Endnotes2017-03-03T21:25:23+00:00

[1] In this Paper, we use the term “patient” in the broadest sense, to include any individual for whom treatment is proposed; this may include residents of long-term care homes and clients of other health care organizations. It also includes “person” as that term is used in this Paper. Further, where we refer to “patient”, it is understood that this means either the capable patient, or if the patient has been found incapable to consent to the proposed treatment, his/her SDM as determined under s. 20 of the Health Care Consent Act, 1996, S.O. 1996, c. 2 Sched. A (HCCA).

[2] We should also note that there are statutory exceptions to the requirement to obtain informed consent, such as for time-limited periods where an individual has been found unfit to stand trial in a criminal matter (see Criminal Code, RSC 1985, c C-46  s. 678.58) or where an individual is infected with an agent of a communicable disease that is a virulent disease and has failed to comply with an order of a medical officer of health (see Health Protection and Promotion Act, RSO 1990, c H.7, s. 35).

[3] HCCA, note 1.

[4] The authors wish to thank the Ontario Hospital Association (“OHA”), the Ontario Association of Non-Profit Homes & Services for Seniors (“OANHSS”) and the Ontario Long-Term Care Association (“OLTCA”) for their assistance in facilitating requests of their members for relevant materials.

[5] Starson v. Swayze., 2003 SCC 32, [2003] 1 S.C.R. 722 at 759.

[6] Stephen V. Fram, Final Report of the Advisory Committee on Substitute Decisions Making for Mentally Incapable Persons (Toronto: Guardianship & Advocacy Review Committee, 1987) 42, 45.

[7] Fram, note 6, 42.

[8] Fram, note 6, 44.

[9] Cuthbertson v. Rasouli, 2013 SCC 53 at para. 18 [Rasouli].

[10] Malette v .Shulman (1990), 72 OR (2d) 417, 1990 CarswellOnt 642, (CA) at para. 45.

[11] Fleming v. Reid (1991), 4 O.R. (3d) 74 (C.A.); see also Janet Dunbrack, “Advance care planning: the Glossary project, Final Report”, (Ottawa: Health Canada, August 22, 2006), 20, online: http://www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/2006-proj-glos/2006-proj-gloss-eng.pdf (Last accessed December 11, 2013); Daniel L. Ambrosini, Anne G. Crocker, Eric Latimer, “Preferences for Instructional or Proxy Directives in Mental Health: An Exploratory Mixed Methods Study” 2012 JEMH Vol.  6.

[12] Fram, note 6, 253.

[13] Fram, note 6, 288.

[14] Educating Future Physicians in Palliative and End-of-Life Care, “Facilitating Advance Care Planning: An Interprofessional Education Program” 33-34, online: EFPPEC, http://www.afmc.ca/efppec/docs/pdf_2008_advance_care_planning_curriculum_module_final.pdf

 (Last accessed December 11, 2013) (EFPPEC).

[15] See for example Male v. Hopmans, [1967] 2 O.R. 457 (Ont CA).

[16] Nelitz v. Dyck (2001), 52 OR (3d) 458, 2001 CarswellOnt 27.

[17] Allan v. New Mount Sinai Hospital (1980), 109 D.L.R. (3d) 634, 28 O.R. (2d) 356 (H.C.J.) at paras. 28, 34, rev’d on other grounds (1981), 125 D.L.R. (3d) 276 (Ont. C.A.).

[18] CED, (Ontario 4th) vol 31, title 80 “Hospitals and Health Care”, at §121-122, see also Ellen I. Picard and Gerald B. Robertson, Legal Liability of Doctors and Hospitals in Canada, 4th edition, (Toronto: Thomson Carswell LLP, 2007), 41-54; John J. Morris and Cynthia D. Clarke, Law for Canadian Health Care Administrators, 2nd Edition (Markham, Ontario: LexisNexis, 2011),189-190.

[19] Halsbury’s Laws of Canada, 2013 reissue (LexisNexis Canada Inc., 2013) “Medicine and Health – III Consent to Treatment” (Contributor: Ayanna Ferdinand). Online: Quicklaw, www.lexisnexus.com;  Ciarlariello v. Schacter, [1993] 2 S.C.R. 119.

[20] Timothy Caufield, “Revising Core Principles: Autonomy, Consent, and the Biobanking Challenge” in Jocelyn Downie & Elaine Gibson, eds. Health Law at the Supreme Court of Canada (Canada: LexisNexis, 2007), 169,170.

[21] Malette v. Shulman, note 10, para. 18.

[22] Hopp v .Lepp, [1980] 2 SCR 192 (QL).

[23] Reibl v. Hughes, [1980] 2 SCR 880 (QL).

[24]Lorne E. Rozovsky, The Canadian Law of Consent to Treatment, 3d ed (Canada: LexisNexis, 2003), 161.

[25]Reibl v. Hughes, note 23, 4; Hopp v. Lepp, Note 23, 11-12;Rozovsky, note 24, 161.

[26] Rozovsky, note 24, 162.

[27] Rozovsky, note 24, 161.

[28] Rozovsky, note 24, 162.

[29] Rozovsky, note 24, 163.

[30] Rasouli, note 9, paras. 18-21.

[31] Stell v. Obedkoff, [2000] O.J. No. 4011 (S.C.J.), para. 201.

[32] Young v. Wellesley Hospital, [1994] O.J. No. 1341 (S.C.J.), paras. 122-123; Laurie v. Parham, 2010 MBCA 62, paras. 65-82. See also Flora v. Ontario (Health Insurance Plan, General Manager), 2008 ONCA 538 – discussing denial of OHIP funding.

[33] HCCA, note 1, s. 10.

[34] HCCA, note 1, s. 11(4).

[35] HCCA, note 1,  s. 11(1).

[36] HCCA, note 1, s. 11(2)-(3).

[37] HCCA, note 1, s. 12.

[38] HCCA, note 1, s. 14.

[39] HCCA, note 1, s. 2 “plan of treatment”.

[40] HCCA, note 1, s. 12.

[41] Rasouli, note 9.

[42] HCCA¸ note 1, s. 2(1).

[43] Rasouli, note 9, para. 68.

[44] Rasouli, note 9, para. 70.

[45] HCCA, note 1, ss. 25(3)(e), 26.

[46] HCCA, note 1, s. 29(4).

[47] HCCA, note 1, s. 27.

[48] HCCA, note 1, s. 25(5)-(9).

[49] HCCA, note 1, s. 25(5)-(9).

[50] HCCA, note 1, s. 2(1).

[51] HCCA, note 1, s. 40.

[52] Long-Term Care Homes Act, 2007, S.O. 2007, c. 8, ss. 44(11)(d), 46-47.

[53] HCCA, note 1, s. 47.

[54] HCCA, note 1, s. 2(1).

[55] HCCA, note 1, ss. 2(1) definition of “recipient,” 57-58.

[56] HCCA, note 1, s. 4(2).

[57] HCCA, note 1, s. 4(3).

[58] HCCA, note 1, s. 29.

[59] Starson, note 5, 759.

[60] HCCA, note 1, s. 4(1).

[61] HCCA, note 1, s. 15.

[62] Starson, note 5, at 761-763.

[63] HCCA, note 1, s. 17.

[64] College of Physicians and Surgeons of Ontario, Consent to Medical Treatment, Policy Number: #4-05 (February 2006), 6-7, online: College of Physicians and Surgeons of Ontario, http://www.cpso.on.ca/uploadedFiles/policies/policies/policyitems/Consent.pdf (Last accessed: October 15, 2013) (Consent Policy).

[65]Mental Health Act, R.S.O. 1990, c. M.7  s. 59 (note also that rights advice is given to the individual for whom a community treatment order is proposed, as well as to the individual’s SDM as applicable).

[66] M.A. v. Benes, 1999 Canlii 3807 (ON CA) para. 23.

[67] Referring to the classical hero Ulysses (Odysseus), who had himself tied to the mast of his ship and his sailors’ ears blocked with wax, so that he could hear the song of the sirens without being drawn closer to shore, where he and his sailors would die. See Homer, The Odyssey, Book XII, Trans. Samuel Barber, online: The Internet Classics Archive, http://classics.mit.edu/Homer/odyssey.12.xii.html (Last accessed, December 10, 2013).

[68] HCCA¸ note 1, s. 32; Substitute Decisions Act, 1992, S.O. 1992, c. 30 s. 50 (SDA).  

[69] SDA. note 68, s. 50.

[70] Starson, note 5, 759-760.

[71] HCCA¸ note 1, s. 32(5)-(7).

[72] HCCA¸ note 1, s. 18(1)-(3).

[73] HCCA¸ note 1, s. 18(4).

[74] HCCA¸ note 1, s. 19.

[75] HCCA¸ note 1, ss. 4(1), 47.1.

[76] HCCA¸ note 1, s. 2(1); Evaluators, O. Reg. 104/96.

[77] HCCA¸ note 1, s. 46.

[78] HCCA¸ note 1, ss. 4(1), 55-69.1.

[79] SDA, note 68, s. 45.

[80] SDA, note 68, s. 49(1), see also s. 66(2.1) and s. 67.

[81] SDA, note 68, s. 49(2).

[82] SDA, note 68, s. 49(2)-(3).

[83] SDA, note 68, s.1(1) “assessor”; Capacity Assessment, O. Reg. 460/05.

[84] SDA, note 68, s. 78(1).

[85] SDA, note 68, s. 78(2).

[86] SDA, note 68, ss. 50(2), 79.

[87] Health Care Consent Act, note 3, s. 20;  Advocacy Centre for the Elderly, “Tip Sheet # 2 Hierarchy of Substitute Decision Makers (SDMs) in the Health Care Consent Act”, online: Advocacy Centre for the Elderly, http://www.acelaw.ca/advance_care_planning_-_publications.php (Last accessed November 5, 2013).

[88] SDA, note 68, ss. 55-68.

[89] SDA, note 68, ss. 46-53, 66-68.

[90] HCCA¸ note 1, ss.  33. 51, 66.

[91] HCCA¸ note 1, ss.20(7)-(8) Definition of Spouse.

[92] HCCA¸ note 1, s .20(9)  Definition of Partner.

[93] HCCA¸ note 1, s.20(10) Definition of Relative.

[94] HCCA¸ note 1, s. 20(6).

[95] HCCA¸ note 1, ss. 20(2)-(3).

[96] HCCA¸ note 1, s. 33(6).

[97] HCCA¸ note 1, s. 33(6)2; D’Arcy Hiltz and Anita Szigeti, A Guide to Consent & Capacity Law in Ontario, 2013 Edition (Markham: LexisNexis, 2013) 185-186.

[98] HCCA¸ note 1, ss. 20(11).

[99] HCCA¸ note 1, s.20(4), Advocacy Centre for the Elderly, Note 90.

[100] HCCA, note 1,  ss. 20(5), 41.

[101] HCCA¸ note 1, s. 58.

[102] Personal Health Information Protection Act, 2004, S.O. 2004, c. 3, Sched. A, s. 26(6).

[103] HCCA¸ note 1, s. 66.

[104] HCCA¸ note 1, s. 21(1).

[105] HCCA¸ note 1, s. 21(2).

[106] HCCA¸ note 1, s. 22.

[107] M.A. v. Benes, note 66, para. 23.

[108] Rasouli, note 9, paras. 79-88.

[109] HCCA¸ note 1, s. 20(1); SDA, Note 68,   ss. 46-53, 66-68.

[110] SDA, note 68,  s. 46(7).

[111] Re K.M.S., 2007 Canlii 29956 (ON CCB), 11.

[112] SDA, note 68, s. 47(1).

[113] SDA, note 68, ss. 47-49.

[114] SDA, note 68, s. 50.

[115] SDA. note 56, s. 50.

[116] SDA, note 68, s. 55.

[117] SDA, note 68, ss. 58-59.

[118] SDA, Note 68, ss. 66-67.

[119] M.A. v. Benes, note 66, paras. 37-39.

[120] Rasouli, Note 9 , paras. 97-98.

[121] Grover v. Grover (2009), 176 ACWS (3d) 1193, 2009 CarswellOnt 1944 (Ont Sup Ct).

[122] HCCA, note 1, s. 33.

[123] HCCA¸ note 1, s. 34.

[124] HCCA¸ note 1, s. 36.

[125] HCCA¸ note 1, s. 35.

[126] HCCA¸ note 1, s. 37(4)-(7).

[127] HCCA¸ note 1, s. 1(c)(iii).

[128] HCCA¸ note 1, s. 21.

[129] HCCA¸ note 1, s. 5.

[130] Fram, note 6, 288.

[131] Committee Transcripts: Standing Committee on Administration of Justice – December 16, 1991 – Bill 74, Advocacy Act, 1992, and Companion Legislation, at 1700-1710, online: http://www.ontla.on.ca/web/committee-proceedings/committee_transcripts.do?locale=en.

[132] For example, see J.C. (Re), 2010 Canlii 52741 (ON CCB).

[133] Fram, note 6, 251.

[134] Fram, note 6, 48-49, 144, 253-256.

[135] M.A. v. Benes, note 66, para. 44.

[136] HCCA¸ note 1, ss. 25-27.

[137] HCCA¸ note 1, ss. 2(1) and 13.

[138] HCCA¸ note 1, s. 11(3).

[139] Scardoni v. Hawryluck, (2004) 69 OR (3d) 700, (Ont Sup Ct) (Scardoni).

[140] Scardoni, note 139, para. 59.

[141] Rasouli, note 9, at para. 105.

[142] M.B. (Re), 2008 Canlii 3954 (ON CCB) 21-22. see also K.M.S. (Re), 2007 Canlii 29956 (ON CCB) where the CCB held that, even if a statement in a power of attorney was not a wish applicable in the circumstances, it constitute the patient’s value and beliefs about the dying process.

[143] M.F. (Re), 2003 Canlii 14908 (ON CCB) 7-8.

[144] M.F. (Re), note 146, 9.

[145] M.F. (Re), note 146, 9, see also See I.A. (Re), 2004 Canlii 29268 (ON CCB) 15-16.

[146] S.S. (Re), 2012 Canlii 85612 (ON CCB) 14.

[147] S.S. (Re), Note 149, at pp. 13-14, 18; also see G.S. (Re) 2012 Canlii 42098 (ON CCB);

[148] M. (Re), 2009 CanLII 33714 (ON CCB) 5-11.

[149] Barbulov v. Cirone, 2009 Canlii 15889 (ON SC) paras. 45-48, 61, 95; see also Friedberg et al. v. Korn, 2013 ONSC 960.

[150] Rasouli, note 9, para. 96.

[151] Health Care (Consent) and Care Facility (Admission) Act,  RSBC 1996, c 181, s. 3.

[152] Health Care (Consent) and Care Facility (Admission) Act, note 151, s. 4.

[153] Health Care (Consent) and Care Facility (Admission) Act, note 151, s. 5.

[154] Health Care (Consent) and Care Facility (Admission) Act, note 151, s. 6, “advance directive”.

[155] Health Care (Consent) and Care Facility (Admission) Act, note 151, s 1.

[156] Representation Agreement Act, RSBC 1996, c 405.

[157] Representation Agreement Act, note 156, ss. 2, 7-8.

[158] Representation Agreement Act, note 156,  ss. 1 “health care”, 7-8; There are limitations on the treatments to which a representative can consent to, see Representation Agreement Act, note 156, s. 9(2).

[159] Representation Agreement Act, note 159, ss. 12, 20; We have been advised by a British Columbia lawyer that the requirement for a monitor for financial matters flows from the fact that the test for capacity to appoint a representative is lower than the threshold for capacity to create an enduring power of attorney in British Columbia. This resulted in the extra-protective measures of a monitor for representation agreements addressing financial matters.

[160] Representation Agreement Act, note 156, s. 16.

[161] Health Care (Consent) and Care Facility (Admission) Act, note 151, s. 19.3.

[162] Representation Agreement Act, note 156, s. 16.

[163] Representation Agreement Act, note 156, s. 16.

[164] Representation Agreement Act, note 156, s. 16(7).

[165] Health Care (Consent) and Care Facility (Admission) Act, note 151, s. 19.7.

[166] Health Care (Consent) and Care Facility (Admission) Act, note 151, s. 9(1.1) – however, there are some treatments for which consent by advance directive is not possible.

[167] Health Care (Consent) and Care Facility (Admission) Act, note 151, ss. 9, 19.7 – 19.8.

[168] Health Care (Consent) and Care Facility (Admission) Act, note 151, ss. 19.8(1).

[169] Health Care (Consent) and Care Facility (Admission) Act, note 151, ss. 19.8(2).

[170] Health Care (Consent) and Care Facility (Admission) Act, note 151, ss. 19.8(3).

[171] Health Care (Consent) and Care Facility (Admission) Act, note 151, s. 1 “advance directive”.

[172] Health Care (Consent) and Care Facility (Admission) Act, note 151, s.19; Representation Agreement Act, note 156, s. 16.

[173] Health Care (Consent) and Care Facility (Admission) Act, note 151, s. 16.

[174] Health Care (Consent) and Care Facility (Admission) Act, note 151, s. 19; Please note that there are limitations on the treatments to which a temporary substitute decision maker can consent to, see Health Care Consent Regulation, BC Reg 20/2000, s. 5.

[175] Health Care (Consent) and Care Facility (Admission) Act, note 151, s. 33.4. 

[176] Representation Agreement Act, note 156, ss. 30-34.

[177] Personal Directives Act, RSA 2000, c P-6.

[178] Personal Directives Act. note 177, s 1(l).

[179] Personal Directives Act. note 177, ss 1(k), 5(1).

[180] Personal Directives Act. note 177, s 14(1).

[181] Adult Guardianship and Trustee Act,  SA 2008, c A-4.2.

[182] Adult Guardianship and Trustee Act, note 181, ss. 3-10.

[183] Adult Guardianship and Trustee Act, note 181, s. 6.

[184] Personal Directives Act. note 177, s 14(2).

[185] Personal Directives Act. note 177, s 14(3); Interestingly, agents may also be required to make decisions in accordance with the best interests requirement under the Alberta Mental Health Act,  RSA 2000, c M-13, s. 28, leaving open the possibility of conflicting decision-making obligations.

[186] Personal Directives Act. note 177, s 19(1)(a).

[187] Personal Directives Act. note 177, s.  23.

[188] Personal Directives Act. note 177, s 19(1)(b).

[189] Personal Directives Act. note 177, s 19(2).

[190] Personal Directives Act. note 177, s. 14.

[191] Adult Guardianship and Trustee Act,  note 181.

[192] Adult Guardianship and Trustee Act, note 181, ss. 87-88.

[193] Adult Guardianship and Trustee Act, note 181, ss. 1 “nearest relative” , 89.

[194] Adult Guardianship and Trustee Act, note 181, s. 92

[195] Adult Guardianship and Trustee Act, note 181, s. 97; Personal Directives Act. note 177, ss. 25-27.

[196] Personal Directives Act. note 177, Part 4.1.

[197] Hospitals Act, RSNS 1989, c 208 s. 54(1).

[198] Personal Directives Act SNS 2008, c 8, s 3(1).

[199] Personal Directives Act, note 198, s. 3(1).

[200] Medical Consent Act, RSNS 1989, c 279, s. 3.

[201] Personal Directives Act, note 198, s. 22(2).

[202] Personal Directives Act, note 198, s. 15; Hospitals Act, RSNS 1989, c 208 s. 54A.

[203] Personal Directives Act, note 198, ss. 18(1-2).

[204] Personal Directives Act, note 198, s. 18(3)(a).

[205] Personal Directives Act, note 198, s. 18(3)(b).

[206] Personal Directives Act, note 198, s. 18(3)(c).

[207] Personal Directives Act, note 198, s. 15; Hospitals Act, RSNS 1989, c 208 s. 54A.

[208] Personal Directives Act, note 198, s 14.

[209] Personal Directives Act, note 198, s 14(2).

[210] Personal Directives Act, note 198, s. 15(4)(a).

[211] Personal Directives Act, note 198, s. 15(4)(b).

[212] Hospitals Act, note 197, s. 54(2).

[213] Personal Directives Act, note 198, ss. 29-31.

[214] Hospitals Act, note 197, ss. 54D, 58(2).

[215] Involuntary Psychiatric Treatment Act, SNS 2005, c 42, s. 65.

[216] Health Care Directives and Substitute Health Care Decision Makers Act, SS 1997, c H-0.001, ss. 2(1)(c), Part II.

[217] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s. 5(1).

[218] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s. 5(2).

[219] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s. 12.

[220] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s. 12.

[221] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s 5(1).

[222] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s. 2(1)(d).

[223] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s. 5(1).

[224] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, ss. 12, 16(3).

[225] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s. 16.

[226] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s. 15(1)(a-h).

[227] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s. 16(3).

[228] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s. 16(4).

[229] Health Care Directives and Substitute Health Care Decision Makers Act, note 216, s. 20.

[230] Mental Capacity Act 2005 (UK), 2005, c 9, ss. 42-43; Mental Capacity Act 2005: Code of Practice, (London: Department for Constitutional Affairs, 2007) online: Imperial College London, http://www3.imperial.ac.uk/pls/portallive/docs/1/51771696.PDF (Last accessed October 21, 2013) [Code of Practice].

[231] Mental Capacity Act, note 230, ss. 24-26.

[232] Mental Capacity Act, note 230,  s 9(1).

[233] Mental Capacity Act, note 230, s 19.

[234] Mental Capacity Act, note 230, s 19(1).

[235] Mental Capacity Act, note 230, ss. 11, 20.

[236] Mental Capacity Act, note 230, s 4.

[237] Mental Capacity Act, note 230, s 26(1).

[238] Mental Capacity Act, note 230, s 25.

[239] Mental Capacity Act, note 230, s 25(5).

[240] Mental Capacity Act, note 230,  s. 4(6).

[241] Mental Capacity Act, note 230, s.  9(4).

[242] Mental Capacity Act, note 230, s 11(1).

[243] Mental Capacity Act, note 230, s 11(7).

[244] Mental Capacity Act, note 230, s 11(8)(a).

[245] Mental Capacity Act 2005: Code of Practice, note 230, at 171.

[246] Mental Capacity Act 2005: Code of Practice, note 230, at 176.

[247] Mental Capacity Act 2005: Code of Practice, note 230, at 119-120.

[248] Mental Capacity Act 2005: Code of Practice, note 230, at 152.

[249] Mental Capacity Act, note 230, s 4.

[250] Mental Capacity Act, note 230, s 4(6).

[251] Mental Capacity Act 2005: Code of Practice, note 230, at 69-70.

[252] Mental Capacity Act, note 230, ss. 37, 40.

[253] Mental Capacity Act, note 230, s. 45-49.

[254] Code of Practice, note 230, 137.

[255] Code of Practice, note 230, 177.

[256] British Medical Association, “Consent Too kit”, 11, online: British Medical Association, http://bma.org.uk/practical-support-at-work/ethics/consent-tool-kit (Last accessed November 5, 2013).

[257] Aintree University Hospitals NHS Foundation Trust v. James, [2013] UKSC 67, paras. 19, 23.

[258] Guardianship and Administration Act 2000 (Qld), s. 64; see also Queensland Health, Guide to Informed Decision-making in Healthcare (Herston Queensland: Centre for Healthcare Improvement, 2012) Part 2.3, online: Queensland Government, http://www.health.qld.gov.au/consent/documents/ic-guide.pdf (Last accessed December 5, 2013).

[259] Powers of Attorney Act 1998 (Qld), s. 5(4).s 35.

[260] Powers of Attorney Act 1998 (Qld), note 260, s. 36(2).

[261] Powers of Attorney Act 1998 (Qld), note 260, ss. 32-33.

[262] Powers of Attorney Act 1998 (Qld), Schedule 1, ss.7, 12.

[263] Queensland Health, note 258, 24.

[264] Powers of Attorney Act 1998 (Qld), note 260, s. 36.

[265] Guardianship and Administration Act 2000 (Qld), s. 66.

[266] Queensland Health, note 258, 24.

[267] Powers of Attorney Act 1998 (Qld), note 260, s. 101.

[268] Queensland Health, note 258, 24.

[269] Powers of Attorney Act 1998 (Qld), note 260, s. 76.

[270] Powers of Attorney Act 1998 (Qld), Schedule 1, Part 2.

[271] Powers of Attorney Act 1998 (Qld), note 260, ss. 62-63.

[272] Queensland Civil and Administrative Tribunal Act 2009 (Qld); Guardianship and Administration Act 2000 (Qld), Chapters. 5-7.

[273] Robert S Olick, “Defining Features of Advance Directives in Law and Clinical Practice. (212) Chest 141(1), 232.

[274] Stuart Zimring, “Health Care Decision-Making Capacity: A Legal Perspective for Long-Term Care Providers” (June 2006), Journal of the American Medical Directors Association, Volume 7, Issue 5, 323.

[275] Olick, note 273, 232.

[276] See Oregon POLST Task Force, “Guidance for Oregon’s Health Care Professionals”, May 2012, online: Oregon POLST Task Force , www.oregonpolst.org/wp-content/uploads/2012/11/GuidebookMay2012final.pdf (Last accessed November 28, 2013).

[277] Oregon Revised Statutes, Title 13, Ch. 127.625 (ORS); see also Hawaii Revised Statutes, Div. 1, Title 19, Ch.327-E7 (HRS)and Texas Health and Safety Code, Title 2, Subtitle H, Ch. 166,  ss.166.045-166.046 (THSC).

[278] Zimring, note 274, 323.

[279] University of Hawaii Elder Law Program, “Health Care Decision Making” online: University of Hawaii, http://www.hawaii.edu/uhelp/healthcare.htm (Last accessed November 4, 2013).

[280] Hawaii Administrative Rules, Title 16, Ch.85-25.

[281] HRS, note 277, Ch.327E.

[282] HRS, note 277, Ch.327K.

[283] HRS, note 277, Ch.327E, note: HRS, Title 30, s.551D-2.5, addressing Guardians and Trustees, varies slightly, stating that “a competent person who has attained the age of majority may execute a durable power of attorney authorizing an agent to make any lawful health care decisions pursuant to chapter 327E.”

[284] HRS, note 277, s.327E-3(a)-(b).

[285] HRS, note 277,s.327E-3(g).

[286] HRS, note 277, s.327E-2.

[287] HRS, note 277, s. 327E-3(g).

[288] HRS, note 277, s.327E-7(d).

[289] HRS, note 277, s.327E-5(a).

[290] HRS, note 277, s.327E-5(f).

[291] HRS, note 277, s.327E-2.

[292] HRS, note 277,  s.327E-2.

[293] HRS, note 277, s.327E-5(b).

[294] HRS, note 277, S. 327E-5(g).

[295] HRS, note 277, s.327E-5(g).

[296] HRS, note 277, s.327E-14.

[297] HRS, note 277, s.327K-1.

[298] HRS, note 277,s.327K-2(a).

[299] HRS, note 277,s.327K-2(d).

[300] HRS, note 277,s.327K-2(a).

[301] HRS, note 277,s.327K-2(c).

[302] HRS, note 277, s.327K-2(a).

[303] ORS, note 277, Ch. 127.507.

[304] ORS, note 277,  Ch. 677.097.

[305] ORS, note 277, Ch. 127.505 – 127.660.

[306] ORS, note 277,Ch. 127.505(12).

[307] ORS, note 277,Ch. 127.535(4).

[308] ORS, note 277, Ch. 127.535(4).

[309] ORS, note 277, Ch.127.565.

[310] ORS, note 277, Ch.127.531.

[311] ORS, note 277, Ch.127.760(3)(c).

[312] ORS, note 277, Ch.127.555(3).

[313] ORS, note 277, Ch.127.565.

[314] ORS, note 277, Ch.127.635.

[315] ORS, note 277, Ch. 127.760.

[316] ORS, note 277, Ch. 127.635(3).

[317] ORS, note 277, Ch. 127.550.

[318] ORS, note 277, Ch. 127.550.

[319] ORS, note 277, Ch.127.663-127.684.

[320] Oregon Administrative Rules  847-35-0030(6) (OAR); See also  “Guidance for Oregon’s Health Care Professionals”, note 281.

[321] OAR, note 320,  847-35-0030(6); See also “Guidance for Oregon’s Health Care Professionals”, note 281, 1.  

[322] Oregon Administrative Rules, note 320, 8.

[323] THSC, note 277, ss. 74.104-74.105; see also Texas Medical Association, “Informed Consent” (February 2012) online: Texas Medical Association, http://www.texmed.org/Template.aspx?id=6049 (Last accessed November 4, 2013).

[324] THSC, note 277, s.166.152(a) [THSC].

[325] THSC, note 277, s.166.158(a).

[326] THSC, note 277, s.166.152(e).

[327] THSC, note 277, s.166.032.

[328] THSC, note 277, s.166.038(b).

[329] THSC, note 277, s.166.038(c).

[330] THSC, note 277, Ch. 166, Subchapter C.

[331] THSC, note 277, s.166.081.

[332] THSC, note 277, s.166.090(a).

[333] THSC, note 277, s.166.082.

[334] THSC, note 277, s.166.087.

[335] THSC, note 277, s.166.039(c), 166.088(c).

[336] THSC, note 277, s.166.039(e).

[337] THSC, note 277, s.166.152(e).

[338] THSC, note 277, s.166.039(b).

[339] THSC, note 277, s.166.039(e).

[340] THSC, note 277, s.166.039.

[341] THSC, note 277, ss. 166.039(g), 166.088(g).

[342] THSC, note 277, ss. 166.046.

[343] HRS, note 277, Ch..327E-7(d).

[344] Dunbrack, note 11, 19, 28.

[345] Dunbrack, note 11, 19-20.

[346] For example, statement that “choice, autonomy and self-determination” is a “Charter right” is broadly correct, but does not recognize some of the limitations on this right.  For example, the Charter right to patient autonomy, in the authors’ opinion, does not require that uninformed wishes must be complied with by health practitioners.

[347] Fram,  note 6, 251.

[348] HCCA, note 1,  s. 29.

[349] Our review the below documents was not exhaustive, but was focussed on the themes identified in this paper.  The fact that we have not commented on a particular passage of a document, should not be interpreted as an endorsement of that passage.

[350] Consent Policy, note 64, at 6.

[351] College of Physicians and Surgeons of Ontario, Decision-making for the End of Life, Policy Number: #1-06, (February 2006), 8, online : College of Physicians and Surgeons of Ontario, http://cpso.on.ca/policies-publications/policy/decision-making-for-the-end-of-life

(Last accessed: October 4, 2013) (End of Life Policy).

[352] ACE has prepared a broader commentary on the Consent and End of Life Policies, which can be accessed on the CPSO website through the below links:

http://policyconsult.cpso.on.ca/wp-content/uploads/2013/11/ACE-Consultation-Feedback-End-of-Life-Nov-22-2013.pdf; http://policyconsult.cpso.on.ca/wp-content/uploads/2013/11/ACE-Consultation-Feedback-Consent-Nov-22-2013.pdf (Last accessed January 2, 2014).

[353] End of Life Policy, note 351, 2.

[354] End of Life Policy, note 351, 3.

[355] End of Life Policy, note 351, 5.

[356] End of Life Policy, note 351, 4-5.

[357]Canadian Medical Protective Association,  “End-of-life care – Support, comfort, and challenging decisions” (Ottawa: Canadian Medical Protective Association, 2011) online: CMPA, https://oplfrpd5.cmpa-acpm.ca/safety/-/asset_publisher/N6oEDMrzRbCC/content/end-of-life-care-%E2%80%94-support-comfort-and-challenging-decisions;jsessionid=A9B6D8C0BFE1B4901A9F8C3E73284149

 (Last accessed: October 21, 2013) (End-of-life-care).

[358] Kenneth G. Evans, Consent: A Guide for Physicians, Fourth Edition (Ottawa: Canadian Medical Protective Association, 2006) online: CMPA, https://oplfrpd5.cmpa-acpm.ca/documents/10179/24897/com_consent-e.pdf (Last accessed October 21, 2013).

[359]Canadian Medical Protective Association, Medico-Legal Handbook for Physicians in Canada, Seventh Edition (Ottawa: Canadian Medical Protective Association, 2010) 24-29, online: CMPA, https://oplfrpd5.cmpa-acpm.ca/documents/10179/24891/com_medico_legal_handbook-e.pdf/a603321b-0721-4574-b216-4fe5b5701c8e (Last accessed October 21, 2013) (Medico-Legal Handbook).

[360] End-of-life-care, note 357, 3.

[361] Medico-Legal Handbook, note 359, 28; End-of-life-care, note 277, 1.

[362] Medico-Legal Handbook, note 359, 28.

[363] Medico-Legal Handbook, note 359, 25.

[364] Evans, note 358, 6.

[365] Canadian Medical Association, Canadian Nurses Association, Canadian Healthcare Association, and Catholic Health Association, “Joint Statement on Resuscitative Interventions”  Can Med Assoc J. Dec 1, 1995; 153(11) 1652A–1652F. (Ottawa: Canadian Medical Association, 1995) online: NCBI, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1488016/pdf/cmaj00083-0099.pdf (Last Accessed October 21, 2013) (Joint Statement).

[366] Canadian Medical Association, Advance Directives for Resuscitation and other Life-Saving or Sustaining Measures. (Ottawa, Canadian Medical Association, 1992) online: CMA, http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD92-02.pdf (Last Accessed October 21, 2013) (Advance Directives for Resuscitation).

[367] Joint Statement, note 365, 1652A–1652F.

[368] Advance Directives for Resuscitation and other Life-Saving or Sustaining Measures, note 366, 1-2.

[369] Joint Statement, note 365,1652A–1652.

[370]Canadian Medical Association, online: http://www.cma.ca/advance-directives-resuscitative-intervention (Last Accessed October 21, 2013).

[371] College of Nurses of Ontario, Consent  (Toronto: College of Nurses of Ontario, 2009) online, CNO, http://www.cno.org/Global/docs/policy/41020_consent.pdf (Last accessed October 21.2013).

[372] College of Nurses of Ontario, Guiding Decisions About End-of-Life Care, 2009 (Toronto: College of Nurses of Ontario, 2009) online, CNO, http://www.cno.org/Global/docs/prac/43001_Resuscitation.pdf (Last accessed October 21.2013).

[373] Ian Anderson Continuing Education Program in End-of Life Care, University of Toronto, “Overview”  online: http://www.cme.utoronto.ca/endoflife/Overview.htm (Last accessed November 15, 2013).

[374] Ian Anderson Continuing Education Program in End-of Life Care, University of Toronto, “Module 4 End-of-Life Decision-Making” online: http://www.cme.utoronto.ca/endoflife/Modules/End-of-Life%20Decision-Making%20Module.pdf

(Last accessed November 15, 2013) (Ian Anderson Module).

[375] Ian Anderson Module, note 374, 45.

[376] Ian Anderson Module, note 374, 27-28.

[377] Ian Anderson Module, note 374, 22.

[378] Ian Anderson Module, note 374, 45.

[379] Ian Anderson Module, note 374, 6,7.

[380] Ian Anderson Continuing Education program in End-of-Life Care website: http://www.cme.utoronto.ca/endoflife/Modules.htm (Last accessed January 2, 2013).

[381] Ian Anderson Module, note 374, 22.

[382] EFPPEC Website: http://www.afmc.ca/efppec/pages/main.html (Last accessed January 5, 2014).

[383] EFPPEC, note 14.

[384] We should also note that ACE does not endorse these materials.

[385] EFPPEC, note 14, 7.

[386] EFPPEC, note 14, 13.

[387] For example, see EFPPEC, note 14, 3, 7.

[388] For example, see EFPPEC, note 14, 27.

[389] For example, see EFPPEC, note 14, 54.

[390] Our review the below documents was not exhaustive, but was focussed on the themes identified in this paper. The fact that we have not commented on a particular passage of a document, should not be interpreted as an endorsement of that passage.

[391] Interrai, “Long-Term Care Facilities” online, Interrai: http://www.interrai.org/long-term-care-facilities.html (Last accessed November 5, 2013).

[392] Ontario Ministry of Health and Long-Term Care, Press Release: “Improving Care For Residents In Long-Term Care Homes” (May 5, 2009) online, Ontario Government: http://news.ontario.ca/mohltc/en/2009/05/improving-care-for-residents-in-long-term-care-homes.html (Last accessed November 5, 2013).

[393] Interrai and Canadian Institute of Health Information, Resident Assessment Instrument (RAI)

RAI-MDS 2.0 User’s Manual, Canadian Version, (Ottawa: Canadian Institute of Health Information, February 2012) (RAI-MDS 2.0 User’s Manual).

[394] RAI-MDS 2.0 User’s Manual, note 393, 247.

[395] RAI-MDS 2.0 User’s Manual, note 393, 69.

[396] Canadian Hospice Palliative Care Association, online: http://www.advancecareplanning.ca/ (Last accessed, October 30, 2013).

[397] Canadian Hospital Palliative care Association, Advance Care Planning Workbook Ontario Edition, (Ottawa: CHPCA) online: CHPCA, http://www.advancecareplanning.ca/media/73433/acp_ontario_workbook_final-rev2013-web.pdf (Last accessed, October 30, 2013).

[398] CHPCA, note 397,  5.

[399] CHPCA, note 397, 13-14.

[400] CHPCA, note 397, 14.

[401] Ian Anderson Module, note 374, 28.

[402] “This Year Give Something Different” online: Canadian Hospice Palliative Care Association, http://advancecareplanning.ca/media/101944/acp_holiday_infographics_2013_–_give_something_different_web.pdf (Last accessed December 17, 2013).

[403] Cancer Care Ontario, “Advance Care Planning Quality Improvement Toolkit” (October 2013) online: Cancer Care Ontario, https://www.cancercare.on.ca/pcs/primcare/qitoolkit/ (Last accessed November 4, 2013).

[404] “Advance Care Planning Quality Improvement Toolkit”, note 403.

[405] “Advance Care Planning Quality Improvement Toolkit”, note 403, 19-28.

[406] “Advance Care Planning Quality Improvement Toolkit”, note 403, 18, 24.

[407] “Advance Care Planning Quality Improvement Toolkit”, note 403,18, 24;

American Family Physician, “Sample Advance Directive Form” online: American Family Physician, http://www.aafp.org/afp/1999/0201/p617.html (Last accessed November 4, 2013).

[408] “Advance Care Planning Quality Improvement Toolkit”, note 403, 24; Respecting Choices Gunderson Health System, online: http://www.gundersenhealth.org/respecting-choices (Last accessed January 3, 2014).

[409] “Advance Care Planning Quality Improvement Toolkit”, note 403, 18.

[410] “Advance Care Planning Quality Improvement Toolkit”, note 403, 6.

[411] Cancer Care Ontario, “Advance Care Planning with Cancer Patients” (April 2012) 15 (22 in pdf), online: Cancer Care Ontario, https://www.cancercare.on.ca/common/pages/UserFile.aspx?serverId=6&path=/File%20Database/CCO%20Files/PEBC/pebc19-1f.pdf (Last accessed November 4, 2013).

[412] See “Advance Care Planning with Cancer Patients”, note 411, 4 (5 in pdf).

[413] Robert w. Sibbald, Paula Chidwick, Mark Handelman and Andrew B. Cooper, “Checklist to Meet Ethical and Legal Obligations to Critically Ill Patients at End of Life” Healthcare Quarterly, Vol. 14, No. 4, 2011, 60-66.

[414] Checklist for meeting Ethical and Legal Obligations ( ChELO ), application by Healthcare Consent Quality Collaborative, online: http://consentqi.ca/projects/chelo/

(Last accessed January 6, 2014) (ChELO Application).

[415] Sibbald, note 413, at p. 64; see also ChELO Application, Note 414.

[416] ChELO Application, note 414.

[417] Fraser Health, “Medical Orders for Scope of Treatment (MOST) and Advance Care Planning (ACP), June 13, 2013, online: Fraser Health, http://www.fraserhealth.ca/media/Medical%20Orders%20for%20Scope%20of%20Treatment%20(MOST)%20and%20Advance%20Care%20Planning%20(ACP).pdf (Last accessed ,October 31, 2013).

[418] Fraser Health, note 417, 1, 3.

[419] Ministry of Health and Long-Term Care,  Training Bulletin, Issue Number 108 – version 1.0 Do Not Resuscitate (DNR) Standard, November 29, 2007, Ministry of Health and Long-Term Care, 3, online: Ministry of Health and Long-Term Care, http://www.ambulance-transition.com/pdf_documents/training_bulletin_108_v1_dnr_standard.pdf (Last accessed January 3, 2014).

[420] Ontario Ministry of Citizenship, A Guide to Advance Care Planning (Toronto: Ontario Seniors’ Secretariat) online: Ontario Seniors’ Secretariat, http://www.seniors.gov.on.ca/en/advancedcare/docs/AdvancedCare.Guide.pdf (Last accessed October 31, 2013).

[421] Ontario Ministry of Citizenship, note 420, 14, 28.

[422] INTERACT, “Interventions to Reduce Acute Care Transfers website”, online: INTERACT, http://interact2.net/about.html (Last accessed November 1, 2013).

[423] “©2011 Florida Atlantic University, all rights reserved. This document is available for clinical use, but may not be resold or incorporated in software without permission of Florida Atlantic University”.

[424] “Advance Care Planning Tracking Form, INTERACT Version 3.0 Tools , 2, online: INTERACT http://interact2.net/docs/INTERACT%20Version%203.0%20Tools/Advance%20Care%20Planning%20Tools/INTERACT%20Advance%20Care%20Planning%20Tracking%20Form%20Dec%2029%202012.pdf (Last accessed November 1, 2013) (INTERACT Version 3.0 Tools).

[425] “Advance Care Planning Communication Guide”, INTERACT Version 3.0 Tools, 1, online: INTERACT,http://interact2.net/docs/INTERACT%20Version%203.0%20Tools/Advance%20Care%20Planning%20Tools/INTERACT%20ACP_Communication_Guide%20Jan%2019%202013.pdf (Last accessed January 5, 2014).

[426] D.W. Molloy, Rosalie Russo, Angela Stiller, and M.J. O’Donnell, “How to Implement the “Let me Decide” Advance Health and Personal Care Directive Program” (September 2000) Vol 7 No. 9 JCOM 41, 41-47, online: http://www.turner-white.com/pdf/jcom_sep00_how.pdf (Last accessed December 30, 2013).

[427] Dr. Michael Gordon, “WHO CAN YOU TRUST WITH YOUR MOST IMPORTANT END-OF-LIFE DECISIONS: LESSONS FROM THE ONTARIO COURT OF APPEAL?” Whaley Estate Litigation Newsletter Vol.3 No. 9 December 2013, online: http://archive.constantcontact.com/fs189/1105045552020/archive/1115958674352.html (Last accessed December 30, 2013).

[428] Molloy et al, note 426, 43.

[429] Molloy et al, note 426, 43.

[430] Schedule of Benefits for Physician Services under the Health Insurance Act, effective October 1, 2013, 9, online: Ontario Ministry of Health and Long-Term Care, http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/genpre.pdf  (Last accessed December 31, 2013).

[431]Judith Wahl, “Health Care Consent and Advance Care Planning: Fairly Good Law, Good Intent, but Not Always Good in Practice” (2013)  Advocacy Centre for the Elderly, 1-2.

[432] M.A. v. Benes, note 64, para. 23.

[433] Excellent Care for All Act, 2010, S.O. 2010, c. 14.

[434] Accreditation Canada, Senior Population Standards (April 25, 2013) 15.

[435] Capacity Assessment, O. Reg. 460/05.

[436] HCCA, note 1, s. 2.

[437] HCCA, note 1, s. 21(2).

[438] HCCA, note 1, s. 4.

[439] HCCA, note 1, s. 25.

[440] HCCA, note 1, s. 2.

[441] Evaluators, O. Reg. 104/96.

[442] Regulated Health Professions Act, 1991, S.O. 1991, c. 18 , Schedule 1.

[443] HCCA, note 1, s. 2.

[444] SDA, note 68,  s. 45.

[445] HCCA, note 1, s. 2.

[446] HCCA, note 1, s. 21(1).

[447] HCCA, note 1, s. 2.

 

 

 

 

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