MEDRADSC 3Y03 - Substitute Decision Maker

According to the Health Care Consent Act, what is the time limit on consent?

None

T/F: Consent does not need to be in writing

True

T/F: Consent can be implied from pt actions and behaviours

True

T/F: Obtaining consent may not be delegated to other health practitioners

False

Who is still responsible legally if consent is delegated to other health practitioners?

Main provider

In an event of an emergency, is consent required?

No, if the wishes of the pt are unknown

When can a dr override SDM?

• Emergency

• SDM not honouring pt’s wishes

• SDM not acting in best interest of pt

T/F: Consent can be withdrawn anytime by pt or SDM

True

Who is responsible for determining capacity/decision-making skills of pt?

Responsible physician

Who else may help a physician assess capacity/decision-making skills?

Other practitioners that have skill and judgement while remaining responsible legally

Who can pt appeal their decision to?

Consent and Capacity Board (CCB)

SDM

Substitute decision maker

SDM definition

Someone entitled by law to make healthcare decision on behalf of pt w/o capacity to make decisions for themselves regarding tx, admission to long term care and personal assistance services

3 types of SDM

1. Family members

2. Persons appointed legally by pt prior to being incapacitated

3. Ontario Public Guardian and Trustee

SDM of last resort

Ontario Public Guardian and Trustee

Requirements to be an SDM

• Capable of making decision that’s required

• 16 y/o or older

• Not requiring care of their own

• Willing to take responsibility

• Available, be reachable by phone within time frame, distance not an impediment

If there are more than 1 SDM of equal ranking (e.g siblings), how can they decide?

Must be able to reach consensus regarding healthcare decisions

Who cannot be an SDM?

• Someone paid to provide you w personal care unless they’re your spouse, partner or relative (e.g nurse, PSW)

• Mentally incapable

• under 16 y/o

• Requires care of their own

SDM Hierarchy

Spouse

• Married

• Lived in common law relationship for 1 year

• Parents of a child together

• Entered into cohabitation agreement under Family Law Act

Partner

• Lived together for at least 1 year

• Close personal r/s that is of primary importance in both lives

• May be non-sexual

Child

Child of their birth or adoptive parents/step-parents

Any other relative

People related by blood, marriage or adoption

What happens when no one meets the requirements or willing to be the SDM?

Ontario Public Guardian and Trustee becomes the SDM

T/F: Ontario Public Guardian and Trustee (OPGT) is not a govt agency

False

What happens when 2 SDMs of equal ranking cannot agree on decisions?

OPGT steps in

T/F: OPGT has less duties and responsibilities as other SDMs

False

Advance Care Planning (ACP)

Process of preparing a person and their SDM abt making decisions in future if necessary

What is discussed in ACP while the pt is capable?

Pt’s healthcare wishes, values and beliefs about future care

ACP wishes are not

• Informed consent to care

• Directions to healthcare practitioners 

Role of ACP

Guide SDM in providing informed consent

ACP may be provided in written or oral form. What takes precedence?

Neither

If neither written or oral form takes precedence, what other factor does?

Whichever is more recent

T/F: Advance directives, living wills are part of the Health Care Act

False

Is ACP voluntary or mandatory?

Voluntary

T/F: Health care facilities must require pts to use forms to write down their wishes

False

T/F: ACP is not only focused on end-of-life care

True