Can KACL Staff request DNR orders?
On occasions Staff of KACL are asked by Doctors for "Do Not Resuscitate Orders". Staff are instructed by their superiors to inform the Doctor that they are not family nor the legal guardian entitled to give introductions requesting such an order. Nor can a staff person be appointed as a substitute decision maker.
Substitute Decisions Act S 46. (1) A person may give a written power of attorney for personal care, authorizing the person or persons named as attorneys to make, on the grantor’s behalf, decisions concerning the grantor’s personal care. 1992, c. 30, s. 46 (1). P.G.T. may be attorney (2) The power of attorney may name the Public Guardian and Trustee as attorney if his or her consent in writing is obtained before the power of attorney is executed. 1996, c. 2, s. 30 (1). Prohibition (3) A person may not act as an attorney under a power of attorney for personal care, unless the person is the grantor’s spouse, partner or relative, if the person, (a) provides health care to the grantor for compensation; or (b) provides residential, social, training or support services to the grantor for compensation. 1992, c. 30, s. 46 (3); 1996, c. 2, s. 30 (2, 3).
Can people with a developmental disability make their own decision to request a DNR Order?
Yes, many people with a developmental disability can make their own decisions about health and personal care issues. Every adult in ontario has the right to make decisions for him/herself as long as he/she is mentally capable of making decisions.
Can people with a developmental disability appoint a substitute decision maker for personal care?
Yes, many people with a developmental disability can appoint a substitute decision maker as long as he/she is mentally capable of making decisions.
What if the person with a developmental disability is not competent to appoint a substitute decision maker?
In such circumstances it may be necessary for a guardian of the person to be appointed by Consent and Capacity Board under the health care Consent Act.
What is the role of KACL Staff?
Staff should advise family, if necessary, that they should get their own legal advice with respect to Consent to Treatment.
The Health Care Consent Act provides
Principles for giving or refusing consent
21. (1) A person who gives or refuses consent to a treatment on an incapable person’s behalf shall do so in accordance with the following principles:
1. If the person knows of a wish applicable to the circumstances that the incapable person expressed while capable and after attaining 16 years of age, the person shall give or refuse consent in accordance with the wish.
2. If the person does not know of a wish applicable to the circumstances that the incapable person expressed while capable and after attaining 16 years of age, or if it is impossible to comply with the wish, the person shall act in the incapable person’s best interests. 1996, c. 2, Sched. A, s. 21 (1).
Best interests
(2) In deciding what the incapable person’s best interests are, the person who gives or refuses consent on his or her behalf shall take into consideration,
(a) the values and beliefs that the person knows the incapable person held when capable and believes he or she would still act on if capable;
(b) any wishes expressed by the incapable person with respect to the treatment that are not required to be followed under paragraph 1 of subsection (1); and
(c) the following factors:
1. Whether the treatment is likely to,
i. improve the incapable person’s condition or well-being,
ii. prevent the incapable person’s condition or well-being from deteriorating, or
iii. reduce the extent to which, or the rate at which, the incapable person’s condition or well-being is likely to deteriorate.
2. Whether the incapable person’s condition or well-being is likely to improve, remain the same or deteriorate without the treatment.
3. Whether the benefit the incapable person is expected to obtain from the treatment outweighs the risk of harm to him or her.
4. Whether a less restrictive or less intrusive treatment would be as beneficial as the treatment that is proposed. 1996, c. 2, Sched. A, s. 21 (2).
Staff should assist the family or guardian to know what the consumer's wishes and values were if they are in a better position to know them then the guardian or family but it is the guardian or family's decisions and responsibility to make the decision concerning health care
(From Wikipedia: A Do Not Resuscitate, or DNR order is a written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. Such an order may be instituted on the basis of an advance directive from a person, or from someone entitled to make decisions on their behalf, such as a health care proxy; in some jurisdictions, such orders can also be instituted on the basis of a physician's own initiative, usually when resuscitation would not alter the ultimate outcome of a disease, and is designed to prevent unnecessary suffering.
Any person who does not wish to undergo lifesaving treatment in the event of cardiac or respiratory arrest can get a DNR order, although DNR is more commonly done when a person who has an inevitably fatal illness wishes to have a more natural death without painful or invasive medical procedures. Misconceptions about Health Care Consent Act and Substituted Decisions Act