consent
permission for something to happen or agreement to do something
- each province/territory has own legislation regarding consent
- responsibility of health care provider to receive consent
- must be informed and volunatry
informed criteria of consent
- consent to treatment
- accept the treatment
- desired outcome
- foreseeable risks
- aware of available options
voluntary criteria of consent
- must not fee pressures
- right to refuse treatment at ANY time
types of consent
- express
- written
- oral
- implied
- in an emergency
express consent
- written or oral
- indicated clear choice of patient
- requires patient to be fully informed
written consent
- all major procedures require written consent
- patient should understand procedure
- may not hold up in court if there is conflicting evidence
- must be signed, dated, and witnessed
oral consent
- equally binding as written
- spoken word in person or on phone
- some require 2 HCPs to validate if over phone
- protocols may vary
- should be clearly documented in chart
implied consent
- when someone seeks treatment in ER or doctors office
- by allowing themselves to be admitted
- includes sharing of info with other care professionals on a needed basis
in an emergency consent
- only obtain consent if possible
- if barrier and delaying could result in serious consequences treatment may be provided without consent
- important to document in a clear, concise but detailed manner explaining decision to provide care in chart
who can give consent
- competent person (having procedure done)
- legal representative/ next of kin
- legal power of attorney
- when someone is legally assigned to make decisions
steps to obtaining consent
1) assess capacity
2) provide emergency treatment or crisis admission
3) inform client that substitute decision maker will decide
4) identify substitute decision maker
5) obtain consent from substitute decision maker
assessing capacity
- does health care provider feel certain that individual is able to understand and make decisions
- age of consent (14 in Quebec, does not exist elsewhere, youth just must be able to fully understand procedure)
- role of evaluator (determine capacity)
- role of capacity assessor (RN & NP can do this, conducts assessment on individuals who need decisions made on their behalf)
- incapable person (consent is to be obtained by highest ranked available substitute decision maker
provide emergency treatment or crisis admission: EMERGENCY
- EMERGENCY: treatment can be provided immediately
- if person is capable of giving consent and does so
- in situations where communications cannot take place, reasonable effort to overcome barriers, but delay may cause further harm and no reason to believe person does not want treatment
- person is incapable with respect to making treatment decision but substitute decision maker is available to consent
- person is incapable with respect to treatment, substitute decision maker not readily available
provide emergency treatment or crisis admission: CRISIS
- person who has been deemed incapable requires immediate admission as a response to crisis
- not reasonably possible to obtain consent on the incapable persons behalf
inform client that substitute decision maker will make decision
- who will make decision for them
- ensure patient knows their rights
identify substitute decision maker
- a spouse, partner or relative who is present when the treatment is proposed may Mae the decision unless: a specifically appointed substitute is available or a spouse partner or relative with a higher priority is available
- using hierarchy work way through list in order of highest priority to lowest
- HCPs can rely on a persons statement that they are substitute decision maker
obtain consent from substitute
- has right to same info as the client
- substitute is to make decision based on what the client would want
- if unsure, make decision in best interest of client
hierarchy of substitute decision maker
- guardian or person
- someone who has been named attorney for personal care
- someone appointed by the Consent and capacity board
- spouse, partner or relative
- public guardian trustee
consent for deceased organ donation
- provincial/territorial legislation
- most 16 years or older
- donor card, drivers license, medicare card
- NS automatic organ donation
barriers to written consent
- religion
- culture
- gender
- social concerns
- language
