According to Professional Practice Standards Section 3: Client-Therapist Relationship, registrants have a duty to place the well-being of the client at the forefront of the therapeutic relationship. With this in mind, consider the following:
The client’s ability to provide consent
In Ontario, there is no “age of consent” with respect to personal health care decisions. In general, clients of any age are considered capable of refusing or providing consent to their own treatment as long as they possess the maturity to reasonably understand the information provided and can appreciate the consequences of their decisions. Where a client is a minor (e.g. under the age of 16 for health care decisions, or under the age of 18 for decisions involving contracts), their capacity to provide consent must be determined on a case-by-case basis.
Every health practitioner who proposes a treatment to a client may perform this type of capacity assessment. Registrants are advised to use their professional judgement and to exercise appropriate care in determining whether a child is capable of consenting to treatment. Where a registrant determines that a child is incapable, treatment may not be carried out unless consent has been obtained from an appropriate substitute decision maker (SDM). Review Standard 3.2: Consent linked in Related Resources below, to see the hierarchy of SDMs.
Keep in mind that a client may be capable of giving consent for some aspects of care, but not others. It is registrants’ responsibility to identify the points where consent is possible and to engage the client in an appropriate informed consent process.
Custody orders and parental agreements
Where a client is not capable of providing consent, it is important to know information about the custody arrangements and whether a custody order or parental agreement exists, as these will inform who may make health care decisions on behalf of the child. For example, even when parents have joint custody, there may only be one parent who, under the custody order, may make decisions relating to the health care of the child.
Linked in Related Resources below, visit the Ontario government webpage on parenting arrangements, which provides information about the differences in custodial arrangements and the implications for health care decisions. See the section entitled “Types of parenting arrangements” where these concepts are explained.
Sharing personal health information
In situations where the client is a minor who is capable of providing consent, be advised that you will require the client’s informed consent in order to share their personal health information with parent(s) or guardian(s). Sensitivity to the issues that can arise in cases of separation and divorce, along with an awareness of the client’s particular concerns, will help you provide the information the client needs to make informed decisions about the sharing of their personal health information.
For more information, see our Informed Consent Workbook linked in Related Resources below.