Consent Guidelines and HCCA

Health Care Consent Act (HCCA)

Legislation promoting individual authority, communication, and family involvement in consent decisions.

Consent

- Required for all treatments, must be informed, voluntary, and not coerced.

- must be given by capable person

*exceptions

consent is required for any treatment except:

treatment provided in an emergency situation

Consent to admission to a care facility is required in all cases except:

in a crisis situation

Consent to personal assistance services is required in all cases except:

the HCCA does not specify that consent to personal assistance service is required; if an evaluator finds a recipient of a personal assistance service incapable of giving consent, it may be obtained from a SDM

is capability universal?

no, ppl can be capable of giving consent for certain things and incapable of others at the same time

Informed consent

Consent given after receiving detailed information on treatment, benefits, risks, alternatives, and consequences of refusal.

Client Capacity and the role of the nurse

nurses can determine client capacity to make a decision about admission to a care facility or a personal assistance service, client can ask consent and capacity board to amend

Substitute Decision Act (SDA)

- deals with decision-making about personal care or property on behalf of incapable ppl

- concerned with ppl who need decisions made on their behalf on a continuing basis

- involves appointment of decision maker by PoA document

PoA document

- legally appointing someone as power of attorney

- through the Office of the Public Guardian and Trustee (PGT) or through a court appointment

Substitute decision-maker

a person identified by the HCCA who may make a treatment decision for someone who is incapable of making their own decision

Consent and Capacity Board (CCB)

A board established by and accountable to the government; considers applications for review of findings of incapacity, for direction regarding the best interests and wishes of an incapable person

Spouse

Two persons who are married to each other, or who are living in a conjugal relationship and have cohabited for at least a year, or who are the parents of a child or who have a cohabitation agreement under the Family Law Act.

Partners

Individuals living together for at least a year with a close personal relationship.

Relatives

Persons related by blood, marriage, or adoption.

Public Guardian and Trustee (PGT)

- Last resort substitute decision-maker for mentally incapable individuals.

- court won't appoint the PGT unless there is no other suitable person available and willing to be appointed

Power of attorney for personal care

Legal document granting authority to make personal care decisions for an incapable individual.

Continuing power of attorney for property

Similar to power of attorney for personal care but for property decisions.

Information about procedures required for informed consent includes:

- nature of treatment

- benefits/risks/side effects

- alternative courses of action

- consequences of not having the treatment

Steps to obtain consent

1. assess capacity

2. provide emergency treatment or crisis admission

3. inform client that SDM will make decisions if incapable

4. identify a SDM

5. obtain consent from SDM

Assess capacity

Determining if an individual understands information and appreciates the consequences of their decision.

is there a minimum age for giving consent

no

who determines capacity

the nurse/an evaluator

capacity evaluator:

NP and RN, need training, conducts assessments of capacity on persons who need decisions made on a continuing basis

what happens if someone is deemed incapable?

consent is obtained from someone on the hierarchy of SDM; PGT is last resort

Hierarchy of substitute decision-makers

Order of individuals authorized to make decisions for an incapable person if no prior arrangements exist.

what is the hierarchy of SDM (from first to last resort)

1. guardian of the person (court appointed)

2. someone named as attorney for personal care

3. someone appointed by the CCB

4

a. Spouse/partner

b. child 16 or older, custodial parent; CAS

c. parent who has only a right of access

d. sibling

e. other relatives

5. PGT (absolute last resort)