Resize text: plus minus

Practical Insights for Busy Caregivers

Consenting to treatment: Don’t assume you can make decisions for a relative


December 5, 2016, by Pat Morden, Caregiver Exchange

When Beth’s husband John was diagnosed with dementia, she assumed that she would begin to make all the decisions about his care. But when he developed prostate cancer, his doctor asked John whether he wanted to undergo treatment and when John said “no,” honoured his choice.

As a caregiver, you can’t assume that you will give consent for treatment, even if the person you are caring for has cognitive issues.

Healthcare providers must obtain consent from their patients before any treatment begins. They must discuss the patients’ condition, the treatment options, the risks, benefits, and side effects of treatment, and the results of refusing treatment. If the provider determines that a patient doesn’t have the mental capacity to make decisions about his or her own care, the patient’s substitute decision maker (SDM) must give consent.

But as Julie Darnay Manager of Partnerships and Communities of Practice at Hospice Palliative Care Ontario says, “Capacity is not a diagnosis.” She points out that a person’s capacity is “issue-specific for each type of decision and for each new decision, and can fluctuate.” For instance, a person may be capable of deciding about personal care, but not a medical procedure. Or the person may be able to provide informed consent on some days, but not on others.

It’s also important to understand that the primary caregiver is not necessarily the substitute decision maker (SDM). To learn more about who may act as an SDM in Ontario, click here.

Here are a few more points to keep in mind:

  • It’s up to the health care provider ­­– not the family caregiver – to determine whether a person has the capacity to give consent. A person is presumed to have capacity unless there are grounds to think otherwise. If you have concerns about the capacity of the person you are caring for, raise them with a provider.
  • The same principles of consent apply to decisions about personal care or admission to a long-term care home.
  • The only time informed consent is not required is in an emergency when the patient is mentally incapable or cannot communicate and the SDM is not available.
  • SDMs have a duty to act on the person’s expressed wishes, or if they haven’t expressed their wishes, in their best interest.
  • The law in Ontario protects the right of capable individuals to make their own choices, even if those choices may seem unwise.
  • Laws regarding consent and capacity vary from province to province, so ensure you are always referring to resources from Ontario

For more information, check out:

Have you faced difficult issues relating to consent? Do you have questions? Are there other topics you'd like to see addressed in this space? Please email us – we’d love to talk to you!