Quality Statement 9: Informed Consent - Health Quality Ontario (HQO)

Resources Quality Statements Advisory Committee About

9

Informed Consent

People living with dementia and symptoms of agitation or aggression are advised of the risks and benefits of treatment options, and informed consent is obtained and documented before treatment is initiated. If a person with dementia is incapable of consenting to the proposed treatment, informed consent is obtained from their substitute decision-maker.

Background

The law requires that providers obtain capable, informed, and voluntary consent prior to initiating a treatment, as stated in the Health Care Consent Act, 1996. In addition, people living with dementia may be assessed for decision-making capacity. If it is determined they do not have the capacity to make decisions with respect to the proposed treatment, a legal substitute decision-maker may be appointed; this is outlined in the Substitute Decisions Act, 1992. Treatment may be initiated without consent in the event of an emergency situation, where people living with dementia and symptoms of agitation or aggression are at risk of causing serious bodily harm to themselves or others or are experiencing severe suffering. According to legislation, “treatment may be continued only for as long as reasonably necessary” to obtain consent from the substitute decision-maker, or from the person with dementia if they regain the capacity to make their own decision. In either case, the provider must document justification of the treatment, and the patient’s values and wishes must always be considered when making a medical decision.

What This Quality Statement Means

For Patients

No changes should be made to your treatments until you have been given information about their benefits and harms and have agreed to these changes. In very rare circumstances, where someone is at risk of being hurt, you might be treated first and then provided with information as soon as possible.

For Clinicians

Provide information on and discuss the risks and benefits of different treatment options with patients, their caregivers, or substitute decision-makers. Always obtain and document informed consent before initiating or stopping a treatment. If a person is unable to consent, obtain informed consent from their substitute decision-maker.

For Health Services

Ensure that all important information on people’s capacity to consent and their substitute decision-makers (if applicable) is documented and accessible in hospitals and long-term care homes.

Quality Indicators

Process Indicator

Percentage of people living with dementia and symptoms of agitation or aggression receiving a medical treatment whose informed consent (obtained directly or from the substitute decision-maker) is documented prior to the initiation of the treatment

Denominator: total number of people living with dementia and symptoms of agitation or aggression who are receiving a medical treatment
Numerator: number of people in the denominator whose informed consent (directly or by substitute decision-maker) is documented prior to initiation of the treatment
Data source: local data collection

Definitions Used Within This Quality Statement

Incapable

In this context, being incapable is a person’s inability to make appropriate decisions. Capacity is always considered with respect to the proposed treatment that requires consent. A person’s capacity can fluctuate depending on the proposed treatment and timing. A person can be capable with respect to some proposed treatments, but incapable for others. Similarly, capacity can be present for a proposed treatment at one time but absent at another time.

Evidence to Improve Care