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Do Your ”Advance Care Planning” Materials Comply with Ontario Law? You may be surprised! Education Event for Health Care Providers

Facilitator Notes !!!!!!!!!!!!!!!!!!!!Facilitator materials!created by the Ontario Health Care Consent and Advance Care Planning Leadership Community of Practice April 2017 Hospice Palliative Care Ontario (HPCO) !!!

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In!the!pages!that!follow!you!will!find:!! Facilitation!and!Presentation!preparation!information!! Facilitation!notes!to!accompany!the!PowerPoint!Presentation:!Do!Your!“Advance!Care!

Planning”!Materials!Comply!with!Ontario!Law?!You!May!be!Surprised?!

!Presentation!Reminders!and!Adaptations!!

" Provide!your!contact!information,!sponsoring!organization!information!and!introduction!to!the!presenters!participating!in!this!event!to!the!group!you!are!speaking!to.!!The!PowerPoint!presentation!is!protected!and!you!will!be!unable!to!add!it!to!the!slide!deck.!!!

" Adult!learning!theory!strongly!recommends!opportunities!to!interact!with!the!material!presented!and!this!presentation!includes!opportunities!to!interact!such!as!table!activities,!record!or!note!taking!of!the!offences.!!

!" Throughout!the!presentation!participants!may!raise!specific!medical!or!legal!questions!that!may!

be!outside!your!expertise!and!experience!–!please!refer!them!to!the!appropriate!resources.!!!

" We!feel!that!this!presentation!is!comfortably!delivered!in!a!twoDhour!format,!allowing!for!questions!and!interaction!with!the!participants.!

!" It!is!our!suggestion!that!prior!to!the!event!a!‘practice’!or!run!through!session!(or!teleconference)!

be!held!with!all!presentation!participants!as!part!of!your!preparation.!!!!Facilitator!Preparation!!!

" To!ensure!a!successful!learning!event!it!is!essential!that!you!prepare!appropriately.!We!strongly!encourage!you!to!access,!review!and!become!familiar!with!the!resources!and!information!on!health!care!consent!and!advance!care!planning!as!it!is!in!Ontario.!!

" Providing!handout!materials,!linkages!for!providers!and!patients!that!reflect!Ontario!specific!laws!and!guidelines!would!be!beneficial!for!your!audience.!We!recommend!you!have!resources!preDordered!and!available!for!distribution!at!the!event.!

Legislation!and!Ontario!Specific!guides:!!!

" Link!to!the!Health!Care!Consent!Act:!!https://www.ontario.ca/laws/statute/96h02!!!

" Link!to!the!Substitute!Decision!Act:!!! https://www.ontario.ca/laws/statute/92s30!!!

" Link!to!the!Consent!and!Capacity!Board!website:!!http://www.ccboard.on.ca/scripts/english/index.asp!!!!

" Link!to!the!Advance!Care!Planning!Workbook!the!Ontario!Edition!available!for!download!at:!http://www.speakupontario.ca/resource/acpDworkbook/!!!

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Key!Website!resources:!!!

" The!Advocacy!Centre!for!the!Elderly!(ACE)D!under!health!care!consent!tab!and!resources!on!HCC!ACP!contained!within!(Tip!sheets,!link!to!law!commission!report!of!January!2014!etc.:!http://www.acelaw.ca/!

!Presentation!Style!This!workshop!in!its!original!format!was!delivered!with!participation!from!12!individuals.!The!cast!of!characters!included!one!Narrator,!one!Supreme!Chief!Justice,!four!lawyers!and!six!Inquest!Panel!members.!Presenting!with!the!full!cast!of!characters!can!allow!for!local!committee!members,!sponsoring!organization!staff!etc.!to!participate!in!the!delivery.!!The!inquest!panel!size!can!be!smaller!in!size!(i.e.!from!2!to!4!members!if!need!be)!as!their!role!in!the!event!is!to!post!the!summary!offenses!sheets.!!!In!adapting!this!workshop!for!provincial!use!we!have!considered!that!this!number!of!participants!may!not!always!be!possible!in!every!situation.!One!can!adapt!these!materials!where!two!people!can!deliver!the!workshop!contents!or!using!variations!on!the!numbers!of!characters!as!listed!above.!!!!For!a!twoDperson!delivery,!the!lawyers’!information!can!be!shared!by!the!narrator!in!the!form!of!a!report!being!read!out!for!example.!The!Inquest!Panel!members’!role!in!posting!the!‘offences’!could!be!managed!by!the!Narrator!or!Chief!Justice!posting!the!‘offenses’!information.!!Basically,!a!twoDperson!delivery!would!entail!the!Narrator!and!Chief!Justice!adding!the!lawyers!and!inquest!panel!members’!tasks!to!their!roles.!!Adapt!your!script!accordingly.!!!!Supporting!props!There!are!props!mentioned!in!the!delivery!that!organizers!will!need!to!determine!if!they!will!gather!for!the!event.!(i.e.!Ontario!pins,!gavel,!‘judge’!garb!etc.)!There!are!other!props!that!are!critical!to!include!in!this!event!(i.e.!offenses!posts,!commitment!to!action!forms,!record!of!evidence!sheets!for!participants)!!!Optional!Props:!Sound&effects!–!Though!used!in!the!original!presentation!the!sound!effects!are!not!embedded!in!these!Power!Points.!You!could!choose!to!play!the!theme!sounds!and!song!separately!by!downloading!the!sounds!using!a!separate!recording!device.!!–!The!scripts!for!those!previous!taped!portions!(i.e.!call!to!law!office)!are!included!in!the!facilitator!notes!to!be!read!to!the!participants!in!this!version.!!(note!D!sound!effects!were!from!the!TV!series!“Law!&!Order”).!Gavel&and&gown&for&the&Justice!–!optional!(e.g.!if!not!available!creative!solutions!such!as!a!choir!robes,!“lawyerly”!clothing!choices!by!presenter,!hammers/mallets!for!gavel).!!Ontario&provincial&pins!–!optional!D!Organizers!may!find!Ontario!provincial!pins!by!contacting!their!local!MPP’s!office!and!asking!for!Ontario!provincial!pins.!Pins!have!been!used!at!the!end!of!the!Commitment!to!Action!activity,!participants!instructed!to!‘pin’!themselves!to!signify!Ontario!knowledge/commitment.!Signage&to&indicate&the&various&role(s)&and&tables!–!optional!(e.g.!Crime!Evidence!Board,!Inquest!or!Lawyer!Panel,!Supreme!Chief!Justice)!!!Required!materials:!Script!D!for!each!‘presenter’!!Offenses&posting&‘board’&for&posting&the&4&Prepared&offenses&sheets!–!(organizers!may!use!selfDstick!flip!chart!paper!or!other!ideas!to!create!a!posting!board.!The!goal!is!to!have!the!‘offenses’!posted!so!participants!can!view!them!following!each!of!the!scenes.)!

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Prepared&Offenses&sheets&for&inquest&panel&to&post!J!4!sheets!in!total,!print!large!enough!to!be!visible!to!back!of!room!–!to!be!with!inquest!panel!members!(numbered,!ready!to!post)!if!full!cast!version.!!!Offences!Board!–!for!scenes!2,!3,!4,!5!–!print!large!enough!for!participants!to!read!from!back!of!room,!number!the!back!of!each!sheet!to!assist!person!posting!to!keep!in!order.!!Scene!2!–!(label!back!of!sheet!J!#1)!

• Didn’t!use!ON!language!i.e.!‘living!will’!• Misled!to!believe!ACP!was!about!decisions!• Misled!to!believe!wishes!guided!Health!Care!Providers!

Scene!3!–!(label!back!of!sheet!!J#2)!• Used!terms!Advanced!Directive!&!Advance!Care!Plan!• Misinformation!about!wishes!guiding!decisions!• Misinformation!that!wishes!guide!treatments!offered!

Scene!4!–!(label!on!back!of!sheet!J!#3)!!• Level!of!Care!Form!is!required!and!signed!• Level!of!Care!Form!is!used!as!consent!• No!attempt!to!determine!Resident’s!capacity!!• Informed!consent!was!not!obtained!

Scene!5!!J!(label!back!of!sheet!!J!#4)!• Health!Care!Provider!asked!about!“Next!of!Kin”!• Obtained!consent!from!incorrect!SDM!• No!attempt!to!determine!Patient’s!capacity!• Informed!consent!was!not!obtained!

!4&Table&Activities&in&numbered&envelopes!–!require!one!set!of!each!of!the!4!table!activities!per!table!plus!one!set!for!the!narrator!to!demonstrate!with.!Tablemates!share!the!activity!and!complete!as!a!group.!In!the!facilitator!notes!the!correct!answers!are!highlighted!in!red!for!the!facilitator!only.!Table!Activities!–!each!table!requires!one!of!each!of!these!manipulative!activities!corresponding!to!scenes!2,!3,!4,!5.!It!is!recommended!to!laminate!the!question!and!answer!strips!or!to!use!card!stock!quality! paper.! ! (All! bulleted! answers! to! questions! are! to! be! printed! on! individual! strips! for! each!answer!bullet!point!to!enable!‘manipulative’!activity!amongst!table!teams)!!!Participants! are! required! to! answer! each! question! by! reaching! consensus! on! the! answer! to! the!question.!It!is!helpful!to!have!each!question!organized!in!a!separate!envelope!to!assist!in!making!the!required!activity!easy!to!locate!and!keep!the!strips!of!paper!contained!to!their!respective!envelop.!!Envelopes!would!be!labeled!with!activity!1!a,!1b,!2a,!2b,!3,!and!4!!The!PPT!and!facilitator!notes!will!indicate!when!these!activities!take!place!in!the!session.!Table!Task!#1a!–!What!is!the!name!of!the!law(s)!that!govern(s)!ACP!in!Ontario?!!

• The!Coroner’s!ACT!• The!Living!Will!ACT!• The!Advance!Care!Planning!ACT!• The!Health!Care!Consent!ACT!• The!Decision!Makers!ACT!• Personal!Directives!Act!

Table!Task!#1b!–!What!is!the!correct!term(s)!used!within!the!law(s)!related!to!ACP!in!Ontario?!!• Advanced!Directive!• Living!Will!

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• Advanced!Care!Plan!• Expressing!Wishes!• Goals!of!Care!• All!of!the!above!• None!of!the!Above!

Table!Task!#2a!D!Determine!the!4!elements!of!a!valid!consent!(Select!4)!o must!relate!to!a!treatment!o must!be!given!voluntarily!o must!be!explained!by!the!physician!!o must!be!signed!and!witnessed!o must!not!have!been!obtained!through!misrepresentation!or!fraud!o must!be!informed!

Table! Task! #2b! D!Determine! the!correct!elements!of! informed!consent!as!outlined! in! the!HCCA! that!are!required!to!be!given!on!a!proposed!treatment!that!a!reasonable!person!would!require!to!make!decisions.!!(Select!6)!

o nature!of!treatment!o alternative!courses!of!action!o who!is!administering!treatment!o cost!of!treatment!o material!risks!of!treatment!o likely!consequences!of!not!receiving!the!treatment!o expected!benefits!of!treatment!o materials!side!effects!of!treatment!

Table! Task! #3! J! A! person! is! considered!mentally! capable! of! providing! informed! consent!when:!(Select!2)!

• She/he!is!able!to!understand!the!information!• She/he!can!appreciate!the!consequences!of!the!decision!• She/he!has!a!miniDmental!score!of!greater!than!18!• She/he!is!between!the!ages!of!18!and!65!years!of!age!• She/he!has!no!known!history!of!cognitive!impairment!or!psychiatric!disorders!

Table! Task! #4! –! Replicate! the! list! of! SDM(s)! found! within! the! HCCA! from! highest! to! lowest! ranked!person(s).!!

• Guardian!of!person!with!authority!for!treatment!• Attorney!named!in!Power!of!Attorney!for!Personal!Care!!• Representative!appointed!by!consent!and!capacity!board!• Spouse!or!partner!• Child!or!parent!or!CAS!• Parent!with!right!of!access!only!• Brother!or!Sister!• Any!other!relative!by!blood!marriage!or!adoption!• Office!of!the!Public!Guardian!and!Trustee!

Resource&package!–!one!package!per!participant.!Suggested!content!of!a!resource!package:!!Advocacy!Centre!for!the!Elderly!Tip!sheets!1!and!2,!SDM!and!hierarchy!information,!Ontario!specific!resource!web!links.!(Ensure!all!resources!reflect!Ontario!legal!framework!for!HCC!ACP).!Ensure!any!resources!or!links!shared!are!Ontario!specific!and!follow!our!legal!framework.!!Evidence&Collection&Sheet!D!one!per!participant!to!record!‘evidence’!issues!shared!within!the!presentation.!!Commitment&to&Action&FormD!one!per!participant.!

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HCC!ACP!Workshop!!!

!Participant!Evidence!Collection!Sheet!!

Name:!___________________________________________________________!!!Scene!1:!Introduction!!!!!!!!Scene!2:!!The!Lawyer’s!Office!!!!!!!!!Scene!3:!!The!Primary!Care!Office!!!!!!!!!Scene!4:!!The!LTC!Care!Home!!!!!!!!!Scene!5:!!The!Hospital!!!!!!!!For!further!assistance!or!to!access!additional!resources!please!contact!the!HPCO!HCC!ACP!Leadership!Community!of!Practice!by!contacting!jdarnay@hpco.ca!or!at!www.speakupontario.ca!

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Ontario!HCC!ACP!Workshop!!

Participant!Commitment!to!Action!Advancing!HCC!and!ACP!Accuracy!in!Knowledge,!Language,!Process,!Forms!

!Ontario!Commitment!1:!(please!describe!your!intent!to!improve,!add!or!correct!HCC!ACP!knowledge!or!process)!!!!!!Timeline!to!initiate:!!!!Resources!I!will!need:!!!!Who!can!help:!!!!!!!Ontario!Commitment!2:!(please!describe!your!intent!to!improve,!add!or!correct!HCC!ACP!knowledge!or!process)!!!!!!Timeline!to!initiate:!!!!Resources!I!will!need:!!!!Who!can!help:!!!!!

!For!further!assistance!or!to!access!additional!resources!please!contact!the!HPCO!HCC!ACP!Leadership!Community!of!Practice!by!contacting!jdarnay@hpco.ca!or!at!www.speakupontario.ca!!

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Facilitator!Notes!Do!Your!Materials!comply!with!Ontario!Law?!You!may!be!surprised!!!Slide!1–!Introduction!to!this!education!event!and!sponsor!!Facilitator!note!–!Narrator!!

o Welcome!participants!to!the!session!and!introduce!event!organizers/sponsors!o Introduce!presentation!team!for!the!session!as!appropriate!i.e.!full!cast!(e.g.!Chief!Justice,!Lawyer!panel,!

Narrator)!or!2Dperson!version.!Adjust!speaking!notes!or!scripts!accordingly!depending!on!number!within!your!presentation!team!(i.e.!instructions!on!posting!offences!for!inquest!panel!member!or!for!narrator!or!justice!to!do)!

!Slide!2!–!Do!Your!”Advance!Care!Planning”!Materials!Comply!with!Ontario!Law?!You!may!be!surprised!!Law!&!Order!Special!HCC!ACP!Unit!!(you!may!consider!turning!off!the!lights!for!the!duration!of!opening!narration!for!dramatic!effect)!!Facilitator!note!–!Narrator!states!!

o In! Ontario! citizens! are! protected! by! 2! separate! yet! equally! important! laws;! the! Substitute!Decisions!Act!and!the!Health!Care!Consent!Act.!!!

o The!following!story!is!based!on!a!compilation!of!real!events!but!the!names!and!cities!have!been!changed!to!protect!the!innocent.!!

Facilitator!note!–!Narrator!states!!!o While!the! judicial!process!may!be!exaggerated!somewhat! in!the!portraying!of! this!case!–!the!

Ontario!Legal!Framework!presented!remains!completely!accurate.!!!&

Slide!3!–!Setting!the!Stage!(lights!back!on)!!&

Facilitator!note!–!Narrator!!

o Indicate! this! case! illustrates!a!number!of!Health!Care!Consent! (HCC)!Advance!Care!Planning!(ACP)!offences!in!Ontario.!!Our!story!will!unfold!as!the!legal!team!shares!its!discovery!findings!with!the!Supreme!Chief!Justice!and!the!Inquest!Panel.!!!

o We!invite!you!to!record!the!evidence!and!offences!that!you!hear!that!do!not!comply!with!the!Ontario! legal! framework!related!to!HCC!and!ACP..!There!are! ‘evidence’!record!sheets!at!your!table.!(hold!up!sample,!allow!brief!moment!for!them!to!find)!!

!Slide!4!–!Presentation!Goals!!Facilitator!note!–!Narrator!reviews!Review!session!objectives!

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• To!promote!an!understanding!of!Health!Care!Consent!(HCC)!and!“Advance!Care!Planning”!(“ACP”)!in!Ontario!(ON)!

• To!review!Health!Care!Provider!role!in!HCC!and!promoting!“ACP”!• To!provide!an!opportunity!to!network!and!share!ON!specific!resources!

!Slide!5!–!Scene!1!Introduction!!Facilitation!note!–!Narrator!reads!!This!is!a!transcript!of!a!call!that!came!into!the!Trailville!Advocacy!Centre!for!the!Elderly!from!a!distraught!family!member.!!!The!call!went!like!this:!I!hope!you!can!help!me.!!My!name!is!Chris!Simpson!and!I’m!calling!about!my!mother,!Alice!Simpson.!She!died!recently!in!your!town!and!I!am!really!angry!about!the!way!she!died.!How!her!final!days,!her!final!wishes!were!handled.!I!want!to!file!a!complaint.!I’m!a!lawyer!in!British!Columbia!so!I’m!hoping!there!is!a!formal!way!I!can!do!this!in!Ontario.!!!Narrator!states:!• The! legal! team! at! their! conference! table! are! sharing! what! they! have! uncovered! during! discovery.!!

(point!to!team)!• The! inquest! panel! members! hearing! the! evidence! are! seated! to! the! side! (point! to,! helpful! to! have!

signage!indicating!inquest!panel)!• This!is!our!crime!evidence!board!(point!to)!that!will!record!offences!after!each!scene.!• After!the!lawyers!share!their!discovery!information,!there!is!an!activity!to!be!completed!by!consensus!

by!each!table!group.!Answers!to!the!activity!will!be!embedded!in!the!education!portion!that!follows!each!activity!as!shared!by!the!Supreme!Chief!Justice.!!Listen!for!the!answers/corrections!as!the!Chief!Justice!talks.!!

Slide!6!–!Scene!2!The!Lawyers!office!!Facilitator!notes!J!Lawyer!#1!!!!

o I!learned!with!my!discovery!that!when!Mrs.!Simpson!was!at!her!lawyer’s!office!about!5!years!ago,!she!was!asked!to!complete!a!‘Living!Will’!as!part!of!her!will!process!

o The! lawyer! indicated! that! she! could! document! in! her! ‘Living!Will’! her! future! directions! and!decisions!for!health!care!!

o He!also! instructed!her! that! the! ‘Living!Will’!helps! instruct!her!health!care!providers!and!will!direct!her!care!by!letting!them!know!what!she!would!want!if!she!cannot!speak!

o He!told!her!that!by!writing!specifics!of!what!should!happen!helps!to!protect!her!o Mrs.!Simpson!indicated!at!that!visit!that!she!did!not!want!CPR!or!‘heroic!measures’.!She!added!

that!if!she!were!seriously!ill!she!would!like!to!be!comfortable!and!be!at!home. o A!Power!Of!Attorney!for!Personal!Care!was!completed!and!Mrs.!Simpson!chose!her!only!child!

Chris!from!BC!as!her!Substitute!Decision!Maker.!She!thought!that!since!Chris!is!a!lawyer,!she!would!ensure!her!‘Living!Will’!is!carried!out.!Copies!of!the!documents!were!shared!with!Chris.!!

• Freeze!Frame!–!(i.e.&lawyers&pause,&sit&in&stillness&until&their&next&part)!

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Slide!7!–!Table!Task!#1!!Facilitator!Notes!J!Narrator!!!

o Explains!Table!Task!–!Open!envelope!#1!and!remove!the!contents.!You!will!find!two!questions!and! their!potential!answer!strips!1!A)!and!1!B)!at!your! tables.!Narrator! to! read! questions!only!from!PPT,!one!at!a!time.!Give!them!5!minutes!to!complete!in!total.!(e/g/!read!question!1!A!and!allow!for!2!or!so!minutes,!then!read!question!2!and!allow!for!similar! length!of!time!to!complete.!(we!have!found!the!initial!activity!questions!may!take!some!time!for!table!participants!to! consider!and!converse!with!each!other.!The! time! taken!can!decrease! through! the! remaining!

questions!as!they!become!familiar!with!format!and!tablemates)!!!

o #1!–!What!is!the!name!of!the!law(s)!that!govern(s)!ACP!in!Ontario?!!o The!Coroner’s!ACT!o The!Living!Will!ACT!o The!Advance!Care!Planning!ACT!o The!Health!Care!Consent!ACT!o The!Decision!Makers!ACT!

o #2!–!What!is!the!correct!term(s)!in!the!law!related!to!ACP!in!Ontario?!!o Advanced!Directive!o Living!Will!o Advanced!Care!Plan!o Expressing!Wishes!o Goals!of!Care!o All!of!the!above!o None!of!the!Above!

!Narrator!to!call!time!and!ask!participants!to!listen!for!the!correct!details!in!the!Chief!Justice’s!information.!!Slide!8!–!What!is!“Advance!Care!Planning”!in!Ontario!!Facilitator!Note!–!Supreme!Chief!Justice!!!ACP!in!Ontario!

1.!IDENTIFYING!the!capable!patient’s!future!Substitute!DecisionJMaker!(SDM),!by!either!confirming!that!the!patient!is!satisfied!with!their!default!SDM!in!the!Hierarchy!list!that!is!in!the!Health!Care!Consent!Act!OR!b)!Choosing!someone!else!to!act!as!SDM(s)!by!preparing!a!Power!of!Attorney!for!Personal!Care!(a!formal!written!document)!2.!Communicating!ones!Wishes,!Values,!and!Beliefs!–!discussing!with!the!capable!patient!about!his/her!wishes,!values!and!beliefs,!and!more!generally!how!he/she!would!like!to!be!cared!for!in!the!event!of!incapacity!to!give!or!refuse!consent!

!Slide!9!–!What!isn’t!“Advance!Care!Planning”!!Facilitator!Note!–!Supreme!Chief!Justice!!

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What!isn’t!“Advance!Care!Planning”!• ‘Advance!Care!Planning’!is!NOT!informed!consent!to!treatment.!• You!still!need!to!obtain!informed!consent!from!a!person,!regardless!of!whether!the!patient!has!

engaged!in!an!advance!care!planning!process,!except!in!an!emergency!• Informed!consent!has!to!come!from!discussions!with!a!person!(either!the!patient!or!their!SDM)!

about!the!patient’s!current!health!condition!–!not!from!a!static!document!• The!terms!“advance!directive”!and!“living!will”!nor!“advance!care!plan”!do!NOT!appear!in!Ontario!

law!and!should!NOT!be!used!in!conversations,!facility!forms!and!records!or!anywhere.!!Slide!10!–!How!Does!Health!Care!Consent!Relate!to!Advance!Care!Planning?!!Facilitator!note!–!Supreme!Chief!Justice!!How!does!Health!Care!Consent!related!to!Advance!Care!Planning?!!

• Under!Ontario!law,!ACP!is!part!of!the!law!of!informed!consent!• Patient!“wishes”!are!only!relevant!where!a!patient!is!incapable!!• Patient!“wishes”!are!interpreted!by!the!SDM!–!not!the!Health!Practitioner!

!Justice!STOP!!(cue!Inquest!Panel!member!#1)!!Slide!11!–!Offences!!Facilitator!Note!–!Inquest!Panel!member!#1!to!post!the!following!offenses!and!Moderator!to!read!out!loud!to!participants!!Places!the!offense!on!the!crime!board:!

• Didn’t!use!ON!language!i.e.!used!‘living!will’!• Misled!to!believe!ACP!was!about!decisions!• Misled!to!believe!wishes!guided!Health!Care!Providers!

Slide!12!–!Scene!3!–!The!Primary!Care!Office!!Facilitator!note!–&Lawyer&#2&shares!!Lawyer!Panel!interaction!resumes!with!Lawyer!#2!who!shares:!

o The!miscues!didn’t!stop!as! I! learned!what!occurred!at!her!physician’s!office!about!a!year!ago!

o Her! Dr.! asked! Mrs.! Simpson! as! part! of! his! usual! practice! D! “Do! you! have! an! ‘advanced!directive’!–!you!know!a!‘living!will’!D!now!that!you!have!health!issues?”!

o He!said!that!given!the!health!issues!she!faced!it!was!important!for!the!health!care!team!to!know!her!wishes!so!they!could!select!treatment!options!for!her!

o She!indicated!she!had!a!living!will!and!shared!the!details!with!him.!!The!doctor!documented!the!conversation!and!details!in!her!health!record!!

o The!Dr.!told!her!this!was!a!good!‘advance!care!plan’!to!instruct!her!health!care!team!moving!forward.!It!appears!this!even!went!further!off!track!as!apparently!he!used!this!information!“plan”!to!select!treatment!options!to!offer!to!Mrs.!Simpson!

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Freeze!Frame!J!(i.e.&lawyers&pause,&sit&in&stillness&until&their&next&frame)!!Slide!13!–!Table!Task!#2!!Facilitator!Note!–!Narrator!!!

o Explain!Group!Table!Task!–!Open!envelope!#2!and!you!will! find!two!questions!with!their!potential!answer!strips!2!A!and!2!B.!(or!label!two!separate!envelopes!2A!and!2B)!Narrator!to!read!questions!from!PPT!as!per!activity!1.!!

o A)!Determine!the!elements!of!a!valid!consent!(select!4)!• must!relate!to!a!treatment!• must!be!given!voluntarily!• must!be!explained!by!the!physician!!• must!be!signed!and!witnessed!• must!not!have!been!obtained!through!misrepresentation!or!fraud!• must!be!informed!

!o B)! Determine! the! correct! elements! of! informed! consent! as! outlined! in! the! HCCA! to! be!

provide! about! a! proposed! treatment! that! a! reasonable! person! would! require! to! make!decisions.!!(select!6)!

• nature!of!treatment!• alternative!courses!of!action!• who!is!administering!treatment!• cost!of!treatment!• material!risks!of!treatment!• likely!consequences!of!not!receiving!the!treatment!• expected!benefits!of!treatment!• materials!side!effects!of!treatment!

!Narrator!to!call!time!and!ask!participants!to!listen!for!the!correct!details!in!the!Chief!Justice’s!information.!!Slide!14!–!What!is!Health!Care!Consent?!!Facilitator!Note!J!Supreme!Chief!Justice!!!!What!is!Health!Care!Consent?!!

o Health!Practitioners!need!to!obtain!consent!or!refusal!of!consent!to!a!treatment!from!the!patient,!if!capable,!before!treating,!except!in!an!emergency!

o If!the!patient!is!not!capable,!the!consent!is!given!by!the!patient’s!SDM!!o Health!care!consent!is!an!informed!and!contextualized!DECISION!o When!seeking!consent,!Health!Practitioners!(including!physicians)!have!a!duty!to!communicate!

with!patients!(or!the!incapable!patient’s!SDM(s))!about!the!patient’s!present!condition!and!the!available!treatment!options!

o Consent!ALWAYS!comes!from!a!person,!not!a!piece!of!paper!!Slide!15!–!Treatment!taking!place!in!the!future!is!NOT!necessarily!“advance!care!planning”!

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!Facilitator!Note!J!Supreme!Chief!Justice!!!Treatment!taking!place!in!the!future!in!NOT!necessarily!“Advance!Care!Planning”!

o A!patient!can!give!an!informed!consent!to!a!treatment!that!takes!place!or!is!withheld!in!the!future!if!that!treatment!relates!to!the!patient’s!current!health!condition!

o This!is!not!“Advance!Care!Planning”,!but!is!consent!!o Patients!at!end!of!life!can!consent!to!No!CPR!and!this!is!NOT!Advance!Care!Planning!!

!Slide!16!–!What!you!need!to!do!….!CONVERSATIONS!to!get!an!INFORMED!CONSENT!!Facilitator!note!–!Supreme!Chief!Justice!!What!you!need!to!do….!CONVERSATIONS!to!get!an!INFORMED!CONSENT!

o Need!to!talk!to!patients!or!appropriate!SDM(s)!to!get!informed!consent!to!a!treatment!or!PLAN!of!treatment!!

o These!conversations!are!fundamental!before!providing!treatment!both!in!law!and!ethics!!!!Slide!17!–!What!is!Valid!Consent?!!Facilitator!note!–!Supreme!Chief!Justice!!What!is!Valid!Consent?!

o Must!relate!to!the!treatment!o Must!be!informed!o Must!be!given!voluntarily!o Must!not!have!been!obtained!through!misrepresentation!or!fraud!

Slide!18!–!What!is!Informed!Consent?!!Facilitator!note!–!Supreme!Chief!Justice!!What!is!Informed!Consent?!It’s!about!informed!decisions!based!on!a!current!health!condition!that!includes:!

o !Context!for!the!decision!o !Nature!of!the!treatment!o !Expected!benefits!of!the!treatment!o !Material!risks!of!the!treatment!o !Material!side!effects!o !Alternative!course!of!action!o !Likely!consequences!of!not!having!the!treatment!

!Slide!19!–!Can’t!get!out!of!consent……!!Facilitator!note!–!Supreme!Chief!Justice!!Can’t!get!out!of!informed!consent……!

o The!right!to!informed!consent!is!a!requirement!that!cannot!be!waived!by!the!patient!

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o Even!where!the!patient!has!completed!an!“advance!directive”,!the!patient!or!their!SDM!must!still!give!or!refuse!informed!consent!(except!in!an!emergency)!

!Slide!20!–!Informed!consent!can!cover!one!treatment!or!a!“plan!of!treatment”!!Facilitator!Note!–!Supreme!Chief!Justice!!Informed!consent!can!cover!one!treatment!or!a!“plan!of!treatment”!!Slide!21!–!Plan!of!Treatment!J!!HCCA!s.2(1)!!Facilitator!Note!–!Supreme!Chief!Justice!!Plan!of!Treatment!–!HCCA!s.2(1)!

o developed!by!one!or!more!Health!Practitioners!o deals!with!one!or!more!health!problems!that!a!person!has!and!may,!in!addition,!deal!with!one!or!

more!of!the!health!problems!that!the!person!is!likely!to!have!in!the!future!given!the!person’s!current!health!condition,!and!

o provides!for!the!administration!to!the!person!of!various!treatments!or!courses!of!treatment!and!may,!in!addition,!provides!for!withholding!or!withdrawal!of!treatment!in!light!of!person’s!current!health!condition.!

BOTTOM!LINE:!Plans!of!Treatment!must!be!grounded!in!the!patient’s!present!health!condition!!Justice!STOP!!(cue!Inquest!Panel!member!#2)!!Slide!22!–!Offences!!Facilitator!note!–!inquest!panel!member!#2!to!post!the!following!offenses!and!Moderator!to!read!out!loud!to!participants!!!Inquest!Panel!Member!places!the!Offense!on!the!board!

o Used!terms!Advanced!Directive!&!Advance!Care!Plan!o Misinformation!about!wishes!guiding!decisions!o Misinformation!that!wishes!guide!treatments!offered!

Slide!23!–!Scene!4!–!The!Long!Term!Care!Home!!Facilitator!note!–Lawyer!#!3!!!Lawyer!#!3!!• The!confusion!continued!at!the!Trailville!LTC!home!6!months!ago:!!

o Mrs.!Simpson!was!admitted!to!LTC!in!a!health!crisis!and!experienced!fluctuating!levels!of!capacity!!

o On!admission!her!daughter!Chris!signed!a!‘required’!(feel!free!to!use!air!quotes!for!the!word!required)!Level!of!Care!Form!and!selected! level!4.!At! this!LTC! it!meant!no!CPR!and!no!transfer!to!hospital.!

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o In! fact!Mrs.!Simpson!did! regain!her!decisional! capacity!once!she!stabilized! in!about!a!week!after!the!move!and!would!have!been!able!to!direct!her!care!

o About!a!1!month!ago!!D!Mrs.!Simpson!fell!and!hurt!her!hip!when!getting!up!at!night.!!!o Staff!called!the!onDcall!physician!who!asked!which!level!she!was!so!when!told!level!4,!he!

did!not!send!her!to!hospital!for!investigation!or!treatment.!o 48!hours!after!the!fall!when!Mrs.!Simpson!was!talking!on!the!phone!with!her!daughter!

and!she!told!Chris!about!her!fall!and!her!pain!and!discomfort!since.!o Chris!called!the!head!nurse!right!away!and!demanded!her!mother!be!transferred!to!the!

hospital!Freeze!Frame!(i.e.&lawyers&pause,&sits&in&stillness&until&their&next&frame)!!Slide!24!–!Table!Task!#3!!Facilitator!note!–!Narrator!!

o Explain! Group! Table! Task! –! Open! envelope! #3! and! you! will! find! one! question! with! the!potential!answer!strips.!!

o !Narrator! to! read! question! from! PPT! and! indicate! amount! of! time! they! have! to! answer!approximately!3I4!minutes.! ! (you!will!be!able!to!judge!as!you!overlook!the!participants!when!to!call!time).!!

o A!person!is!considered!mentally!capable!of!providing!informed!consent!when!(select!two!from!the!list):!

o She/he!is!able!to!understand!the!information!o She/he!can!appreciate!the!consequences!of!the!decision!o She/he!has!a!miniDmental!score!of!greater!than!18!o She/he!is!between!the!ages!of!18!and!65!years!of!age!o She/he!has!no!known!history!of!cognitive!impairment!or!psychiatric!disorders!!

!Narrator!to!call!time!and!ask!participants!to!listen!for!the!correct!details!in!the!Chief!Justice’s!information.!!Slide!25!–!Consent!must!be!obtained!from!the!patient!if!mentally!capable!!Facilitator!note!J!Supreme!Chief!Justice!!!!Consent!must!be!obtained!from!the!patient!if!mentally!capable!!Slide!26!–!Definitions!in!Legislation!!Facilitator!note!J!Supreme!Chief!Justice!!Definitions!in!Legislation!Definition!of!capacity!in!respect!to!treatment,!admission!to!care!facilities,!and!personal!assistance!services!

Health!Care!Consent!Act,!s.!4!!

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o !Able!to!understand!the!information!that!is!relevant!to!making!a!decision!about!the!treatment,!admission,!or!personal!assistance!service!as!the!case!may!be!and!able!to!appreciate!the!reasonable!foreseeable!consequences!of!a!decision!or!lack!of!decision.!

Slide!27!–!WHO!assesses!capacity!for!treatment!!Facilitator!note!J!Supreme!Chief!Justice!!WHO!assess!capacity!for!treatment!

o Duty!of!Health!Practitioner!offering!the!treatment!to!determine!if!patient!capable!or!not!and!whether!its!necessary!to!turn!to!the!patient's!SDM!for!consent!

o This!is!NOT!done!by!a!“capacity!assessor”!as!defined!in!the!Substitute!Decisions!Act!!Slide!28!–!How!is!capacity!determined?!!Facilitator!note!J!Supreme!Chief!Justice!!How!is!Capacity!determined?!

o Mental!capacity!is!not!a!medical!determination!o It!is!not!a!score!on!the!Mini!Mental!Test!o It!is!not!a!diagnosis!o Mental!capacity!for!decisionDmaking!is!a!legal!determination!based!on!an!analysis!of!whether!a!

person!has!the!ability!to!understand!and!the!ability!to!appreciate!information!relevant!to!making!a!decision!

Slide!29!!J!Capacity!–!take!away!points!!Facilitator!note!J!Supreme!Chief!Justice!!Capacity!–!take!away!points!

• Issue!specific!• Can!fluctuate!• Presumption!of!capacity!unless!evidence!otherwise!• It!is!the!duty!of!the!treating!Health!Practitioner!to!determine!if!patient!is!capable!to!consent!to!

treatment!If!the!person!is!not!capable!for!a!particular!decision!then!the!Health!Practitioner!must!turn!to!that!person’s!highest!ranked!SDM(s)!for!the!decision.!!Slide!30!–!What!about!Emergencies?!!Facilitator!note!J!Supreme!Chief!Justice!!What!about!Emergencies?!

• In!an!EMERGENCY,!Health!Care!Providers!do!not!need!consent!in!order!to!treat.!• But,!they!must!follow!any!known!WISHES!(‘advance!care!planning’)!of!the!patient!in!respect!to!the!

proposed!treatment.!!Slide!31!–!What!is!an!Emergency?!!

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Facilitator!note!J!Supreme!Chief!Justice!!What!is!an!Emergency?!

• Meaning!of!“emergency”!• S.25(1)!!…!there!is!an!emergency!if!the!person!for!whom!the!treatment!is!proposed!is!apparently!

experiencing!severe!suffering!or!is!at!risk,!if!the!treatment!is!not!administered!promptly,!of!sustaining!serious!bodily!harm.!!

Justice!STOP!!(cue!Inquest!Panel!member!#1)!!Slide!32!–!Offenses!!Facilitator!note!–!Inquest!Panel!member!#3!to!post!the!following!offenses!and!Moderator!to!read!out!loud!to!participants!!Inquest!Panel!Member!places!the!Offense!on!the!crime!board!!

• Level!of!Care!Form!is!required!and!signed!• Level!of!Care!Form!is!used!as!consent!• No!attempt!to!determine!Resident’s!capacity!!• Informed!consent!was!not!obtained!

Slide!33!–!Scene!5!–!The!Hospital!!Facilitator!notes!–!Narrator!and!Lawyer!#4!!Lawyer!#!4!!At!the!Trailville!Ontario!Hospital!during!her!stay:!!

o The!ER!determined!a!hairline!hip!fracture!and!admitted!her!about!14!hours!after!she!came!to!the!emergency!department.!

o Although!Mrs.! Simpson! had! a! great! deal! of! pain! she! did!maintain! her!mental! capacity! to!make!decisions!relevant!to!her!care!

o Her! cousin!Meredith! arrived! at! the! hospital! at! the! request! of!Mrs.! Simpson’s! daughter! Chris! to!have!a!first!hand!look!at!what!was!going!on.!!!

o The!hospital! staff! asked!Meredith! if! she!was! the! ‘next!of! kin’! –!Meredith! said!yes! and! then!was!asked!right!there!by!the!staff!to!give!consent!for!surgery.!!

o Meredith! gave! consent! for! surgery! since!Mrs.! Simpson!was! clearly! in!pain! and! she! felt! she!was!experiencing!some!confusion!!!

o Mrs.!Simpson!did!survive!the!surgery!but!died!a!number!of!hours!later!unfortunately!alone!while!still!in!recovery.!

!Freeze!Frame!–!(i.e.!lawyers!pause,!sits!in!stillness)!!Slide!34!–!Table!Task!#!4!!Facilitator!note!–!Narrator!!

o Explains!Group!Table!Task! –!Open! envelope!#4! and!do! this! final! question.!Narrator! to!read!question!from!PPT.!Inform!audience!how!much!time!they!have!to!complete!(!up!to!4!minutes!if!needed)!

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o Replicate!the!list!of!SDM(s)!found!within!the!HCCA!from!the!highest!to!lowest!person(s).!D Guardian!of!person!with!authority!for!treatment!!D Attorney!named!in!Power!of!Attorney!for!Personal!Care!D Representative!appointed!by!consent!and!capacity!board!D Spouse!or!partner!D Child!or!parent!or!CAS!D Parent!with!right!of!access!only!D Brother!or!Sister!D Any!other!relative!by!blood!marriage!or!adoption!D Office!of!the!Public!Guardian!and!Trustee!

!Narrator!to!call!time!and!ask!participants!to!listen!for!the!correct!details!in!the!Chief!Justice’s!information.!!Slide!35!–!Who!is!patient’s!SDM!and!what!is!SDM!role?!!Facilitator!note!J!Supreme!Chief!Justice!!!Who!is!the!patient’s!SDM!and!what!is!the!SDM’s!role?!!Slide!36!–!Hierarchy!(a!ranked!list)!of!Substitute!Decision!Makers!!Facilitator!note!J!Supreme!Chief!Justice!!!Hierarchy!(a!ranked!list)!of!Substitute!Decision!Makers!

1. Guardian!of!Person!2. Attorney!named!in!a!POAPC!3. Representative!appointed!by!Consent!and!Capacity!Board!4. Spouse!or!Partner!5. Child!or!Parent!or!CAS!(Person!with!Right!of!Custody)!6. Parent!with!right!of!access!7. Brother!or!Sister!8. Any!other!relative!9. Public!Guardian!or!Trustee!

!Slide!37!–!Requirements!for!person!to!be!an!SDM!!Facilitator!note!J!Supreme!Chief!Justice!!!Requirements!for!person!to!be!an!SDM!The!person!highest!in!the!hierarchy!may!give!or!refuse!consent!only!if!he!or!she!is:!a)!Capable!in!respect!to!the!treatment;!!b)!At!least!16!years!old!unless!the!parent!of!the!incapable!person;!c)!Not!prohibited!by!a!court!order!or!separation!agreement!from!acting!as!SDM;!d)!Available!(including!via!electronic!communications);!and,!e)!Willing!to!act!as!SDM.!BOTTOM!LINE:! It! is! the!obligation!of! the!Health!Practitioner!obtaining! consent! from!an!SDM! to!ensure!these!requirements!are!met.!

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!Slide!38!–!SDMs!!Facilitator!note!J!Supreme!Chief!Justice!!!SDMs!

• Only!turn!to!an!SDM!for!consent!when!the!patient!is!incapable!• !List!is!hierarchical!(i.e.!start!at!the!top!and!work!your!way!down)!• !All!persons!on!same!rung!rank!equally!(i.e.!all!brothers!and!sisters!are!equally!SDMs)!• !Every!person!ALWAYS!has!an!SDM!if!they!are!incapable!!!• !The!Ontario!Public!Guardian!and!Trustee! is! the!SDM! if!no!one!on! the!Hierarchy! is!

available!or!if!there!is!a!conflict!between!equally!ranked!SDMs!!Slide!39!–!How!does!the!SDM!make!decisions?!!Facilitator!note!J!Supreme!Chief!Justice!!

!How!does!the!SDM!make!decisions?!

• In!making!decisions!on!behalf!of!an!incapable!patient,!SDMs!have!to:!• Follow!any!applicable!wishes!that!were!expressed!by!the!patient!when!capable;!OR!• If!no!applicable!wishes!were!expressed!when!the!patient!was!capable,!make!decisions!

in! the!patient’s! best! interest! (including!considering! the!patient’s!values,!beliefs!and!any!other!wishes!expressed!by!the!patient)!

!Slide!40!–!Best!Interest!Definition!HCCA!s.21(2)!!Facilitator!note!J!Supreme!Chief!Justice!!!Best!Interests!Definition!HCCA!s.21(2)!

• SDM!to!consider:!!a) values!and!beliefs!b) other!wishes!(i.e.!expressed!while!incapable)!c) whether!treatment!likely!to:!i. improve!condition!ii. prevent!condition!from!deteriorating!iii. reduce!the!extent!or!rate!of!deterioration!d) whether!condition!likely!to!improve!or!remain!the!same!or!deteriorate!without!the!treatment!e) if!benefit!outweighs!risks!f) whether!less!restrictive!or!less!intrusive!treatment!as!beneficial!as!treatment!proposed!

Slide!41!–!Role!of!SDM!Continued…..!!Facilitator!note!J!Supreme!Chief!Justice!!!Role!of!SDM!Continued……!

• SDM!is!the!“interpreter”!of!the!patient's!wishes,!values!and!beliefs!and!must!determine:!• whether!the!wishes!of!the!patient!were!expressed!when!the!patient!was!still!capable!(and!

were!expressed!voluntarily);!!

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• whether!the!wishes!are!the!last!known!capable!wishes;!• what!the!patient!meant!in!that!wish;!!• whether!the!wishes!are!applicable!to!the!particular!decision!at!hand;!and,!• If! there! are! no! applicable/capable! wishes,! how! the! patient’s! values,! beliefs,! and!

incapable/inapplicable!wishes!would!apply!to!the!patient’s!best!interest.!!Slide!42!–!What!are!the!obligations!of!Health!Practitioners!when!seeking!informed!consent!from!an!SDM?!!Facilitator!note!J!Supreme!Chief!Justice!!!What!are!the!obligations!of!Health!Practitioners!when!seeking!informed!consent!from!an!SDM?!

• First,!Health!Practitioners!must!be!satisfied! that! they!are!speaking!with! the!correct!SDM!on!the!Hierarchy! and! that! the! proposed! SDM! meets! the! prescribed! requirements! (i.e.! is! capable,!available,!willing!to!act,!etc.)!

• Second,!Health!Practitioners!must!advise!the!SDM!of!his/her!obligations!when!making!decisions!on! behalf! of! an! incapable! patient! (i.e.! to! follow! applicable! prior! capable! wishes! or! act! in! the!patient’s!best!interest)!!

• Third,! Health! Practitioners! must! provide! information! to! the! SDM! sufficient! for! an! informed!consent!(i.e.!the!risks!and!benefits!of!treatment,!etc.)!

• Fourth,! Health! Practitioners! must! determine! whether! the! SDM! is! complying! with! his/her!decisionDmaking! obligations,! and! decide! whether! to! bring! an! application! to! the! Consent! and!Capacity!Board!where!the!SDM!is!not.!!

Justice!STOP!!(cue!Inquest!Panel!member!#4)!!Slide!43!–!Offences!!Facilitator!note!–!Inquest!Panel!member!#4!to!post!the!following!offenses!and!Moderator!to!read!out!loud!to!participants!!Inquest!Panel!Member!places!the!Offense!on!the!crime!board!

• Health!Care!Provider!asked!about!“Next!of!Kin”!• Obtained!consent!from!incorrect!SDM!• No!attempt!to!determine!Patient’s!capacity!• Informed!consent!was!not!obtained!

!Slide!44!–!Headlines,!Sued,!Cited!and!Disciplined?!!Facilitator!note!–!Supreme!Chief!Justice!!What!did!the!headlines!read?!Who!was!sued?!Who!was!cited?!Who!was!disciplined?!!Summary!of!situation!by!Chief!Justice!

o Slams!gavel!and!concludes!that!there!is!responsibility!across!all!parties!involved!

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o Points! to! Offenses! Board! (**do! not! read! out! again,! unless! it! is! not! clearly! readable! to!participants!farther!back!in!the!room)–!There! is! the! listing!of!errors!and!miscommunications!throughout!this!families!journey!

o Briefly!emphasises!why!is!this!important?!!o Opens! up! for! liability,! legal! actions! that! individuals! and! families! can! take! against!

organizations,!physicians,!systems!etc.!!o We!know! it! is!happening!–!briefly!mention! the!Law!Commission!Report!on!HCC! from!

January!of!2015!(i.e.!found!numerous!forms,!policies!and!practices!that!do!not!represent!or!conform!to!Ontario!legal!framework,)!

o Understanding!and!following!the!legal!framework!supports!patient!centered!care.!!o Bottom!line!it!is!about!HSP!accountability,!(i.e.!recent!reports!such!as!the!Patient!First!

Report)!!Slide!45!–!Could!this!happen!to!you?!!Facilitator!note!–!Supreme!Chief!Justice!!Could!this!happen!to!you?!!!Slide!46!–!Consequences!!Facilitator!note!–!Supreme!Chief!Justice!!Consequences!!

o Story!was!told!to!the!local!media!!o Hospital!&!LTC!home!mentioned!in!media!reports!(local!and!provincial)!o Hospital!&!LTC!home!were!cited!to!their!respective!reporting!and!oversight!bodies!o Physician!was!reported!to!the!CPSO!!o Complaint!lodged!at!the!Law!Society!about!the!lawyer!o The!family!lodged!a!civil!suit!against!the!LTC!home,!hospital!and!family!physician!o LHIN!found!negligent!under!the!MinistryDLHIN!Accountability!Agreement!

!Slide!47!–!Main!Impact!!Facilitator!note!–!Supreme!Chief!Justice!!Impact!

• Increased!suffering!for!the!patient!• Increased!stress!and!anxiety!for!the!patient!and!the!family!!• Increased!family!suffering!about!how!their!mother!died!and!how!the!system!perpetuated!

misinformation!!Justice!STOP,!narrator!to!resume!!Slide!48!–!Why!talk!about!this?!!

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Facilitator!note!–!Narrator!!Why!talk!about!this?!

• We!live!in!Ontario!• There’s!a!difference!between!HCC!&!ACP!• There’s!confusion!about!the!differences!• It!is!your!personal!responsibility!to!yourself,!family!and!friends!!• It!is!your!professional!practice!or!role!responsibility!

!Slide!49!–!The!Opportunities!!Facilitator!note!–!Narrator!!The!Opportunities!

• clear!the!confusion!and!dispel!misconceptions!• promote!knowledge!about!the!legal!framework!in!Ontario!• encourage!consistent!practices!• using!accurate!language!will!promote!clear!communication!• discover!ON!specific!tools,!supports!and!resources!(paper!&!people)!

!Slide!50!–!Ontario!Resources!and!Activities!!Facilitator!note!J!Narrator!!!We!have!two!requests!of!you!today!!First!!J!Ask!#1!–!Learn!more!–!Ontario!Resources!and!Activities!!!Ontario!resource!webpages/materials!–(links!can!be!provided!by!organizers!in!a!participant!resource!package)!!!Narrator!to!indicate!that!we!will!touch!on!a!few!Ontario!resources!in!the!next!few!slides!(narrator!encouraged!to!review!each!of!the!projects!and!activities!as!preparation!for!this!part!of!the!education!event.!

Familiarity!with!the!materials!can!aid!in!being!able!to!proceed!through!these!slides)&

!1) HPCO!Speak!Up!Ontario!website!(slide!52)!2) HPCO!HCC!ACP!Community!of!Practice!(slide!53,!54)!3) WW!Conversations!Worth!Having!(slide55)!4) ETHeL!HCC!ACP!Tools!(slide!56)!5) ACP!Conversation!Guide!Clinical!Primer!&!Guide!for!Persons!and!SDM(s)!–!on!resource!sheet!only!6) CCO!Quality!Improvement!Plan!for!Primary!–!on!resource!sheet!only!!7) Advocacy!Centre!for!the!Elderly!(slide!57)!

!Slide!51!–!HPCO!Speak!Up!Ontario!website!!Facilitator!note!–!Narrator!!!HPCO!Speak!Up!Ontario!website!!

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Speak!Up!Ontario!–!!http://www.speakupontario.ca!!• Ontario!ACP!Workbook!(hard!copy,!download,!onDline!version)!• Educational!presentations!–!health!service!provider!and!public!• Provincial!best!practice!repository!is!intent!of!site,!challenge!you!to!use!your!new!knowledge!to!

vet!content!!!

HPCO!HCC!ACP!Communities!of!Practice!in!Ontario:!• HCC!ACP!Leadership!CoP!• HCC!ACP!Regional!Champions!CoP!• HCC!ACP!General!Membership!CoP!• HCC!ACP!sector!working!groups!(LTC,!Hospital)!

!Slide!52!–!Health!Care!Consent!Advance!Care!Planning!Leadership!Community!of!Practice!!Facilitator!note!–!Narrator!!Health!Care!Consent!Advance!Care!Planning!Leadership!Community!of!Practice!!

• To!create!opportunities!to!influence!policy!and!system!issues!related!to!Health!Care!Consent!and!Advance!Care!Planning!in!an!Ontario!legal!framework.!!

• To!develop!as!an!active!and!engaged!community!of!practice!advancing!the!goals!as!defined!by!its!members.!!

• To!create!awareness!and!educational!materials!and!opportunities!about!health!care!consent!and!advance!care!planning!within!an!Ontario!legal!framework.!!

!Slide!53!–!If!you!are!interested!in:!!Facilitator!note!–!Narrator!!If!you!are!interested!in:!Joining!the!general!HCC!ACP!CoP!community!of!practice!or!in!having!your!organizational!and!educational!materials!related!to!HCC!and!ACP!reviewed!to!determine!if!they!are!Ontario!compliant!then!please!contact:!Julie!Darnay,!!Manager,!Partnerships!&!Communities!of!Practice!jdarnay@hpco.ca!1D800D349D3111!ext.!30!!Slide!54!–!“Conversations!Worth!Having”!!Facilitator!note!–!Narrator!!

• Waterloo!Wellington!Advance!Care!Planning!Education!Program!• 3!year!initiative!funded!by!WW!LHIN!• Uniquely!designed!to!engage!general!public,!community!professionals!and!health!care!providers!to!

build!Consent!and!ACP!understanding!and!capacity!across!their!region!• Focuses!on!Change:!change!awareness,!attitudes,!knowledge!and!behaviours!associated!with!

Consent!and!ACP!!Slide!55!–!Ontario!ACP!toolkit!–!East!Toronto!HealthLink!

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!Facilitator!note!–!Narrator!!

• Toolkit!for!people!with!chronic!diseases!and!the!healthcare!providers!who!care!for!them!• Used!the!Ontario!Speak!Up!campaign!as!a!framework,!tools!created!to!help!patients!with!chronic!

progressive!disease!as!part!of!a!coordinated!care!plan,!discuss!their!future!care!wishes!with!their!family!and!members!of!their!health!team!

• EDlearning!module!created!–!an!ACP!Primer!and!Practical!Approaches!for!healthcare!providers!!Slide!56!–!Advocacy!Centre!for!the!Elderly!!Facilitator!note!–!Narrator!!Excellent!resources!for!understanding!HCC!as!it!relates!to!ACP!Examples!include:!

• !ACE!Tip!Sheet!#1:!Health!Care!Consent!and!Advance!Care!Planning!the!Basics!• ACE!Tip!Sheet!#2:!HIERARCHY!of!Substitute!Decision!Makers!(SDMs)!in!the!Health!Care!Consent!

Act!• ACE:!Advance!Care!Planning!–!Ontario!–!Summary!–!Health!Care!Consent!Act!• Link!to!Law!Commission!Report:!

!HEALTH!CARE!CONSENT!AND!ADVANCE!CARE!PLANNING!IN!ONTARIO!Legal!Capacity,!DecisionDMaking!and!Guardianship!January!2014!!Slide!57!–!Commitment!to!Action!–!(second!‘ask’!to!participants)!!Facilitator!note!J!Narrator!!Ask!#2!–!Commitment!to!Action!!!We!are!asking!you!as!witnesses!to!today’s!inquest!and!more!knowledgeable!practitioners!to!complete!a!Commitment!to!Action!sheet.!Be!part!of!the!change!to!improve!understanding,!rectify!the!misconceptions,!misunderstandings!and!incorrect!practices!in!your!role!or!place!of!work.!!!

o On!your!tables!are!Commitment!to!Action!forms.!!Please!complete!a!commitment!to!action!form!now!(either!on!your!own!behalf!or!on!your!role!or!organizational!behalf).!!

!!!!!!!!!!!!!(allow!for!5!minutes!to!read!and!complete!form)!!Ask!participants!to!give!themselves!a!round!of!applause!for!their!participation!and!commitment!to!action!today.!!OR!!If!you!have!Ontario!Provincial!pins!this!is!the!time!to!ask!them!to!put!on!the!pins!in!recognition!of!their!Ontario!knowledge!in!HCC!and!ACP!and!applaud!their!participation.!!!Slide!58!–!In!Closing!!Facilitator!note!–!Narrator!!

o Thank!you!for!your!participation!!(audience!and!presenters)!

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o Reminder!to!complete!the!evaluations!(***if!you!have!created!one!to!use!for!the!event)!o Any!further!questions!

Slide!59!–!Workshop!created!by!HCC!ACP!Leadership!CoP!!Facilitator!note!–!Narrator!!Workshop!created!by!Health!Care!Consent!Advance!Care!Planning!Leadership!Community!of!Practice!!!Contact!Information:!Julie!Darnay,!!Manager,!Partnerships!&!Communities!of!Practice!jdarnay@hpco.ca!1D800D349D3111!ext.!30!!Slide!60!–!Workshop!key!reference!documents!!Facilitator!note!–!Narrator!!Share!references!used!to!create!education!session.!Please!note!to!participants!link!change!over!time!at!sites!and!these!links!may!not!be!active.!Advise!them!to!search!the!appropriate!sites!to!find!the!information!and!resources.!(i.e.!Consent!and!Capacity!site,!OPGT!site!etc.)!!Key!Reference!Documents:!

• Ontario!Health!Care!Consent!Act,!1996!D!https://www.ontario.ca/laws/statute/96h02!• Ontario!Substitute!Decisions!Act,!1992!D!https://www.ontario.ca/laws/statute/92s30!• Consent!and!Capacity!Board!D!http://www.ccboard.on.ca/scripts/english/aboutus/index.asp!• Public!Guardian!and!Trustee!Office!

https://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/!• ACE!Advocacy!Centre!for!the!Elderly!D!http://www.acelaw.ca/advance_care_planning_J_publications.php!• Hospice!Palliative!Care!Ontario!D!http://www.hpco.ca!• Speak!Up!Ontario!–!http://www.speakupontario.ca!

!Slide!61!–!a!Blank!Unprotected!Slide!for!users!of!this!material!to!add!local!information!such!as:!acknowledgement!to!the!presenters,!sponsors,!or!to!provide!connection!information!on!your!regional!HCC!ACP!champion!!