About the standard
This consultation closed on Jan. 15, 2024.
The Informed Consent standard (proposed new title: Informed Consent & Determining Capacity to Consent) was last reviewed in 2016. Expansion of the standard provides clarity around recording consent process, patient autonomy, safety around respecting boundaries and circumstances where proceeding without consent is permitted. Through these clarifications, both regulated members and their patients are better protected and supported throughout the physician-patient relationship.
- Proposed name change to Informed Consent & Determining Capacity to Consent to acknowledge content relating to defining the patient’s capacity to consent;
- Addition of a preamble and glossary to provide context for the standard and more detailed definitions;
- Added and amended language to emphasize the importance of the consent documentation process, patient autonomy, the physician-patient relationship, patient safety and shared decision-making;
- Directions included to better guide regulated members through different circumstances where proceeding without consent or delegating responsibility is permitted.
View the draft standard
For your convenience, the draft standard has clean and marked copies available.All Resources
Your opinion matters
Changes to CPSA’s Standards of Practice impact your day-to-day practice. Your feedback is important, as it helps us develop clear, reasonable expectations and helpful, applicable resources. We appreciate the time you took and the input you provided.
CPSA regulated members, partner organizations, other healthcare professionals and Albertans were invited to provide feedback from December 12, 2023 to January 15, 2024.
Anonymized feedback will be considered by Council at their March 2024 meeting. Once amendments are finalized and approved by Council, members will be notified by email and The Messenger newsletter.
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Other feedback on this standard
Asking for documentation of consent for every examination or visit would be a major shift in practice and a large burden on already busy physicians, without much if any benefit to patients. If a patient books an appointment because of a sore throat, it strikes me as quite over the top that there would have to be an informed consent discussion that I documented prior to looking in their throat. Implied consent should be kept as a concept, though physicians should be conscious of a patient's right to stop at any point, and the requirement to document the consent should be limited to specific circumstances, such as procedures. There can be a middle ground for items such as breast or genital exams, such as confirming that it is OK to proceed, or that they expect to have a Pap smear done etc, but I feel that is largely handled in the later section of the proposed standard. Documenting this in the middle of a complete physical, for example, seems to me to be too high of a burden, when a simple, "Is it OK if I do a breast exam now?" would generally suffice.
In your draft standard of practice on informed consent, when you have changed your pronouns from "him/her" to "their" and then refer back to the possessive "patient's" you have placed the apostrophe between the "t" and the "s" whereas in the draft standard of practice on conscientious objection, you used the word "patients'", placing the apostrophe beyond the "s". I do not know which is correct because, in both cases, the passages refer to individuals thus the plural pronouns shouldn't be used. However, if we are going to use the plural pronouns instead of individual ones in the standards, there should at least be some consistency.
On the issue of MAID, it needs to be pointed out that warnings were expressed when it was first implemented that it would quickly descend down a slippery slope towards expanded inclusion criteria. The powers at the time were adamant that it would not be expanded and these concerns were overblown and simply fear mongering. Looks like the objectors were correct after all. Just because it is legal, does not make it ethical. Doctors should push back against this legislation before it becomes law.
My experience as a patient and as a nurse, is that informed consent is considered burdensome by many physicians, who themselves don't actually know the adverse affects associated with many pharmaceutical interventions, so there is a tendency to downplay or even, sadly, gas-light to push aside pt. concerns and just move the patient through the system as quickly as possible. Just last week, I shared the drug monograph with the patient who identified an adverse effect relevant to her history that I was not aware of, in my short interview with her in a triage environment. I connected her to the physician to discuss her concerns before proceeding with the treatment, so that she would have actual informed consent. I have noticed that with the roll out of the covid vaccines, many patient's had questions about adverse effects associated and physicians seemed unwilling to discuss these with patients and were very dismissive. The unintended consequence of this, especially in light of subsequent vaccine injury that is coming to light, is that the physician/patient relationship has been violated. I see many patients reluctant to even come into hospital now, when they clearly would benefit from our care, and it seems to be related to lack of trust that has now developed. I try to reassure patients, but many are very suspicious of their MHRP now, and that is a new development.
While implied consent would apply to many actions in a doctor’s office (history taking, doing a blood pressure or basic exam, prescription refills), documenting this consent on every visit would be onerous and add significantly to the administrative burden.
Defining medical emergency for which informed consent is not required as ‘demonstrable severe suffering,” and for which treatment is required to “prevent prolonged suffering” opens the door for all sorts of abuses, including physician assisted suicide/MAiD when capacity has been lost. How is “suffering” defined? Who decides? Indeed, one could argue that in order to prevent prolonged suffering in almost any condition, a physician could proceed without consent for virtually any medication adjustment or treatment. In order to protect vulnerable patients who cannot give consent, medical emergency should be limited to “immanent threat to the life of the patient”. And treatments “to those necessary to deal with imminent threats to life, limb or health.”
This informed consent document gives "registered people" a license to manipulate patients. Thempa-acpm.ca/en/advice-publications/handbooks/consent-a-guide-for-canadian-physicians#standard is much much better and discusses many court cases which support the obligations of doctors and how they will be seen in court. Your draft says doctors should let patients know about common risks. WRONG. Doctors must disclose ALL risks that a reasonable person would want to know about. The risk of death, even if rare, is something that a doctor shouldn't trick a patient into not knowing about. They also must provide alternate treatments. I would request informed consent be sought through a written document providing the patient with at least 3 days to review and sign. The doctor must answer all and any questions brought by the patient. The doctor must never receive any money or incentive or pressure in any way from anybody except the patient. If the doctor is under duress to recommend a treatment because he fears to lose his job or if he will get kickbacks for having a certain number of patients take a treatment, this must be disclosed for the patient to have full informed consent. Doctors should face permanent suspension of membership if ever accused and found to have committed a breach of informed consent. All doctors should have to admit to and request pardon for the violation of informed consent that they have inflicted on the community through: childhood vaccines, ADHD and depression medications, Opioid and other pain medicines, statins and above all masking, isolation, distancing, no COVID early treatment and the COVID injections. The cowardice, ignorance and callousness of doctors means that have absolutely nothing to offer patients. This informed consent document could begin to recover something from the ashes of a once honourable profession.
Regarding Clause 3.b.: A point should be added regarding the course of action to be taken by a physician who suspects that the decision-maker is under "undue influence, duress or coercion in making the consent decision". A situation could exist where someone close to the patient has an undisclosed interest in or could benefit from the decision of the patient; this is of great concern in cases of MAID, for example.
Informed consent has been ignored these last few years during the lockdown scenario for sure. How could the coersed, fearmongered population be informed when an experimental drug/treatment had not been properly tested. Shameful years in Canada's history and for sure our medical history. Let's begin an about face and value ethical practices again. Informed consent leaves the individual in control of their health decisions. Informed consent means providing benefits and risks.
What constitutes 'reasonable grounds' to disagree with parents these days can be cause for concern. The Advice to the Profession Re: Informed Consent for Minors makes the point. They state, "The guardian’s decision must always be in the best interests of the child." Depending on the physician, this could be extrapolated to mean that disagreeing with their sacrosanct medical opinion is not an option. Who gets to decide?
The definition of 'reasonable understanding' that is alluded to in number 5 (d), and the 'capacity assessment process' in number 6, are areas where reasonable latitude can be exploited and may vary, depending on many factors, including the physician or surgeon's worldview. What should the consent of parents look like in these standards?
When I trained as a Nurse these matters were black and white. Mature minor consent could only be acceptable in matters of life of death, where the patient would die without intervention.
Now it seems to be expanding to whatever the healthcare system wants it to. This is alarming! Parental consent and parental rights need to be safeguarded. They know their child best and they are the ones who will deal with the long term consequences (and expenses) of their child’s actions. The government and public institutions cannot and must not usurp this authority!
As a person who has suffered incredibly physically for over 15 years, there were times I felt like a Veterinarian wouldn’t allow an animal to suffer like what I was enduring, however for me and for many, there was a light after a long tunnel, and its concerning how many may give up while in such vulnerable states if the option was so easily available to them. Although the journey here was unbelievably difficult, I am so thankful that I held on, as I am here blessed to live a full life and be a present Mother to my precious son. If someone in such difficult circumstances gave up and there was an easy option to help someone do that available, it’s concerning how many may take the ticket out in their suffering state. I trusted that if God still had me here, then He still had plans for me, and I’m so thankful my faith held the line in those excruciating times and I’m here to write this and to live my life. I felt called to write this as I know what it’s like to be desperate, to be beyond what you feel a humans capacity to endure is, it’s a very vulnerable difficult state. I have great compassion for those suffering, and I also have a testimony to offer, of hope, faith and freedom that choosing ‘life’ can bring.
All I can say about informed consent issue is that parents need to be involved in every aspect of their child's life. No government, official, physician or nurse should have any right to inform a child that death is an option under any circumstance. Parents must retain their right to parent their children in all levels and issues of life. I ask that informed consent of a minor at any age be rejected in the strongest way and that we consider life as sacred as we once did in this nation. When women and men put themselves in a position of playing God, it never works out well for anyone. As there is only one God and creator in whom we will all give an account to one day. Thank you