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The Health Care Consent Act does not come with an explanation of ‘how-to’ fulfil the requirements it outlines. This may seem odd, but it is just a function of how the legislation is written. To make the consent process more explicit and user-friendly, we have put together a flowchart of the consent process as we understand it here:
Many have asked us about the necessity of the values assessment but it boils down to a simple fact. Without understanding a patients values, it is impossible to determine which treatment plan is in their best interests in the event of their incapacity. Given how ill patients in acute care hospitals are today, the potential to loose capacity for treatment decisions is not insignificant, and so we should be taking values histories for all of our acute care patients.
With respect to ‘treatment options’, we point out that only a regulated healthcare professional can appropriately determine what the ‘range’ of treatment options are. Shared decision making does not play a role in this step. It is a function of what constitutes the range of acceptable or indicated treatments whereby clinicians fulfill this step. Concerns over paternalism are addressed by professional regulation here, as it would be negligent for a clinician to fail to offer treatments that his/her profession deems medically appropriate for a given context.
Treatment Selection addresses how a patients values and goals of care screen the list of available treatments determined by the clinician. For example, a Jehovah’s Witness with strong values regarding avoidance of blood products, might select out any treatments that would include them. Where a patient is incapable, the substitute decision maker and clinician work through this step together. Treatment selection is the stage at which relevant risks and benefits of the treatment options are discussed.
Finally, when the above steps are complete, only the patient or legal substitute decision maker may choose to consent, or not consent.