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To view this presentation as a webinar with sound visit CLEONet http://www.cleonet.ca/training CLEONet is a web site of legal information for community workers and advocates who work with low-income and disadvantaged communities in Ontario.  www.cleonet.ca
About our presenter… Judith Wahl has been the Executive Director and Senior Lawyer at the Advocacy Centre for the Elderly (ACE)  since 1984. ACE is a community legal service for low income seniors that focuses on legal issues that have a greater impact on the older population. Judith has organized and taught numerous public legal education programmes on legal issues that arise in day to day work with seniors, including Advance Care Planning - Physicians’ Training Ontario College of Family Physicians and Alzheimer Society of Ontario; Gerontology Programme at McMaster University, Faculty of Social Sciences; the Diversity Training Course at C.O. Bick Police College; as well as Continuing Legal Education Programmes for the Law Society of Upper Canada, Ontario Bar Association, the former Canadian Bar Association – Ontario, and the Canadian Bar Association National.
Health Care Consent and    Advance Care Planning  - Getting it Right   Part I – Health Care Consent Basics Part II- Advance Care Planning   Judith Wahl, B.A., LL.B. Barrister and Solicitor Advocacy Centre for the Elderly  [email_address]   Advocacy Centre for the Elderly 2010 CLEONet CLEONet
Advocacy Centre for the Elderly Advocacy Centre for the Elderly 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Today’s Webinar  Part I of 2     Health Care Consent and Advance Care Planning  - Getting it Right Part I – Health Care Consent Basics   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Advocacy Centre for the Elderly Advocacy Centre for the Elderly 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Next Webinar  Part 2 of 2     Health Care Consent and Advance Care Planning  - Getting it Right Part 2 – Advance Care Planning   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Questions during Webinar ,[object Object],[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Legislation ,[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Do You or Your Organization/Facility understand Health Care Consent and Advance Care Planning (ACP)?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
General Challenges to Patient-Physician Communication ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Problems in Health Consent and Advance Care Planning ,[object Object],[object Object],Advocacy Centre for the Elderly 2010
Problems in Health Consent and Advance Care Planning ,[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Health Care Consent  – The Framework   ,[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
What is Health Care?  ,[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Definition Of Treatment ,[object Object],Advocacy Centre for the Elderly 2010
Definition Of Treatment  (cont’d) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Admission  ,[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Legal Context of  Decision-making (1)  Advocacy Centre for the Elderly 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Legal Context of  Decision-making (1)  ,[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
What is an emergency?  ,[object Object],Advocacy Centre for the Elderly 2010
Emergency treatment without consent ,[object Object],Advocacy Centre for the Elderly 2010
Emergency Treatment without consent  ,[object Object],Advocacy Centre for the Elderly 2010
Emergency treatment despite refusal of consent by SDM ,[object Object],Advocacy Centre for the Elderly 2010
Legal Context of  Decision-making (2) Advocacy Centre for the Elderly 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Legal Context of  Decision-making (3) Advocacy Centre for the Elderly 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Questions?  ,[object Object],Advocacy Centre for the Elderly 2010
What is Valid Consent? ,[object Object],Advocacy Centre for the Elderly 2010
What is Informed Consent? Advocacy Centre for the Elderly 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Consent to One treatment or to a Plan of Treatment  ,[object Object],[object Object],Advocacy Centre for the Elderly 2010
Plan of Treatment – HCCA, s.2(1) ,[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Decisions can be for present care and care in the future ,[object Object],[object Object],Advocacy Centre for the Elderly 2010
Treatment in the future is NOT necessarily ACP  ,[object Object],[object Object],Advocacy Centre for the Elderly 2010
Who Gives or Refuses Consent?   ,[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Capacity- Legal Definition Advocacy Centre for the Elderly 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Definition of Capacity with respect to Treatment, Admission to Care Facilities, and Personal Assistance Services ,[object Object],Advocacy Centre for the Elderly 2010
Mental Capacity for Treatment   ,[object Object],[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Pocket Tool on Capacity and Consent ,[object Object],[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Who Assesses Capacity with Respect to Treatment? Advocacy Centre for the Elderly 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
If the patient is assessed as not mentally capable for treatment, then…. ,[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Decisions (Consents) vs. Wishes ,[object Object],[object Object],Advocacy Centre for the Elderly 2010
Questions?  ,[object Object],Advocacy Centre for the Elderly 2010
SDMs ,[object Object],Advocacy Centre for the Elderly 2010
Hierarchy of SDMs Advocacy Centre for the Elderly 2010 1.   Guardian of person 2. Attorney in POAPC 3. Representative appointed by the Consent and  Capacity Board 4. Spouse or partner 5. Child or parent or CAS (person with right of  custody) 6. Parent with right of access 7. Brother or sister 8. Any other relative 9. Office of the Public Guardian and Trustee
Definition of Spouse ,[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Definitions - Partner and Relative ,[object Object],[object Object],Advocacy Centre for the Elderly 2010
SDMs Advocacy Centre for the Elderly 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Requirements for Person to be an SDM Advocacy Centre for the Elderly 2010 The person highest in the hierarchy may give or refuse consent only if he or she is: a) Capable in respect to the treatment b) At least 16 years old unless the parent of the  incapable person c) Not prohibited by a court order or separation  agreement from acting as SDM d) Available e) Willing to act as SDM
Requirements to be an SDM – Responsibility of Health Care Practitioners   ,[object Object],[object Object],Advocacy Centre for the Elderly 2010
Requirements to be an SDM – Responsibility of Health Care Practitioners ,[object Object],Advocacy Centre for the Elderly 2010
How SDMs Make Substitute Decisions Advocacy Centre for the Elderly 2010 It is the responsibility of the SDM to make treatment decisions for an incapable person by: a) following any  wishes (advance care plans)  of  the patient expressed  when capable that are  relevant to the decision;  and b) if no wishes are known or are relevant to the  particular decision, to act in the  best interests  of the patient
Best Interests Definition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
SDM’s Role – CONSENT, not ACP   ,[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Time that the consent “lasts”  ,[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Consent to Plan of Treatment  ,[object Object],Advocacy Centre for the Elderly 2010
Applications to Consent & Capacity Board - Treatment ,[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Applications to Consent & Capacity Board - Treatment ,[object Object],Advocacy Centre for the Elderly 2010
Summary  ,[object Object],[object Object],[object Object],[object Object],[object Object],Advocacy Centre for the Elderly 2010
Questions?  ,[object Object],Advocacy Centre for the Elderly 2010
2010, Community Law School (Sarnia-Lambton) Inc. This webinar was brought to you by CLEONet For more information visit the Health and Disability section of CLEONet at  www.cleonet.ca For more public legal information webinars visit: http://www.cleonet.ca/training

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Health Care Consent and Advance Care Planning

  • 1. To view this presentation as a webinar with sound visit CLEONet http://www.cleonet.ca/training CLEONet is a web site of legal information for community workers and advocates who work with low-income and disadvantaged communities in Ontario. www.cleonet.ca
  • 2. About our presenter… Judith Wahl has been the Executive Director and Senior Lawyer at the Advocacy Centre for the Elderly (ACE) since 1984. ACE is a community legal service for low income seniors that focuses on legal issues that have a greater impact on the older population. Judith has organized and taught numerous public legal education programmes on legal issues that arise in day to day work with seniors, including Advance Care Planning - Physicians’ Training Ontario College of Family Physicians and Alzheimer Society of Ontario; Gerontology Programme at McMaster University, Faculty of Social Sciences; the Diversity Training Course at C.O. Bick Police College; as well as Continuing Legal Education Programmes for the Law Society of Upper Canada, Ontario Bar Association, the former Canadian Bar Association – Ontario, and the Canadian Bar Association National.
  • 3. Health Care Consent and Advance Care Planning - Getting it Right Part I – Health Care Consent Basics Part II- Advance Care Planning Judith Wahl, B.A., LL.B. Barrister and Solicitor Advocacy Centre for the Elderly [email_address] Advocacy Centre for the Elderly 2010 CLEONet CLEONet
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  • 44. Hierarchy of SDMs Advocacy Centre for the Elderly 2010 1. Guardian of person 2. Attorney in POAPC 3. Representative appointed by the Consent and Capacity Board 4. Spouse or partner 5. Child or parent or CAS (person with right of custody) 6. Parent with right of access 7. Brother or sister 8. Any other relative 9. Office of the Public Guardian and Trustee
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  • 48. Requirements for Person to be an SDM Advocacy Centre for the Elderly 2010 The person highest in the hierarchy may give or refuse consent only if he or she is: a) Capable in respect to the treatment b) At least 16 years old unless the parent of the incapable person c) Not prohibited by a court order or separation agreement from acting as SDM d) Available e) Willing to act as SDM
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  • 51. How SDMs Make Substitute Decisions Advocacy Centre for the Elderly 2010 It is the responsibility of the SDM to make treatment decisions for an incapable person by: a) following any wishes (advance care plans) of the patient expressed when capable that are relevant to the decision; and b) if no wishes are known or are relevant to the particular decision, to act in the best interests of the patient
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  • 60. 2010, Community Law School (Sarnia-Lambton) Inc. This webinar was brought to you by CLEONet For more information visit the Health and Disability section of CLEONet at www.cleonet.ca For more public legal information webinars visit: http://www.cleonet.ca/training

Editor's Notes

  1. Let’s start briefly with some background information. Physicians are generally dedicated and competent – so why are there such deficits in patient-physician communication in general as well as at the EOL? [ Teacher’s Note : You may want to ask which of these next factors participants find particularly challenging, or to add some additional barriers that are not on the overhead, such as; “ This is not part of my job description” Belief in what we’re already doing. Practicing defensive medicine through fear of litigation] Excellent resources are available for general communication skills development for physicians.