Informed Consent in BC


			
			

Have you ever had a doctor or nurse talk to you about your health care options and just not been able to understand what they are saying?

Do you understand what your doctor is telling you?

Doctors and nurses are wonderful, caring people. But they are often talking about things which are scary or confusing to most people. Sometimes that makes it hard to understand them.

Maybe they were using jargon you didn’t understand, or English isn’t your first language, or you are hard of hearing.

Maybe they have just told you that you have a life-limiting or life-ending illness and you all you can hear in your head as they are talking is “I’m sorry, but you have cancer”.

But I trust my doctor – shouldn’t I just do what they tell me to?

So your health care provider is talking to you about your health care and you don’t understand what they are saying. Now what?

Doctors, nurses and other health care providers train for a very long time to get good at what they do. Shouldn’t you just listen to them? Shouldn’t you trust that they know what’s best?

It can be very tempting to just trust a health care provider’s recommendation, or to say “do whatever you think is right” to your health care provider, especially if you don’t really understand what they are saying to you.

But your health care providers need to make sure you understand and consent to health care before they can treat you.

This doesn’t mean just saying “yeah, yeah, do whatever”. Your health care practitioners are required to obtain something called informed consent from you before they can proceed.

This is important for two main reasons:

  • if your health care provider treats you in a way that you didn’t properly consent to, they could face severe professional and legal consequences for failing to get your consent
  • maybe your health care provider didn’t know that you have specific health care needs, or beliefs about health care that need to be honoured as part of your care (and giving you treatment without that knowledge would harm you in some way)

What is informed consent?

Informed consent means that your health care provider must make sure that you understand exactly what your health care situation is, what your options are, and that you have all the information necessary to make a good decision.

Here are the legal requirements for consenting to health care in BC:

Elements of consent
6   An adult consents to health care if
(a) the consent relates to the proposed health care,
(b) the consent is given voluntarily,
(c) the consent is not obtained by fraud or misrepresentation,
(d) the adult is capable of making a decision about whether to give or refuse consent to the proposed health care,
(e) the health care provider gives the adult the information a reasonable person would require to understand the proposed health care and to make a decision, including information about
(i) the condition for which the health care is proposed,
(ii) the nature of the proposed health care,
(iii) the risks and benefits of the proposed health care that a reasonable person would expect to be told about, and
(iv) alternative courses of health care, and
(f) the adult has an opportunity to ask questions and receive answers about the proposed health care.

Health Care (Consent) and Care Facility (Admission) Act, RSBC 1996, c.181, s.6

Let’s imagine a few scenarios:

An easy case for informed consent

First, let’s say you break your clavicle.

Getting informed consent to treatment for a broken clavicle might be relatively simple.

A very clean, simple break with no complications. That’s painful, but fairly straightforward. Imagine that your doctor wants you to have an x-ray, and then to put your arm in a sling.

Now let’s walk through the elements of consent and see whether you can provide consent:

Element of ConsentIssues
has the doctor explained what kind of condition you have?yes – they have explained that you broke your clavicle
has the doctor explained the kind of care they want to give you?yes – they want you to have an xray and a sling
has the doctor explained the risks and benefits of this care?yes – they have told you that xrays have a small amount of radiation, but nothing that will harm you, and that without the xray they won’t really know what’s happened to your clavicle; and they have talked to you about what happens if your clavicle isn’t treated
have they explained other possible treatments?yes – they have told you that you might need surgery if the bone doesn’t set properly
have you had a chance to ask questions about this treatment?yes – they have answered your questions about how long you will need to wear the sling, and how will they know if it is working?
are they asking you to consent to the xray and the sling, or something else? yes, they only want you to have the xray and the sling, nothing else for now
are you consenting voluntarily to the xray and the sling?yes
is there any fraud or misrepresentation going on?no
are you capable of making this decision?yes

Great! It sounds like you understand what is happening and can give informed consent.

A more difficult case for informed consent

Giving informed consent in emergency situations can be scary and difficult.

Now, let’s think about something more complicated.

Let’s imagine you have just had a heart attack, and you have just been brought into the emergency room. You are looking for your family, and don’t see them. You are in and out of awareness, you are scared, and there is a lot of noise and action all around you.

Let’s work through the elements of consent in this situation:

Element of ConsentIssues
has the doctor explained what kind of condition you have?the doctors and nurses have been talking to you about what is happening, but they are using words you don’t really understand, and you are too scared to really listen properly; you think you are having a heart attack, but you can’t tell how bad it is
has the doctor explained the kind of care they want to give you?you think so, but you’re not really sure what they’re saying
has the doctor explained the risks and benefits of this care?yes – they have said some scary things that you are really worried about
have they explained other possible treatments?you’re not really sure – everything seems to be happening so fast
have you had a chance to ask questions about this treatment?you don’t even know what kinds of question to ask, and you are starting to feel too panicked to think straight; you are starting to think about other people you know who have had heart attacks and died, and to worry about your family
are they asking you to consent to treatment for a heart attack, or something else? you’re not really sure
are you consenting voluntarily to the treatment?yes, because you want to get better
is there any fraud or misrepresentation going on?no
are you capable of making this decision?you aren’t really sure, but you’re trusting your doctors and nurses to do what’s right; you have been looking for your spouse or children to help you decide, but can’t find them

Now remember that your perceptions as you go through such a scary experience can be warped. Your doctors and nurses might have done an amazing job of explaining what’s happening and what needs to happen to you, but you might be so confused or afraid that you aren’t able to properly process everything.

So when you say yes to the treatment the health care providers propose, are you giving informed consent?

There are an awful lot of missing elements in this second scenario. It’s entirely possible that you aren’t able to give your health care providers informed consent.

So now what?

Health care providers have strict rules about how they are allowed to proceed when they can’t get informed consent from you.

You can make it easier for everyone (including yourself) by appointing someone as your representative under a Representation Agreement. Then that person you appoint has the legal right to help you with these decisions.


			
			
			May 19, 2019 12:24 pm 
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