Informed Consent and Confidentiality
This domain tests the Health Care Consent Act, 1996 (HCCA) and Personal Health Information Protection Act, 2004 (PHIPA) rules that govern starting treatment, sharing information, and refusing requests for disclosure.
Consent to treatment
Under the HCCA, consent must be given by a capable person, be informed, be voluntary, and relate to the specific treatment proposed. The practitioner proposing the treatment obtains consent and determines capability - not a psychiatrist, not a family physician, not a parent by default. Capability means the person can understand information relevant to the decision and appreciate reasonably foreseeable consequences. Ontario has no fixed age of consent to treatment; a capable 14-year-old may consent, and an incapable adult may not.
Substitute decisions and information
If the client is incapable, consent comes from a substitute decision-maker in the HCCA hierarchy (guardian, attorney for personal care, spouse or partner, parent, sibling, and so on). Under PHIPA, the psychologist is a health information custodian; sharing within the circle of care for treatment is permitted on implied consent. Disclosure beyond that requires consent or legal authority.
Where confidentiality yields
- Reasonable grounds to believe disclosure is necessary to eliminate or reduce a significant risk of serious bodily harm (permissive, not mandatory).
- Child protection reporting under the Child, Youth and Family Services Act, 2017 - mandatory and personal.
- Mandatory reporting of sexual abuse by another regulated health professional to that College.
- A court order or statute; a lawyer's letter is not a court order.
Worked example
A capable 15-year-old consents to counselling; the parents demand the full file. Capability, not age, governs. The psychologist explains the limits of confidentiality at the outset, then tells the parents the teen controls access to the record. If the teen lacked capability, the parent would act as substitute decision-maker.
Traps that cost marks
- Invoking "therapeutic privilege" to withhold information; Ontario does not recognise it as a consent shortcut.
- Assuming parental consent is always required for minors.
- Treating a subpoena from opposing counsel as authority to release everything.
- Failing to document the consent conversation itself.