CRPO Exam Lab
Canada Therapy & Wellness
Printable sheet
canadatherapy.ca/crpo/sheets/consent
Consent and capacity, on one page
Valid consent, capacity, who decides for an incapable client, children, and consent to share information.
Valid consent (HCCA s. 11)
- Four elements: it relates to the treatment, is informed, voluntary, and not obtained by misrepresentation or fraud.
- Informed: nature, expected benefits, material risks and side effects, alternatives, consequences of no treatment, answers to questions.
- A signature does not necessarily make consent informed.
Ongoing and documented (Standard 3.2)
- On an ongoing basis; a significantly different approach needs fresh consent.
- Touch: express consent in every instance, even for a technique used before.
- Withheld or withdrawn: comply immediately.
- Document the date, what was discussed and how consent was indicated.
Capacity (HCCA s. 4)
- Capable: able to understand the relevant information and to appreciate the reasonably foreseeable consequences of a decision or of none.
- Presumed, unless there are reasonable grounds to believe otherwise; specific to the decision and to the moment.
- Appears to lack capacity: assess and document it; if incapable, identify the substitute decision-maker (3.2.1).
The substitute (HCCA ss. 20, 21)
- The highest-ranked person below who is capable, 16 or older (unless a parent), available, willing, and not barred by a court order or separation agreement.
- Nobody qualifies, or equals disagree: the Public Guardian and Trustee decides.
- They follow the client's prior capable wish applicable to the circumstances, made at 16 or older; failing one, their best interests.
Who decides, in rank order (HCCA s. 20 (1))
- Guardian of the person with authority for treatment
- Attorney for personal care with that authority
- Representative appointed by the Consent and Capacity Board
- Spouse or partner
- Child or parent, or a children's aid society or other person lawfully entitled to consent in the parent's place
- Parent with only a right of access
- Brother or sister
- Any other relative
Children and separated parents
- No minimum age for consent: a capable child consents to their own therapy and controls the information about that therapy.
- Incapable child: a parent decides; either may act for both (CLRA s. 20 (3)), except a separated parent the child does not live with, absent an order or agreement (s. 20 (4)).
- Read any order or separation agreement: it can set who decides, or bar a parent (HCCA s. 20 (2)).
Consent to share information (PHIPA)
- Circle of care: implied only for health care, between custodians, never once withheld. Not employers, insurers, lawyers, schools or family.
- CRPO strongly encourages express consent for other providers; share only what is relevant and necessary.
- A capable client decides, at any age. Under 16, a parent may too (not on treatment the child chose alone); a capable child prevails (s. 23).
Capacity for this decision, now. Consent the client understands, for this treatment.