Overview
Under the Health Care (Consent) and Care Facility (Admission) Act, every adult in B.C. has the right to:
- Accept or refuse health care
- Take part in decision making about their own health care
Health care professionals must obtain informed consent from a patient before providing a health care treatment. All adults are presumed to be capable of providing consent unless a health care provider determines them to be incapable of giving consent, for example if they are unconscious or mentally incapable.
If a health care provider finds an adult incapable of providing consent, and there is no legal substitute decision maker or advance directive, a temporary substitute decision maker (TSDM) may be needed. If there is no willing, available and qualified TSDM, the Public Guardian and Trustee (PGT) can authorize someone to be the TSDM. As a last resort, the PGT can act as TSDM.
Health care providers covered by the Act include physicians, dentists, nurse practitioners, nurses, physiotherapists, psychologists, occupational therapists, optometrists, chiropractors and others.
When an adult’s consent to health care is not required
Consent is not required when:
- Urgent or emergency health care is required, the adult is incapable of consenting and a committee or representative with authority to consent or a temporary substitute decision maker is not available
- When involuntary psychiatric treatment is needed under the Mental Health Act
- For preliminary examinations such as triage or assessment
Steps to go through before contacting the PGT
If you are a heath professional responsible for obtaining consent for health care treatment, the Health Care (Consent) and Care Facility (Admission) Act requires you to follow these steps:
Step 1
Ask the adult for a decision. An adult's representative, family or close friend may support them to make this decision.
Step 2
If you are concerned the adult doesn’t understand the information provided about the health care and that this information applies to the adult’s situation, find out if there is a decision maker you can contact. They are, in order:
- A court-appointed committee of person. They have the legal authority to make decisions about personal matters for the adult for whom they are acting.
- A representative appointed by the adult. They may be able to make the health care decision if the representation agreement covers the decision.
- A valid advanced directive. This gives or refuses consent to the health care or treatment proposed at a later date, when the adult is not capable of making health care decisions.
For more information on these decision makers and documents, see Personal planning options for adults.
Step 3
If there is no representative or committee of person and no valid advance directive, you must choose the first willing, available and qualified temporary substitute decision maker from this list:
- The adult’s spouse
- The adult’s child
- The adult’s parent
- The adult’s brother or sister
- The adult’s grandparent
- The adult’s grandchild
- Anyone else related by birth or adoption to the adult
- A close friend of the adult
- A person immediately related to the adult by marriage
To qualify to make the health care decision, the person chosen to be TSDM must:
- Be at least 19 years of age
- Have been in contact with the adult during the preceding 12 months
- Have no dispute with the adult
- Be capable of giving or refusing substitute consent
- Be willing to comply with the duties of a TSDM
Step 4
If there is no available, willing and qualified TSDM, or if there is a dispute between equally ranked TSDMs about who is to be chosen that cannot be resolved by the heath care provider, contact the PGT:
Phone: 1-877-511-4111
Fax: 604-660-9479
Email: AIS-PDS@trustee.bc.ca
The role of the PGT
Under the Health Care (Consent) and Care Facility (Admission) Act, the PGT has two possible roles
- Authorize an available, willing and qualified person to make the health care decision as a TSDM
- Act as TSDM to make the care facility admission decision
If the PGT acts as the TSDM, we will verbally advise you of the decision. We will then confirm the decision in writing. The adult is also advised of the decision.
- Minor health care decisions will be made within one day of receiving all the information required to make the decision
- Major health care decisions will be made within three days of receiving all information from the health care provider, taking into consideration the complexity and urgency of the adult’s health care
For more information about temporary substitute decision maker duties under the Act and the role of the PGT, see Guide to being a temporary substitute decision maker.
Restrictions on treatments
The Health Care (Consent) and Care Facility (Admission) Act does not apply to certain decisions such as:
- Those related to psychiatric treatment of involuntary patients under the Mental Health Act
- Non-therapeutic sterilization
- Certain communicable diseases set out in the law
In addition, a committee of person, representative or TSDM may be limited in the decisions that they can make depending on the scope of their authority under the relevant legislation, court order or authorizing document.
Resolving health care decision disputes
If you have concerns that a committee of person, or representative (or TSDM that was authorized by the PGT), is not complying with their duties, you can make a report to the PGT at 604-660-4507 or by sending an email to AIS-PDS@trustee.bc.ca. However, we cannot override decisions made by another substitute.