Capacity and consent in Canada

November 19, 2007

An editorial in the Nov. 20, 2007 issue of the Canadian Medical Association Journal cases involving patients in 2 Canadian provinces to highlight the broadly divergent capacity and consent legislation in Canada. The authors state that the extremes within Canada's patchwork approach" to capacity and consent result in different management approaches and challenge clinicians, patients and families.

Consent legislation provides guidance on when physicians must seek consent to provide therapy, but guidance varies widely when physicians must seek consent to provide -- or withdraw -- therapy that is not medically indicated.

"At a minimum, all legislation should be based on an explicit national standard mandating the inclusion of patients' families and caregivers in the decision-making process," state the authors.

The CMAJ editorial concludes with a call for a national debate on the issues so that all relevant stakeholders are heard.

"These extremes of care, foisted upon Canadians through poorly conceived provincial consent and capacity legislation, should be amended," conclude the authors. "Failing this, national standards could be tied to federal transfer payments."
p. 1329 Whose life is it anyway? Capacity and consent in Canada
-- S. Straus, T. Stelfox

Canadian Medical Association Journal

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