Category: Definitions

A list of individuals who may be called upon to make decisions on behalf of a patient who lacks the capacity to decide for themselves. The next-of-kin hierarchy is used only if the patient has not assigned someone as their power of attorney. The exact order in which family members are listed varies by jurisdiction. Some of the relevant legislation for Canadian Provinces and Territories can be found here: https://cnps.ca/article/consent-for-the-incapable-adult/. ...

A document that authorizes one person to act on behalf of another. In Canada, a power of attorney for personal care can be used to assign someone to make health care decisions on your behalf if you lack the capacity to make them yourself. See also, advance directive. ...

Ethically relevant differences are aspects of context or facts of the matter that shift the values that we think to be applicable to deciding a course of action.  These are essential in determining whether or not justice has been achieved in that particular situation. For example, there could be two patients who are clinically very similar, but one lacks capacity and the other does not.  The difference in decision making capacity between the two means that respect for autonomy will be less important in both the content and form of decision making for the patient who lacks capacity, such that a best interests standard is much more likely to be applied (and we see this reflected in guidelines around decision making with infants and children). Other ethically relevant differences might be resource constraints; decisions made about care during times of crisis (higher demand) or shortages (reduced supply) are not expected to be the same as those made during times when it is...

The allocation of health care resources is possibly the most significant ethical challenge in health care, although it is not often perceived as such by the general public.  Decisions about allocation of resources provide significant insight into how an organization translates its values->organizational values into practice; it is not a stretch to claim that the most significant ethical document an organization produces is its budget and business plan. Resource allocation in health care is a zero sum game in a meaningful way; decisions that generate benefit for one group preclude generating benefit for another group, raising concerns about justice in these allocations. In health care we are concerned not just about the use of funds but also the allocation of space, equipment, and health care provider time.  Resource allocation decisions are deeply ethical in that they significantly determine how individuals are treated (or not) by the health care system....

Privacy is the right that individual have to protect and control the access that others have to information about themselves. Privacy is a strong right but is not absolute; individual privacy can be breached when another individual’s significant interests are at stake....

Reciprocity recognizes mutual dependency and vulnerability.  In the health care context, reciprocity is generally focused on actions that respond to this dependency and vulnerability to generate mutual benefit; the proverbial “treat others as you would yourself be treated”.  ...

The rights of patients to access and control their health information (along with other personal information) has been recognized In legislation that protects privacy. Use of health information must serve the presumed interests of the individual whose information it is; that is, health information can be shared at the request of the patient or with others who are directly involved in providing care.  The health record belongs to the patient, not the health care provider or the organization. The expectation is that the minimum amount of information necessary will be shared, and wherever possible (for quality improvement, for example) aggregate or de-identified data will be used....

The value of solidarity acknowledges the interdependence of human beings upon each other and that cooperation is in the interests of individuals in achieving their various ends.   Solidarity focuses on collective effort toward a common goal, even as particular individuals contribute in different ways to achieving the end.  In essence, it is recognition of the fact that we are all in this together....

Informed consent is a cornerstone of contemporary medical practice in the West.  It is the primary means through which the principle of respect for autonomy is translated into practice.  Informed consent procedures acknowledge that the patient has the right to make care decisions. Consent makes it permissible to do things, such as inserting foreign objects into another person’s body, that would otherwise be considered illegal (without consent, inserting foreign objects into another person’s body would be a clear example of assault). Legal precedents regarding informed consent have established that patients have a right to know what their health care provider intends to do, what risks are entailed by the proposed action, and any other information that would be pertinent to a reasonable person in the patient’s position....

Capacity refers to the ability to understand health care information and make health care decisions (and is sometimes used interchangeably with competence in colloquial discussion, although there is a legal distinction whereby competence is a more global property).   Capacity is specific to a particular decision, and requires that the person making the decision understands information relevant to the decision and the consequences of choices (including refusing to act). Capacity is required as an aspect of informed consent, along with disclosure (being provided with the information needed to make the decision in accordance with the reasonable person standard) and voluntariness (freedom from coercion)....