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Standard for Preventing Sexual Abuse

Evidence that the practitioner obtained informed consent from the patient for the treatment. This could be in the form of a signed document (handwritten signature or digital signature) or a notation by the practitioner in the patient record setting out what was discussed. The written consent reassures the practitioner and the patient that the patient has provided informed consent so that the practitioner can provide the treatment.

Remember that the written consent is evidence that the patient provided informed consent. The actual informed consent is obtained by providing all of the necessary information to the patient, and answering all of the relevant questions from the patient.

Yes, the College has created a template consent form that includes sensitive areas. Please refer to the College's updated form.

While email and text messages may be convenient, practitioners have a legal and ethical responsibility to keep patient information confidential. Email communication may not always be secure and, as such not recommended for information that includes identifiable personal health information.

Further there is a risk that if there is a time lag between obtaining the consent and providing the treatment, the patient may have changed their mind or had additional questions. It is the responsibility of the practitioner to always ensure that the consent is still valid and that there have been no changes to the patient’s health as this could affect the possible risks of the treatment.

Yes. The information can be kept in digital format. Members must ensure all electronic records are kept securely (via password). If any information is being kept in a digital format, issues pertaining to the access of the files along with the storage of information should be considered (e.g., if using a cloud server, efforts should be made to ensure that information is kept in Ontario, etc.)

Remember that the signature on the consent form (or the written notation in the patient chart) is merely evidence that the patient provided informed consent. The member will want to ensure that they still have the consent of the patient to proceed. Sometimes it will be prudent to have the patient sign a new consent form. Sometimes it will be sufficient to verbally confirm that the consent is valid and document this in the patient chart. Consent is an ongoing process. Members should re-confirm consent at each visit. This will ensure that the practitioner has the consent of the patient to proceed. Further, there may be a change in the patient’s health over time. The change in health could affect the treatment provided by the Member. This is why it is important to ensure with the patient that the consent is still valid at each visit. If the practitioner confirms that there is no change in treatment plan, or the patient’s health, then the practitioner can simply indicate in the patient chart that the original informed consent applies. However, if there is a change in treatment plan, the Member will be required to obtain a new informed consent.

However, note that for treatment of sensitive body parts, the practitioner is required to obtain written consent for the initial treatment, and express (or verbal) consent for any subsequent treatments involving the same treatment plan. The practitioner should document that they obtained express consent in the patient record.

Written consent will be required for initial treatment of sensitive areas (upper and inner thigh, buttocks, penis, vagina, breasts and chest wall muscles). For future follow up visits, verbal or express consent is required. To maintain accuracy and comprehensiveness of patient records, verbal consent ought to be noted in patient records immediately after treatment.

If the treatment does not involve sensitive body parts, and the treatment plan has not changed, the practitioner can assume that the original informed consent is valid.

However, if there has been any change to the treatment plan or the patient’s health, a new informed consent is required. This is why it is prudent to verify with the patient at each appointment if they still provide consent to proceed and to check in on any changes to the patient’s health.

There is no minimum age of consent for healthcare in Ontario. As such, members should not make assumptions on capacity based on age. Rather members must assess each patient on their ability to understand the nature of the treatment being proposed, and the possible outcomes of consenting or not consenting to treatment.

Yes. The original consent would have involved a discussion of treatments, risks, alternatives, etc. that were specific to the original issue. If another issue or concern is raised, then this would require the member to obtain informed consent for that specific issue as different treatments, risks, alternatives, etc., will be discussed. This is necessary in order to ensure the consent is informed.

Written consent is merely evidence of the patient providing informed consent. If the treatment involves contact with a sensitive area, a practitioner must obtain written consent before beginning treatment. This would involve the practitioner having the necessary discussion with the patient first, going through all of the elements of informed consent and answering any relevant questions of the patient, and then asking the patient to sign the written consent form.

If the treatment does not involve contact with a sensitive area, the practitioner must still obtain informed consent as set out above. However, the patient is not required to sign a consent form. The practitioner may wish the patient to do so, but it is not required from the College. The practitioner may wish to simply note in the patient record that informed consent was obtained and set out the information that was discussed in order to obtain informed consent.

The Standard for Consent (which came into effect on April 1, 2020) requires a consent form for the initial treatment that involves contact with a sensitive area. Expressed consent can be used for follow up visits and treatments that do not involve contact with a sensitive area. It is not necessary for members to get consent forms signed retroactively (i.e., for treatments received before April 1, 2020).

Sensitive areas include the upper and inner thigh, buttocks, penis, vagina, breasts, and chest wall muscles. (Standard for Preventing Sexual Abuse).

This will depend on the part of the body being treated. If the treatment involves contact with a sensitive area, you must obtain informed consent (by discussing all of the relevant information) and then asking the patient to sign the written consent form before beginning treatment. If the treatment does not involve a sensitive body part, obtaining verbal informed consent is sufficient. However, it will be important for the member to document in the patient record that they obtained verbal consent. This is evidence of informed consent being provided by the patient.

No. The Regulated Health Professions Act , 1991 states that it is a controlled act to put an instrument, hand, or finger beyond the labia majora. Members of this College are not authorized to perform this controlled act.

Yes. The Standard for Preventing Sexual Abuse states that members should not touch the nipple or areola. It is the position of the College that providing TCM should not involve touching the nipple or the areola. Therefore, members should advise patients that they will not touch that body part.

The Standard for Consent requires written consent on the first visit for treatments with contact of sensitive areas. This is not required for treatments near the sensitive area; however, members should use their professional judgement for any precautions for treating these areas. For instance, members should ensure proper draping is maintained when treating near sensitive areas. (Safety Program Handbook, page 80-82)

Members must not provide services to a person with whom they have a sexual relationship, including spouses, except in an emergency. It is not recommended for the practitioner to treat other members of their family, as the practitioner will likely be unable to discharge their fiduciary duty in light of the emotional connection to the patient.

Members can accept gifts of nominal value from patients; however, gifts of high value may risk crossing professional boundaries. Members should consider whether receiving or providing a gift constitutes a conflict of interest. (Jurisprudence Course Handbook, pg. 20-21, 64-65) Members need to be mindful that accepting a gift does not blur the boundary between the patient and the practitioner.

It is the member's responsibility to maintain professional boundaries. If a member is concerned that a patient's behaviour is posing a risk to those boundaries, the member must address the behaviour directly. If the member finds that it is not possible to maintain the professional boundary, they must take the steps to end the patient-practitioner relationship as outlined in the Standard for Maintaining Professional Boundaries.

It is the member's responsibility to maintain professional boundaries. If a member is concerned that a patient's behaviour is posing a risk to those boundaries, the member must address the behaviour directly. If the member finds that it is not possible to maintain the professional boundary, they must take the steps to end the patient-practitioner relationship outlined in the Standard for Maintaining Professional Boundaries.

The one year period is referenced in the Health Professions Procedural Code. Under the Code, practitioners must not engage in sexual relations with a patient or engage in sexual behaviour or make remarks of a sexual nature towards their former patients within one year after the date upon which the individual ceased to be the practitioner’s patient.

The College of Massage Therapist of Ontario (CMTO) requires written consent for treatment involving contact of a sensitive area. Unlike the College, the CMTO requires its registrants to obtain written consent before every treatment session that involves touching of the sensitive areas.

The webinar is equivalent to 1 hour of professional development activities and a certificate of participation was emailed to all members that joined in during the live stream.