The Canadian Mental Health Association believes that people who may need mental health care deserve the full range of informed choices surrounding the best possible care. This includes the choice to reject treatment. Self-help options and informal personal supports may complement or supplant the full range of formal psychosocial and medical treatments, in accordance with the wishes of the individual. It cannot be assumed that medical treatment is the only or best option for individuals.
The consent dynamic is fundamental to the relationship between service provider and consumer. The right of the consumer to control treatment, often honoured more in the breach than the affirmation, exists as a fundamental precept of civil rights, self-respect and human dignity.
Based on these beliefs, the National Board of Directors of the Canadian Mental Health Association endorses the following principles:
- The individual’s voluntary informed consent must be a prerequisite to any treatment. Exceptions should be rare and only applied in cases of emergency or mental incompetency.
- Emergencies are defined by their temporary nature, the complete inability of the individual to consent and the existence of circumstances which require immediate treatment to avert death or serious harm to self or others.
- At all times, the individual must be treated with respect, dignity and as having the capacity to make informed decisions regarding consent to treatment and/or treatment options or refusal of treatment.
- Before obtaining consent, the physician or other service provider must ensure that the individual understands the range of options to be used, as well as potential benefits, risks and side effects of each option.
- An individual’s strengths, insight into their mental health problem/illness, and ability for self-care must be part of the assessment process.
- It is the ethical responsibility of the physician or the service provider and/or treatment facility to articulate clearly any significant conflicting medical or psychosocial opinion regarding the recommended treatment and the reasons for the use of one treatment rather than an alternative.
- The risks of treatment versus no treatment should be examined.
- The measure of competency should be whether the individual to receive care understands and appreciates the implications of the issues above. Criteria for measuring competency should be explained to the individual. Refusal to consent should not be deemed evidence of an inability to understand or a part of symptomatology. Rather it may be an act of self determination and freedom, particularly in the context of a potentially coercive institutional environment.
- All individuals have the right to a second opinion.
- Steps should be taken to determine whether a type of advance health care directive exists, and, if so, every effort made to honour it. The opportunity to develop an advance health care directive should be made available to all people across Canada.
- All individuals should have the right to appoint a person who should make fully informed decisions on their behalf in case of the individual’s incompetency. In the instance of incompetency the decision – maker appointed by the individual should be the first person approached for a fully informed consent. If such a person has not been appointed, legal processes shall be used to obtain consent.
- All individuals should have access to timely and affordable legal counsel or access to individuals or agencies that can act on their behalf.
- Language, culture, race, country of origin, social class, gender, sexual orientation, age and religious beliefs should never be barriers to equality of treatment, kind or level of care. Any form of discrimination is unacceptable.
- Individuals should have knowledge of access to review procedures concerning their competency to consent, within a reasonable and short period of time.
- As with a physical disorder, individuals possess an absolute right to full knowledge about their mental health status and prognosis.
- The medical file should be considered the property of the individual client, subject to the right of the caregiver or institution to house the file.
- The individual has an absolute right to examine and obtain copies of all information in his/her file.
- Co-ordination of case management among disciplines is essential in order that all caregivers have the same level of information and similar orientations to care.
- At the outset of treatment, information-sharing is important to ensure that the individual will be able to utilize all the resources in the community, not just those offered by the formal health care system. For example, individuals should be told of self-help groups, family supports and community agencies upon entry into the diagnosis and treatment phase.