1. “IT’S TIME TO
Talk))))
“Are you telling me what to do?
Who decides?”
Consent & Capacity
Substitute Decision Makers
Moji Adurogbangba BDS,MPH,MA
Bioethicist; Clinical Services &Research
Debbie Driver RN(EC) MN GNC(C)
Nurse Practitioner, GAIN Geriatric Clinic
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2. What you should know
• Consent (voluntary permission) is needed for
– treatment
– admission to care facilities and
– personal assistance service
• You have a right to make health care decisions for yourself as
long as you are mentally capable of making decisions.
• Your health care provider will assume you are capable unless
there is a reason to believe otherwise.
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3. What Does ‘Capacity’ Mean?
People are considered to be capable if they are able to:
– understand the decision to be made (Grasp and retain
information relevant to the decision at hand.)
– appreciate the consequences of a decision or
lack of decision (Grasp how a given treatment will affect
him/her personally.)
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4. What Is My Role in the Consent Process?
• Understand the treatment being proposed
• Appreciate the consequences of the decision or lack of decision
• Let the health care providers know the values and beliefs that
may play a part in the decision making.
• Following the discussion, make a decision to either consent to or
refuse the proposed treatment
• Ensure your questions are answered
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5. What Should I Do To Understand?
• Have relevant information provided in a language
you can understand.
• Ask to be educated about your illness, the
treatment proposed and alternatives.
• Ask about the risks and benefits of each alternative.
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6. What Should I Do To Appreciate?
• Know how a given treatment, its risks and benefits
and the alternatives will affect you personally.
• Ask yourself: “How did I arrive at this decision?”
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7. What you should know
• If you are not mentally capable of making a
particular decision, someone else, a person known
as the substitute decision-maker would be
entitled to make these decisions for you.
• If you are incapable, your substitute decision maker
needs to give consent for:
– treatment
– admission to care facilities and
– health care related decisions.
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8. Who Makes Decisions if I am No Longer
Capable?
• In order of legal priority
– A spouse or partner
– A child or parent or children’s aid society
– A parent who has only a right of access
– A brother or sister
– Any other relative (related by blood, marriage or
adoption)
OR
– Public Guardian and Trustee
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9. Role of your Substitute Decision Maker
• Helps decide what you would want if still able to tell
the health care team.
– NOT what the substitute decision maker would want
for you.
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10. What If My Substitute Decision Maker
Does Not Know My Wishes?
• Your Substitute-Decision Maker’s job is to talk to
the health care team to decide what treatment
would:
– Be in line with the values and beliefs you held while
capable
– Improve or change your condition for the better.
(Best interest standard)
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11. Choosing Your Substitute Decision Maker
• Family member, loved one, friend: someone who
knows you well
• Decrease anxiety by talking with your SDM, sharing
your wishes and thoughts about future care.
• Challenging role; stress of seeing loved one unwell
– Understanding nature of illness, treatment options
– Making ‘best’ decision
• Be proactive and have these discussions before an
issue arises
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12. What About My Property/Finances?
• Power of Attorney for Property mentions who will
make decision with respect to your
property/finances.
• The person may or may not be the same person as
your substitute decision maker.
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13. Be Pro-Active!
http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/incapacity/poa.asp
Google: Power of Attorney and click on Ministry of Attorney General
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