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Consent to Treatment in Non- Emergency Situations

Except in emergency circumstances described below, paramedics shall obtain consent prior to administering treatment. If a patient is incapable of consenting to the treatment being proposed by a paramedic, consent may be given or refused on his or her behalf by the patient’s substitute decision- maker (SDM). Consent may be expressed or implied. Implied consent may be assumed where a person provides a physical indication that they consent to the treatment being proposed. For example, a patient who cannot speak but extends his hand to a paramedic after the paramedic indicates she is going to perform a simple procedure, such as a blood glucose determination, may be giving implied consent to the treatment.

The elements required for consent to treatment are:

  1. consent must be given by a person who is capable of giving consent with respect to treatment;
  2. consent must relate to the treatment;
  3. consent must be informed;
  4. consent must be given voluntarily; and
  5. consent must not be obtained through misrepresentation or fraud.

Consent to treatment is informed if, before it is given by the person, he or she has:

  1. received the following information that a reasonable person in the same circumstances would require in order to make a decision about the treatment:
    1.  the nature of the treatment;
    2. the expected benefits of the treatment;
    3. the material risks of the treatment;
    4. the material side effects of the treatment;
    5. alternative courses of action;
    6. the likely consequences of not having the treatment; and
  2. received responses to his or her requests for additional information about those matters.

Valid consent requires that a person has the capacity to provide consent. A person is presumed to have the capacity to provide consent with respect to treatment and a paramedic may rely on that presumption unless the paramedic has reasonable grounds to believe that the person is capable with respect to the treatment. A paramedic must perform a capacity assessment if it is not reasonable in the circumstances to presume the person is capable of consenting to the treatment.

A patient is capable with respect to treatment if the patient is:

  1. Able to understand the information that is relevant to making a decision about the treatment or alternatives being proposed; and
  2. Able to appreciate the reasonably foreseeable consequences of a decision or lack of decision with respect to

If a patient is incapable of consenting to a proposed treatment, and the paramedic is aware or is made aware that the person has a prior capable wish with respect to the proposed treatment, they must respect that wish (for example, if the person does not wish to be resuscitated).

Contact

Ministry of Health and Long-Term Care
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5

416-327-7900

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