What is Advance Care Planning and what is informed consent?

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What is Informed Consent?

In Ontario, health care professionals are required to get “informed consent” before giving you any treatment or care. That informed consent must come from you, if you are mentally capable of giving it. If you are not mentally capable to give it, consent must come from your Substitute Decision Maker.

Substitute Decision Maker is the person or people who will give or refuse consent for any treatment or other care for you if you are not mentally capable to do so for yourself.

Before giving consent to treatment you are entitled to know:

  • what your health problems are
  • the risks, benefits and side effects of the treatment being offered
  • any alternatives to the treatment being offered
  • what would happen if you refused the treatment

If you are mentally incapable, the health care provider must give this same information to your Substitute Decision Maker(s) before that person(s) makes any health decisions for you.

The requirement to get an informed consent from you or, if you are not mentally capable to give informed consent, from your Substitute Decision Maker ensures that there is always someone who will have all the information needed to think through important decisions about your care.

Under Ontario Law, Advance Care Planning is part of the Health Care Consent. An important part of the Advance Care Planning process is identifying the person who you would want to make healthcare decisions for you if you were not mentally capable to give or refuse consent for treatment or other care. This person (or people, you can have more than one) would be your Substitute Decision Maker(s). You need to understand what the law says about who your automatic Substitute Decision Maker is, and what you must do if you want to appoint someone else other than the automatic Substitute Decision Maker.

If you are not mentally capable to give or refuse consent to treatment or other care, the law provides you with an automatic Substitute Decision Maker. The Ontario Health Care Consent Act includes a hierarchy (a ranking list) of Substitute Decision Maker(s). The person or persons in your life that are the highest ranked in this hierarchy and that meet the requirements to act as a Substitute Decision Maker(s) will be your Substitute Decision Maker(s) for health care.

What is Advance Care Planning?

In Ontario, Advance Care Planning (ACP) is a process that involves:

  • identifying your Substitute Decision Maker(s)
  • sharing your values, wishes, and preferences for future care with your Substitute Decision Maker(s).

Advance care planning is a way to make sure there is someone who knows your wishes and can give or refuse consent for you. It’s a way to give your family and friends the confidence to make health care decisions that reflect what’s important to you.

Under Ontario Law, Advance Care Planning is part of the Health Care Consent Act. An important part of the Advance Care Planning process is identifying the person(s) who you would want to be your Substitute Decision Maker and make health care decisions for you.

The goal of Advance Care Planning is to communicate your wishes, values and beliefs to your Substitute Decision Maker(s) so they can be in the best position to make decisions for you if necessary.

Advance Care Planning may also involve having conversations with your health care professional with your Substitute Decision Maker(s) present — although the most important conversations that your health care professional should have with you are about getting your informed consent before treatment.

There are 5 Steps to Advance Care Planning:

  • Think
    What Makes My Life Meaningful
    Think about what’s important to you. What makes your life meaningful?
  • Learn
    Familiarize Yourself with Relevant Terms
    Learn about important terms.
  • Decide
    Who Will Speak On Your Behalf?
    Decide on a person who you trust and who would be willing and able to make future health and personal care decisions if you were not mentally capable to give or refuse consent. The Health Care Consent Act sets out a list of people who will automatically become your Substitute Decision Maker unless you choose someone else by signing a Power of Attorney for Personal Care. (See Choosing a Substitute Decision Maker below.)
  • Talk
    Start the Conversation
    Talk with your Substitute Decision Maker(s), family, friends and health care providers about your wishes, values and beliefs.
  • Record
    Record your Substitute Decision Maker and Communicate Your Wishes
    Record or communicate your beliefs, values and wishes with your Substitute Decision Maker. Review your wishes regularly with your Substitute Decision Maker because they may change. You can share your wishes orally, in writing or by any other means you use to communicate. These wishes are meant to guide your Substitute Decision Maker.

You will learn more about all of these steps as you work through this interactive workbook.

Deciding on a Substitute Decision Maker

When deciding on your Substitute Decision Maker(s), it’s important to understand what the law says about who your automatic Substitute Decision Maker is, and what you must do if you want to appoint someone else.

If you are not mentally capable of giving or refusing consent for your care, the law provides you with an automatic Substitute Decision Maker. The Ontario Health Care Consent Act sets out a hierarchy or ranked list of Substitute Decision Maker(s). The person or persons in your life that are closest to the top of the list and who meet the requirements to act as a Substitute Decision Maker(s) will automatically be your Substitute Decision Maker(s) for health care unless you appoint someone else.

Your wishes can be expressed orally, in written form, or by any alternative means that you use to communicate, such as a picture board or computer. Expressed wishes are meant to guide to your Substitute Decision Maker.

Your Substitute Decision Maker should be a person who:

  • understands you
  • understands your wishes, values and beliefs
  • is in the best position to interpret and apply your wishes, values and beliefs when making decisions for you
  • Is willing and able to make future health care decisions on your behalf should you become incapable

Only in an emergency, if there is no time to talk to you or to your Substitute Decision Maker, may a health care professional take direction from a written or previously communicated expression of your wishes.

It is important to be clear about anything you write down or communicate to your health care professionals so they would understand what you would want in an emergency.

Advance Care Planning may also involve having conversations with your health care professional, with your Substitute Decision Maker(s) present although the most important conversations that your health care professional should have with you are about getting an informed consent before treatment.

 

The 5 Steps to Advance Care Planning

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