Regulation of the Nursing Profession and Informed Consent in Canada

In this lesson we will continue to examine the laws, structures and procedures that regulate the practice of nursing in Canada. We will explore the challenges facing internationally educated nurses (IENs) who seek to work in the Canadian healthcare system before turning to the subject of disciplinary and competency issues. We will then turn to the subject of informed consent and discuss a number of groundbreaking legal cases that have helped generate the growing body of legal precedent used to resolve issues of competence and consent in Canadian health care.

By the end of this lesson, students should have a clear understanding of:
• The laws, procedures, and structures regulating the nursing profession in Canada
• The role, function, and responsibilities of nursing governing bodies
• The implications of the doctrine of informed consent
• The concept of competence and the means used to assess competence
• The challenges associated with obtaining informed consent from children and incompetent adults
• The concept of proxy or substitute consent and the legislation governing substitute decision making 

Please take the time to reflect on and discuss the two assigned articles with your fellow group members and respond to one of the following questions. Please post your response as well as

your reply to one of your fellow group member’s posts online via Moodle.
1. Please discuss Corrigan’s notion that the idea of informed consent should be expanded from its current “‘tight and limited’ focus”. Please identify some of the freedom-limiting features that constrain the process of obtaining meaningful informed consent.
2. Do you agree with the Supreme Court’s decision in Starson v Swayze that Ontario’s Consent and Capacity Board should have based its decisions solely on Starson’s mental capacity rather than his best interests?

Once you have read the materials for the lesson, please complete the following case analysis and post it online for review and grading by your fellow group members. Analyses must not exceed 3 double-spaced pages. Each analysis is worth 5 points and will be graded by your fellow group members, who must assign a grade from 0 to 5, based on the thoroughness of the response. You should cite relevant material in the assigned course readings as appropriate. You are also welcome to consult external sources but must provide proper references for any quotation or citation from external sources. Once you have completed grading the assignments, please have one group member email the grades to me. Each individual case analysis will be worth 5 points.

Case:
Jim is a 34-year-old man who is well-known to the community health centre that he and his family have attended for several years. He is married and has two young children. His wife is eight months pregnant. He is a computer salesman and spends much time away from home travelling to clients across the country.

A few weeks ago, Jim presented to the clinic complaining of generalized fatigue and lethargy. He had recently lost five kilograms and had noticed some unusual lesions on his inner thighs.

Lesson 3: Regulation of the Nursing Profession and Consent to Treatment
Lesson 3: Regulation of the Nursing Profession and Consent to Treatment
Copyright © 2021 Continuing & Distance Education, St. Francis Xavier University. All rights reserved. 21 of the blood screening done at that time, an HIV test was undertaken. This turned out to be positive. Given his clinical picture, it was likely that he had already developed AIDS.

Jim’s primary care nurse is present when his physician relays the bad news to Jim. Clearly distraught, Jim admits that he has had sexual intercourse with a number of women during his business trips, and on several occasions did not bother to use a condom. Fearful of the effects that this revelation would have on both his family and his business contacts, Jim pleads with his caregivers to keep this information, and his diagnosis, confidential. Given his wife’s pregnancy, he feels this knowledge might cause her undue harm. He assures them that he and his wife have not had intercourse since her pregnancy. He refuses any treatment for his AIDS-related symptoms, since this would make the diagnosis obvious to everyone. Instead, he asks that his family, including his wife, be told that he has terminal and incurable cancer. Jim’s physician (who is also his friend) says that he will respect Jim’s wishes for now.

1. Did the clinic have the right to test Jim for HIV without his knowledge or consent?
2. Should the health care team keep Jim’s diagnosis confidential from his wife?
3. If the primary care nurse disagrees with the decision of the physician, what can she do?