Understanding Informed Consent and Assent in Support Services

Before a support service begins, the person receiving it should have a usable explanation of what is proposed and a meaningful way to ask questions. A consent form may document a decision, but it does not replace the conversation needed to understand that decision.

This guide explains questions to raise about consent, assent and participation in support services. It is general information, not a legal opinion about who can decide in a particular case. Applicable rules depend on the jurisdiction, service and circumstances; ask the provider to explain the requirements it follows.

Understand the terms in context

The Canadian Paediatric Society’s decision-making statement describes informed consent in terms of decision-making capacity, relevant information and voluntariness. It also discusses involving children according to their capacity and circumstances. The statement was reaffirmed in 2024; its broad ethical guidance does not replace checking current local requirements.

Consent concerns authorisation for the proposed service or treatment under the applicable rules. Assent concerns a child’s involvement and agreement when they are not the person providing legally valid consent. Dissent means an objection or unwillingness that needs to be recognised and explored. These terms should not be used interchangeably.

Ask the provider to explain which term applies to the decision in front of you. Avoid assuming that a diagnostic label, a communication method or a birthday alone answers every question about decision-making. The explanation should concern the actual person, proposed service and relevant requirements.

Make the information usable before deciding

The College of Occupational Therapists of Ontario’s consent standard requires an ongoing process and accessible communication. It cautions against presuming incapacity from factors such as disability, diagnosis or communication challenges. These are Ontario occupational therapy requirements, not a universal statement about every service.

Ask for the information in a format the person can understand and use. This might mean written points, an explanation in stages, an interpreter, a communication aid or more time. Check whether technical terms can be replaced with a concrete description of what will happen.

Invite questions without turning the discussion into a test of compliance. A person may understand the proposal and still disagree. Ask the provider how it distinguishes an access difficulty, uncertainty and a decision not to proceed.

The National Joint Committee’s Communication Bill of Rights supports communication access and meaningful participation. It is a professional statement, not Canadian consent law. It offers a useful reminder that a person’s communication method should be supported during the discussion.

Ask concrete questions before starting

Keep the conversation tied to the actual proposal. Agreeing to an initial assessment does not explain every future activity, recording or report-sharing arrangement. Ask which decisions are being made now and which will require another discussion.

Clarify practical matters that affect your choice: fees where relevant, expected work between visits and who will deliver the service. If someone introduces a new activity or person later, ask how it fits the agreement and whether further consent is needed.

Include children without offering false choices

The Canadian Paediatric Society recommends developmentally appropriate information and opportunities for participation. It also says a child’s strong objection should prompt careful consideration of the proposed intervention’s necessity, risks and benefits. Assent does not replace the applicable consent process, and medically necessary care can involve additional complexities.

Explain what is genuinely open to choice. If a child may choose the order of two activities but another decision requires adult or clinical responsibility, say so clearly. Offering a choice that will be ignored can make the next explanation harder to trust.

Agree how the child can express uncertainty, discomfort or a wish to pause. Ask how the provider will respond. The response should explore what is happening rather than treating every objection as something to overcome without discussion.

Separate decision-making support from authority

A trusted person can help organise questions, explain unfamiliar wording or take notes. Those supportive tasks do not by themselves explain who has legal authority to consent. Ask the provider to clarify the role of anyone attending and the basis for any substitute decision-making arrangement.

For an autistic adult, do not assume a parent or accompanying person automatically makes the decision. For a child or youth, do not assume that one age rule applies across every Canadian setting. Bring relevant documentation if requested and ask about the process for resolving uncertainty.

If there is disagreement about capacity or decision-making authority, request a clear explanation and the available review or advice route. A general website cannot resolve that individual question. Keep the person’s participation and communication needs visible while the issue is addressed.

Treat consent as an ongoing conversation

The Ontario occupational therapy standard distinguishes consent for services from consent relating to personal information. Ask your provider how it handles both. Find out who receives reports or recordings and which sharing is required, optional or subject to specific rules.

Ask how to withdraw or change an agreement and whether any safety considerations affect the transition. Clarify what can happen to information already shared. Do not assume that stopping future participation automatically erases every existing record or copy.

In a fictional example, a teenager agrees to discuss communication goals but is uncertain about recording a session. The clinician explains the recording’s purpose and available options separately, provides time for questions and confirms the applicable consent process. The uncertainty about recording is not treated as agreement to it.

Record decisions and raise concerns clearly

Keep a short note of what was explained, which questions remain and what was agreed. Ask for a copy of relevant information or forms through the service’s usual process. A record helps you revisit the decision without relying on memory.

If something differs from your understanding, describe the specific difference and ask for clarification. Start with the provider or service’s designated contact, and ask about further complaint or review options when needed. For a serious or urgent health concern, seek appropriate care rather than waiting for an administrative response.

Common questions