Consent to Treatment

Informed consent is a communication process whereby the person must understand information provided to them, retain that information, consider the consequences of that information and reliably communicate their decision.

Having a speech, language and communication disability does not always preclude one’s ability to effectively communicate and give informed consent.  For that to happen, people may need appropriate communication accommodations and supports that meet their individual needs.  If a patient does not have an effective way to communicate, a Speech-Language Pathologist must be engaged to conduct a communication assessment in order to determine the most appropriate communication methods, accommodations and supports to meet their needs.

Communication accommodations and aids include an array of tools that can facilitate a person’s ability to understand and communicate effectively, such as hearing aids, glasses, picture/photo/text cards, symbol and letter boards, and communication devices.  Some communication accommodations are personalized; others are generic to a particular situation such as an intensive care setting.

Communication supports refers to human assistance that a patient may require to understand and / or to reliably communicate their intent to a practitioner. Communication support is often provided informally by a person who is familiar with the patient and how they communicate, such as a family member, friend, or a caregiver.  It is important that the patient authorize the person who provides this assistance and that the healthcare provider observes the patient directing and approving what their assistant “interprets” as their communication.

In other situations, where there is no familiar person to assist with communication or where there is a question about conflict of interest or the reliability of the communication support provided, a Speech-Language Pathologist should be engaged to directly provide independent, neutral communication support.

The healthcare provider should ensure that the following has been addressed and documented as part of the consent process for a patient who has a significant communication disability:

• The communication methods and accommodations that the patient used to understand information, retain and communicate questions, opinions and decisions.
• The communication assistance that the patient required and used.
• Evidence of patient’s authorization of the person who assisted with communication.
• Evidence of any perceived conflict of interest for the person assisting with communication.
• Evidence that the communication assistance was observed by the healthcare provider.
• Validation that the communication assistance was provided in a way that was directed and confirmed by the patient; that messages were not coerced in any way; that leading questions were not used; that assumptions were not inferred; that the assistant did not control or influence the patient’s communication.

Adapted from Vulnerable Person’s Standard (Collier, Abbott and Self, 2018)