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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).


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