Making your own decisions
Consent and capacity are two concepts that relate to your ability to make decisions. When you are young, your parents or caregivers make most of the decisions for you. In general, as you get older, you are able to make more decisions by yourself. You can always ask your parents/caregivers for help or advice on making health-care decisions, regardless of your age. Some of the most important decisions that you make can involve giving permission to other people.
There are specific rules around two of the most important types of decisions that can be made: decisions related to health and decisions related to being sexually active.
What are consent and capacity?
Consent means giving permission for something to happen, or agreeing that someone will do something for you on your behalf. You give consent for different things every day. For example, if you make a new friend and decide to share your phone number, you are giving them consent or permission to contact you. Another example is when you install a new app on your phone; it may ask you for your consent or permission to know your location.
Capacity relates to your ability to make decisions. When you are a baby, you do not have very much capacity, that is, you cannot make many decisions for yourself. As you get older and become more mature, you have the capacity to make more and more decisions for yourself. Your capacity to make some decisions is often related to your age. For example, you have to be 18 years old in order to vote in an election. However, your capacity is also determined by how much you understand. For example, you have to be 16 years old in Ontario before you are able to write your driver’s test, but you cannot obtain your full licence until you have passed two driving tests.
Making decisions about your health
The decisions you make about your health and health care are very important. They are so important that they are governed by a set of laws. To be able to make your own decisions about your health, your health-care provider (doctor, nurse, physiotherapist, etc.) needs to know that you are capable to make those decisions. In health care, capacity has a special definition with two parts:
- Understanding: your health-care provider needs to know that you understand the information about the decision you are going to make.
- Appreciation: your health-care provider needs to know that you appreciate what the decision and the consequences of the decision mean to you as a person.
Let’s use an example of having an ear infection caused by bacteria. Your doctor may recommend that you take antibiotics to treat the infection. To make sure that you are capable of making the decision to take antibiotics to treat the infection, your doctor has to confirm that you understand that ear infections may not go away on their own; ear infections can be cured with antibiotics; if the ear infection is not treated, it may cause hearing loss; and the treatment the doctor recommends, antibiotics, may have side effects. The doctor will also have to make sure that you appreciate what this decision means for you and your life. If you choose to take the antibiotics, you appreciate that you want the infection to be cured so you do not lose your hearing. You also appreciate that, while you may not like the side effects of antibiotics, it is still better for you to take the medicine to get rid of the infection than to refuse treatment.
In the province of Ontario, unlike driving and voting, there is no minimum age to consent to medical treatment. Every person, regardless of their age, is assumed to be capable to make decisions about their health unless a health-care provider determines they are not capable. Capacity is not a “blanket concept,” meaning just because you are capable of making one decision, does not mean you are always capable of making every decision. When you are younger, you may be capable of making some small-scale decisions, but you may still need help from your parents/caregivers to make more important decisions.
What happens if I am not capable of making a decision about my health?
Sometimes, it is obvious when a person is not capable of making a decision about their health. For example, it is obvious that babies cannot make their own decisions about their health. Another example is if you are in an accident and unconscious; it is clear you cannot make decisions when you are unconscious. In those situations, a substitute decision maker will make decisions on your behalf. For children and teens, their parents/caregivers are most often their substitute decision makers. Substitute decision makers are required, by law, to make the best decision for you, which means they must make the decision that is in your best interests.
There are other situations where it is not so clear if a person is capable of making their own health decisions. This might be because the person is suffering from a physical or mental illness, or they are a young teen who is still maturing. For very important decisions, health-care providers may do a capacity assessment to ensure you are capable of making the health-care decision. The capacity assessment must be performed by the health-care provider who is suggesting the treatment, such as your doctor, nurse, or therapist.
