Health practitioners are encouraged to tell their patient’s about advance care planning as well as to engage in such discussions with patients and the patient’s future SDMs. However many busy health practitioners question whether they have the time and resources to do this effectively.
There is medical and health literature that detail the benefits to the health system, to patients and their families, and to health practices if patients engage in advance care planning. By doing advance care planning, there may be savings in time and money and a reduction of conflicts and family disputes about decision-making for an incapable patient.
What does the law state about who should do specific tasks related to ACP and consent?
The law does require the health practitioner offering treatment:
- to get the informed consent before treatment,
- to determine whether the patient is capable to provide that consent 
- to determine who is the incapable patient’s SDM, 
- to explain to the SDM their duty to make decisions for the patient by honouring the patient’s previous capable wishes or acting in the nest interests of the patient. 
More details on what is involved in getting informed consent and what must be communicated by the health practitioner to the patient or SDM is explained in other Q and As. Also other Q and As detail whether any of these obligations may be delegated to another health practitioner or person although the health practitioner is responsible.
In respect to tasks related to advance care planning discussions, the law does not specifically place an obligation on any particular person to explain to a patient that they can express wishes about future care and to inform them that that their SDMs would make decisions for them when incapable although this would be of great benefit to a patient to know.
The law also doesn’t place a specific obligation on anyone to explain to the patient that the SDM is required to follow their capable wishes when making decisions for them and that if wishes are not know that the SDM then must make decisions in their best interests. This is in contrast to the legal requirement placed on health practitioner to explain to SDMs these principles of substitute decision making (wishes-best interests).
The law also doesn’t specify how some tasks need to be done. Do certain tasks need to be done through discussions whereas some information may be conveyed through written materials, posters, audio and video clips?
Could certain tasks, such as the asking the patient who would be a patient’s future SDM be incorporated into administrative procedures?
Assuming there is a benefit to the health practitioner, the patients and the SDMs, and to the health system to have everyone be more knowledgeable about advance care planning and health care consent, health practitioners and persons responsible for health systems management should think about the various elements of both health care consent and advance care planning and determine which tasks should be done by which people in a health practice, health facility or health service.
Who should do what tasks and the best way of doing those tasks related to health care consent and advance care planning is too complex to answer in a simple Q and A.
This question should alert health practitioners and health systems managers that attention should be paid to thinking through how information on advance care planning and health care consent should be communicated in the health system and in health services.
This is a more complex issue than it may appear on the surface and good advance care planning and good consent practices involve a variety of health practitioners, allied health and others. It is critical to understand how advance care planning is related to the requirement for informed consent before designing programmes on advance care planning. Any programmes on advance care planning or health care consent need to be reviewed to ensure that these are compliant with Ontario law before being used.
The relationship between ACP and health care consent is explained in another Q and A.