Michel Silberfeld, MD, MSc, CRCP(C)
Coordinator, Competency Clinic, Department of Psychiatry
Baycrest Centre for Geriatric Care. North York, Ontario
In Ontario, as in some other provinces, there was a push to modernize guardianship and consent legislation, which culminated in new statutes in 1992. The motivations for new legislation came from several directions. The Ontario Mental Incompetency Act was felt to be outdated because it only permitted plenary guardianship. Plenary guardianship gives a person authority over all decision-making, much like a parent has over a small child. Furthermore, incapacity was poorly defined, based primarily on evidence as to the severity of an illness, and a person deemed incapable had to be incapable in all respects. There were no provisions for Powers of Attorney for personal care.
Several policy initiatives came from patient rights advocates. There was a desire to promote patient autonomy. This was accomplished by clarifying the definitions of capacity in statutes. The new definitions permitted the recognition of partial competence whereby a person could be incapable in one respect and yet retain the right of discretion in all others.
