SDM
Everyone in Ontario has one automatically appointed.
What is a Substitute Decision Maker.
Step 1 in ACP
What is identifying your SDM.
Makes health care decisions ONLY when the patient is incapable of making their own decisions.
Who is the SDM or POAPC
Used to determine patients wishes, values and beliefs in order to inform future health care decisions, support goal-oriented and person centered decision making.
What are goals of care conversations.
Goals of Care conversations are the same as consent.
False - The term “goals of care” is not a legal term and is not defined in the Health Care Consent Act. GOC discussion may be very valuable and lead to better health decision making and consent / refusal of consent which is the required legal outcome
The Health Care Consent Act document referenced when determining a SDM.
What is the Substitute Decision Maker Hierarchy.
Step 2 in ACP
What is discussing your values, wishes and beliefs with your SDM. So they have a better understanding if and when they need to make health care decisions on your behalf.
Language often used in ACP and are illegal in Ontario.
What are "living will" and "advanced directives".
Discussions I have now about future health care scenarios are considered ACP and consent if that scenario were to occur. Yes or No.
What is no. Consent applies to a current medical condition, not one that may occur in the future. These conversations may help guide my SDM and my healthcare team in making decisions for me if I become mentally incapable of making my own, but it is not consent.
Goals of care are not decisions and patients/ SDM do not provide consent to a Goal of care. Goals of care precede and inform the discussion that leads to an informed consent decision.
ACP is a one time conversation.
False - ACP and GOC conversations are intended to better inform the SDM or POAPC and the health care team as to what your wishes may be in the event that you are unable to speak for yourself.
They are ongoing conversations and should occur as wishes, values, beliefs and/or condition changes.
Documents needing to be completed if you want to choose someone other than the SDM automatically appointed in Ontario.
What is Power of Attorney for Personal Care (POAPC) documents.
Intended to guide the patient’s future SDM to assist the SDM in making decisions for the patient when the patient becomes incapable. They are "wishes" and not decisions.
What are ACP "wishes".
The health practitioner MUST turn to the Public Guardian and Trustee for the decision and the PGT is required to act and cannot decline to act.
What is the action required when the equal ranking SDMs can't agree?
Is code status a goal of care. Yes or No.
No, Code status is not equivalent to Goals of Care.
The term “Code status” refers to the type of resuscitation procedures (if any) that the health care team would provide to a patient if the patient’s heart stopped beating and/or the patient stopped breathing. Code status requires an informed consent from the patient or incapable patient’s SDM. This is the result of a discussion between the patient / incapable patient’s SDM with a physician after the patient/ SDM is informed about the patient’s health condition.
Code status is a decision not a goal.
Consent can be obtained from the future SDM or POAPC if a capable person gives the health care provider permission.
False - SDMs only get authority to make decisions for the patient if the patient is incapable for treatment decision making.
The capable patient may rely on whomever they wish to assist them in making treatment decisions but they cannot delegate the responsibility of giving or refusing consent to someone else.
Ranks 4th on the SDM Hierarchy
Who is spouse or partner.
He or she must be:
(a) is capable with respect to the treatment;
(b) is at least 16 years old, unless he or she is the incapable person’s parent;
(c) is not prohibited by court order or separation agreement from having access to the incapable person or giving or refusing consent on his or her behalf;
(d) is available; and
(e) is willing to assume the responsibility of giving or refusing consent.
What is the criteria for a SDM.
I have Started the Conversation.
What is bonus points if you have identified your SDM and started the conversation.
If I have 3 children, my eldest is the legal SDM.
False - children and parents rank equally on the hierarchy. Therefore my parents and all 3 of my children would need to agree on the health care decision(s). It would be advisable to complete a POAPC document.
Legally appointed SDM
Automatic family member SDM
SDM of last resort
What are the types of SDM on the Hierarchy as per the HCCA.
May be communicated in writing, orally, or in any way that the person uses to communicates, such as via a computer, picture board or other assistive device.
Later expressed orally or by other means of communication will override earlier written ones.
What are ACP wishes.
The act defining law in relation to consent.
Health Care Consent Act - Ontario
An informed and contextualized decision involving a mentally capable person and a health care provider. Health care providers proposing treatment must obtain informed consent from either a capable patient or the mentally incapable patient’s SDM(s). This discussion must include an explanation of the persons' present condition (context), available treatment options, risks/benefits/side effects, alternatives to treatment and what would happen without the proposed treatment.
What is the definition and requirements of health care consent.
Family may prevent the HCP from informing the patient about their health condition/illness and treatments.
False - The HCP must get an informed consent from the patient before treatment and that requires that the health practitioner inform the patent of their illness and the treatment options.
Patients may consent to other family also being given all the information about the patient’s illness and the patient may seek help or support from the family in making health decisions but the family cannot block information being given to the capable patient.