Organization
[February 13, 2024 3:29 PM]
Ontario Medical Association (OMA)
 
Response in PDF format:
OMA Response_20240213.pdf
Organization
[February 12, 2024 7:40 AM]
Ontario Trial Lawyers Association (OTLA)
 
Please find attached the response from the Ontario Trial Lawyers Association.
 
Response in PDF format:
OTLA_Consent_Response_20240212.pdf
Organization
[February 09, 2024 11:08 AM]
Professional Association of Residents of Ontario (PARO)
 
Response in PDF format:
PARO Response_20240209_Redacted.pdf
Other health care professional (including retired)
[February 07, 2024 2:36 PM]
Hello,

As a mature adult living in Ontario, a retired nurse (employed in pharmaceutical cancer drug research in last position prior to early retirement after company was acquired by large out of province drug company) my observation is the increasingly emerging challenge for doctors when patients of any age who might be of a culture or level of understanding and sometime presentation in an urgent care situation and perhaps with limited comprehension in English.

There are examples of times when a patient might appear to be cognitively competent and in English by agreeing or responding with socially correct responses however are in fact limited.  To ask several questions from a known basic cognitive test - home address, date, other - would confirm mental status.

The reliability of family members / SDM to make decisions according to wishes of patient in English let alone perhaps when language and culture might compromise the patient without question is a concern.  Many may act without question in best interest of the patient but not always.

I reviewed the corresponding document and the very few comments.

CCB:  I may have missed the term for this abbreviation however assume a board to which patient or SDM/family might report complaint to.

Under the few comments, I agree with the physician who replied on December 20.

Also with the CNO document response earlier today.

Ideally clear documentation along with authorized interpreter who is not a family member is the ideal but not always available.

This adds a cost - time and money - to this complicated doctor-patient relationship.
Organization
[February 07, 2024 10:41 AM]
College of Nurses of Ontario (CNO)
 
Good Morning,
Thank you for the opportunity to review and provide feedback on the following four policies: Consent to Treatment, Physician Treatment of Self, Family Members, or Others Close to Them, Principles of Medical Professionalism and Professional Behaviour.
Overall, we found these documents articulate important expectations to the profession. We found the policies to be relevant and concise. Also, we found the companion resources to be particularly helpful when looking for more information to support the expectations.
We have attached a document that highlights a few considerations that may support your update of these resources.
Please feel free to reach out to me directly should you have any questions or require any clarification.
 
Response in PDF format:
CNO_Response_20240207.pdf
Physician (including retired)
[January 29, 2024 1:53 PM]
The current policy does not adequately cover an important problem for patients with serious illness: waiver of consent.

To what extent are patients free to waiver their involvement in the consent process.

We encounter many cases where elderly patients clearly express a desire to defer decision-making to their adult children. In these cases both the patient and the SDM are explicitly asking NOT to hear details (such as a metastatic cancer diagnosis) and our current policy compels physicians to disclose this information. What is the CPSO's advice to the profession in this matter?
Physician (including retired)
[January 25, 2024 5:22 PM]
I would like a little more on the issue of age and competency .( Both the young to the aged )
Physician (including retired)
[January 16, 2024 9:16 PM]
The consent policy is clear and reasonable.
Physician (including retired)
[January 18, 2024 12:45 PM]
Adequate definition..too much clarification can cause confusion
Physician (including retired)
[December 20, 2023 12:39 AM]
I feel that there needs to be a more comprehensive section in the Consent to Treatment policy with specific regards to the use of family members and translation services in the care and management of non-English-speaking patients. I am personally of the opinion that if a patient is seeking care in Canada, then it is reasonable that they be asked to abide by the values of our ethics system, i.e. patient consent as one of the core tenets, meaning that physicians cannot allow family members to withhold information from patients even with the best of intentions.
Physician (including retired)
[December 13, 2023 8:36 AM]
I recently had a case where the daughter translated for the patient. The daughter did not want her mother to know she had breast cancer and asked that I not use that word because it would cause enormous anxiety.  I think this was due to their culture and religion.

I advised her to use the word growth instead of cancer but I suspect she used the word infection. The daughter acted as translator and signed the consent for surgery document as the translator. The patient underwent the appropriate surgery and did well. They thanked me at the last visit and were pleased with the treatment.

A nurse reported me to administration for not using a formal translator to inform the patient she had cancer despite her daughter's request. The administration person was an ethicist who was very critical of me and did not accept my argument regarding respect for the religious principles of the patient and her family. Fortunately he did not take it any further.

I did not see anything in the CPSO consent to treatment policy about using a formal translator instead of family members in a situation like this.
Physician (including retired)
[January 18, 2024 1:07 PM]
This is an interesting case. Having focused practice in palliative care we encounter many families who request that we withhold information from a patient. We believe that there are many variations within racial and religious groups and that it is unwise to assume that a person of a group will adopt all the wishes of said group. It is important to ask the person about their wishes with respect of information. Then follow their wishes. This is difficult to negotiate without formal translation available. It is also difficult to apply these wishes should the person require follow up. For instance, the case described was one with a breast lesion. Should the pathology reveal a malignancy and should the best interests of the patient be served with further treatment such as chemotherapy or radiation treatment which are usually delivered to the patient at a Cancer Centre--information may come to the patient indirectly and in an uncontrolled manner. It is often impossible to continue to not disclose the information to the patient. Also, during a life threatening or life limiting illness it is not usually a good thing to have a barrier to communication between the patient and the rest of the family. Gentle truth-telling can be very helpful.