As is evident throughout this Interim Report, legal capacity, decision-making and guardianship laws raise many difficult issues. Entangled as these laws are in the broader social contexts surrounding aging and disability, family caregiving, and delivery of health and social services, they present challenging ethical and practical questions. They also raise issues of fundamental rights for individuals who are very frequently vulnerable or marginalized. Consultees have emphasized to the LCO the gravity of the issues at stake in reforming these laws, and the seriousness of society’s responsibility to those affected. The LCO has taken this message to heart, and has attempted to craft recommendations that respond to the circumstances of those affected and that respect and promote their rights and wellbeing.
At the same time, the LCO has recognized the constraints surrounding reform of these laws, including fiscal restraints for government and key institutions, competing needs among stakeholders, and, in a number of areas, a lack of a clear evidentiary base on which to proceed.
There are two ways of approaching the implementation of the proposed reforms in this Interim Report. The first approach addresses the comprehensive impact and ultimate goals of the draft recommendations. As an aid to implementation and as part of its progressive realization approach to law reform in this area, the LCO has below identified key priorities for reform, those draft recommendations which have the greatest potential to substantially transform this area of the law and address the most serious, systemic issues. The second approach provides a practical framework for how to achieve this comprehensive reform over time. For this purpose, the LCO has identified draft recommendations which are relatively straightforward to implement, and so can be addressed in a shorter time frame, as well as those which require more time, thought or resources for implementation. These are discussed in section 3 below, and a full listing provided in Appendix B. The LCO’s identified priorities are not necessarily among those draft recommendations that are simplest to implement: the timeframes are not a reflection of priorities, but an acknowledgement of the challenges of reform. Institutions which are the subject of the LCO’s draft recommendations might choose to focus first on priority recommendations, or on first addressing more straightforward changes while working towards more challenging reforms.
A. Key Priorities for Reform
In this Interim Report, the LCO has made over fifty draft recommendations for reform to laws, policies and practices: a summary of these draft recommendations, organized by topic, can be found in Appendix A. Among these many draft recommendations, the LCO gives priority to those that most substantially and systemically address the key themes identified in Chapter I of reducing unnecessary and inappropriate intervention, improving access to the law, and enhancing the clarity and coordination of the laws. The LCO has identified as high priorities the following three sets of draft recommendations:
Expansion and reform of the Consent and Capacity Board to create an expert, independent, specialized administrative tribunal able to provide flexible, accessible and timely adjudication with respect to appointments of substitute decision-makers, resolve disputes related to the roles of these decision-makers, and enforce the rights under the legislation (Chapter VIII). In the view of the LCO, many of the shortfalls in the current system arise from the inaccessibility and inflexibility of the current rights enforcement and dispute resolution mechanisms under the Substitute Decisions Act, 1992, and an expanded administrative tribunal provides the most viable means of addressing these issues.
Relevant draft recommendations: 24-26, 32 – 33
· Transferring jurisdiction over the creation, variance and termination of guardianship appointments, and of the review of accounts and provision of directions regarding powers of attorney from the Superior Court of Justice to the CCB;
· Reforming the composition and rules of procedure of the CCB to strengthen its expertise and tailor its processes for this new jurisdiction, including reconsideration of current time limits for adjudication;
· Broadening the power of the CCB to provide directions with respect to the wishes of the person and to determine compliance with a substitute decision-maker’s obligations; and
· Development of a pilot project to develop a specialized mediation program at the CCB.
These reforms would not only enable more meaningful responses to widespread concerns regarding abuse and misuse of substitute decision-making powers, but would enable the application of a more tailored and limited approach to guardianship through the reforms proposed in Chapter IX and highlighted below.
Strengthening information and education for individuals affected, families and professionals and service providers involved with legal capacity and decision-making law (Chapter XI): it was clear to the LCO during public consultations that this area of the law is poorly understood. The complexity of the law makes this lack of knowledge and comprehension understandable, but in practice it leads to systemic shortfalls in the implementation of the law. Without better understanding of the law, not only is the current law poorly implemented, but any reforms would face the same challenges.
Relevant draft recommendations: 45 – 54
· Creation of a clear statutory mandate for coordination and development of education and information initiatives, strategies and materials, addressing the needs of persons directly affected, substitute decision-makers and supporters, professionals and service providers;
· Development of a central, coordinated clearinghouse of information for substitute decision-makers and supporters, in plain language and in a variety of accessible formats;
· Empowering adjudicators to require a guardian or person acting under a personal appointment to obtain education on specific aspects of her or his duties and responsibilities;
· Professional educational institutions and the health regulatory colleges re-examine their requirements and curricula in this area, and consider strengthening coverage of issues related to this area of the law.
Improving the quality of assessments of capacity and promote access to basic procedural rights for those found incapable under the Health Care Consent Act, 1996 (Chapter V): the LCO was gravely concerned about the widespread lack, in practice, of basic procedural and quality assurance protections for individuals whose fundamental rights to make determinations for themselves are being removed. These recommendations would improve understanding of the law among those responsible for administering assessments and providing rights information, strengthen access to the law for those found to be lacking legal capacity under the HCCA, and reduce inappropriate use of substitute decision-making under that Act.
Relevant draft recommendations: 8 – 14
· Creation of official Guidelines for assessments of capacity under the HCCA;
· Development of statutory minimum standards for the provision of rights information under the HCCA:
· Exploration of means of providing independent and expert advice about rights to persons found incapable under the HCCA;
· Strengthening oversight and supports for rights information provision through existing institutions, such as Health Quality Ontario, the Local Health Integration Networks and the monitoring and quality control systems for long-term care; and
· Monitoring and evaluating these reforms with respect to their success in administering assessments of capacity and respect for procedural rights.
B. Other Areas of Focus
The realization of the priorities through the draft recommendations identified above would have a transformative effect throughout this area of the law: addressing the priorities would have an overarching impact on multiple aspects of the law. The identification of these high priority recommendations does not detract from the significance of addressing concerns related to more specific issues, especially those regarding safeguards against abuse, and reducing or tailoring the use of guardianship. Concerns about these issues were raised by a wide range of stakeholders from the inception of this project, and identified as central to the effective functioning of this area of the law. They are profoundly connected to the values underlying the law, and addressed by the Framework principles.
Reducing or tailoring the use of guardianship (Chapters VI, IX): One of the central underlying aims of Ontario’s current laws regarding legal capacity, decision-making and guardianship is to avoid unnecessary or inappropriate intervention, and to preserve to the extent possible the autonomy of individuals whose decision-making abilities are impaired. Guardianship is intended as a last resort. In practice, however, there are significant shortfalls in Ontario’s current law, whether because of implementation challenges, or a lack of options to meet the diversity o