ELDER CARE Krista James
HEALTH CARE CONSENT, AGING, AND DEMENTIA
Mapping Law and Practice in BC
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n collaboration with the Alzheimer Society of BC, the Canadian Centre for Elder Law (CCEL) has launched a new project on the law, policy, and practice with respect to health care consent in British Columbia.
The project arose from a concern that people living with dementia and their substitute or supportive decision-makers are not always adequately consulted on treatment and medication options and decisions. Instead, community care facilities and physicians sometimes appear to be making decisions about medication and treatment without getting consent from the appropriate person or having sufficiently detailed conversations with people about options and alternatives. At the same time, statistics and research suggest significant use of medication by older people in BC, especially antipsychotics and antidepressants. The BC Seniors Advocate has documented a concern regarding medication use in continuing care facilities in two of her recent reports. An estimated 70,000 people in BC are living with Alzheimer’s disease or another dementia and the number is growing as our population ages. Medication and treatment decisions
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TABLE OF CONTENTS
have a tremendous impact on quality of life; the decision-making process can determine whether a person feels safe and respected within the health care system or receives the best care. Respect for the right to consent is important to everyone but people with disabilities may face greater barriers to ensuring their rights are respected. Adults living with dementia can be particularly vulnerable to being excluded from conversations about medication and treatment options due to communication challenges and assumptions about their mental capacity.
Advance planning can be a tremendously empowering act; the Notarial community is key in supporting British Columbians to do all they can do to ensure their wishes are respected across their lives. BC Notaries have conversations with their clients about their wishes for end-of-life care for themselves or for a loved one for whom they are responsible for making health care decisions. The decision-making autonomy is a right that people treasure. The loss of that autonomy is a source of great fear for many people living with a degenerative disease. The Society of Notaries Public of British Columbia
Advance planning can be a tremendously empowering act; the Notarial community is key in supporting British Columbians to do all they can do to ensure their wishes are respected across their lives. But what if the nurse or physician does not talk to you before changing your mother’s medication? What if a decision is made to put your father on antipsychotic medication because one of his angry outbursts causes concern about safety for staff and other care-facility residents and you notice your father’s moments of joy become fewer and fewer after the change of medication? What are people’s rights in those situations? Who exercises those rights? And what can people do if they are struggling to get the very busy physician to listen to them? Health care practitioners are often doing their best under enormously challenging circumstances. Physicians and directors of care, however, can appear to wield a tremendous amount of power and knowledge and can be a source of intimidation. Faced with a growing concern in the community about a potential disconnect between health care consent law and practice, the CCEL sought funding from the Law Foundation of BC to explore Volume 26 Number 1 Spring 2017
