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The College’s Consent to Treatment policy received final approval from Council on May 28, 2015, and is now an official policy of the College of Physicians and Surgeons of Ontario.
We would like to thank all those who submitted their feedback and contributed to this policy review. While not every comment or suggested edit was incorporated into the final policy, all comments were carefully considered in light of current practice issues, the values and duties of medical professionalism, and the College’s mandate to protect the public.
Below is a brief summary of the policy review process, including an overview of the feedback received and revisions undertaken:
Who we heard from
71 submissions were received in response to this consultation.
Feedback was primarily submitted by physicians and members of the public, but we also heard from a number of key organizations such as the Ontario Medical Association’s Critical Care Section, the Advocacy Centre for the Elderly, and health care regulators from Ontario and other provinces.
Broadly speaking, respondents expressed support for the policy.
The majority of respondents thought the policy was clear and easy to understand, and were generally supportive of the expectations set out within.
Of those respondents who provided constructive criticism on the draft policy, suggestions included:
Discouraging the use of family members as interpreters.
Identifying physicians’ legal obligation to ensure substitute decision-makers understand the substitute decision-making requirements set out in the Health Care Consent Act, 1996.
Requiring physicians to inform incapable patients that they can contest a finding of incapacity or appoint a substitute decision-maker of their choice.
Requiring that express consent be obtained in certain circumstances.
In addition to the feedback, we considered a wide range of other information while developing the final policy. This included:
The legal requirements regarding consent to treatment in Ontario, as codified in the Health Care Consent Act, 1996.
Policies and guidelines of other medical regulators within Canada and other health regulators within Ontario, as well as other relevant documents from organizations such as the Canadian Medical Protective Association and the Ontario Hospital Association.
An extensive literature review which focused on a range of issues related to consent to treatment.
How we responded to your feedback
A number of revisions and additions were made to the draft policy in response to your feedback. The majority aimed to improve the overall clarity of the policy and the expectations set out within.
Two of the more significant revisions are highlighted below, as are two important instance where revisions were not made:
The policy now states the physicians have a legal obligation to ensure substitute decision-makers understand the substitute decision-making requirements set out in the Health Care Consent Act, 1996 and a footnote references relevant case law.
Substitute decision-makers must be aware of and comply with their legal obligations if patient autonomy is to be respected and supported.
Physicians must be aware of, and comply with, their legal obligation in this regard.
The policy requires physicians to inform patients who disagree with a finding of incapacity or with the involvement of the present substitute decision-maker that they can apply to the Consent and Capacity Board for a review of the finding or to select a substitute decision-maker of their choice. The policy also advises physicians to take reasonable steps to assist patients who wish to exercise either of these options.
Similar expectations were found in the College’s previous Consent to Medical Treatment policy, but were removed from the draft policy.
Upon consideration of stakeholder feedback and in order to support patient autonomy, these expectations were added back into the policy.
These expectations are consistent with some other provincial health regulators.
The policy does not advise against the use of family members as interpreters.
The policy identifies the limitations of using family members as interpreters and advises physicians to use their judgment about the appropriateness of this practice on a case-by-case basis.
It would be impractical to prohibit the use of family members as interpreters in all practice settings and for all treatment decisions.
The policy does advise physicians to obtain express consent in specific circumstances, but does not require that physicians express consent be obtained.
The Health Care Consent Act, 1996 does not set any expectations for physicians regarding when to obtain express consent.
It is always an option for physicians to obtain express consent, and it was not necessary to set out specific circumstances where physicians are required to do so.
The final policy
The final Consent to Treatment policy received final approval from CPSO Council on May 28, 2015. It is now a formal policy of the College of Physicians and Surgeons of Ontario.
The policy states that physicians must obtain valid consent before treatment is provided. In order for consent to be valid it must be obtained from the patient if they are capable with respect to the treatment or from the incapable patient’s substitute decision-maker, be related to the treatment, be informed, be given voluntarily, and not be obtained through misrepresentation or fraud.
The policy provides guidance regarding the information physicians must provide to patients or substitute decision-makers about the treatment as part of the consent process and requires physicians to engage in a dialogue with patients or substitute decision-makers about this information, regardless of whether or not they use supporting documents, including consent forms.
Physicians are required to document information regarding consent to treatment in certain circumstances, and are advised to do so in all other circumstances.