CINT935: Legal and Ethical Frameworks in Aging
Assignment #1—Health Care Substitute Decision Making
Inaccuracy #1:
From 1:00-1:05, the video states that under the Health Care Consent Act (HCCA), when an
individual requires intervention from the health care system in Ontario, it is “the doctor’s role is
to figure out what’s going on, what treatment might work, and propose a plan” (PoET Project,
2016). This is inaccurate because the HCCA does not make explicit reference to doctors or even
physicians vis-à-vis treatment or treatment plans. The term used in the HCCA is “health
practitioner,” defined in s. 2(1) as “a member of a College under the Regulated Health
Professions Act, 1991 or a member of a category of persons prescribed by the regulations as
health practitioners.” Per Schedule 1 of the Regulated Health Professions Act, 1991, this includes
26 “self governing health professions,” only one of which is medicine (). Section 2(1) of the
HCCA also defines the term “plan of treatment” as “a plan…developed by one or more health
practitioners.” Thus, though a plan of treatment could be developed by a doctor, it could also be
developed by an audiologist, a chiropodist, a massage therapist, a nurse, a psychologist, or many
other types of health practitioner, in any combination thereof.
Inaccuracy #2:
From 1:07-1:11, the video states, “the doctor should ask you before doing anything. This is
called obtaining consent” (PoET Project, 2019). There are a few inaccuracies in this statement.
One of these hinges on the concept of included consent. Section 12(a) of the HCCA states that:
A health practitioner is entitled to presume that consent to a treatment includes consent to
variations or adjustments in the treatment, if the nature, expected benefits, material risks and
material side effects of the changed treatment are not significantly different from the nature,
expected benefits, material risks and material side effects of the original treatment.
Thus, s. 12(a) of the HCCA outlines a circumstance in which a health practitioner (e.g., doctor)
can presume one’s consent and act without asking.
Inaccuracy #3:
From 1:07-1:11, the video states, “the doctor should ask you before doing anything. This is
called obtaining consent” (PoET Project, 2019). As aforestated, there is more than one
inaccuracy in this statement; one of these pertains to emergency treatment. Sections 25(2) and (3)
of the HCCA outline circumstances in which, “despite section 10, a treatment may be
administered without consent to a person” deemed incapable or capable respectively, “if, in the
opinion of the health practitioner” certain conditions are satisfied. Moreover, s. 25(4) of the
HCCA states that “despite section 10, an examination or diagnostic procedure that constitutes
treatment may be conducted by a health practitioner without consent if” certain conditions as
outlined are met.
Inaccuracy #4:
From 1:44-1:56, the video defines the role of the substitute decision maker (“SDM”) as having
“to base decisions about your health care on your wishes, your values, and your beliefs—not his
or her own.” Under s 21(1) of the HCCA, the SDM must make decisions as to treatment in
accordance with one of two principles: if the SDM “knows of a wish applicable to the
circumstances that the incapable person expressed while capable and after attaining 16 years of
age, the person shall give or refuse consent in accordance with the wish.” However, if an
applicable wish is not known, “or if it is impossible to comply with the wish, the person shall act
in the incapable person’s best interests.” While the SDM’s determination of the incapable
person’s best interests should “take into consideration the values and beliefs that the [SDM]
knows the incapable person held when capable and believes he or she would still act on if
capable” per section 21(2)(a), it should also consider per section 21(2)(c) “whether the treatment
is likely to improve the incapable person’s condition or well-being, prevent the incapable
person’s condition or well-being from deteriorating, or reduce the extent to which, or the rate at
which, the incapable person’s condition or well-being is likely to deteriorate.”
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