“The right to determine what shall or shall not be done with one’s own body, and to be free from non-consensual medical treatment is a right deeply rooted in Canadian common law. The right underlines the doctrine of informed consent.
“With very limited exceptions (such emergency use or incapacity), every person’s body is considered inviolate and accordingly every competent adult has the right to be free from unwanted medical treatment.
“The fact that serious risks or consequences may result from a refusal of medical treatment does not vititate the right of medical self-determination.
“The doctrine of informed consent ensures the freedom of individuals to make choices about their medical care. It is the patient, not the physician (or others) who ultimately must decide if treatment–any treatment–is to be administered.” Justice Robbins of the Ontario Court of Appeal.
I deeply believe that the key to optimal health is taking full responsibility and accepting all personal power for one’s own health. This may involve doing research, educating oneself, or assembling a team of trusted health professionals, with you, the patient at the centre.
We have a busy and overloaded healthcare system and even well-meaning professionals can find themselves hurriedly having a conversation in which they are not properly informing patients of the risks and benefits, or alternatives to treatment that they are recommending. I have had patients hurriedly scheduling for surgeries they weren’t sure they wanted, or pressured into hysterectomies or long-term treatments whose risks they didn’t understand.
I have also had patients make perplexing choices in the name of their own care–choices I didn’t necessarily agree with, such as forgoing conventional cancer treatments or further testing or screening.
However, it is the duty of the healthcare provider to provide advice. And it is the right of every patient to accept or reject that advice.
In light of recent, disturbing events, I have started posting some facts on Canadian law and Informed Consent only to be met with surprise–many people are not aware of their rights to refuse medical treatment, to be informed of the risks, and to be allowed to make a choice free of pressure or coercion.
Despite it being deeply enshrined in Canadian law, many patients are not aware of their right to full bodily integrity, autonomy, and choice.
Since 1980, the Supreme Court of Canada made it the right of every patient to be given full informed consent before any medical procedure such as taking blood, giving an injection or vaccination, performing a physical examination, exposing the patient to radiation, and so on.
“The underlying principle is the right of a patient to decide what, if anything, should be done with his body.” Is quote from the famous Supreme Court case of Hopp v. Lepp.
Every health professional under the Regulated Health Professions Act, including naturopathic doctors has a duty to uphold informed consent. We are well versed in it. We are required to uphold it, document it, and maintain it with every patient we see.
Our naturopathic guidelines on consent state, “The ability to direct one’s own health care needs and treatment is vital to an individual’s personal dignity and autonomy. A key component of dignity and autonomy is choice. Regulated health professionals hold a position of trust and power with respect to their patients and can often exercise influence over a patient; however, decision-making power must always rest with the patient.”
In 1996 Ontario passed the Health Care Consent Act, a legal framework for documenting, communicating, establishing and maintaining informed consent in all healthcare settings.
Informed consent is required before all treatment can be administered. Treatment includes: “anything that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health-related purpose, and includes a course of treatment, plan of treatment or community treatment plan.”
Informed consent must be present in 4 key areas:
- The consent must relate to the treatment.
- The consent must be informed.
- The consent must be given voluntarily, i.e.: made by the patient, and under no coercion, pressure, or duress.
- The consent must not be obtained through misrepresentation or fraud.
In order to obtain your full informed consent, you must be given the following information:
- The nature of the treatment.
- The expected benefits of the treatment.
- The material risks of the treatment, no matter how small, especially if one of the risks of side effects is death. The risks should not be minimized for the purpose of influencing your decision-making. The risks should be in relation to your health history. For example, if you suffer from cardiovascular disease, you should be made aware of the the risk of blood clots or myocarditis. It should also be disclosed if certain risks remain unknown.
- The material side effects of the treatment. Again, these side effects should be explicitly stated, no matter how small, and if long-term side effects are unknown, that should be stated.
- Alternative courses of action.
- The likely consequences of not having the treatment. These consequences should not be exaggerated and must be related to the particular patient at hand. What is the actual risk of the patient not receiving the treatment?
Consent cannot be given in a state of duress or coercion. Healthcare providers must be aware that they hold a position of authority and may maintain a power imbalance. They must not misrepresent the benefits of the treatment, and they must disclose any conflict of interest.
Healthcare providers must ensure that patients are not acting under the pressures of someone else, such as an employer, government agency or family member, and are making this decision on their own.
Finally,
The Informed Consent Guide for Canadian Physicians states, “Patients must always be free to consent to or refuse treatment, and be free of any suggestion of duress or coercion. Consent obtained under any suggestion of compulsion either by the actions or words of the physician or others may be no consent at all and therefore may be successfully repudiated. In this context physicians must keep clearly in mind there may be circumstances when the initiative to consult a physician was not the patient’s but was rather that of a third party, a friend, an employer, or even a police officer.
“Under such circumstances, the physician may be well aware that the paitent is only very reluctantly following the course of action suggested or insisted upon by a third person. Then, physicians should be more than usually careful to assure themselves that patients are in full agreement with what has been suggested, that there has been no coercion and that the will of other persons has not been imposed on the patient”.
It is your body and it is your choice. You always have the right to do what’s best for you. True, empowered health cannot come from a place of coercion or pressure.
Know that you always have a choice–your doctor has a duty to inform you of your choice, as well as the information necessary for you to make the right choice for you, regardless of what is happening in the media or in politics.
Informed consent is your right and it’s the law.
