Glossary2017-03-03T18:33:23+00:00

Advance Care Planning

A generic term used across many jurisdictions to describe the process of planning by an individual for a time when he or she no longer has the mental capacity to make decisions about health care. Advance care planning is comprised of two elements:

(1) Selection of the individual who will make decisions for the patient in the event the patient becomes incapable (sometimes referred to as a “Proxy Directive,” as the patient is designating their proxy decision-maker – referred to as the SDM in the HCCA); and,

(2) Expression of wishes, values, and beliefs about future health care decisions to be made in the event the patient becomes incapable (sometimes referred to as the “Instructional Directive,” as the patient is giving instructions about future care – referred to as “wishes” in the HCCA).   


Advance Directive

A generic term used in Ontario to refer to specific communications from patients containing the patient’s express wishes regarding health care choices in the future. In the HCCA, these wishes may be communicated orally, in writing, or by alternative means. However, in many other jurisdictions this phrase refers instead to a formal document providing directions to a health practitioner and substitute decision-maker. The term “Advance directive” is also sometimes used beyond the expression of wishes, values, and beliefs (instructional directives) to refer to the designation of a substitute decision-maker (a proxy directive).  Under the SDA and HCCA, a proxy directive would be a power of attorney for personal care designated an attorney for personal care. A power of attorney for personal care may also include wishes, values and beliefs.

 

Agent

A legal term used in this Paper, in the broadest sense, to refer to the individual appointed by the patient to make health care decisions on the patient’s behalf. Under the HCCA, the patient’s agent would be his/her SDM.

 

Assessor (commonly referred to as a “Capacity Assessor”)

Means a member of the:

1. College of Physicians and Surgeons of Ontario.
2. College of Psychologists of Ontario.
3. Ontario College of Social Workers and Social Service Workers and holding a certificate of registration for social work.
4. College of Occupational Therapists of Ontario.
5. College of Nurses of Ontario and holding a general certificate of registration as a registered nurse or an extended certificate of registration as a registered nurse,

who has complied with the requirements set out in regulation, as quoted below:

Persons qualified to do assessments of capacity

2. (1) A person is qualified to do assessments of capacity if he or she,

(a) satisfies one of the conditions set out in subsection (2);
(b) has successfully completed the qualifying course for assessors described in section 4;
(c) complies with section 5 (continuing education courses);
(d) complies with section 6 (minimum annual number of assessments); and
(e) is covered by professional liability insurance of not less than $1,000,000, in respect of assessments of capacity, or belongs to an association that provides protection against professional liability, in respect of assessments of capacity, in an amount not less than $1,000,000. O. Reg. 460/05, s. 2 (1).

(2) The following are the conditions mentioned in clause (1) (a):

1. Being a member of the College of Physicians and Surgeons of Ontario.
2. Being a member of the College of Psychologists of Ontario.
3. Being a member of the Ontario College of Social Workers and Social Service Workers and holding a certificate of registration for social work.
4. Being a member of the College of Occupational Therapists of Ontario.
5. Being a member of the College of Nurses of Ontario and holding a general certificate of registration as a registered nurse or an extended certificate of registration as a registered nurse. O. Reg. 460/05, s. 2 (2).

(3) The requirement that the person hold a general certificate of registration as a registered nurse or an extended certificate of registration as a registered nurse, as set out in paragraph 5 of subsection (2), does not apply to a member of the College of Nurses of Ontario who, on November 30, 2005, is qualified to do assessments of capacity under Ontario Regulation 293/96 (Capacity Assessment) made under the Act. O. Reg. 460/05, s. 2 (3).

(4) Clause (1) (b) does not apply to a person who, on November 30, 2005, is qualified to do assessments of capacity under Ontario Regulation 293/96 (Capacity Assessment) made under the Act. O. Reg. 460/05, s. 2 (4). [435]

 

Attorney for Personal Care

An attorney under a power of attorney for personal care given under the Substitute Decisions Act, 1992.[436]

 

Best Interests

The HCCA sets out the following considerations that must be considered as part of determining the patient’s best interests:

21(2) In deciding what the incapable person’s best interests are, the person who gives or refuses consent on his or her behalf shall take into consideration,

(a) the values and beliefs that the person knows the incapable person held when capable and believes he or she would still act on if capable;
(b) any wishes expressed by the incapable person with respect to the treatment that are not required to be followed under paragraph 1 of subsection (1); and
(c) the following factors:

1. Whether the treatment is likely to,
i. improve the incapable person’s condition or well-being,
ii. prevent the incapable person’s condition or well-being from deteriorating, or
iii. reduce the extent to which, or the rate at which, the incapable person’s condition or well-being is likely to deteriorate.

2. Whether the incapable person’s condition or well-being is likely to improve, remain the same or deteriorate without the treatment.

3. Whether the benefit the incapable person is expected to obtain from the treatment outweighs the risk of harm to him or her.

4. Whether a less restrictive or less intrusive treatment would be as beneficial as the treatment that is proposed.[437]

 

Capacity

Under the HCCA, a person is capable with respect to treatment, admission to a care facility or personal assistance services if the person is able to understand the information that is relevant to making a decision about the treatment, admission or personal assistance service, as the case may be, and able to appreciate the reasonably foreseeable consequences of a decision or lack of decision.[438]

 

Default SDM

The individual authorized to make a particular health care decision on behalf of an incapable patient under the HCCA, where the incapable patient has not otherwise selected an individual to make that health care decision.

 

Emergency

There is an emergency if the person for whom the treatment is proposed is apparently experiencing severe suffering or is at risk, if the treatment is not administered promptly, of sustaining serious bodily harm.[439]

 

Evaluator

Means, in the circumstances prescribed by the regulations [under the HCCA],

(a) a member of the College of Audiologists and Speech-Language Pathologists of Ontario,
(b) a member of the College of Dietitians of Ontario,
(c) a member of the College of Nurses of Ontario,
(d) a member of the College of Occupational Therapists of Ontario,
(e) a member of the College of Physicians and Surgeons of Ontario,
(f) a member of the College of Physiotherapists of Ontario,
(g) a member of the College of Psychologists of Ontario,
(h) a member of a category of persons prescribed by the regulations as evaluators,[440] or,
a member of the Ontario College of Social Workers and Social Service Workers.[441]

 

Grantor

A legal term referring to an individual who has granted legal rights and responsibilities to another individual – such as an individual granting authority under a power of attorney for personal care to a substitute decision-maker.

 

Guardian with authority for personal care

A guardian of the person appointed under the Substitute Decisions Act, 1992, where the terms of the guardianship order grant the guardian authority to make personal care decisions.

 

Health Care

A broad term used in this paper to refer to all decisions made for a health-related purpose, including decisions about treatment, admission to a care facility, and personal assistance services in a care facility.

 

Health Practitioner

Means a member of an Ontario health regulatory college governing the following health professions under the Regulated Health Professions Act:

Audiology and Speech-Language Pathology
Chiropody
Chiropractic
Dental Hygiene
Dental Technology
Dentistry
Denturism
Dietetics
Kinesiology
Massage Therapy
Medical Laboratory Technology
Medical Radiation Technology
Medicine
Midwifery
Nursing
Occupational Therapy
Opticianry
Optometry
Pharmacy
Physiotherapy
Psychology
Respiratory Therapy
Traditional Chinese Medicine[442]

and also means a naturopath registered as a drugless therapist under the Drugless Practitioners Act or a member of a category of persons prescribed by the regulations as health practitioners.[443]

 

Instructional Directive

A broad term referring to expressions of wishes, values, and beliefs made by the patient about future health care decisions to be made in the event the patient becomes incapable.

 

Patient

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.

 

Personal Care

A broad term encompassing health care, nutrition, shelter, clothing, hygiene or safety, as defined under the SDA.[444]

 

Plan of Treatment

Means a plan that,

(a) is developed by one or more health practitioners,
(b) deals with one or more of the health problems that a person has and may, in addition, deal with one or more of the health problems that the person is likely to have in the future given the person’s current health condition, and
(c) provides for the administration to the person of various treatments or courses of treatment and may, in addition, provide for the withholding or withdrawal of treatment in light of the person’s current health condition. [445]

 

Power of Attorney for Personal Care

A formal written document under the Substitute Decisions Act, 1992 appointing an attorney for personal care, which may also give instructions to that attorney.

 

Principal

A legal term, referring to the person on whose behalf decisions are made by an agent. In some jurisdictions, a patient-appointed substitute decision-maker is referred to as an agent in legislation.

 

Prior Capable Wish

Under the HCCA, a wish applicable to the circumstances that the incapable person expressed while capable and after attaining 16 years of age.[446]

 

Proxy

A term used in the broadest sense in this paper to refer to the individual selected by the patient to make decisions for the patient.

 

Proxy Directive

A term used in the broadest sense in this paper to refer to a statement selecting the individual who will make health care decisions for the patient in the event the patient becomes incapable       

 

SDM (Substitute Decision-Maker)

A term used in the broadest sense in this Paper to refer to any individual making health care decisions on behalf of another individual.

 

Treatment

Under the HCCA, treatment means anything that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health-related purpose, and includes a course of treatment, plan of treatment or community treatment plan, but does not include,

(a) the assessment for the purpose of this Act of a person’s capacity with respect to a treatment, admission to a care facility or a personal assistance service, the assessment for the purpose of the Substitute Decisions Act, 1992 of a person’s capacity to manage property or a person’s capacity for personal care, or the assessment of a person’s capacity for any other purpose,

(b) the assessment or examination of a person to determine the general nature of the person’s condition,

(c) the taking of a person’s health history,

(d) the communication of an assessment or diagnosis,

(e) the admission of a person to a hospital or other facility,

(f) a personal assistance service,

(g) a treatment that in the circumstances poses little or no risk of harm to the person.[447]

 

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