The Consent Standard of Practice goes into effect January 15, 2019.
Practice standards define the minimum level of expected performance for registered massage therapists, and therefore define what constitutes safe, ethical, and competent delivery of care by RMTs.
RMTs are responsible for exercising their professional judgment to apply the standards to the situations that they face in practice.
Consent to treatment is a cornerstone of patient-centred health care. Informing patients and involving them in decisions about their treatment is integral to care delivery.
Obtaining consent requires ongoing communication between the RMT and the patient. It is the RMT’s legal and professional responsibility to make sure that this communication occurs, and that the patient’s consent to treatment is both informed and voluntary. Patient consent supports good clinical decision-making, patient safety, and predictable and desired treatment outcomes.
In addition to RMTs’ professional obligations, there are two statutes in British Columbia that set out legal requirements for patient consent. The Health Care (Consent) and Care Facility (Admission) Act (the “Consent Act”) defines the scope and elements of consent for adults (individuals aged 19 and older). The Infants Act sets out the requirements for obtaining consent from a minor or “infant” (legally defined as an individual under the age of 19 years). These statutes form part of the basis for this standard.
Note: This standard applies only to consent for delivery of massage therapy. It does not apply to consent for collection, use or disclosure of patients’ personal information, which is governed by different legal and ethical obligations. It also does not apply to obtaining consent to participate in research.
The requirements below apply to all patients unless the requirements are stated to be age-specific (either 19 years of age or older, or under 19 years of age).
Substitute decision-maker: A person who is authorized to make health care decisions on another person’s behalf as one of the following:
Determining Capacity to Give Consent
Section 13 of this standard requires an RMT to determine the patient’s capacity to give consent in accordance with the Consent Act, where the patient is 19 years of age or older.
The RMT must presume that the patient is capable of giving, refusing, or revoking consent to health care unless there is a reason to believe otherwise.
A patient is seen to be capable of giving consent if the patient is able to:
Some strategies to apply during the process of determining capacity include:
Obtaining Consent from Minors
Section 14 of this standard requires an RMT to determine whether a patient under 19 years of age is able to consent to the patient’s own treatment under the Infants Act, as a mature minor.
The RMT must understand the legal requirements for determining if a minor patient is able to give consent to the minor’s own health care and know who may give consent if the minor cannot.
A mature minor’s consent is sufficient if the RMT is satisfied that the minor understands the nature, consequences, and reasonably foreseeable benefits and risks of the proposed health care.
However, valid consent can only be obtained if the treatment is in the minor patient’s best interests. It is the responsibility of the RMT to make reasonable efforts to ensure that the treatment is in the minor patient’s best interests.
When determining whether the minor is capable of consenting to the minor’s own health care, the RMT should:
The RMT must then assess whether the minor has understood the discussion, whether the minor is capable of providing consent, and whether the proposed massage therapy serves the minor’s best interests.
If the minor is not capable of providing consent, the RMT must obtain consent from the patient’s parent(s) or legal guardian(s).
Communication During the Consent Process
Section 4(c) of this standard requires an RMT to communicate in a way that is appropriate to the patient’s level of understanding.
RMTs can strengthen their communications by giving explanations in ways best understood by the patient and by using a combination of strategies. These might include:
Section 11 of this standard requires the RMT to document the patient’s consent, both initial and ongoing, or refusal to consent, in the health care record for that patient.
Documentation should reflect the consent process, and include: