Chapter 6: The Law of Consent and Capacity in Health Care
Additional Recommended Readings
Sibbald, R., P. Chidwick, and L. Hawryluck (2014). Standard of care and resource implications of the Cuthbertson v. Rasouli ruling. Canadian Medical Association Journal, 186(5), 327–328. http://www.cmaj.ca/content/186/5/327
This article discusses the clinical and health system implications of the Supreme Court of Canada’s decision regarding withdrawal of life support in Rasouli.
Lamont, S., Y. Jeon, and M. Chiarella (2013). Health-care professionals’ knowledge, attitudes and behaviours relating to patient capacity to consent to treatment: An integrative review. Nursing Ethics, 20(6), 684–707. http://nej.sagepub.com/content/20/6/684.abstract
In a synthesis of 23 research studies, the authors examine the knowledge, attitudes, and behaviours of health care professionals with respect to patient capacity to consent to or refuse treatment. They note that there is tension between legal, ethical, and professional standards and what occurs in practice.
Chettih, M. (2012). Turning the lens inward: Cultural competence and providers’ values in health care decision making. The Gerontologist, 52(6), 739–747. http://gerontologist.oxfordjournals.org/content/52/6/739
This article stresses the importance of considering patients’ cultural values and beliefs on these issues of informed decision-making. A social constructivist perspective and the clinical concept of cultural counter transference are proposed as aides in achieving this awareness and improving care.
Relevant Legislation
Federal: http://laws.justice.gc.ca/en
- Canadian Charter of Rights and Freedoms, Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c. 11 http://laws-lois.justice.gc.ca/eng/const/page-15.html
- Criminal Code, R.S.C. 1985, c. C-46 http://laws-lois.justice.gc.ca/eng/acts/c-46/
- Personal Information Protection and Electronic Documents Act, 2000, c. 5 http://laws-lois.justice.gc.ca/eng/acts/p-8.6/
- Privacy Act, R.S. 1985, c. P-21 http://laws-lois.justice.gc.ca/eng/acts/p-21/
Alberta: www.qp.alberta.ca/laws_online.cfm
- Adult Guardianship and Trusteeship Act, S.A. 2008, c. A-4.2 http://www.qp.alberta.ca/documents/Acts/A04P2.pdf
- Health Information Act, R.S.A. 2000, c. 5-H http://www.qp.alberta.ca/1266.cfm?page=h05.cfm&leg_type=Acts&isbncln=9780779780921
- Personal Directives Act, R.S.A. 2000, c. P-6 http://www.qp.alberta.ca/1266.cfm?page=P06.cfm&leg_type=Acts&isbncln=9780779775538
- Powers of Attorney Act, S.A. 1991, c. P-13.5 http://www.qp.alberta.ca/1266.cfm?page=p20.cfm&leg_type=Acts&isbncln=9780779786404
British Columbia: www.bclaws.ca
- Adult Guardianship Act, R.S.B.C. 1996, c. 6 http://www.bclaws.ca/civix/document/id/complete/statreg/96006_01
- Freedom of Information and Protection of Privacy Act, R.S.B.C. 1996, c. 165 http://www.bclaws.ca/civix/document/id/complete/statreg/96165_00
- The Health Care (Consent) and Care Facility (Admission) Act, R.S.B.C. 1996, c. 405 (enacted in part only) http://www.bclaws.ca/civix/document/id/complete/statreg/96181_01
- Human Tissue Gift Act, R.S.B.C. 1996, c. 211 http://www.bclaws.ca/civix/document/id/complete/statreg/96211_01
- Infants Act, R.S.B.C. 1996, c. 223 http://www.bclaws.ca/civix/document/id/complete/statreg/96223_01
- Patients Property Act, R.S.B.C. 1996, c. 349 http://www.bclaws.ca/civix/document/id/complete/statreg/96349_01
- Personal Information Protection Act, R.S.B.C. 2003, c. 63 http://www.bclaws.ca/civix/document/id/complete/statreg/03063_01
- Power of Attorney Act, R.S.B.C. 1996, c. 370 http://www.bclaws.ca/civix/document/id/complete/statreg/96370_01
- Public Guardian and Trustee Act, R.S.B.C. 1996, c. 383 http://www.bclaws.ca/civix/document/id/complete/statreg/96383_01
- Representation Agreement Act, R.S.B.C. 1996, c. 405 http://www.bclaws.ca/civix/document/id/complete/statreg/96405_01
Manitoba: web2.gov.mb.ca/laws/index.php
- Child and Family Services Amendment Act, S.M. 1995, c. 23 https://web2.gov.mb.ca/bills/40-3/b068e.php
- Health Care Directives Act, C.C.S.M. 1998, c.H-27 http://web2.gov.mb.ca/laws/statutes/ccsm/h027e.php
- Human Tissue Gift Act, 1987, C.C.S.M. c. H180 http://web2.gov.mb.ca/laws/statutes/ccsm/h180e.php
- Personal Health Information Act, C.C.S.M. 1997, c. P33.5 http://web2.gov.mb.ca/laws/statutes/ccsm/p033-5e.php
- The Powers of Attorney Act, C.C.S.M. 1996, c. P97 http://web2.gov.mb.ca/laws/statutes/ccsm/p097e.php
- Vulnerable Persons Living with a Mental Disability Act, S.M. 1993, c. 29 http://web2.gov.mb.ca/laws/statutes/ccsm/v090e.php
New Brunswick: www2.gnb.ca/content/gnb/en/departments/attorney_general/acts_regulations.html
- Hospital Act, R.S.N.B. 1992, c. H-6.1 http://laws.gnb.ca/en/showfulldoc/cs/H-6.1//20150802
- Human Tissue Gift Act, R.S.N.B. 1973, c. H-12 http://laws.gnb.ca/en/showfulldoc/cs/2014-c.113//20150802
- Infirm Persons Act, R.S.N.B. 2000, c. I-8 http://laws.gnb.ca/en/showfulldoc/cs/I-8//20150802
- Medical Consent of Minors Act, R.S.N.B. 1976, c. M-6.1 http://laws.gnb.ca/en/showfulldoc/cs/M-6.1//20150802
- Property Act, R.S.N. B. 1973, c. P-19 http://laws.gnb.ca/en/showfulldoc/cs/P-19//20150802
Newfoundland and Labrador: www.assembly.nl.ca/Legislation
- Advance Health Care Directives Act, R.S.N.L. 1995, c. A-4.1 http://www.assembly.nl.ca/Legislation/sr/statutes/a04-1.htm
- Human Tissue Act, R.S.N.L. 1990, c. H-15 http://www.assembly.nl.ca/Legislation/sr/statutes/h15.htm
Nova Scotia: nslegislature.ca/legc/
- Hospitals Act, R.S.N.S. 1989, c. 208
- Human Tissue Gift Act, R.S.N.S. 1989, c. 215
- Incompetent Persons Act, R.S.N.S. 1989, c. 218
- Medical Consent Act, R.S.N.S. 1989, c. 279
- Powers of Attorney Act, R.S.N.S. 1989, c. 352
Ontario: www.assembly.nl.ca/Legislation
, S.O. 1996, c. 2 http://www.ontario.ca/laws/statute/96h02 - Personal Health Information Protection Act, 2004, S.O. 2004, c. 3 http://www.ontario.ca/laws/statute/04p03
- Substitute Decisions Act, S.O. 1992, c. 30 http://www.ontario.ca/laws/statute/92s30
- Trillium Gift of Life Network Act, S.O. 1998, c. 18 http://www.ontario.ca/laws/statute/90h20
Prince Edward Island: www.gov.pe.ca/law/statutes
- Consent to Treatment and Health Care Directives Act, S.P.E.I. 1996, c. 10 http://www.gov.pe.ca/law/statutes/pdf/c-17_2.pdf
- Hospitals Act, R.S.P.E.I 1988, c. H-10.1 http://www.gov.pe.ca/law/statutes/pdf/H-10-1.pdf
- Hospital Management Regulations, PEI Reg EC49/11 http://www.gov.pe.ca/law/regulations/pdf/H&10-2.pdf
- Human Tissue Donation Act, R.S.P., P.E.I. 1988 http://www.gov.pe.ca/law/statutes/pdf/h-12_1.pdf
- Powers of Attorney Act, R.S.P.E.I. 1988, c. P-26 http://www.gov.pe.ca/law/statutes/pdf/p-16.pdf
Quebec: www3.publicationsduquebec.gouv.qc.ca/loisreglements.en.html
- An Act Respecting Access to Documents held by Public Bodies, S.Q. 1982, c. A-2.1 http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=%2F%2FA_2_1%2FA2_1_A.htm
- An Act Respecting the Protection of Personal Information in the Private Sector, R.S.Q., 1993, c. 39 http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=%2F%2FP_39_1%2FP39_1_A.htm
- Mandate Given in Anticipation of Incapacity, Arts. 2130-2185 C.C.Q. http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=%2F%2FCCQ_1991%2FCCQ1991_A.htm
- Civil Code of Québec, S.Q. 1991, c. 64, arts. 10–31 http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=%2F%2FCCQ_1991%2FCCQ1991_A.htm
- Public Curator Act, S.Q. 1989, c. 54 http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=%2F%2FC_81%2FC81_A.htm
Saskatchewan: www.qp.gov.sk.ca
- Health Care Directives and Substitute Health Care Decision Makers Act, S.S. 1997, c. H-0.001 http://www.qp.gov.sk.ca/documents/English/Statutes/Statutes/H0-001.pdf
- Regional Health Services Act, S.S. 2002, c. R-8.2 http://www.qp.gov.sk.ca/documents/english/Statutes/Statutes/R8-2.pdf
- Hospitals Standards Regulations, R.R.S. 1979, Reg. 3231 http://www.qp.gov.sk.ca/documents/English/Regulations/Regulations/SR331-79.pdf
- Health Information Protection Act, S.S. 1999, c.H-0.021 http://www.qp.gov.sk.ca/documents/english/Statutes/Statutes/H0-021.pdf
- Human Tissue Gift Act, R.S.A. 2000, c. H-15 http://www.qp.gov.sk.ca/documents/English/Statutes/Statutes/H15.pdf
- Powers of Attorney Act, 2002, S.S. 2002 http://www.qp.gov.sk.ca/documents/english/Statutes/Statutes/p20-3.pdf
Northwest Territories: www.justice.gov.nt.ca/legislation/search
- Access to Information and Protection of Privacy Act, S.N.W.T. 1994, c. 20 https://www.justice.gov.nt.ca/en/files/legislation/access-to-information-and-protection-of-privacy/access-to-information-and-protection-of-privacy.a.pdf
- Guardianship and Trusteeship Act, S.N.W.T. 1994, c. 29 https://www.justice.gov.nt.ca/en/files/legislation/guardianship-and-trusteeship/guardianship-and-trusteeship.a.pdf
- Human Tissue Donation Act, R.S.N.W.T. 1988, c. H-6 https://www.justice.gov.nt.ca/en/files/legislation/human-tissue-donation/human-tissue-donation.a.pdf
- Powers of Attorney Act, S.N.W.T. 2001, c. 15 https://www.justice.gov.nt.ca/en/files/legislation/powers-of-attorney/powers-of-attorney.a.pdf
Nunavut: www.justice.gov.nu.ca
- Access to Information and Protection of Privacy Act, S.N.W.T. (Nu) 1994 http://www.justice.gov.nu.ca/apps/authoring/dspPage.aspx?page=CURRENT+CONSOLIDATIONS+OF+ACTS+AND+REGULATIONS&letter=A
- Human Tissue Act, R.S.N.W.T. (Nu) 1988 http://www.justice.gov.nu.ca/apps/authoring/dspPage.aspx?page=CURRENT+CONSOLIDATIONS+OF+ACTS+AND+REGULATIONS&letter=H
- Powers of Attorney Act, S. Nu. 2005 http://www.justice.gov.nu.ca/apps/authoring/dspPage.aspx?page=CURRENT+CONSOLIDATIONS+OF+ACTS+AND+REGULATIONS&letter=P
Yukon Territory: www.gov.yk.ca/legislation/
- Enduring Power of Attorney Act, S.Y. 1995, c. 8 http://www.gov.yk.ca/legislation/acts/enpoat_c.pdf
- Health Act, S.Y. 1989–90, c. 36, s. 45 http://www.gov.yk.ca/legislation/acts/health_c.pdf
- Human Tissue Gift Act, 2002, c. 117 http://www.gov.yk.ca/legislation/acts/hutigi_c.pdf
Discussion Questions
- What are the elements of valid consent?
- When must consent be obtained?
- What is one exception to the consent requirement?
- What are substitutes to individual consent and when may they be used?
- Is the substitute decision-maker for health care also the decision-maker for financial issues? Explain.