Canadian occupational therapists aspire to be client-centred. As a profession we continue to debate what this means. The question of how to be client-centred becomes more acute when the client has cognitive deficits, and capacity, including the legal right to consent to treatment, is called into question. Further, in current literature and law, capacity is described as situational (i.e., specific to the time, circumstances and question being asked) and thus, difficult to determine. In this discussion, the author will explore two strategies, graded decision-making and advocacy, for practicing in a client-centred manner with cognitively impaired clients.
Bill 109: An act respecting consent to treatment. (1992). Statutes of Ontario (Chapter 31). Toronto, ON: Queen's Printer for Ontario.
2.
Canadian Association of Occupational Therapists. (1991). Occupational therapy guidelines for client-centred practice.Toronto, ON: CAOT Publications.
3.
CurtinL.L. (1995). Good intentions pave the road …. Nursing Management, 26(2), 7–8.
4.
Department of National Health and Welfare Canada & Canadian Association of Occupational Therapists. (1983). Guidelines for the client-centred practice of occupational therapy (H39–33/1983E). Ottawa, ON: Minister of Supply and Services.
FulbrookP.(1994). Assessing mental competence of patients and relatives. Journal of Advanced Nursing, 20, 457–461.
7.
GageM.PolatajkoH. (1995). Naming practice: The case for the term client-driven. Canadian Journal of Occupational Therapy, 62, 115–118.
8.
HobsonS. (1995). On being client-centred when the client is cognitively impaired [Round table conducted at the annual conference of the Canadian Association of Occupational Therapists, Edmonton, AB, in May.]. Canadian Journal of Occupational Therapy, 62 (Conference Supplement), 23.
9.
LawM.BaptisteS.Carswell-OpzoomerA.McCollM.A.PolatajkoH.PollockN. (1991). Canadian Occupational Performance Measure.Toronto: CAOT Publications.
10.
SilberfeldM. (1992). New directions in assessing mental competence. Canadian Family Physician, 38, 2365–2369.
11.
SumsionT. (1993). Client-centred practice: The true impact. Canadian Journal of Occupational Therapy, 60, 6–8.
12.
VenesyB.A. (1994). A clinician's guide to decision making capacity and ethically sound medical decisions. American Journal of Physical Medicine and Rehabilitation, 73, 219–226.
13.
YerxaE.J.ClarkE.FrankG.JacksonJ.ParhamD.PierceD.SteinC.ZemkeR. (1989). An introduction to occupational science, a foundation for occupational therapy in the 21st century. Occupational Therapy in Health Care, 6(4), 1–17.
