Starson refused medication proposed for his bipolar disorder. His treating physicians found him incapable and the Ontario Consent and Capacity Board agreed. The reviewing judge set that finding aside, and the Supreme Court dismissed the appeal.
The Court distinguished capacity from a clinician's view of best interests. The Ontario statutory test concerns the ability to understand relevant information and appreciate reasonably foreseeable consequences of the decision. Disagreement with a recommended treatment, including a decision others consider unwise, doesn't by itself displace the presumption of capacity.
Professor Starson refused medication for a diagnosed psychiatric condition. His doctors and the Consent and Capacity Board believed that he could not appreciate the consequences of that refusal. The majority focused instead on the precise Ontario statutory capacity test, which requires understanding information relevant to treatment and appreciating the reasonably foreseeable consequences of a decision. A person is not incapable merely because the treatment team strongly believes another choice would be better, or because the person disputes a diagnostic label.
The Supreme Court upheld the reviewing judge's decision that the Board's finding of incapacity was unreasonable on the record. Its analysis distinguished the ability to appreciate consequences from agreement with the medical recommendation. It did not establish a universal entitlement to receive any requested treatment, nor did it make the safety of involuntary care irrelevant. It clarified that an institution exercising authority over treatment choices must prove incapacity under the governing statutory criteria rather than substitute a best interests evaluation at the threshold stage. Justice Major wrote for the majority, with dissenting reasons supporting the Board's finding.