Thank you for taking the opportunity to provide feedback on our draft Standard of Practice.

Your input will inform the Standard of Practice and ensure that it:
  • reflects current practice issues,
  • embodies the duties of medical professionalism, and
  • is consistent with the College’s mandate to act in the public interest.
Please note: All feedback collected through this survey is anonymous.

The draft Standard of Practice can be found here.

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* 1. Which best describes you? (select all that apply)

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* 2. If you are a physician, do you feel you understand how to appropriately obtain consent to treatment?

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* 3. The updated draft Standard states:

Consent must be obtained from the patient’s substitute decision maker (SDM) in circumstances where the patient lacks capacity. This individual has legal authority to act on behalf of the patient in respect of healthcare decisions.

In some cases, a patient may have appointed a SDM through legal documentation to act on their behalf in the event of incapacity. If a patient has not appointed a SDM, a physician should obtain consent from the applicable person outlined in the Advance Health Care Directives Act. It is important to be aware that the person listed as “next of kin” in the patient’s medical record is not necessarily the patient’s legal SDM.

Do you support these statements?

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* 4. The updated draft Standard states:

Assessing capacity in a minor is based on maturity, not chronological age. In most cases, a minor is considered capable of consenting or refusing treatment if they have the capacity to fully appreciate the nature of the proposed treatment, its anticipated effect, and the consequences of refusing treatment. A minor may have the capacity to consent to certain treatments, but not others. Where a physician determines that a minor has capacity to consent, they must obtain consent from the minor. If a minor does not have capacity, consent must be obtained from the parent or guardian of the child.

A physician may proceed with providing treatment to a minor on the basis of having obtained consent from one parent with decision-making responsibility. If there is a dispute between parents about the proposed treatment, the physician should try and obtain consensus through discussing the goals of care in a manner that is patient centered. If consensus cannot be achieved, physicians are encouraged to seek ethical and legal advice on how to proceed.

Do you support these statements?

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* 5. The updated draft Standard states:

Physicians must provide their patients with adequate information regarding the treatment to allow them to make an informed decision. The adequacy of consent explanations is judged by the "reasonable patient" standard, that is, what a reasonable patient in the particular patient's position would have expected to hear before consenting. Material risks must be disclosed. This includes risks that occur frequently as well as those that are rare but very serious. In addition, physicians should consider whether the patient has any special circumstances which might require discussion of potential, but normally uncommon, risks of treatment.

Do you support these statements?

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* 6. The updated draft Standard states:

Physicians must consider the specific circumstances of the patient and use their clinical judgement to determine what information must be provided. In most cases, physicians should advise the patient as to:
  1. the nature of the treatment;
  2. the anticipated outcome of the treatment;
  3. the material risks involved in the treatment, including common risks, serious risks, and those that have particular relevance to the patient;
  4. the consequences of not undertaking the treatment; and
  5. any alternatives available.
Physicians should be satisfied that the patient demonstrates a reasonable understanding of the information being provided regarding treatment.

Do you support these statements?

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* 7. The updated draft Standard states:

Consent is often implied based on the actions of the patient. Where a reasonable person would believe that consent has been given, implied consent may be inferred. If relying on implied consent, physicians should be confident the actions of the patient imply consent. When there is doubt, the patient should be asked to express their consent verbally.

When treatment may be more than mildly painful, carries appreciable risk, or is a surgical or invasive investigative procedure, the patient must be asked to specifically express their consent, either verbally or in writing. Express consent is also required for an examination of the pelvic, genital, breast, or rectal area of a patient’s body.

Do you support these statements?

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* 8. The updated draft Standard states:

A patient’s consent should be documented through a contemporaneous note in their medical record.

Documentation of the consent process is required in circumstances where the treatment is likely to be more than mildly painful, carries appreciable risk, will terminate a bodily function, is a surgical or invasive investigative procedure, or will lead to significant changes in consciousness. If a patient provides written consent, a copy of the consent document must be included in the patient’s medical record.

Do you support these statements?

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* 9. The updated draft Standard states:

Consent is not required in a medical emergency where there is severe suffering or an immediate threat to the life of the patient if treatment is delayed to obtain consent. Under such circumstances, treatments must be limited to those that are necessary to prevent prolonged suffering or to deal with imminent threats to life, limb, or health.

Consent is also not required for patients admitted to a healthcare facility on an involuntary basis as detailed in the Mental Health Care and Treatment Act. Physicians who provide treatment to patients under the authority granted through this Act must be aware of and act in accordance with all legal requirements, including those relating to consultation with the patient and their representative.

Do you support these statements?

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* 10. Are there any gaps in the draft Standard which you think we should address?

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* 11. Please share any comments and/or concerns about the draft Standard.

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* Please feel free to answer the following additional questions regarding your demographics.

Information collected will allow us to ensure we have reached a diverse group of survey respondents and identify any trends. 

Optional Question 1: In which NL Health Services zone or geographic region do you reside?

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* Optional Question 2: How do you identify?

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* Optional Question 3: Which category includes your age?

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