This presentation will review clinical cases where competence to consent to or refuse obstetrical treatment is in question. We will then discuss an interdisciplinary initiative, led by two Senior Practice Leaders at BC Women’s Hospital, to develop guidelines aimed at assisting health care practitioners in making decisions about patient competence and patient care. This process included a systematic review of ethics literature regarding informed consent and the right to refuse treatment and a legal review of the British Columbia Mental Health Act and the Health Care (Consent) and Care Facility (Admission) Act. We will present a competence assessment tool and an ethical decision making framework and illustrate their application in the previous cases.

Implications of these guidelines for respecting patient autonomy and supporting patient-centered care will be discussed.