Dr. Richard Shulman

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Dr. Shulman is a geriatric psychiatrist at Trillium Health Partners and is an associate professor at the University of Toronto. He is medical director of the Capacity Clinic and available for independent medical-legal capacity assessments.

Consent to Medical Assistance in Dying vs. Withdrawal of Life-Sustaining Treatment

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The cases before the court of Shalom Ouanounou and Taquisha McKitty[i] focus on the declaration of brain death and the withdrawal of life-sustaining treatment without consent. I will not address the issue of declaration of brain death as that lies outside my scope of practice, but rather will comment on consent issues as they relate to end-of-life decision-making. The law makes clear that consent is a sufficient condition for the….

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Capacity Evaluation of an Expressed Choice

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In law, expressed choices are not necessarily a reflection of capable decision making. For example, regarding testamentary capacity, the Ontario Court of Appeal in Hall v. Bennett Estate (2003)[i] stated in paragraphs 15 and 16 that it is not sufficient simply to show that a testator had the capacity to communicate his or her testamentary wishes. Those wishes must be shown to be the product of a sound and disposing….

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Capacity Law, Elder Care, Elder Law, Family Conflict, Guardianship, Powers Of Attorney and Guardianship Disputes, Spouse

The SDA and Incapacity to Manage Personal Care – Additional Commentary on Limitations in Legislation

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Pursuant to Section 45 of the Substitute Decisions Act (SDA),[i] incapacity for personal care is defined as – A person is incapable of personal care if the person is not able to understand information that is relevant to making a decision concerning his or her own health care, nutrition, shelter, clothing, hygiene or safety, or is not able to appreciate the reasonable foreseeable consequences of a decision or lack of….

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Capacity Law, Guardianship, Power of Attorney

The SDA and Incapacity to Manage Personal Care – Another Example of a Limitation In Legislation

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A frequent clinical challenge for doctors caring for seniors in hospitals is assessing decision making capacity and discharge planning. The following question arises; “Doctor, is the patient ‘capable’ to return home?” The problem with this question is the doctor has no authority in determining the answer. As per Section 45 of the Substitute Decisions Act (SDA)[i]; incapacity for personal care is defined as: A person is incapable of personal care….

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Capacity Law, Elder Law, Power of Attorney

The HCCA and Presumption of Capacity to Consent to Treatment; Principled but Flawed

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Capacity to make treatment decisions in the Health Care Consent Act (HCCA)[i] refers to an intact ability to understand information that is relevant to making a decision to a proposed intervention and equally important the ability to appreciate the reasonably foreseeable consequences of a decision or a lack of decision. In order to be capable, an individual must satisfy both parts of the definition. Informed consent for a proposed treatment….

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Capacity Law, Elder Law

Schizophrenia in Late Life and Impact on Decision-Making Capacity

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Schizophrenia in adults is the most common illness causing psychosis (a loss of contact with reality, a lack of ability to tell what is real from what is not real in some way). Schizophrenia generally commences in late adolescence or less commonly after age 40 referred to as late onset schizophrenia in DSM-5. Seniors with schizophrenia will likely have had an early onset of the disease with chronic persistent mental….

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Disability, Elder Care, Uncategorized
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