Practice Guideline- Informed Consent PDF

Informed Consent Approved: 2006 Revised: 2014, 2019 CONTENTS Role of the College of Alberta Psychologists............................................3 Introduction....................................................................................................4 Definitions...........................

Informed Consent Approved: 2006 Revised: 2014, 2019 CONTENTS Role of the College of Alberta Psychologists............................................3 Introduction....................................................................................................4 Definitions................................................................................................................4 CAP Standards of Practice and Informed Consent.................................4 Informed Consent: A Dynamic Process.......................................................6 Determining Who is/are the Client(s)...........................................................6 Determining Who Can Provide Consent......................................................6 When to Obtain Informed Consent................................................................7 Documenting the Informed Consent Process...........................................7 Revisiting Informed Consent............................................................................7 Rescinding Consent..............................................................................................7 Exceptions to Informed Consent................................................................8 Emergencies/Urgent Need................................................................................8 Court Mandated Services...................................................................................8 Compulsory Treatment......................................................................................8 Special Considerations in Informed Consent.............................................9 Appendix A: Questions for Reflecting on the Informed Consent Process.......................................................................... 14 Role of the College of Alberta Psychologists The role of the College of Alberta Psychologists (CAP) is to protect the public and maintain their confidence by ensuring that all psychologists engage in competent, skilled and ethical practice. To this end, CAP establishes, adopts and implements good character, academic (and related) requirements for entry to the profession, standards of practice, codes of ethics, and ethical decision-making principles. As a self-regulated profession, psychologists are ultimately responsible and accountable for all activities they engage in as a regulated member as well as those that link to and reflect upon the profession. As such, CAP provides general clinical and ethical guidance to members, this includes guiding members in identifying, interpreting, and applying regulatory resources (e.g., Legislation, Standards of Practice, Practice Guidelines/Alerts) to their practice situation. CAP does not provide legal, business, or practice specific direction. All psychologists are encouraged to seek additional expert subject matter consultations when faced with complex clinical, technical (practice or ethical), legal and/or business issues. Practice Guidelines support CAP’s primary public protection role by enhancing the practice of psychologists through the integration of standards of practice and ethical principles to specific subject areas. The CAP Standards of Practice outline the minimum expectations of the profession. The Canadian Psychological Association (CPA)’s Canadian Code of Ethics for Psychologists establishes the foundational ethical principles that underpin the profession of psychology. While often considered aspirational in nature, they may also reflect minimum professional expectations like practice standards and form the basis of discipline-related actions. Practice Guideline - Informed Consent 3 Introduction According to the CPA’s Code of Ethics, psychologists pay close attention to the moral rights of their clients through thoughtful practices. This includes developing and following procedures for informed consent, protection of privacy and confidentiality, non-discrimination, fair treatment, and due process (p. 11). Informed consent is understood to involve a person agreeing to what is proposed by a psychologist, based on sufficient information to make a reasoned decision. Seeking informed consent from a direct recipient of psychological services is recognized as essential because it establishes the parameters of the professional relationship. Furthermore, failing to obtain informed consent is a violation of professional standards and may result in complaints along with a risk of professional liability and/or discipline. While the concept of informed consent may appear straightforward, translating it into practice is often complex. Providing a prescriptive set of guidelines applicable to all situations is not possible and would negate the individuality of clients and the diversity of clients, settings, populations, assessment situations, and treatment situations as well as the self-regulatory nature of the profession. Definitions Psychologists are encouraged to regularly reflect upon and review their informed consent practices and engage/consult with colleagues in respect to these. Appendix A contains a set of questions that may be beneficial to a reflective process on informed consent. 1 2 Assent: means the expression of approval or agreement by demonstrating a willingness to proceed1. Consent: permission to do something (not necessarily informed). Informed Consent: a process of obtaining consent whereby psychologists seek to engage “full and active participation from individuals and groups in decisions that affect them, respecting and integrating as much as possible their opinions and wishes.”2 In the practice of psychology, assent typically is sought when working with a minor, working with someone who presents with diminished capacity, or in emergency situations. Canadian Psychological Association Code of Ethics I.16 Practice Guideline - Informed Consent Informed consent-related questions are one of the most frequently received inquiries by the professional guidance department at CAP. As such, this practice guideline contains information about the generic informed consent process. As well, it identifies a variety of common informed consent issues, such as serving clients under the age of 18, responding to mandated psychological services, and services involving multiple clients. CAP Standards of Practice and Informed Consent The CAP Standards of Practice contain a description of the minimal requirements of the informed consent process necessary to define the parameters of the service(s) to be provided. The informed consent process is intended to empower and protect both clients and psychologists. Overall, this process entails psychologists provide sufficient relevant information, ensuring that clients understand the information, and that clients voluntarily choose to participate. 4 As established by the CPA Code of Ethics, the CAP Standards of Practice, and the College, the following topics are to be addressed as part of obtaining informed consent: 6) likely benefits and risks; 7) alternative modalities of assessment/ treatment; 1) purpose and nature of the activity; 8) likely consequences of non-action; 2) mutual responsibilities; 9) 3) confidentiality protections and limitations including how information will be stored and who may have access; option to refuse or withdraw at any time, without prejudice by the psychologist; 10) time period covered by the consent; 11) 4) how confidential information can be accessed; how to rescind consent, if a decision to rescind consent is made; and 12) fees and financial arrangements. 5) how communication will happen between the psychologist and client(s), guardian(s) or third-parties; Practice Guideline - Informed Consent Again, these are the ‘minimum required’ to meet professional standards. Other areas psychologists may wish to address during the informed consent process include logistics and/or business considerations (e.g., cancellation policy, social media policy). 5 Informed Consent: A Dynamic Process Informed consent is more than a completion of a form or a one-time conversation, but rather a dynamic process. Further, it should not be considered a barrier to professional services, but a foundation. It is an ongoing process through which consent is obtained both initially and as the professional relationship develops, boundaries are established, and professional rapport is built. Generally, there are four parts to the informed consent process: 1) providing relevant and understandable information about professional services; 2) creating the opportunity for questions; 3) evaluating the client’s capacity to understand the information; and 4) obtaining consent. Informed consent must be obtained directly by psychologists from the recipient(s) of their services, and not through a third party (e.g., administrative staff, lawyer, physician, etc.). Psychologists are responsible for engaging in a dynamic informed consent process with clients and documenting the process along with any forms (e.g., informed consent document) or salient issues. The informed consent process should consider communication needs, including language with translations available when necessary. Determining Who is/are the Client(s) Psychologists are encouraged at the outset of services to determine what their role is as a psychologist (e.g., therapist, consultant, Practice Guideline - Informed Consent diagnostician, or expert witness) and who is/are the client(s). For example, when psychologists agree to provide services to a person, there may be others involved (e.g., spouses, significant others, parents, children, or third-parties). Psychologists are encouraged to explicitly identify and state who is the primary “client(s),” and who is a secondary client (if any), and the relationship the psychologist will have with all interested parties. For example, it may be helpful to address how and what information arising from a psychological service will be documented and stored, who can access it, and how they can access it. Psychologists shall avoid dual or multiple relationships that are not justified by the nature of the activity, by cultural or geographical factors, or where there is a lack of reasonably accessible alternatives. Determining Who Can Provide Consent It is important to formally establish who has the legal right to provide consent. Adults over the age of 18 are presumed to have capacity to consent for their own psychological service unless there is reason to believe otherwise. With minors or those with limited capacity, consent for a psychological service may be required from someone other than the recipient of the service. In the case of a minor, consent will need to be obtained from the minor’s guardian, parent, divorced parent with legal standing, or appointed case-manager as authorized by law. Examples of people who may not provide consent for a minor include step-parents, grandparents, significant others, family friends, and/or caregivers. 6 For those with limited capacity to consent, a legally appointed guardian or trustee may need to provide consent prior to providing a psychological service. When to Obtain Informed Consent The CAP Standards of Practice and the CPA Code of Ethics both require psychologists to obtain informed consent prior to providing professional services to a client. Under the Health Professions Act (Schedule 22), in their practice, psychologists do one or more of the following: a) assess, diagnose, treat, guide and support persons or groups of persons in order to enhance development, effective living and quality of life or to prevent, remedy or ameliorate mental, emotional, cognitive, behavioural and interpersonal difficulties; b) teach, supervise or consult in the practice of psychology; b.1) c) manage and conduct research in the science, techniques and practice of psychology; provide restricted activities authorized by the regulations. Documenting the Informed Consent Process Clients may indicate their consent for psychological services in the following three ways: written, verbal, or by action (e.g., nodding one’s head). CAP Standards of Practice require that psychologists document the informed consent process along with the client questions and responses to the informed consent process in the psychological record. In many circumstances, psychologists will use an informed consent document as part of their informed consent process. If a written consent form is not appropriate due to culture, literacy, disability, or for any other legitimate reason, psychologists should ensure they document the process and verbal or action response to the informed consent process. Practice Guideline - Informed Consent Revisiting Informed Consent As previously stated, informed consent is a dynamic, fluid, and ongoing process. It is reasonable for psychologists to formally revisit the informed consent process when there are changes in the professional relationship, changes in the treatment plan or goals of service, or if there is a significant break in service provision. Common examples of when psychologists would want to revisit the informed consent process: an adolescent is nearing 18 years of age, there is a change in parental/guardianship rights, and/ or a third-party payer enters/exits the service agreement. Other reasons to formally revisit informed consent may include changes to the client capacity to make decisions, safety concerns arise (for client and/or others), involvement of other authorities (e.g., Children’s Services, Corrections Canada, Workers Compensation), Court Order, and/or when revisiting the initial service agreement. As well, psychologists who update their billing practices or change their fees might also wish to explicitly communicate and document the conversation in the client psychological record. Rescinding Consent In general, clients have the right to rescind consent voluntarily and without fear of reprisal from the psychologist. The manner in which clients rescind consent is to be covered in the informed consent process. In some contexts, psychologists may require clients to rescind their consent in writing. After a client rescinds consent, the psychologist is to collaborate with the client to determine what (if any) resources/services/referrals are needed to ensure reasonable continuity of care. Psychologists should discuss with clients what (if any) communication will take place with the thirdparty (if appropriate) to inform them that consent has been rescinded. Generally, psychologists are no longer to release client information to any previously agreed upon third-party without the client explicit written consent. 7 Exceptions to Informed Consent In some situations, psychological services may be carried out without psychologists first seeking informed consent. The following are examples of such exceptions. Emergencies/Urgent Need Informed consent must be obtained from all persons who are competent to give consent for psychological services except in circumstances of urgent need (e.g., disaster, emergency or other crisis). In urgent circumstances psychologists could proceed initially with the assent of the client to the extent necessary to alleviate the urgent circumstances. Psychologists would be required to obtain fully informed consent as soon as possible and before providing additional psychological services following the alleviation of the emergency. Compulsory Treatment In Alberta, a Community Treatment Order (CTO) is a tool intended to assist patients in maintaining compliance with treatment while in the community; thereby breaking the cycle of involuntary hospitalization, decompensation, and rehospitalization. Psychologists working with individuals under a CTO ought to be familiar with the Mental Health Act and ensure they apply the principles of informed consent as reasonably appropriate given the circumstances and the competence of the individual requiring such an order. Court Mandated Services Some clients are in a position of receiving Court mandated services. Regardless, the principles of informed consent are to be applied. For example, it is reasonable to expect that the consent process would include providing adequate information about the nature and scope of services, risks/ benefits of participating, and other relevant details. The informed consent process for mandated clients should ensure the individual is made explicitly aware of additional limitations in confidentiality as well as careful consideration of the consequences of participating versus not participating in Court-requested services (this may include psychologists advising clients to seek legal consultation). Practice Guideline - Informed Consent 8 Special Considerations in Informed Consent (presented alphabetically) 1. Clients Presenting with Reduced Capacity to Consent Decision-making capacity refers to the client’s ability to understand a situation, identify decisions required, and ability to identify possible courses of action (along with the possible consequences). Clients who do not appear to understand the information provided or who do not appear to appreciate the reasonably foreseeable consequences of the decision to participate in treatment may be unable to provide consent. Generally, psychologists assume an adult client is capable of providing their own consent to services unless there is evidence that the client is experiencing reduced capacity. Reduced capacity may arise for a variety of reasons: a) impairment, b) cognitive decline (e.g., due to aging, head injury, psychosis), and c) intellectual disability. In these situations, psychologists are to follow the general principles of informed consent/assent, recognizing it may be helpful to use different formats, communication aids, interpreters, assistive devices, and/or longer time frames for making decisions. As well, psychologists are to obtain informed consent from a legal guardian when possible. 2. Collaborative and/or Interdisciplinary Practice Many psychologists work within larger systems (such as schools and health clinics) and find themselves in unique team environments where they are expected to share information with others concerning the well-being of a client. Clients receiving services in collaborative settings are to be made aware of what psychological information will be shared with whom and under what circumstances. Practice Guideline - Informed Consent Working in a collaborative environment requires psychologists to demonstrate sensitivity and consider enabling legislation while also using their professional judgment (which includes careful study of applicable legislations [e.g., Children First Act, Personal Information Protection Act, Health Information Act] and professional standards) in determining what client information will be shared or disclosed. 3. Guardianship for Adults When seeing adult clients who have a guardian, psychologists are to provide an appropriate explanation to the client, seek the client’s assent, and consider the client’s preferences and best interests before providing a professional service to the client. Psychologists are to seek informed consent from the assigned guardian or substitute decision-maker. Further, psychologists must seek and document the informed consent process in the client file prior to providing services. If a guardian has yet to be appointed, psychologists attempt to seek as fully informed consent/assent as possible. 4. Limitations in Maintaining Confidentiality While psychologists are responsible for maintaining client confidentiality, there are a variety of limits to confidentiality in the provision of psychological services. Again, depending on the individual client factors and the diversity of client settings, populations and treatment situations, psychologists must be knowledgeable and communicate clearly limits on client confidentiality. Duty to Report Psychologists have several mandatory legislated reporting obligations. Psychologists’ duty to report refers to such obligations that fall under the various non-exclusive authorities such as the Child, Youth, and Family Enhancement Act, the 9 Health Professions Act, the Traffic Safety Act, Children First Act, and the Workers Compensation Act. Psychologists are encouraged to review the annually updated Jurisprudence Document for Alberta Psychologists on the CAP website. It is important to remain current in their jurisprudence knowledge related to limitations on confidentiality as well as to communicate these limitations effectively to clients. a decision (See J.S.C. and C.H.C v. Wren [Alberta Court of Appeal]). Duty to Disclose Related to Client/Public Safety. The decision to consider designating a minor as mature should be made prior to the provision of services and the factors and rationale for determining that a minor is mature should also be clearly documented in the client file. Safety situations may arise that may require disclosure of client information without consent. The CAP Standards of Practice specify that psychologists may disclose confidential information about clients “without informed written consent of the client when the psychologist has reasonable and probable grounds to believe that disclosure is necessary to prevent imminent and grave harm to: the client; another person’s mental or physical health or safety; and/or public safety.” Disclosure is most often acceptable in situations where psychologists have established a formal client relationship and possesses reasonable and probable grounds to believe that their client is at imminent risk or grave danger to themselves or others. Psychologists may relay this information to those at risk (i.e., potential foreseeable victims) and those in a position of authority to offset the potential harm (i.e., police or a treating physician). The CAP Standards of Practice use the words “may disclose,” not “shall disclose.” As such, a reasoned analysis is required in assessing disclosure and this analysis should be documented in a client’s file. 5. Mature Minors In Canada, the Supreme Court of Canada ruling in A.C. v. Manitoba (2009) found that minors (individuals under the age of majority) may exercise personal autonomy in making decisions about their medical treatment if they have sufficient understanding and cognitive skills to enable them to sufficiently understand what is being proposed. In Alberta, psychologists are responsible for making a determination whether a minor is a mature minor and therefore able to consent on their own behalf. The Courts have established that the significant factor is that the minor must be able to understand the information that is relevant to making the decision about the proposed medical treatment and is able to appreciate the reasonably foreseeable consequences of a decision or lack of 3. Psychologists must consider a variety of factors before treating a minor as a mature minor. This includes considering the age and maturity of the minor, the nature and extent of the minor’s dependence on the parents or guardians and the nature and complexity of treatment. Questions3 for psychologists to consider when determining if someone is a mature minor: 1. What is the nature, purpose, and utility of the recommended treatment? What are the risks and benefits? 2. Does the young person demonstrate the intellectual capacity to understand the relevant information and the potential consequences? 3. Is there reason to believe the young person’s views are stable and a true reflection of core values? 4. What is the potential impact of the young person’s lifestyle, family relationships, and broader social affiliation on their ability to exercise independent judgment? 5. Are there existing emotional or psychiatric vulnerabilities? 6. Does the young person’s illness or condition (if any) have an impact on their decision making? 7. Is there any relevant information from adults who know the young person, such as parents, teachers, or doctors? Psychologists should document their informed consent discussions with the mature minor, including discussions surrounding any potential limitations to confidentiality. When clients are deemed a mature minor, psychologists generally must uphold their privacy rights and should not disclose information to their guardians without the mature minor’s consent. However, exceptions to this may occur if the information is ordered for Supreme Court of Canada Ruling: A.C. v. Manitoba (2009) Practice Guideline - Informed Consent 10 release by a Court or under other limited exceptions permitted by law. When guardians are aware of their child accessing service, ideally, psychologists shall advise all guardians at the outset the minor has been deemed mature and the potential limitations for sharing/non-sharing of confidential information. 6. Medical Assistance in Dying (MAiD) Due to the legal and clinical complexities of providing MAiD psychological services, psychologists must ensure that they have complied with all relevant federal and provincial laws in all respects along with adhering to CPA Code of Ethics and CAP Standards of Practice. Please see the CAP Practice Guideline: Medical Assistance in Dying (MAiD) for information on informed consent considerations when working in this context. 7. Minors An individual under the age of 18 is presumed to be a minor unless they have been deemed a mature minor. If a psychologist is engaged by a minor’s guardian(s) to provide services to the minor, then informed consent must be obtained prior to the services being provided. Generally, psychologists are not required to obtain informed consent from both parents or all guardians, since either parent, or any of the guardians individually, normally has the right to consent to treatment on behalf of a minor child. Nonetheless, when possible and practical, psychologists should attempt to seek informed consent from all guardians to ensure transparency and objectivity in the delivery of professional services. At a minimum, psychologists should make appropriate inquiries to ensure that the adult requesting services on behalf of the minor is the minor’s parent or guardian. If the minor’s parents are separated or divorced, a Court Order may be in place that specifically addresses or impacts the issue of consent. In light of the possibility a Court Order is in place that impacts the issue of consent, psychologists must make reasonable inquiries to determine whether the parent seeking psychological services on the minor’s behalf has the right to consent to treatment. In some instances, the Court Order may specify that only one parent has the authority to make decisions affecting the child’s health (including the right to consent to treatment). In such circumstances, the other parent would not be legally entitled to consent to the provision of professional services on the child’s behalf. If the adult is not the parent but has been appointed as Practice Guideline - Informed Consent the child’s guardian, psychologists should seek a copy of the Court Order establishing guardianship and the terms of any order. It is usually advisable for psychologists to request and review the most recent Court documentation prior to providing services for a child of divorced or separated parents. However, it may not be practical or possible to do so in every situation and psychologists can proceed on the word of the parent that they have guardianship and decisionmaking authority. However, psychologists should still seek any legal documents available as soon as possible for their records. In determining whether a review of Court documentation is required, psychologists should consider all relevant factors, including: When psychologists have concerns regarding whether the parent seeking professional services on the minor’s behalf has legal authority to do so, psychologists should request copies of all relevant Court Orders before proceeding. The length of time since the minor’s parents have been separated or divorced. If divorce and custody proceedings are ongoing, the parties may be more sensitive to issues affecting parental rights, including which parent has the right to consent to treatment on the minor’s behalf. In this circumstance, psychologists may prefer to obtain an actual copy of relevant Court orders, rather than relying upon one parent’s representation regarding their right to consent to treatment on behalf of a minor child. The nature and the circumstances in which the services are being provided. Whether or not it is reasonable for psychologists to rely, without reviewing Court documentation, on a parent’s representations regarding the right to consent to treatment, may also depend on the nature of the services being provided. For example: »» It may not be feasible for psychologists who are providing counselling services to a minor who requires assistance on an urgent basis to obtain Court documentation prior to rendering services, since a delay in providing services could pose a threat to the minor’s well-being. 11 »» »» Psychologists who are rendering opinions for the purposes of litigation, including custody and access proceedings, may be held to a higher standard to ensure that the parent requesting psychological services has legal authority to provide consent on the minor’s behalf. It is recommended that psychologists who are providing psychological services in the context of custody and access proceedings obtain relevant Court documentation prior to rendering services. It may not be necessary for psychologists who are providing services that are unlikely to impact parties’ legal rights to obtain Court documentation confirming that the parent seeking services has legal authority to consent. For example, it may be reasonable for psychologists who are providing learning strategies relating to a specific student whose parents are divorced to provide services without obtaining copies of Court documentation, since the consultation is unlikely to impact the legal rights of the student or the legal rights of either parent. If psychologists have concerns with respect to issues relating to consent for minors, it is recommended that psychologists consult a peer, legal counsel, or professional guidance at CAP, prior to proceeding to provide services. Third-Party Requests and Minors In some instances, psychologists may be retained by a third party to provide psychological services that may affect a minor. Even though the psychologist is not retained directly by the minor’s guardian, it is still necessary to obtain informed consent from the minor’s guardian before providing psychological services. For example, psychologists who are employed/ contracted by a school district may be asked to consult with a teacher regarding learning strategies in the school context. Consent is not required if psychologists are providing general information to the teacher regarding teaching strategies, classroom set-up or other advice that is not specific to a particular, named student. However, if psychologists are providing specific advice or recommendations regarding a particular, named student, psychologists must obtain Practice Guideline - Informed Consent informed consent from the minor’s guardian(s) before providing professional services. 8. Multiple Clients Psychological services may also be provided when more than one person is present (i.e., couples, family, group counselling). It is essential psychologists follow the informed consent process, conveying additional considerations such as limitations on confidentiality. This includes describing the psychologist’s efforts (and limitations) to secure a commitment from the members of the group to preserve confidentiality. The informed consent process should also include how group records are accessed in the event a client record is requested (e.g., in legal proceedings). 9. Observing and/or Recording Clients Signed informed consent is required from a client before permitting the professional service to be observed by others or electronically recorded for academic, supervision, research, or consultation purposes. 10. Supervision and Consultation Supervision is defined as an ongoing, evaluative, hierarchical relationship with an implicit or explicit contract specifying the goals and term of the relationship. In a supervisory relationship, supervisors are professionally, ethically, and legally responsible for advice given, records kept, and ensuring that psychological services resulting from that relationship are delivered competently. This is verified through the co-signing of all clinical and assessment documents (i.e., reports). Psychologists or provisional psychologists under supervision are to communicate with clients that they are receiving supervision as part of the informed consent process. Clients are to be aware of and provide consent to services with the understanding that their information will be provided to the supervising psychologist. Clients should understand and provide consent that supervising psychologists may review case notes, discuss full details of the case with the treating professional, and will countersign any written documents and reports before release. In some cases, special signed consent should be obtained from clients when supervision methodology includes reviewing of video-taped sessions or live supervision (see CAP Standards of Supervision for more information). 12 Consultation occurs between professionals of relatively equal status, is typically brief in duration and more irregular in frequency, is based on restricted amount of information, and offers a point of view that is not binding. Psychologists should be aware that in all circumstances, they are accountable for providing competent information relevant to psychological services. Further, all consultations should be documented by the professional receiving the consultation. Consultation may be formal or general in nature. General consultation does not typically require treating psychologists to disclose confidential client details to consulting psychologists who would then offer recommendations. Conversely, formal consultation would involve soliciting client specific recommendations and likely require disclosure of confidential client information in order to receive client-centered recommendations. When reasonable, psychologists engaging in formal consultation ought to obtain the client written consent in advance of any consultation which involves disclosing possibly identifying information. Wherever possible, psychologists are to limit the amount of identifying information to maximize the client right to privacy during formal and/or informal consultations. Practice Guideline - Informed Consent 11. Telepsychology Due to the additional risks related to the delivery of service through telepsychology, psychologists must demonstrate additional thoughtfulness in engaging in the informed consent process with others (especially clients). In addition to the informed consent requirements as outlined in the CAP Standards of Practice and this guideline, there are additional informed consent requirements. Please see the CAP Practice Guideline: Telepsychology Services. 13 Appendix A: Questions for Reflecting on the Informed Consent Process The following is a sample of the type of questions psychologists may wish to address when reflecting on their informed consent processes. Diversity and Cultural Competency Have I considered literacy, language, culture, degree of detail, attitudes to authority, etc., in my informed consent process? Do I have access to translation services, if needed? General Do I have a defined informed consent process in my practice setting? Does my informed consent process address clinical, administrative, legal and financial issues? Do I have a process to determine who has legal authority to give consent? Have I defined, for my practice, what information a “reasonable” person might need to know/understand in order to give consent? How do I evaluate that a client understands the information provided to them? Decision-Making Capacity What types of client related capacity issues might I encounter in my practice? How do I define capacity to provide consent within my practice? How do I determine that a person has the capacity to provide consent? What processes do I have in place if feedback confirms that the client does not understand the information provided? Practice Guideline - Informed Consent Documentation What level of documentation, in terms of legal and professional requirements, is appropriate in my practice setting? Do I have a format/method of documenting the informed consent process in my practice? Do I have a process to obtain and document informed consent for consultations, reports and letters? Does my informed consent process address record retention (for example, storage after retirement) and distribution of reports to third parties? Collaborative/Organizational Requirements How might the practices and demands of other team members or third parties impact my informed consent process? 14 Emergencies How do I define an emergency situation in my practice? Am I familiar with the CAP Standards of Practice related to consent and emergencies? How do I ensure that professional services provided in an emergency are provided only to the extent necessary to reduce/ alleviate the emergency? Do I have a process in place to transition from an emergency situation, in terms of the consent process? Practice Guideline - Informed Consent 15