Specific Decision Making (Schedule 1) (Form 6) - Alberta Human Services - Government of Alberta

Specific Decision Making (Schedule 1) (Form 6)

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The Adult Guardianship and Trusteeship Act (AGTA) allows a physician, nurse practitioner, or dentist (for dental care only) to utilize Specific Decision Making (SDM) when an adult has no guardian or personal directive and the adult does not have the capacity to make a health care or placement decision. SDM may be utilized at the discretion of the health care provider. It is intended to “fill a gap” when formal decision making mechanisms are needed.

Instructions for Health Care Providers

This form has three parts:

  • Part 1 has four items and deals with the capacity assessment process when using SDM. Part 1 is completed by the health care provider (physician, nurse practitioner, dentist). It is acceptable to attach a treatment plan to this form if more room is required to describe the proposed health care.
  • Part 2 has five items and is completed by the family member selected to make the decision. Note: Part 2 refers to a pamphlet you should provide to the family member selected to act as the Specific Decision Maker.
  • Part 3 has two items and confirms the process completed (e.g., who you selected to be the specific decision maker and details about the final decision such as a facility’s address).

Part 1 – Capacity Assessment

Item 1 asks for basic information: who, what, and when. It is acceptable to attach a treatment plan to the form if more space is required to describe the proposed health care.

Item 2 – confirms you have conducted the capacity assessment in the manner described in the AGTA Regulations. This includes allowing the adult to have their spouse, family, or friends present to help them understand information and communicate their understanding of the information (AGTA Regulations, Section 20). It also obligates the health care provider to communicate with the adult in a manner best suited to the adult’s skills and abilities. Prior to assessing the adult’s ability to make the specific decision, the health care provider must inform the adult of their right to refuse to be assessed or continue with the assessment. You must also inform the adult of the impact a refusal may have on providing health care, admission, or discharge (e.g., admission delayed) (AGTA Regulations, Section 18).

With respect to a health care decision (AGTA Regulations, Section 19(1)), the health care provider is required to meet with the adult and provide the adult with information a reasonable person would require to make the decision. This includes:

  • the condition for which the health care is being proposed
  • the nature of the proposed health care
  • the material risks/expected benefits
  • the likely side effects
  • the alternative forms of health care
  • the reasonably foreseeable consequences if the health care is not provided.

With respect to a decision about temporary admission/discharge to a facility (AGTA Regulations, Section 19(2)), the health care provider is required to meet with the adult and provide the adult with information a reasonable person would require to make the decision. This includes:

  • the reasons for the proposed admission/discharge
  • the location/type of facility (if admission)
  • the material risks/expected benefits to the adult re: admission/discharge
  • the alternatives available to the adult if they are not admitted/discharged
  • the reasonably foreseeable consequences if the adult is not admitted/discharged.

Item 3 – is your determination of the adult’s capacity to make the specific decision: in your opinion, the adult did or did not understand the information and appreciate the consequences of making/failing to make the decision. Reminder: it is acceptable for the adult to have family and friends assist them in understanding and communicating during the process.

Item 4 – applies only when you determine the adult lacks the capacity to make the specific decision. If you determine the adult can not make the decision, you must inform the adult of your finding and that you may select a Specific Decision Maker (relative) to make the decision. You must also inform the adult that they (or their family and friends) can request a more in-depth capacity assessment and that they, or those close to them, may apply to the Court for a review of the capacity assessment or the decision of the Specific Decision Maker (AGTA, Section 97).

The AGTA defines nearest relative by means of a ranked list. Relatives of the whole blood being preferred to relatives of the same description of the half-blood and the elder or eldest of two or more relatives regardless of gender:

  1. spouse or adult interdependent partner
  2. adult son or daughter
  3. father or mother
  4. adult brother or sister
  5. grandfather or grandmother
  6. adult grandson or granddaughter
  7. adult uncle or aunt
  8. adult nephew or niece

Part 2 – Declaration of Specific Decision Maker

The Specific Decision Maker completes all items in Part 2. Provide the Specific Decision Maker with a pamphlet explaining their role and duties.

Part 3 – Record of Health Care Provider

This confirms the process and final decision of the Specific Decision Maker. For example, if modifications were made to the original health care proposed, you would specify the final health care agreed to here. Again, it is acceptable to attach a description of the health care to the form.

Collection of Personal Information

The personal information required on these forms is collected pursuant to s. 33 (a) and (c) of the Freedom of Information and Protection of Privacy Act and the Adult Guardianship and Trusteeship Act (AGTA) and its associated regulations (AR 219/2009 & 224/2009). Your personal information will be used for purposes related to the administration of the AGTA and its regulations. Your information will not be further used or disclosed without your permission unless authorized or required by law. If you have any questions about the collection of your personal information, please contact: Administrator, Office of the Public Guardian, Alberta Human Services, 4th Floor, Standard Life Centre, 10405 Jasper Avenue, Edmonton, AB T5J 4R7 or by telephone at 1‑877‑427‑4525.

Created:
Modified: 2015-04-21
PID: 16538

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