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:

• understand the information that is relevant to making a decision about the proposed care, including how the information applies to the patient’s situation; and
• appreciate the reasonably foreseeable consequences of a decision or lack of decision.

Some strategies to apply during the process of determining capacity include:

• remembering that incapacity in one legal area does not necessarily imply incapacity in another;
• assessing capacity more than once to accommodate fluctuations in the person’s cognitive abilities; and
• considering whether to seek assistance from the patient’s family or the patient’s general physician.

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:

• consider:
  • the age and maturity of the minor;
  • the nature of the proposed massage therapy and the area of the body where the proposed treatment would be delivered;
  • the condition or impairment for which massage therapy is proposed;
• discuss (with the minor):
  • the condition or impairment for which massage therapy is proposed;
  • the areas of body where the proposed massage therapy would be delivered, whether it would be necessary to remove clothing, and explain how the minor would be draped during the treatment;
  • the nature, the anticipated positive effects of the proposed treatment, and any anticipated negative effects that may be associated with the proposed treatment;
  • the therapeutic rationale for the proposed treatment approach;
  • alternatives to the proposed treatment approach;
• ask open-ended questions to determine the minor’s level of understanding;
• give the minor time to think over the information provided;
• invite questions; and
• consider whether the proposed massage therapy serves the minor’s best interests.

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:

• giving verbal explanations;
• using visual aids and handouts;
• asking patients for feedback about what they understand;
• asking patients if they have any questions;
• engaging any family or friends who are supporting the patient to help the patient understand;
• using plain language and age-appropriate terminology;
• using the services of a qualified interpreter if a language barrier exists; and
• providing information through an alternate mode (e.g., using sign language or speaking in the patient’s mother tongue).

Documenting Consent

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:

• confirmation that criteria for valid consent were met;
• when and how consent was obtained;
• concerns raised during the consent process, and actions taken to address concerns;
• reason for refusal or withdrawal from massage therapy services; and
• reasons for determining that a patient was not capable of making an informed decision, and action taken to identify a parent/guardian or substitute decision-maker.