Assisted reproduction, power authority and control.May 27, 2009
End of life care, advance directives, “euthanasia”June 3, 2009
Refusing and “choosing” treatments
In Ontario the Health Care Consent Act (1996) grants an important right – but the name of the act doesn’t really tell you the nature of the right. The principle of the act is that there should be no treatment without consent. But the right that is granted by the act – the power that is conferred, is not so much the right to consent or agree to a treatment but rather the right to refuse. If there can be no treatment without consent then the right that a patient has is to refuse a treatment. If the patient refuses treatment then, generally speaking, the health-care provider is not entitled to insist on performing the treatment.
This right to refuse a treatment is granted in the first instance to patients who are “capable” of giving or withholding consent. Simply put, in Ontario a patient is deemed to be capable of giving consent to a treatment if he or she understands that a treatment decision needs to be made, understands the nature of the decision, including the likely consequences of having or not having the treatment and is able to communicate his or her decision. (See the forthcoming post on “capacity.”)
The right to refuse a treatment is not the same thing as a right to “choose” a treatment. At the risk of oversimplifying what should be a dynamic and interactive relationship it is the role of the patient to express and explain his or her situation (identify symptoms, and the nature of the problem as lived by the patient, it is then the responsibility of the physician or treatment team to propose appropriate treatments, and then it is the responsibility of the patient to choose from amongst the available treatments or reject all of them. (See the forthcoming post on the dynamics of health care decision-making.”) It is not the role, or within the authority of the patient to “choose” the appropriate treatment, just to choose from amongst the treatments offered, or reject all of them. Nor is it the role of the physician or care-giving team to choose the treatment for the patient or insist that he or she accepts a treatment he or she does not want.