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Introduction

There are two facets to consent:

• consent to collect, use and disclose personal health information, and
• content to services

Consent to collect, use, and disclose personal health information is directed by the Personal Health Information Protection Act (PHIPA) and must:

• be a consent of the individual
• relate to the information;
• must not be obtained through deception or coercion; and
• be knowledgeable.

Consent is knowledgeable if it is reasonable in the circumstances to believe that the individual knows:

• the purposes of the collection, use or disclosure; and
• that they may give or withhold consent.

Consent to services, as directed by the Health Care Consent Act, must be "valid". This means that before an audiologist or speech-language pathologist begins to provide screening, assessment, and/or treatment services, it is necessary to ensure the consent:

• is informed,
• is given voluntarily,
• is not obtained through misrepresentation or fraud, and
• relates to the services being proposed.

  For example: it would not be valid for a CASLPO member to obtain consent for and all services for a given year.

The term "informed consent", under the Health Care Consent Act, means that before agreeing to the service, the patient/client or substitute decision maker has received information that a reasonable person in the same circumstances would require. In addition, the person must have received responses to his or her requests for further information.

Necessary information that the member must provide includes:

• the nature of the service,
• the expected benefits of the service,
• the material risks of the service,
• the material side effects of the service,
• alternative courses of action, and
• the likely consequences of not having the service.

Material risks and side effects are:

• Those which are probable or likely to occur;
• Those that are possible rather than probable, but can have serious consequences;
• Anything else which would be considered relevant by a reasonable person in the same circumstances.

Individuals with a Communication Impairment

Obtaining consent from a patient/client is the cornerstone of patient/client-centred care. However, for individuals with communication impairments, giving consent may pose a significant challenge. As communication professionals, members must ensure that all reasonable steps are taken to allow a patient/client to understand the service options and express his or her wishes in the process of obtaining consent for audiology and speech-language pathology services. The existence of a disability, including a speech, language, or hearing impairment, is not sufficient to presume a patient/client is incapable of giving consent.

A patient/client is presumed to be capable of giving consent unless the member has reasonable grounds to assume otherwise. The Health Care Consent Act (HCCA) requires that a patient/client must have the ability to understand the information provided and appreciate the consequences of the decision in order to be considered capable of giving consent.

It is important to recognize that when a person makes a decision that is unanticipated or disagrees with the member's recommendations, the member cannot assume there is a lack of capacity. The member must respect the patient's/client's wishes and may engage in further discussion to increase the member's understanding of the patient's/client's rationale.

Facilitating an Informed Consent Discussion

Provide patients/clients with every opportunity to use their most effective mode of communication. Members should make every effort to obtain appropriate training and skills in communication techniques and use appropriate materials.

Comprehension may be enhanced through a combination of strategies including:

• Use of simple language
• Use of language that is appropriate to the patient/clients linguistic and cultural background
• Explain concepts
• Ensure hearing is sufficient
• Provide visual aids
• Write main points down
• Use pictures

Encourage the patient/client to paraphrase verbally, by pointing to pictures or gesturing to ensure they have understood the message. Verify comprehension after each component if there are memory concerns.

Expression may be enhanced through a combination of strategies including:

• Use of both direct and indirect questions
• Frequent pausing
• Use pictures and interactive drawing
• Encourage pointing and gesturing
• Use of yes/no responses

Audiologists and speech-language pathologists, by virtue of their unique and specialized training in communication disorders, have a responsibility to ensure that patients/clients are able to give informed consent to the services provided by members, independent of their communication difficulties. Patients/clients must be given every opportunity to engage in a partnership with the member when intervention decisions are made.