When Your Right to Make Treatment Decisions Is at Stake: Why a Communication Intermediary Is Needed in the Hospital System

In our last publication, we discussed why communication intermediaries are needed in the justice system. Today, we explore the use of communication intermediaries in the hospital system. According to the law, there are two parts to decision making: 1) understanding the information relevant to the decision; and 2) appreciating the consequences of a decision. If either of these requirements are not able to be met, a patient’s right to make treatment decisions can be revoked. Communication difficulties can mask a person’s ability to make treatment decisions. This is where a communication intermediary can be extremely valuable.


(Please note the details of this case have been changed to protect the identity of the client)

Sheila suffered a stroke and was hospitalized. She indicated that she wanted to return home despite physical challenges and lack of support at home. The hospital team felt there was significant safety concerns around her going home. To complicate matters, Sheila’s stroke resulted in severe expressive aphasia (the inability to verbally communicate using language). Her comprehension was relatively intact. The hospital team was uncertain whether Sheila was able to make treatment decisions.

We were called in as communication intermediary to provide a comprehensive assessment to determine what tools were required to assist Sheila to ensure she understood the questions that were being asked, and was able to respond non-verbally. After the assessment, we provided our recommendations for communication supports and were invited to facilitate at an informal capacity assessment. Sheila was found quite clearly capable to make treatment decisions based on her ability to gesture and select key words demonstrating her understanding of the possible consequences of going home.

As indicated in our last segment, intermediaries follow strict the guidelines laid out by the Communication Disability Access Canada (CDAC). CDAC supports people across Canada who can’t communicate and deserve fair assessment to determine candidacy to make treatment decisions. Please visit the CDAC website for more information. The Communication Intermediary Roster contains a list of intermediaries that have completed the necessary training (including those at our agency).

Bobi Tychynski Shimoda is a Speech-Language Pathologist with more than a decade of experience working with neurological communication and swallowing disorders. She has worked in a variety of settings including inpatient rehab, acute care, community, and private practise. She is highly skilled in assessment, and innovative treatment approaches.