In Ontario, Advance Care Planning (ACP) is
• Confirming your substitute decision maker(s) (SDMs)
• Communicating your wishes, values and beliefs about care to help
your SDM(s) make health and personal care decisions for you if you
become mentally incapable of doing so for yourself.
Why is this Important?
In Ontario, the law requires all health care providers to get informed consent, or refusal of consent, before providing a patient with any treatment or care. Health practitioners must tell you about your illness and what may be done to treat you. You then have the right to make a decision and agree to or refuse the treatments offered. This is called health care consent: it is a basic patient right to decide what health care to receive.
Only in emergencies, to save a life or to reduce suffering, can people be treated without informed consent. Consent always comes from a person: either the mentally capable person or their substitute decision maker(s).
If you are not mentally capable, the health practitioner will turn to another person, your substitute decision maker, who will then speak for you and make the decision about your care.
Advance care planning is not about decisions. It is about preparing you, and your future substitute decision maker(s), for a time when you may not be able to make your own health or personal care decisions because of your lack of mental capacity. At that time, your future SDM would step in to give or refuse consent for treatment.
You make your own decisions about any health care as long as you are mentally capable – that is, as long as you have the ability to understand and appreciate information relevant to making that decision.
Ontario law defines capacity as:
- Having the ability to understand information that has to do with making a decision about the treatment, admission or personal assistance service; and
- Having the ability to appreciate the likely consequences of a decision or lack of decision.
If you become mentally incapable for any particular health decision, then your SDM would be the person who would make health decisions for you.
Health practitioners are required to get your informed consent, or refusal of consent, to treatment or other health care decisions before providing treatment or other health care. If, in the opinion of the health practitioner, you are not mentally capable to make a treatment or other health care decision, then the health practitioner must get the consent or refusal from your substitute decision maker.
Who Determines Mental Capacity?
The health care provider proposing the treatment will determine if you are mentally capable of consenting to or refusing treatment. If you are found incapable, you have the right to ask the Consent and Capacity Board to review that finding. The health care provider who believes you are mentally incapable must tell you about that right of review.
What is Informed Consent?
Informed consent refers to the permission you give health care providers for medical investigations and/or treatments. It is an informed decision made after you have been given information about your current health condition and the treatment options. Health care providers are required to offer you — and you are entitled to receive — detailed explanations of the investigations/treatments including:
- their risks
- their benefits and side effects
- any alternatives to these options
- what would likely happen if you refuse the options.
Health care providers must also answer any questions you have about the treatments and the information must be provided before you give consent.
Substitute Decision Maker, click here.
Start the Conversation, click here.
Ontario Health Care Consent Advance Care Planning workbook, click here.