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:
- consent must be given by a person who is capable of giving consent with respect to treatment;
- consent must relate to the treatment;
- consent must be informed;
- consent must be given voluntarily; and
- 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:
- received the following information that a reasonable person in the same circumstances would require in order to make a decision about the treatment:
- the nature of the treatment;
- the expected benefits of the treatment;
- the material risks of the treatment;
- the material side effects of the treatment;
- alternative courses of action;
- the likely consequences of not having the treatment; and
- 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:
- Able to understand the information that is relevant to making a decision about the treatment or alternatives being proposed; and
- 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).