Informed Consent: Capacity and Shared Decision-Making

Informed consent is a continuing conversation that supports the patient’s authority over treatment. The NP explains the proposed care, its likely benefits and material risks, reasonable alternatives and what may happen without treatment. The patient needs an opportunity to ask questions and decide voluntarily. A signature records part of this process; it does not replace it. Capacity is specific to the decision and the time. Under Ontario’s Health Care Consent Act, presume capacity unless there are reasonable grounds to believe otherwise. An ordinary informed-consent discussion is not an automatic requirement for a formal capacity assessment before every decision; when concerns arise, assess the legally relevant abilities for the particular treatment. Do not infer incapacity from a diagnosis of dementia, a psychiatric diagnosis, a language difference or disagreement with the recommended plan. Address communication barriers and reversible contributors such as pain, medication effects or delirium before drawing conclusions, when the clinical situation allows. A patient may need substantial support to communicate and still make the decision. Apply the law of the province or territory. In Ontario, the Health Care Consent Act...