Who Decides? Patient Rights and Powers under the Ontario Health Care Consent Act & Substitute Decisions Act

Speaker: Maria McDonald JD, MHSc (Bioethics) | Michael Garron Hospital | University of Toronto Abstract: Decision-making is a core aspect of clinical care, yet becomes complex when patient capacity fluctuates. This Bioethics Grand Rounds session, in collaboration with Maria McDonald, will explore these challenges through a case-based discussion. Using evolving hypothetical cases, we will examine key issues including capacity evaluation, the limits of deferring decisions, and the responsibilities of substitute decision makers when decisions conflict with a patient’s known wishes and values - all grounded in the legal framework of Ontario’s Health Care Consent Act and Substitute Decisions Act. Learning Objectives: - Distinguish between capacity evaluation under the Health Care Consent Act and formal capacity assessment under the Substitute Decisions Act. - Apply Ontario’s Health Care Consent Act to determine who should make treatment decisions when capacity fluctuates or a patient defers to family. - Identify appropriate ethical and legal responses when an SDM’s decision appears inconsistent with the patient’s wishes, values, beliefs, or best interests. Bio: Maria McDonald is a member of the Health Ethics Alliance affiliated with the Sunnybrook Hospital and works half-time as the Bioethicist at Michael Garron Hospital. For 15 years she was the course director for a half-year course on law, policy and ethics in the Masters of Health Science Program in Bioethics at the University of Toronto Joint Centre for Bioethics. She continues to be an Associate Member of the UofT Dalla Lana School of Public Health. Maria has a strong interest in topics that intersect law, policy and ethics such as justified decision making, consent and capacity, and human rights in health care settings.