CNO Consent and Capacity in Nursing Practice 2 — Questions and Answers
Question 1: Under the Health Care Consent Act, which TWO criteria must BOTH be met to find a person incapable of making a treatment decision?
- Age over 65 and presence of a cognitive diagnosis
- Unable to understand relevant information AND unable to appreciate the consequences (Correct answer)
- Diagnosis of mental illness AND refusal of recommended treatment
- Inability to communicate verbally AND absence of a substitute decision maker
Correct answer: Unable to understand relevant information AND unable to appreciate the consequences
Incapacity under the HCCA requires that the person cannot understand information relevant to the decision AND cannot appreciate the reasonably foreseeable consequences of consenting or refusing.
Question 2: Who holds the highest priority as a substitute decision maker (SDM) for an incapable adult under Ontario's Health Care Consent Act hierarchy?
- Spouse or partner
- Attorney for personal care named in a power of attorney
- Court-appointed guardian of the person with treatment authority (Correct answer)
- Adult child of the incapable person
Correct answer: Court-appointed guardian of the person with treatment authority
A court-appointed guardian of the person who has been granted authority to make treatment decisions ranks highest in the HCCA substitute decision maker hierarchy.
Question 3: When making treatment decisions on behalf of an incapable person, what standard must a substitute decision maker apply first?
- What the SDM believes is in the incapable person's best medical interest
- The prior capable wishes expressed by the incapable person when they were capable (Correct answer)
- The recommendation of the treating healthcare team
- The consensus of the majority of family members present
Correct answer: The prior capable wishes expressed by the incapable person when they were capable
SDMs must first apply any prior capable wishes expressed by the incapable person; only when no wishes are known may they use the best interests standard.
Question 4: A nurse disagrees with a substitute decision maker's refusal of a recommended treatment for an incapable client. What is the most appropriate first action?
- Proceed with the treatment to protect the client from harm
- Immediately file an application with the Consent and Capacity Board
- Discuss concerns with the healthcare team and consider ethics consultation (Correct answer)
- Document the disagreement and take no further action
Correct answer: Discuss concerns with the healthcare team and consider ethics consultation
When conflict arises with an SDM's decision, the nurse should first address concerns through team discussion and available resources such as ethics consultation before escalating to the Consent and Capacity Board.
Question 5: A capable 16-year-old refuses a blood transfusion on religious grounds. How should the nurse respond?
- Obtain consent from the parents, who have authority over all minors in Ontario
- Proceed with the transfusion because it is life-saving
- Respect the capable minor's refusal and escalate to the healthcare team (Correct answer)
- Contact child protective services immediately
Correct answer: Respect the capable minor's refusal and escalate to the healthcare team
Ontario's HCCA sets no minimum age for capacity; any person capable of understanding a treatment decision — including minors — has the right to consent or refuse.
Question 6: A client who was previously capable and is now found incapable once stated clearly that they never wanted cardiopulmonary resuscitation. What is this statement's legal status?
- An advance directive that is no longer enforceable once the person loses capacity
- A prior capable wish that the substitute decision maker is legally obligated to follow (Correct answer)
- A general preference that requires physician verification before it can be honored
- An informal oral statement with no legal weight under the HCCA
Correct answer: A prior capable wish that the substitute decision maker is legally obligated to follow
Prior capable wishes expressed by a person while capable retain their legal force under the HCCA and must be followed by the substitute decision maker.
Question 7: Which body in Ontario has the authority to review findings of incapacity made by health practitioners and resolve disputes between substitute decision makers and healthcare providers?
- The College of Nurses of Ontario
- The Ministry of Health and Long-Term Care
- The Consent and Capacity Board (Correct answer)
- The Office of the Public Guardian and Trustee
Correct answer: The Consent and Capacity Board
The Consent and Capacity Board is an independent tribunal that reviews capacity findings, resolves SDM disputes, and can authorize treatment in certain circumstances.
CNO Consent and Capacity in Nursing Practice 2
Under the Health Care Consent Act, which TWO criteria must BOTH be met to find a person incapable of making a treatment decision?