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Documentation of Capacity and Identification of Substitute Decisionmakers in Ontario

Published online by Cambridge University Press:  27 May 2014

THOMAS C. FOREMAN ,
DOROTHYANN CURRAN ,
JOSHUA T. LANDRY  and
MICHAEL A. KEKEWICH
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Abstract:

Documenting capacity assessments and identifying substitute decisionmakers (SDMs) in healthcare facilities is ethically required for optimal patient care. Lack of such documentation has the potential to generate confusion and contention among patients, their family members, and members of the healthcare team. An overview of our research at the Ottawa Hospital and issues that influence the consistency of documentation in the Canadian context are presented here, as well as ideas for the mitigation of these issues and ways to encourage better documentation.

Keywords

capacity assessmentsubstitute decisionmakinghealthcare consentdocumentationCanadian bioethicsadvance directive
Type
Special Section: Bioethics Beyond Borders
Information
Cambridge Quarterly of Healthcare Ethics , Volume 23 , Issue 3 , July 2014 , pp. 334 - 340
Copyright
Copyright © Cambridge University Press 2014 

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References

Notes

1. Glezer, A, Stern, TA, Mort, EA, Atamian, S, Abrams, JL, Brendel, RW. Documentation of decision-making capacity, informed consent, and health care proxies: A study of surrogate consent. Psychosomatics 2011;52:521–9.CrossRefGoogle ScholarPubMed

2. Health Care Consent Act (1996), S.O., c.2, Sched. A. Government of Ontario.

3. Hospitals Act, 2007 (Nova Scotia); Health Act, 2002 (Yukon Territory); Health Care (Consent) and Care Facility (Admission) Act (British Columbia), 2000; Health Care Consent Act, 1996 (Ontario); Quebec Civil Code, 1994 (Quebec); Consent to Treatment and Health Care Directives Act 1996 (Prince Edward Island); Medical Consent of Minors Act Mental Capacity (New Brunswick); Health Care Directives and Substitute Health Care Decision Makers Act, 2000 (Saskatchewan); Mental Health Act (Northwest Territories, 1998; Nunavut, 1999); Care Consent Act, 2003 (Yukon).

4. Under these rules, SDMs are obligated to first consider the patient’s previously expressed capable wishes that apply to the circumstances and then consider the patient’s best interests if no such wishes exist. See HCCA, section 21.(1).

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