REx-PN Management of Care: Informed Consent and Client Rights
Study informed consent, decision-specific capacity, substitute decision-making and a client's right to refuse.
- A signature alone does not establish informed consent.
- Capacity is about the particular decision; a diagnosis alone does not establish incapacity.
- A capable client's informed refusal must be respected.
Sources checked 6 October 2026.
What makes consent informed?
Ontario's Health Care Consent Act requires consent relating to the treatment, informed and voluntary, without misrepresentation or fraud. Information includes the treatment's nature, expected benefits, material risks and side effects, alternatives and likely consequences of not receiving it. Give the client an opportunity to ask questions. Signing a form is not a substitute for this process.
How is capacity different from agreement?
Capacity involves understanding the relevant information and appreciating reasonably foreseeable consequences of a decision or lack of decision. A person can disagree with the team and still be capable. Age, a psychiatric label, disability or an unusual choice alone does not answer the capacity question. Capacity is decision-specific and may change.
Who decides when the client is incapable?
Follow the applicable substitute decision-maker hierarchy and legal process. Being present or being a family member does not automatically establish the highest-priority authorised decision-maker. An advance wish and the substitute decision-maker's duties must be handled according to the law; do not treat a family's preference as permission to override a capable client.
What should the nurse do with refusal or missing information?
Check understanding, support communication and interpretation needs, clarify unresolved information with the responsible practitioner, and document the decision and actions. Respect a capable client's informed refusal. Emergency exceptions have specific conditions; do not apply an emergency shortcut to ordinary care. Use the current consent guideline and local policy for practice decisions.