View source for Health Care Consent Act (Ontario)

{{Short description|Ontario, Canada statute}}
{{italictitle|text=Health Care Consent Act}}
The '''''Health Care Consent Act''''' ('''HCCA''') is an [[Ontario]] law concerned with the capacity to [[consent]] to treatment and admission to care facilities. (i.e., [[informed consent]]).<ref name="Berg2001">{{cite book|author=Jessica W. Berg|title=Informed Consent: Legal Theory and Clinical Practice|url=https://books.google.com/books?id=b6w7V7gCkSIC|access-date=14 May 2012|date=12 July 2001|publisher=Oxford University Press|isbn=978-0-19-512677-8}}</ref><ref name="BloomBay1996">{{cite book|author1=Hy Bloom|author2=Michael Bay|title=A Practical Guide to Mental Health, Capacity and Consent Law of Ontario|url=https://books.google.com/books?id=BmD1PAAACAAJ|access-date=14 May 2012|date=1 March 1996|publisher=Carswell|isbn=978-0-459-55396-8}}</ref> {{As of|2023|August|2}} on a date to be named by proclamation of the Lieutenant Governor, the act will also apply to confining in a care facility.{{update after|2027|12|31|reason=This is the day section 10.1 of the Legislation, 2006 would apply to this. See https://www.ontario.ca/laws/public-statute-provisions-repealed-under-section-101-legislation-act-2006}}<ref>{{cite web |title=Health Care Consent Act, 1996, S.O. 1996, c.2, Sched. A |url=https://www.ontario.ca/laws/statute/96h02#BK1 |website=ontario.ca |publisher=elaws |access-date=7 August 2023}}</ref>

The HCCA states that a person has the right to consent to or refuse treatment if they have mental [[capacity (law)|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”.<ref>''Health Care Consent Act, 1996'', S.O. 1996, c. 2, Sched. A., §4, sub§1 [as of 2010-07-01].</ref>

==Relationship to other Acts==

The HCCA exists in addition to the Ontario ''[[Mental Health Act (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<ref name="Winick2005">{{cite book|author=Bruce J. Winick|title=Civil commitment: a therapeutic jurisprudence model|url=https://books.google.com/books?id=lWiQAAAAMAAJ|access-date=14 May 2012|date=30 January 2005|publisher=Carolina Academic Press|isbn=978-1-59460-021-0}}</ref> (for example, with anti-psychotic medication that can reduce symptoms of serious mental illness such as [[schizophrenia]]).

The Ontario HCCA is also 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]].{{Citation needed|date=May 2012}} 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.”<ref>[http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_92s30_e.htm ''Substitute Decisions Act, 1992'', S.O. 1992, c. 30], §45.</ref>

==HCCA and the Right to Refuse Treatment==
{{See also|Right to refuse medical 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]] thinking).<ref>{{cite web|url=http://scc.lexum.org/en/2003/2003scc32/2003scc32.html |title=Supreme Court of Canada - Decisions— Starson v. Swayze |publisher=Scc.lexum.org |date=2003-06-06 |access-date=2012-05-14}}</ref>

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 (ethics)|beneficence]].<ref name="ncbi">{{Cite journal | last=Metcalfe | first =D.H.H.  | title = FOR THE PATIENT'S GOOD: The restoration of beneficence in health care | journal =[[The Journal of the Royal College of General Practitioners]] |volume=38 |issue=316 |pages=526 |date=November 1988 | pmc=1711632}}</ref><ref>{{cite book|last=O'Neill|first=Onora|title=Autonomy and Trust in Bioethics|year=2002|publisher=Cambridge University Press}}</ref> Autonomy is a complex concept in [[bioethics]] that has many variations.<ref name="Post2004">{{cite book|author=Stephen Garrard Post |title=Encyclopedia of bioethics |url=https://books.google.com/books?id=LlBqAAAAMAAJ |access-date=14 May 2012 |year=2004 |publisher=Macmillan Reference USA |isbn=978-0-02-865916-9}}</ref> 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.<ref>{{cite web|url=http://www.library.yorku.ca/find/Record/2278009 |title=Holdings: Consent and capacity in Ontario's civil mental health system |publisher=York University Libraries |date= |access-date=2012-05-14}}</ref>

== References ==
{{Reflist}}

== External links ==
* ''Ontario Health Care Consent Act'' [http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_96h02_e.htm]
* ''Ontario Mental Health Act'' [http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90m07_e.htm]
* ''Substitute Decisions Act'' [http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_92s30_e.htm]
* ''Starson v. Swayze'' [http://scc.lexum.org/en/2003/2003scc32/2003scc32.html]
* Ontario Consent and Capacity Board [http://www.ccboard.on.ca/scripts/english/index.asp]
* Psychiatric Patient Advocate Office [http://www.sse.gov.on.ca/mohltc/ppao/en/default.aspx]{{Dead link|date=July 2024 |bot=InternetArchiveBot |fix-attempted=yes }}

[[Category:Health in Ontario]]
[[Category:Ontario provincial legislation]]