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Capacity to consent to treatment of substance use disorders at Ontario's Consent and Capacity Board: A review of past reported decisions.
An Ontario review of legal cases which have considered patients' ability to consent to substance use treatmentsPlain Language SummaryIn general, prescribers must consider whether informed consent was provided prior to starting a treatment. A patient is presumed to be capable to consent to a proposed treatment but could be incapable with respect to any medical treatment. While incapacity is often considered for psychiatric treatments, it could be relevant to substance use treatment like methadone or suboxone, which are also called "Opioid Agonist Therapies" or OAT. OAT is lifesaving and prevents relapse and overdose when a person has an opioid use disorder. If a patient is found incapable of consenting to a treatment, a Substitute Decisions Maker would become the decision maker. In such cases, the patient has the ability to contest or disagree with the finding, and this results in a tribunal hearing at the Consent and Capacity Board in Ontario (CCB). In certain circumstances, the CCB publishes what are known as its Reasons for Decision (RDs), which explain the tribunal's reasoning in coming to a decision in favour of the physician or the person found incapable. This information is publicly searchable. Our methods involved a search of all available CCB RDs in Ontario for search terms related to substance use treatment, such as "methadone". We found that between June 1, 2003 (the date on reporting of RDs began) and June 27, 2023, only 71 RDs involved substance use search terms, out of a total of 10,463 reported RDs. Only one case involved the CCB upholding a finding of incapacity with respect to methadone treatment. These results imply that there are few cases in which the CCB has considered incapacity with respect to substance use treatment, although it is possible that these cases are reported at a lower frequency than other cases.
RESUMO
Phosphorus significantly influences the eutrophication process, modifying the quality of waterways and habitat, especially in stagnant waterbodies exposed to septic tank effluent at high nutrient levels. This research explores the development of a cost-effective, efficient, and affordable on-site wastewater treatment system targeted as total phosphorus (TP) removal technology. The research objective is to demonstrate the TP removal efficiency of an optimized clay-zeolite medium by chemical adsorption. The study observes the effects of pellet medium design and modifications, influent concentrations, and contact time. Following various stages of optimization, the preliminary testing achieves a 45 ± 1.8% removal after 45 minutes of contact time. The optimized pellets are contained within a five-layer bench-scale model, achieving equilibrium TP removal of 72 ± 2.9% after 3 hours. Theoretical extrapolation to 12 contact hours indicates an achievement of 88% removal is possible. The results show a positive correlation with the linearized Langmuir and Freundlich adsorption isotherms.
