BY You or your substitute decision maker. To be valid consent must: Related to the treatment, Be informed, Given voluntarily, Not be obtained through misinterpretation or fraud.
To understand and appreciate!! Ask questions and clarify information from your health care provider. Ask yourself: Do I know that I have a choice? Can I remember the information long enough to reach a decision? Can I remember my decision and be consistent over time?
Consent & Capacity - Substitute Decision Makers
“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 1
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. 2
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.) 3
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 4
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. 5
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?” 6
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. 7
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 8
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. 9
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) 10
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 11
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. 12
Be Pro-Active!http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/incapacity/poa.aspGoogle: Power of Attorney and click on Ministry of Attorney General 13