What is the Ontario Consent and Capacity Board?

The Consent and Capacity Board (CCB) is an independent administrative tribunal created by the Province of Ontario. It operates under the Health Care Consent Act, 1996 (HCCA) and also holds hearings under other laws, including the Mental Health Act, Substitute Decisions Act, 1992, Personal Health Information Protection Act, 2004, and parts of the Child, Youth and Family Services Act, 2017.

The CCB’s core role is to resolve disputes quickly where a person’s liberty, autonomy, or health-care rights are at stake. It has the power to hold time-sensitive hearings, receive evidence, and make legally binding decisions. Although it functions more informally than a court, it follows rules of practice and procedure and issues decisions that can be appealed to the Superior Court of Justice in many situations.

When does the CCB apply?

The CCB becomes involved only when an application is made under one of the statutes it administers. It does not provide general advice or oversee all health-care decisions; it deals with specific disputes identified in the legislation.

Common situations include:

• Capacity to consent to treatment: If a health-care practitioner finds that a person is not mentally capable of making a decision about a specific treatment, admission to a care facility, or a personal assistance service, that person can often apply to the CCB to review the finding of incapacity. 
• Capacity to manage property: In some cases, particularly where the Mental Health Act or Substitute Decisions Act applies, the CCB can review findings that a person is not capable of managing property, including when there is a statutory guardian of property in place. 
• Involuntary admission and community treatment orders (CTOs): People detained in psychiatric facilities as involuntary patients, or subject to community treatment orders, can apply to the CCB to review whether the legal criteria for their status are met. The CCB also conducts mandatory reviews in some circumstances. 
• Disputes about substitute decision-makers (SDMs): If a substitute decision‑maker is alleged not to be following the HCCA principles (such as prior capable wishes and best interests), health practitioners or others can apply to the CCB for directions or to change who is making decisions. 
• Personal health information decisions: Under PHIPA, the CCB can review certain findings of incapacity to consent to the collection, use, or disclosure of personal health information, or appoint representatives to make such decisions. 

In each of these situations, the Board does not “take over” all decisions in a person’s life; it decides only the specific questions put to it in the application.

Rights before and during a CCB hearing

Parties to a CCB proceeding have procedural rights designed to make the process accessible and fair. These rights are set out in the Board’s rules and in the governing statutes.

If you are a patient, a person found incapable, an SDM, or another party, you can expect to receive notice of the hearing that explains what application has been made, what legislation it is under, and the time and format of the hearing (for example, in person, telephone, or videoconference). Facilities and practitioners have responsibilities to facilitate this process and ensure that the person involved understands that a hearing is taking place. 

Every party has the right to participate in the hearing, which includes presenting evidence, calling witnesses, and making submissions about how the law should apply to the facts. Hearings are typically conducted by a panel of one or more Board members, who may include lawyers, psychiatrists, and public members. 

Crucially, parties have the right to be represented by counsel. The Board can direct Legal Aid Ontario to arrange for a lawyer for a patient or person alleged to be incapable, and parties also have the option of retaining their own counsel or representing themselves. 

 The Board must issue its decision within a short time after the hearing, often within one day, and written reasons are available if requested within the timeframe specified in the rules (currently 30 days).

Evidence the CCB considers

The CCB’s task is to apply statutory tests to the evidence before it. For example, in a treatment capacity case under the HCCA, the key question is whether the person is able to understand the information relevant to making a decision and to appreciate the reasonably foreseeable consequences of a decision or lack of decision about the proposed treatment. 

Evidence at a hearing may include:

• Testimony from health-care practitioners about assessments, observations, and the decision-making process.
• The patient’s own evidence about their understanding, values, and reasons for agreeing or refusing treatment.
• Medical records, capacity assessments, and care plans.
• Information about prior capable wishes, such as past statements, written directives, or patterns of decision-making, especially in SDM and best‑interests cases.
• For property and guardianship-related matters, evidence about how finances have been managed and the person’s ability to understand financial information and consequences. 

The Board is not limited to medical evidence; it can also hear from family members, SDMs, and others with relevant knowledge. However, it will focus on the statutory criteria rather than on whether it personally agrees with the treatment decision or life choices in abstract.

Possible outcomes and what they mean

The CCB’s decision depends on the type of application, but common outcomes include:

• Upholding or overturning a finding of incapacity: The Board may confirm the practitioner’s finding that a person is incapable of consenting to a specific treatment, or it may find them capable and restore their right to decide. 
• Directions to substitute decision-makers: In disputes about SDMs, the Board may give directions about how the HCCA principles (prior wishes and best interests) must be applied to a proposed treatment plan or may change who acts as SDM in certain circumstances. 
• Review of involuntary status or CTOs: In Mental Health Act cases, it may confirm or rescind an involuntary admission, change a patient’s status, or confirm/vary community treatment orders. 
• Reviews of property guardianship or PHI capacity: For certain property and personal health information matters, it can confirm or change findings of incapacity, or appoint representatives to make decisions. 

All of these decisions are legally binding unless and until they are changed on appeal or by a subsequent Board decision.

Timelines, decisions and appeals

One of the defining features of the CCB is its speed. Hearings are typically scheduled quickly, often within a matter of days, because treatment decisions, involuntary admissions, and SDM disputes usually cannot wait for a standard court timetable. The Board must issue its decision promptly (generally within one day), and written reasons follow within a few business days after a proper request. 

In many cases, parties who disagree with a CCB decision have the right to appeal to the Ontario Superior Court of Justice. Under the HCCA, appeals of many treatment capacity decisions must be started within a short time, often within seven days of receiving the decision, and may address questions of fact, law, or mixed fact and law. Further appeals to the Court of Appeal may also be possible.

Because appeal timelines are strict and the process can be complex, it is important to obtain legal advice quickly if you are considering challenging a CCB decision.

Practical preparation for a CCB hearing

Being the subject of a CCB application, or acting as an SDM or health-care provider in a hearing, can be stressful. Preparation helps ensure that the Board has the information it needs and that your rights or obligations are properly presented.

A focused preparation checklist:

• Read the application and notice carefully so you understand the specific issue and legislation involved;
• Obtain legal advice where possible, particularly if liberty or significant treatment decisions are at stake;
• Collect key documents (clinical notes, capacity assessments, advance directives, prior statements, financial records, or SDM appointment documents) that relate directly to the statutory criteria;
• Think about examples that show how the person understands (or does not understand) the information and consequences relevant to the decision;
• Consider which witnesses should attend and how they will connect their evidence to the legal test the Board must apply.

When to seek legal advice about the CCB

CCB hearings bring together health-care facts, statutory tests, and individual rights in a compressed timeline. Understanding what the Board can and cannot decide, what evidence matters, and how to approach possible appeals is essential for patients, families, SDMs, and facilities. This article is general information only and does not replace tailored legal advice.

Facing a Consent and Capacity Board hearing in Ontario? Our team can explain the process, help you prepare the right evidence, and guide you through your options before, during, and after the proceeding.

Frequently asked questions: Ontario Consent & Capacity Board

What does the Consent and Capacity Board do?

The CCB is an independent tribunal that conducts hearings and makes binding decisions about specific issues of capacity, consent, substitute decision‑making, involuntary admission, community treatment orders, and certain personal health information matters under Ontario legislation. 

How quickly are CCB hearings held?

Hearings are usually scheduled on an expedited basis, often within days, because they involve time-sensitive treatment and liberty interests. The Board must provide its decision very quickly, typically within one day of the hearing, with written reasons available shortly thereafter on request. 

Do I need a lawyer at a CCB hearing?

Parties are not required to have a lawyer, but they have the right to be represented. The Board can direct Legal Aid Ontario to arrange counsel for certain patients or incapable persons, and many people choose to seek legal assistance because the issues and timelines can be complex. 

What happens if I disagree with the Board’s decision?

In many cases, you can appeal to the Ontario Superior Court of Justice within a short statutory deadline (often seven days in treatment capacity matters). The court can confirm, vary, or overturn the decision. Because appeal routes and timelines depend on the legislation, legal advice is important. 

Does the Board decide all aspects of my capacity?

No. The CCB decides only the specific issues before it—for example, capacity to consent to a particular treatment, or capacity to manage property—not a broad declaration about every area of your life. Capacity is often decision‑specific and time‑specific under Ontario law.