Health Care Consent Act

The HCCA exists in addition to the Ontario Mental Health Act (MHA) because, while the MHA governs detention in a psychiatric facility, the HCCA governs whether or not a person can be treated while in hospital (for example, with anti-psychotic medication that can reduce symptoms of serious mental illness such as schizophrenia). The Ontario HCCA is also relevant to the Substitute Decisions Act. A person may be found to lack capacity for personal care and need a substitute decision maker (SDM) to decide whether to consent to or refuse treatment with psychiatric medication. The law says that “a person is incapable of personal care if the person is not able to understand information that is relevant to making a decision concerning his or her own health care, nutrition, shelter, clothing, hygiene or safety, or is not able to appreciate the reasonably foreseeable consequences of a decision or lack of decision.” ==HCCA and the Right to Refuse Treatment==

There is a widely reported Supreme Court of Canada case called Starson v. Swayze that dealt with the right of a mentally ill person to refuse treatment, even if it is in their best interests to be treated (for example, with anti-psychotic medication that would reduce delusional thinking). The majority in Starson v. Swayze ultimately decided that Starson did not lack capacity so he could make his own treatment decisions, even if his decision (to refuse anti-psychotic medication that would reduce delusional thinking) was not in his best interests. As a result, he could not be treated with psychiatric medication, even if that meant that his health deteriorated as a result. Critics of the decision in Starson argue that, because of mental deterioration, Starson did not have the capacity to make the decision to refuse treatment, and that his right to autonomy needs to be balanced with the right to be well. See also: autonomy as opposed to paternalism or beneficence. Autonomy is a complex concept in bioethics that has many variations. For example, there is the concept of supported autonomy, that is, in order to support the autonomy of the person in the long term it may be necessary to compromise autonomy in the short term. == References ==