(s) (except in emergencies)

REFLECTION AND EXPRESSION OF WISHES FOR FUTURE CARE (A)

Discussion Guide:

• Determine client’s current capacity to express wishes about future care. If the person is currently capable to make a specific decision, they are capable to express wishes about that decision.

• Identify/determine the client’s future substitute decision maker(s) in accordance with the Health Care Consent Act should they become incapable to make health care decisions in the future.

• Suggest the client prepare a Power of Attorney for Personal Care if the client wishes to appoint someone to act in place of the highest ranking substitute decision maker on the hierarchy in the HCCA.

• Include future substitute decision maker(s) in the discussion if the client agrees, as well as anyone else the client requests

REFLECTION AND EXPRESSION OF WISHES FOR FUTURE CARE (B)

• Facilitate reflection and gather information about the client’s wishes, preferences, values, spiritual, religious and/or health beliefs and quality of life indicators that may assist a substitute decision maker(s) to provide an informed consent on the clients behalf should the client be found to be incapable of making the treatment decision.

• Assess understanding and clarify misconceptions

• Facilitate/encourage ongoing communication with substitute decision maker(s), health care providers, family and friends

• Document a summary of the discussion including key details about the process, nature and outcome of the conversation

• Provide client with a copy of the documentation

Previously Expressed Wishes become void when:

• New wishes are expressed while a person is capable - verbally, written or by any other means of communication and to anyone.

Previously Expressed Wishes are not relevant when:

• The wishes are not applicable in the context of the person’s current health condition

PREVIOUSLY EXPRESSED WISHES

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ADVANCE CARE PLANNING IS VOLUNTARY

Patients CANNOT be required to complete any hospital or long term care home advance

directive forms if they do not want to put their wishes

in writing, want to use their own method of

communicating or do not want to express any wishes at all.

IMPORTANT REMINDER

ARE YOU CONFUSED?

You are not alone. There is a province wide, lack of foundational knowledge of the Health Care CONSENT Act, the construct of CAPCITY and the implications for Regulated Health Care Providers across all sectors of

health care.

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Why?

- It’s not taught in core curriculums

- It’s not part of job training or orientation

- It’s not emphasized in our organizational policies and procedures

ARE YOU CONFUSED?

You are not alone. There is a province wide, lack of foundational knowledge of the Health Care CONSENT Act, the construct of CAPCITY and the implications for Regulated Health Care Providers across all sectors of

health care.

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Why?

- It’s not taught in core curriculums

- It’s not part of job training or orientation

- It’s not emphasized in our organizational policies and procedures

AhHA!OOHHH?

IDENTIFIED CONCERNS

• Facilities/ organizations/ health providers are not always getting informed consent before treatment

• Organizations are misusing ACP as a replacement to an informed consent – ACP documents and advance wishes are NOT consents

• Organizations are using patient’s “wishes” inappropriately instead of making application to the CCB when the health practitioners disagree with SDMs

• A number of organizations use “levels of care forms” inappropriately as consents or ACP documents

• Some organizations try to get “pre-consent” – this is not legal

This is directly impacting Patient Safety and Quality of Care

RELEVANT ONTARIO LEGISLATION

• Health Care Consent Act, 1996http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_96h02_e.htm

 • Substitute Decisions Act, 1992

http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_92s30_e.htm

• Long-Term Care Homes Act, 2007http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_07l08_e.htm

• Personal Health Information Protection Act, 2004http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_04p03_e.htm

This legislation provides the framework for developing an informed plan of treatment and outlines the responsibilities of Regulated Health care Providers in

Ontario.

It’s the law!

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Before providing any treatment, admitting

someone to a long term-care home, or providing any personal assistance service in a long-term

care home, health care providers must get a valid, informed consent or refusal of consent from a

capable person, either the client if they are mentally capable for decision making or from their appropriate substitute decision maker(s) if they are

not mentally capable.

BASIC PRINCIPLES OF CONSENT

WHAT IS TREATMENT?

Treatment: Any intervention by a regulated health professional for a therapeutic, preventative, palliative, diagnostic, cosmetic or other health-related purpose.

Course of treatment: A series or sequence of similar treatments administered to a client over a course of time for a particular health problem that they are currently experiencing

Plan of Treatment: A plan of treatment is developed by one or more health care providers that deals with one or more of the health problems that a person has and may, in addition, deal with one or more of the health problems that the person is likely to have in the future given the person’s current health condition. A plan of treatment can provide for the administration of various treatments or courses of treatment and may, in addition, provide for withholding or withdrawal of treatment in light of person’s current health condition.

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WHAT IS VALID CONSENT?

1. Must relate to the treatment2. Must be informed3. Must be given voluntarily4. Must not have been obtained through misrepresentation or fraud

• Consent can be withdrawn at any time by a capable client or their substitute decision maker if the client is incapable.

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WHAT IS INFORMED CONSENT?

Patient must receive information on the: • Nature of the treatment• Expected benefits of the treatment• Material risks of the treatment• Material side effects• Alternative course of action• Likely consequences of not having the treatment

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WHO GIVES OR REFUSES CONSENT?

• The client provides informed consent if they are capable with respect to the particular treatment decision.

• The client’s substitute decision maker provides informed consent if the client is incapable with respect to the particular treatment decision.

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DEFINITION OF CAPACITY WITH RESPECT TO TREATMENT

• What does capacity mean in this context?

Able to understand the information that is relevant to making a decision about the treatment, admission, or personal assistance service as the case may be and able to appreciate the reasonably foreseeable consequences of a decision or lack of decision.

CAPACITY IS TIME AND DECISION SPECIFIC

A person may be …• Capable with respect to some treatments and not

capable with respect to others• Incapable with respect to a treatment at one time and

capable with respect to the same treatment at other times

Important:• Always include client in treatment planning regardless

of their current capacity to be the decision maker

* Make every attempt to maximize a client’s capacity and ability to communicate

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WHO ASSESSES CAPACITY WITH RESPECT TO TREATMENT DECISIONS?

•The health care provider who proposes a treatment is required to form an opinion about the capacity of the client to consent to the treatment

• If a plan of treatment is proposed , one health practitioner may determine the patient’s capacity to consent to the treatments referred to in the plan of treatment on behalf of all the health practitioners involved in the plan

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HIERARCHY OF SUBSTITUTE DECISION MAKERS – HCCA, 1996

1. Guardian of person2. Attorney in Power of Attorney for Personal Care

http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/poa.pdf

3. Representative appointed by the Consent and Capacity Board4. Spouse or partner5. Child or Parent or CAS (person with right of custody)

6. Parent with right of access7. Brother or sister8. Any other relative9. Office of the Public Guardian and Trustee

POWER OF ATTORNEYFOR PERSONAL CARE

Creating A Power or Attorney for Personal Care is the only way a person can appoint someone to act in place of the highest ranking substitute decision maker on the hierarchy in the HCCA.

• You cannot name a substitute decision maker verbally• To qualify as a POAPC the written document must meet the

requirements listed in the Substitute Decisions Act.

A POAPC must: be executed by a client while they are capable, and be

witnessed by two people.

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REQUIREMENTS TO ACT AS SUBSTITUTE DECISION MAKER

The person highest in the hierarchy may give or refuse consent only if he or she is:

a) Capable in respect to the treatmentb) At least 16 years old unless the parent of

the incapable personc) Not prohibited by a court order or

separation agreement from acting as Substitute

Decision Makerd) Availablee) Willing to act as as Substitute Decision

Maker

HOW THE HIERARCHY WORKS

• List is hierarchical If the highest ranking person on the list does not meet the requirement to act, move down to the next highest ranking person. (Even if the highest ranking SDM is the attorney in the POAPC)

• All persons on same level of the hierarchy have equal right to be the SDM

(i.e.. all brothers and sisters equally rank and must come to consensus )

• People always have a SDM if they are incapable. The OPGT is SDM if person has no one higher on hierarchy

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HOW SUBSTITUTE DECISION MAKERS MAKE DECISIONS

It is the responsibility of the Substitute Decision Maker to make treatment decisions for an incapable person by:

a) following any wishes of the patient expressed when capable that are relevant to the decision;

andb) if no wishes are known or are relevant to the particular decision, to act in the best

interests of the client

The Substitute Decision Maker is the “interpreter” of the wishes and must determine:

• whether the wishes of the patient were expressed when the patient was still capable (and were expressed voluntarily);

• whether the wishes are the last known capable wishes or whether the patient changed his/ her mind when still capable,

• what the patient meant in that wish; • whether the wishes are applicable to the particular decision at hand

EXCEPTION:EMERGENCY TREATMENT REQUIRED

Consent is not required if patient appears to be incapable and:

1) The person is experiencing severe suffering or is at risk, if the treatment is not administered promptly, of sustaining serious bodily harm.

AND

2) the delay required to obtain a consent or refusal on the person’s behalf will prolong the suffering that the person is apparently experiencing or will put the person at risk of sustaining serious bodily harm.

Health Care providers must act based on clinical judgement and any known wishes expressed by the client while capable

Treatment may continue without consent as long as reasonable necessary to locate the person’s SDM or until the person regains capacity.

REFLECTION and EXPRESSION of WISHES while capable

TREATMENT

CARE PLANNING

EMER

GEN

CY

INFORMEDCONSENT

TREATMENT

CARE PLANNING (A)

Care Planning is a process of information sharing between the client, their substitute decision maker and members of the client’s health care team. It addresses the physical, psychological, social, and spiritual needs of the client and leads to the development of a plan of treatment or course of treatment and

can include components in addition to medical treatment such as personal care and support

requirements, nutrition and activity needs and recreation.

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DOCUMENTATION GUIDELINES

Document:

• Current capacity of client provide informed consent or refusal of consent and your reasoning and if they wish to apply to have your finding reviewed

• People present for the care planning discussion

• The appropriate substitute decision maker that ranks highest on the hierarchy and that meets the requirements as outlined in the HCCA and their contact information

• Details of each component of the treatment/care plan

• That you obtained a valid, informed consent or refusal of consent for each component of the treatment plan from the client, if capable, or the appropriate substitute decision maker if the client is incapable.

• Document that you discussed when the treatment/care plan will be re-evaluated.

Summarize:

• Details of the conversation

• Information provided about diagnosis, prognosis, the risks, benefits and expected side effects and alternatives to the proposed treatment and the consequences of not receiving treatment

• Questions you asked to elicit information, the person’s responses , questions asked by the person and the responses that you provided

• The client’s expressed preferences, wishes, values, religious/spiritual and beliefs, that are relevant to the current plan of treatment

** Try to use the client’s own wording when possible 46

HOW LONG DOES CONSENT LAST?

• A treatment plan needs to be re-evaluated and informed consent re-obtained or reconfirmed when:

1) The client is discharged/transferred from current health care team

2) There is a significant change in the client’s health condition

3) A new component of the treatment/care plan is incorporated

4) A new personal assistance service is required5) The client, if capable, or their substitute decisions

maker if the client is incapable, withdraws consent to a component of the care plan or requests a review47

CONFLICT RESOLUTION

Health care providers have an obligation to make every effort to resolve any disagreements that they may have with the client, and/or their substitute decisions makers(s) in respect to treatment decisions.

If the health care provider cannot resolve the conflict, he or she must follow the conflict resolution options that are provided in the Health Care Consent Act.

CONTACT ONTARIO PUBLIC GUARDIAN AND TRUSTEE WHEN:

The OPGT is responsible for making decisions on behalf of incapable people where medical treatment is proposed and there are no other

substitute decision makers in the HCCA hierarchy, in that person’s life, who are available, capable and willing to make decisions for the

incapable person.

1)Equal ranking SDM’s cannot come to consensus: •as to which of them should make the treatment decision or •as to what particular decision should be made for treatment

and therefore cannot provide a valid, informed consent or refusal of consent

2) There is no substitute decision maker that meets the requirements to act

Contact:Treatment Decision Unit Monday – Friday 1-800-891-0504Weekends/Holidays 1-800-387-2127

http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt

APPLICATIONS TO THE CONSENT AND CAPACITY BOARD CAN BE MADE WHEN:

• Client chooses to request a review of a finding of incapacity Form A - Application to the Board to Review a Finding of Incapacity under Subsection 32(1), 50(1) or 65(1) of the Act

• Client accepts finding of incapacity but wants the Consent and Capacity board to appoint someone to act as their Representative which is the third highest ranking SDM

Form B - Application to the Board to Appoint a Representative under Subsection 33(1), 51(1) or 66(1) of the Act

• When there is no court ordered Guardianship or no Power of Attorney for Personal Care in place, and someone wants to have themselves appointed as the client’s Representative

Form C - Application to the Board to Appoint a Representative under Subsection 33(2), 51(2) or 66(2)

• SDM(s) unsure if wishes are applicable and/or seeks clarification of wishes

Form D - Application to the Board for Directions under Subsection 35(1), 52(1), or 67(1) of the Act

• SDM or Health Care provider wants permission to depart from known wishes expressed while the client was capable

Form E - Application to the Board for Permission to Depart from Wishes under Subsection 36(1), 53(1) or 68(1) of the Act

• Health care provider believes that the SDM is not acting according to the client’s known wishes and/or best interests

Form G - Application to the Board to Determine Compliance under Subsection 37(1), 54(1) or 69(1) of the Act

REFLECTION

• What’s already going on in your organization?

• What’s working well?

• What’s not working so well?

• Are policies in place? Partially in place?

• Are policies followed?

• Are your policies and procedures correct from a legal context?

• What should be done first?

• Are there changes that can be made quickly?

A Special THANK-YOU

to Judith Wahl, B.A., LL.B for her contribution to the content in

this project and for her ongoing support.

Advocacy Centre For the Elderly www.acelaw.ca

THANK-YOU!

• Questions• Comments• Thoughts• Reflection• Moments

AhHA!

TEST

1. Client’s with cognitive impairments, such as Alzheimer’s disease and dementia, are presumed to be incapable of making their own treatment decisions and health care providers should consult their substitute decision maker for treatment decisions.

TRUE□ FALSE□

FALSE. A person is presumed to be capable for treatment, admission to care facilities and personal assistance services unless you have reasonable grounds to believe the other person is incapable in respect to treatment, admission to care facilities, personal assistance services as case may be. The definition of capacity does not make exceptions for age, physical disability or mental disability. A health care provider must always asses the client’s current capacity to make the specific treatment decision and determine if they are able to understand the information that is relevant to making the decision and able to appreciate the reasonable and foreseeable consequences of a decision or lack of decision.

2. Once a person has been assessed by a physician to be mentally incapable for a treatment decision, they are mentally incapable for all treatment decisions.

TRUE□ FALSE□

FALSE.

A person’s capacity to make treatment decisions depends on the treatment decision needs to be made and on the time that the treatment decision needs to be made. A person may be capable with respect to some treatments and not capable with respect to others or incapable with respect to a treatment at one time and capable with respect to the same treatment at other times. If a substitute decision maker makes a decision on behalf of an incapable client, and then the client regains capacity to make the decision, the client‘s decisions prevail.

3. Executing a Power or Attorney for Personal Care is the only way a person can appoint someone as an attorney to act in place of the highest ranking substitute decision maker on the hierarchy in the HCCA.

TRUE□ FALSE□

TRUE.

You cannot name a substitute decision maker verbally and to qualify as a POAPC the written document must meet the requirements as listed in the Substitute Decisions Act. A POAPC must: be executed by a client while they are capable, name a person(s) to act as attorney, and be witnessed by two people that must sign in the presence of and at the same time that the client executes the document.

4. If a person has executed a “power of attorney for personal care” document, then the health care provider should always consult the named attorney to get consents or refusals of consents for treatment, admission, and personal assistance services.

TRUE□ FALSE□

FALSE. Before obtaining consent or refusal of consent from the client’s attorney, health care providers must first determine:

1) If the individual is or is not mentally capable with respect to the decision to be made. Only when a health care provider believes that the person is incapable in respect to the treatment decision can they turn to a substitute decision maker. An attorney in a POAPC does not get authority to make substitute decisions for the grantor unless the grantor is not capable. Just because a person has executed a POAPC does not mean that he or she is incapable.

2) The health care provider must determine who the client’s appropriate substitute decision maker, as outlined in the HCCA, is. In order to act as substitute decision maker, the person must be the highest ranking person on the hierarchy and meet the requirement in the HCCA. Even if the attorney is named in a POAPC and has the authority to give or refuse consent to treatment, the attorney must; be capable in respect to the treatment proposed for the incapable person; be at least 16 years of age, unless he or she is the incapable person's parent; not be prohibited by a court order or separation agreement from having access to the person or of giving or refusing consent to treatment on his or her behalf; be available; and be willing to assume the responsibility of giving or refusing consent the requirements to be a substitute decision maker.

If the attorney does not meet these requirements, then the health care provider must contact the next highest ranking person on the hierarch who does meet the requirements.

5. If a person has executed an advance directive or a living will, the health care provider still needs to get an informed consent or refusal of consent from the individual, if they are capable or the appropriate substitute decision-maker if the client is incapable before providing a treatment that is mentioned in the living will.

TRUE□ FALSE□

TRUE. Advance care planning does not constitute an informed consent. If a client is capable of making the decision, regardless of the creation of an advance directive, then they provide an informed consent or refusal of consent prior to the initiation of any treatment. If the client is incapable of making the decision, the health care provider must turn to the substitute decision maker for an informed consent or refusal of consent to the specific treatment. The wishes expressed in an advance care plan ‘speak’ to the substitute decision maker, not to healthcare provider, except in an emergency, and the substitute decision maker must determine if the wishes apply to the particular health care decision and interpret the wishes within the context of the client’s current health condition.

6. A substitute decision maker may complete an advance directive or create an advance care plan on behalf of a person who is incapable of making treatment decisions.

TRUE□ FALSE□ 

FALSE. A substitute decision maker cannot express wishes on behalf of someone else; they can only provide informed consent or refusal of consent to treatment or a treatment plan when the client is incapable to make decisions.

7. If a physician signs a medical directive or a written advance directive, that was completed by the capable client, this form can be attached to the person's chart and can be considered consent in the event that the person is unable to make health care decisions in the future.

TRUE□ FALSE□  

FALSE. All health care providers, including physicians, are required to get informed consent prior to any treatment, and cannot take instructions from an advance directive (except in the emergency situation). An advance directive is NOT consent to treatment. An advance directive is a statement of a person's wishes with respect to future treatment that a person completes without the required information that must be communicated as part of the process of informed consent. An advance directive primarily "speaks" to the clients substitute decision maker and NOT to the health care provider. Having the doctor sign the directive does not change its status and make it into consent. A person cannot provide an informed consent in advance for a treatment that does relate not to their current health condition Health care providers taking directions from such an "order" will be treating the client without the proper and necessary consent.

8. Health care organizations cannot require individuals to execute powers of attorney for personal care or complete standard advance directive forms as a condition of admission or receiving treatment.

TRUE□ FALSE□

TRUE. Health care providers may provide information about these documents and use them to facilitate discussion about a client’s wishes for future treatment but organizations cannot legally require that clients complete these documents as a condition of service or admission, as any form of advance care planning is entirely voluntary.

9. A person may provide an informed consent for a plan of treatment that deals with one or more health problems that they are likely to have in the future, given their current health condition.

TRUE□ FALSE□ 

TRUE. The definition of "plan of treatment" states that the plan may deal with one or more of the health problems the person currently has or is likely to have in the future "given the person's current health condition". Thus, the plan must relate to the current health condition of the individual. The plan cannot be so general as to provide for consent to treatments not related to or contemplated by the person's current health condition. A person can provide an informed consent to a plan of treatment if the person has been given all of the required information (nature of the treatment, the expected benefits of the treatment, the material risks of the treatment, the material side effects of the treatment, the alternative course of action, and the likely consequence of not having the treatment) with respect to all components of the treatment plan and has had an opportunity to ask questions. A plan of treatment that is overly broad will not meet this requirement.

10. Any health care provider can make an application to the Consent and Capacity board if they are concerned that a substitute decision maker is not acting in accordance with the incapable client’s previously expressed wishes and/or in their best interests.

TRUE□ FALSE□

TRUE. If a health care provider who proposed treatment, the person who is responsible for authorizing admissions to the care facility or the person responsible for providing the personal assistance services believes that an substitute decision maker is not following the principles set out in the act, they may apply to the Board for a determination as to whether the principles have been followed and for an order for the substitute decision maker to comply with the Act. Use of this application is limited to the health care provider of the incapable person (e.g. family members cannot apply to the Board). Whenever an application of this type is received, the law provides that the client is deemed to have applied for a review of his or her capacity to make the relevant decision.