The ''Health Care Consent Act'' (HCCA) is an Ontario law that has to do with the capacity to
consent
Consent occurs when one person voluntarily agrees to the proposal or desires of another. It is a term of common speech, with specific definitions as used in such fields as the law, medicine, research, and sexual relationships. Consent as und ...
to treatment. See also:
informed consent.
The HCCA states that a person has the right to consent to or refuse treatment if they have mental
capacity. In order to have capacity, a person must have the "ability" to ''understand'' and ''appreciate'' the consequences of the treatment decision. The law says that “a person is capable with respect to a treatment, admission to a care facility or a personal assistance service 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”.
Relationship to other Acts
The Ontario HCCA is relevant to the Ontario ''
Mental Health Act'' (MHA) because, while the MHA governs detention in a psychiatric facility, the HCCA governs whether or not a person can be treated while in hospital
(for example, with anti-psychotic medication that can reduce symptoms of serious mental illness such as
schizophrenia
Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social wit ...
).
The Ontario HCCA is relevant to the ''
Substitute Decisions Act.'' A person may be found to lack capacity for personal care and need a substitute decision maker (SDM) to decide whether to consent to or refuse treatment with
psychiatric medication
A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of ...
. The law says that “a person is incapable of personal care if the person is not able to ''understand'' information that is relevant to making a decision concerning his or her own health care, nutrition, shelter, clothing, hygiene or safety, or is not able to ''appreciate'' the reasonably foreseeable consequences of a decision or lack of decision.”
HCCA and the Right to Refuse Treatment
There is a widely reported
Supreme Court of Canada case called ''
Starson v. Swayze'' that dealt with the right of a mentally ill person to refuse treatment, even if it is in their best interests to be treated (for example, with
anti-psychotic medication that would reduce
delusional
A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some o ...
thinking).
The majority in ''Starson v. Swayze'' ultimately decided that Starson did not lack capacity so he could make his own treatment decisions, even if his decision (to refuse anti-psychotic medication that would reduce delusional thinking) was not in his best interests. As a result, he could not be treated with psychiatric medication, even if that meant that his health deteriorated as a result.
Critics of the decision in Starson argue that, because of mental deterioration, Starson did not have the capacity to make the decision to refuse treatment, and that his right to autonomy needs to be balanced with the right to be well. See also:
autonomy as opposed to
paternalism or
beneficence.
Autonomy is a complex concept in
bioethics
Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, m ...
that has many variations.
For example, there is the concept of
supported autonomy, that is, in order to support the autonomy of the person in the long term it may be necessary to compromise autonomy in the short term.
References
{{Reflist
External links
* ''Ontario Health Care Consent Act'
* ''Ontario Mental Health Act'
* ''Substitute Decisions Act'
* ''Starson v. Swayze'
* Ontario Consent and Capacity Boar
* Psychiatric Patient Advocate Offic
Health in Ontario
Ontario provincial legislation