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Difference between revisions of "Health Care Consent in Residential Care"
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Health Care Consent in Residential Care (view source)
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The Supreme Court of Canada in Cuthbertson v. Rasouli ( an Ontario case) considered what the terms “treatment” and “health related purpose” meant in the context of (withdrawing) life support. In Rasouli the Court noted these two terms are not confined to procedures that the patient's health care providers consider as a medical benefit to the person. Rather, the focus is on why it is being done -- "treatment" is broadly defined as "anything that is done" for one of the enumerated purposes (therapeutic, preventative, palliative, diagnostic and cosmetic) or "other health-related purpose". In Rasouli, the Court also emphasized that treatment includes stopping treatment. | The Supreme Court of Canada in Cuthbertson v. Rasouli ( an Ontario case) considered what the terms “treatment” and “health related purpose” meant in the context of (withdrawing) life support. In Rasouli the Court noted these two terms are not confined to procedures that the patient's health care providers consider as a medical benefit to the person. Rather, the focus is on why it is being done -- "treatment" is broadly defined as "anything that is done" for one of the enumerated purposes (therapeutic, preventative, palliative, diagnostic and cosmetic) or "other health-related purpose". In Rasouli, the Court also emphasized that treatment includes stopping treatment. | ||
==Consent Rights== | |||
With respect to health care rights, the Health Care (Consent) and Care Facility (Admission) Act states every adult has the right to: | |||
:(a) give consent or to refuse consent on any grounds, including moral or religious grounds, even if the refusal will result in death, | |||
:(b) select a particular form of available health care on any grounds, including moral or religious grounds, | |||
:(c) revoke consent, | |||
:(d) expect that a decision to give, refuse or revoke consent will be respected, and | |||
:(e) be involved to the greatest degree possible in all case planning and decision making. | |||
''':Noteworthy : Forms versus Consent | |||
::Signing a consent form is not the same as giving consent.''' | |||
==The Consent Process== | |||
One of the many common misunderstandings in this area of residential care, is that having a signed consent form is the same as “consent”. It is not. Consent is predicated on communication, understanding and choice. | |||
Effective communication is essential to ensuring that resident’s decisions about his or her own health care are understood, expressed and respected by everyone involved. Communication and decision-making about health care is often an ongoing process. While residents may consent to an initial plan for care, there can be a need for health care providers to re-establish consent. This might arise for example if the health care provider is contemplating changes to the plan or believe resident may be reconsidering the decision. | |||
==How Does a Person Give Consent?== | |||
Decisions about health care must be voluntary. No one can pressure or force the person to decide in a particular way, or deliberately give wrong information to influence decision. | |||
People can give consent in different ways—by speaking, by writing, or through behaviour, such as nodding or making a sign that the person agrees. Although behaviour may count as consent— for example, offering an arm for an injection when requested, opening their mouth, or complying with a course of treatment—cooperating is not always the same thing as giving informed consent. | |||
==Exceptions to Requiring Consent== | |||
===Are there circumstances in which the person’s consent to health care is not required?=== | |||
Consent is not possible when the adult is unconscious, mentally incapable of making that particular decision, or, otherwise unable to give consent. Consent is not required: | |||
* for preliminary examinations such as triage or assessment, | |||
* when the person needs urgent or emergency health care, (*) | |||
* when the adult is incapable, and there is no committee, representative, advance directive or TSDM available. | |||
* when the person needs involuntary psychiatric treatment under the Mental Health Act. | |||
(*) Health care provider cannot just wait for things to become urgent or an emergency | |||
==Health Care at the Margins== | |||
It is not always automatically apparent what is or is not “health care”. The law describes two kinds of health care in the context of substitute decisionmakers’ mandates: | |||
;Minor health care: which includes matters such as regular checkups, routine tests, basic dental and eye care, immunizations, medications, and other care that is not major health care. | |||
;Major health care: which includes matters such as surgery, risky or complex tests, any treatment involving a general anesthetic, radiation, chemotherapy, and kidney dialysis. | |||
The public might assume that almost anything done in a health care setting such as a private hospital, extended care unit of a hospital or residential care facility would be “health care”. Similarly they may assume anything involving technology or medical equipment; prescribed by a physician; done by a nurse, nurse practitioner, or care worker was “health care “ or “treatment “; and anything physically intrusive in a care setting is “treatment”. However a recent British Columbia case (Bentley v. Maplewood Seniors Care Society, a case involving spoon | |||
{{REVIEWED | reviewer = BC Centre for Elder Advocacy and Support, June 2014}} | {{REVIEWED | reviewer = BC Centre for Elder Advocacy and Support, June 2014}} | ||
{{Legal Issues in Residential Care: An Advocate's Manual Navbox}} | {{Legal Issues in Residential Care: An Advocate's Manual Navbox}} | ||
