Chapters 1-5

Question 1

What are the 7 factors that explain the expanding role of law in treatment?

Answer 1

1) rise in concern about the legal rights of patients and clients (shift to less paternalistic)
2) recognition that all competent patients (i.e. young, old, mentally ill etc) can make their own treatment decisions regardless of their next-of-kin
3) increases in public concern about specific issues i.e. child abuse, violence, privacy etc (cycle of apathy, crisis, panic)
4) lots of legislation that is piecemeal and overlapping
5) expansion of what is included in health i.e. naturopaths, traditional Chinese medicine etc
6) politicizing health care i.e. wait times, doctor fees etc
7) increasing fiscal restraint

Question 2

How is the conduct of health professionals in Canada assessed?

Answer 2

did they act reasonably in the circumstances

did they act in good faith

Question 3

Describe the Canada Health Act (CHA)

Answer 3

DOES NOT provide Canadians with any legal right to publicly-funded health care
sets out the conditions for full federal cash contribution to the provinces
is the legislative basis for the Federal-Provincial Health Accord (which expired in 2014)
is not comprehensive, it only covers the “insured health services” and “insured persons”
provincial insurance plan cannot provide payment for extra-billing or user fees
federal contribution must be acknowledged
does not address provincial policies on fees that physicians may charge for uninsured services

Question 4

What are the 5 pillars of medicare?

Answer 4

1) public administration- must be administered on a non-profit basis by a public authority appointed or designated by the province
2) comprehensiveness- must cover all insured services (sets out ones that are mandatory)
3) universality- insured persons must be entitled to all insured health services on a uniform basis (not insured include Canadian Forces, RCMP, federal prisoners, visitors and transients)
4) portability- no minimum waiting period longer than 3 months before residents are eligible for insured services, also must provide coverage to insured persons who are travelling
5) accessibility- health care must be provided on uniform basis that does not directly or indirectly impede reasonable access to insured services

Question 5

What are the levels of assault under the Criminal Code?

Answer 5

assault
assault with a weapon or causing bodily harm
aggravated assault (i.e. maiming, wounding etc)

there are a parallel set of sexual assault offences
sexual assault
sexual assault with a weapon, while threatening a third party or causing bodily harm
aggravated sexual assault

Question 6

Define assault under the Criminal Code

Answer 6

intentionally applying force to another person, directly or indirectly, without that person’s consent
also includes attempting or threatening to apply force to another person if one has, or causes another person to reasonably believe that one has, the present ability to carry out the threat
does NOT include all future threats of force, only those which are framed in terms of immediate harm
Note: consent is not a defence if the victim submits because of a threat of force, fraud or exercise of authority

Question 7

Define sexual assault under the Criminal Code

Answer 7

intentional application of force to another of a sexual nature, without consent, or attempting or threatening such conduct
Note: consent of a person under 16 years of age provides no defence to any sexual assault charges unless the complainant is 12 or 13 and the accused is less than 2 years older, or 14 or 15 and less than 5 years older (cannot be in a relationship of trust, power or authority)

Question 8

What is sexual exploitation?

Answer 8

Criminal Code
a person who is in a position of trust or authority with a young person (16 or 17) or on whom the young person is dependent engaging in any sexual conduct with that young person
Note: it is also an offence to invite or encourage a young person to engage in such sexual conduct

Question 9

What is criminal harassment?

Answer 9

Criminal Code
stalking
any person who knows, or is reckless as to whether another person is harassed, from engaging in specified conduct that causes that person to reasonably fear for his or her own safety or that of anyone known to them
(only an offence if the accused engaged in the specified conduct without lawful authority)
i.e. repeatedly following or communicating with the person, watching his or her home or workplace or engaging in threatening conduct

Question 10

What is cyberbullying?

Answer 10

Criminal Code
publishing an intimate image without consent
transmitting, distributing or making available an intimate image of others knowing that they did not consent or being reckless in this regard
only an offence if there was a reasonable expectation of privacy when the recording was made and when they offence was committed

Question 11

Describe providing the necessities of life

Answer 11

Criminal Code
parents, foster parents, guardians and heads of a family have a legal duty to provide the necessities of life to their children who are under 16 years of age
is a criminal offence if:
-the children are in “destitute or necessitous circumstances”
-the failure endangers their lives, or has or is likely to permanently endanger their health

also a similar one to provide necessities of life to those under your charge i.e. elderly parents but only if:
they are unable to withdraw from your charge and provide the necessities of life for themselves and the failure endangers their lives, or has or is likely to permanently endanger their health

Question 12

Describe suicide and the Criminal Code

Answer 12

everyone who counsels, aids or abets a person to commit suicide is guilty of an indictable offence regardless of whether the suicide occurs (s. 241)
also section 14 says that no one can consent to having death inflicted upon him or herself, and that such consent does not affect the criminal liability of any person who acts upon it

Question 13

Explain the civil law process

Answer 13

pleadings- plaintiff files a statement of claim or writ of summons which sets out their claim against the defendant and the compensation they’re seeking, court clerk issues the claim but affixing the seal of the court and signing on the court’s behalf, plaintiff must arrange for a copy to be served on the defendant, defendant can provide a statement of defence (if not they are held liable), the statement of claim, statement of defence and all other documents filed with the court are called pleadings

discovery- pre-trial meeting at which the parties can clarify the issues and examine the witnesses, evidence and documents that the other party intends to use at trial, can settle

trial- plaintiff’s case is presented first, plaintiff must prove that the defendant committed a tort and that the tort was a cause of his/her losses (must establish that they are recognized as being recoverable in law), then the defendant makes his/her case, lawyers can cross-examine each other’s witnesses, both parties summarize their cases for the judge or jury and judge or jury decides if the defendant is liable and assesses damages

Question 14

When a judge or jury assesses damages what are they doing?

Answer 14

attempt to put the plaintiff in the position, to the extent that money can do so, that he or she would’ve been in had the tort not been committed
usually pay legal costs as well
Note: a damage award provides no guarantee of recovering compensation, just permits the plaintiff to pursue various credit remedies against the defendant

Question 15

In Carter v Canada what did the Supreme Court decide?

Answer 15

that ss. 241 (b) and 14 of the Criminal Code violated the Charter in regard to physician-assisted dying in the case of competent adults with grievous and irremediable medical conditions that cause enduring and intolerable suffering

Question 16

Describe the tort of battery (civil law)

Answer 16

the intentional bringing about of any harmful or socially offensive physical contact with the person of another
don’t need to be harmed or away of the contact at the time
once the contact is proven, the defendant will be held liable unless he or she can establish defence i.e. consent
Note: mistaken belief that the plaintiff consented is not a valid defence

Question 17

Describe assault in tort law

Answer 17

defined more narrowly than in criminal

the intentional creation in the mind of another of a reasonable apprehension of imminent physical contact

if the defendant had the apparent intent and ability, it doesn’t matter whether he/she actually intended or had the ability to do so
includes a threat of any immediate harmful or socially offensive physical contact

Question 18

What is vicarious liability based on?

Answer 18

based on their relationship with the wrongdoer and not personal fault on their part

Question 19

Can managers, supervisors and administrators be held vicariously liable for wrongful acts committed by their subordinate staff?

Answer 19

no but they may be held directly liable in negligence for failing to adequately screen, hire, train, place, monitor or discipline their staff

Note: employer would be held vicariously liable for the wrongful act of the frontline staff and the responsible manager, supervisor or administrator

Question 20

Can board members be held vicariously liable for torts committed by an organization or its employees?

Answer 20

no

Question 21

What is the 2-step approach to figuring out if someone can be held vicariously liable?

Answer 21

if pre-existing cases establish that it applies in the circumstances
if they were in a sufficiently close relationship with the wrongdoer and there was a significant connection between the wrongful act and the wrongdoer’s assigned task or authorized conduct

Question 22

Child and Family Services Act

Answer 22

includes section that have statutory ages of consent for stipulated services and the mandatory reporting obligation regarding children in need of protection

Note: the CFSA’s definition of capacity, informed consent, age requirements, record keeping rules, and confidentiality provisions differ from those in the common law and the HCCA

Question 23

Coroner’s Act

Answer 23

coroners are responsible for investigating and recording unexplained and suspicious deaths and deaths that occur in specified institutions, such as jails and other custodial institutions
also contains several mandatory reporting obligations
i.e. everyone who reasonably believes that a person may have died as a result of negligence, suicide, homicide, misadventure or other suspicious circumstance needs to report it to a coroner or police officer

Question 24

Health Protection and Promotion Act

Answer 24

purpose is to protect the health of the public

creates boards of health to oversee the provision of programs and services i.e. sanitation, immunization, monitoring communicable diseases, preventative dentistry for school children, family planning, home care for the chronic and actually ill and public health education

also provides for the inspection and regulation of restaurants etc

also outlines the situations in which various health agencies and professionals just report communicable diseases or dangerous conditions to a medical officer of health

Question 25

Trillium Gift of Life Act

Answer 25

governs inter-vivo and post-mortem donations of organs and tissue
ie must be 16 and competent to donate inter-vivo donation of non-regenerative tissue
also regulates substitute consent for these procedures

Question 26

Mental Health Act

Answer 26

governs administration of psychiatric hospitals, and the criteria and procedures for voluntary, informal and involuntary admission, and community treatment orders
ie prohibits substitute consent to psychosurgery
also requires that every person admitted to a psychiatric facility be examined by a physician to determine their capacity to manage his/her own property

Question 27

Public Hospitals Act

Answer 27

governs the administration of public hospitals
including medical records, admission of patients, funding and appointment of medical staff and the provision of training facilities for students
also provides for provincial grants and loans to hospitals

Question 28

Limitations Act

Answer 28

stipulates the maximum amount of time that can pass between a wrongful act and a civil suit
standard limitation period is 2 years

limitation period doesn’t begin until the plaintiff knew or ought to have known the facts upon which the action is based, understood the harms that resulted from the wrongful act and was physically, mentally and psychologically able to commence an action

Question 29

Unless a statute states otherwise what governs the relationship between health professionals and their patients?

Answer 29

common law principles of consent

Question 30

At common law is a practitioner’s mistaken belief that the patient consented a defence?

Answer 30

no

Question 31

What are some exceptions to the common law principles of consent?

Answer 31

unforeseen medical emergency where it is impossible to obtain a patient’s consent

consent to surgery, an overall course of treatment or a treatment plan provides consent to subordinate or technical procedures that are an inherent part of the surgery, course of treatment or treatment plan

therapeutic privilege to withhold information (not so much anymore)

Question 32

When does the HCCA replace the common law?

Answer 32

only in regard to specified treatment and services provided by stipulated categories of professionals

Question 33

What does Part II of the HCCA apply to?

Answer 33

applies to “treatment” which is broadly defined as anything that is done for a therapeutic, preventative, palliative, diagnostic, cosmetic or other health-related purpose and includes a course of treatment or plan of treatment
however this EXCLUDES:
capacity assessments, any treatment that poses little or no risk, examinations to determine the patient’s general condition, taking a history, admission to a hospital, psychiatric, care or other facility and personal assistance services
unless you proceed as though an excluded treatment was treatment then it does (LOL WTF)

applies to regulated health practitioners, but not social workers, addiction counsellors, employment assistance workers and youth workers

also governs substitute consent to general and emergency admission to hospitals and psychiatric facilities

Question 34

What does Part III of the HCCA apply to?

Answer 34

governs substitute consent to admission and crisis admission to a care facility

Question 35

What does Part IV of the HCCA apply to?

Answer 35

governs substitute consent to personal assistance services i.e. feeding, washing etc

Question 36

What does Part V of the HCCA apply to?

Answer 36

governs the CCB (Consent and Capacity Board)

Question 37

What does the HCCA not apply to?

Answer 37

various orders of a medical officer of health relating to communicable or virulent diseases
regulations governing communicable diseases in the eyes of newborns
substitute consent to research, non-medical sterilizations, and organ and tissue transplantation
the common law duty of caregivers to confine and restrain a person to prevent serious bodily harm

Question 38

What is the general principle of consent under the HCCA?

Answer 38

Regulated health practitioners cannot provide treatment unless they are of the opinion that the patient was capable and consented or of the opinion that the patient was incapable and his/her SDM consented

Question 39

What are the elements of a valid consent under the HCCA?

Answer 39

consent must be related to the proposed treatment
patient must be adequately informed prior to consenting
questions need to be answered honestly
must be voluntary
may be given expressly or implicitly
must not be obtained by misrepresentation or fraud

Question 40

What kind of claim does failure to obtain a valid consent give rise to?

Answer 40

traditionally was battery
however now is only battery if the patient did not consent at all, the consent was exceeded or obtained fraudulently
in all other cases a negligence claim must now be brought

Question 41

What is the 2-part test for capacity under the HCCA?

Answer 41

a patient is capable if they are able to understand the information related to the specific decision AND is able to appreciate the reasonable foreseeable consequences of consenting or refusing consent
Note: this applies whether the patient is an adult, minor, developmentally disabled, intoxicated, high, involuntarily detained in a mental hospital, vulnerable, frail, rash, or immature
also note: there is not diminished capacity, either capable or not

Question 42

What happens when a CCB decision is challenged to the court?

Answer 42

until the case is resolved no treatment can be provided, except in an emergency

Question 43

When are binding prior expressed wishes made?

Answer 43

when the patient is 16 and capable

Question 44

When is a person capable of making property decisions? What act does this fall under?

Answer 44

if he/she is able to understand the information relevant to making the financial decision in question and is able to appreciate its reasonably foreseeable financial consequences
substitute decisions act

Question 45

What is the age of consent to treatment at common law? HCCA?

Answer 45

there is no age for consent for either common law or the HCCA
however some courts have reframed the test of capacity to ensure that they are “mature” minors

Question 46

What are the statutory ages of consent under the HCCA?

Answer 46

16 and older can consent to any services
under 16 require parental or guardian consent for residential care or psychotropic drugs
12 and older may consent to counselling without parental knowledge, however under 16 they must be informed of the desirability of involving their parents

Note: the CFSA does not address whether a competent child under the age of 12 can consent to counselling without parental consent

Question 47

What does the Education Act say in terms of consent?

Answer 47

parental consent is required for IQ or personality testing for a student under 18
parents have a right to the pupil’s Ontario Student Record if the pupil is under 18

Note: the Education Act does not prevent schools from offering treatment, referral, assessment or counselling services to competent students under 18

Question 48

Under the HCCA, if there are no prior expressed binding wishes, what must an SDM take into account when determining the patient’s best interests?

Answer 48

values and beliefs
previously expressed wishes when 16 or under or incapable
whether their condition or well-being is likely to improve
whether the treatment’s benefits outweigh the risks
whether a less intrusive treatment would be just as beneficial

Question 49

Can an SDM consent to ancillary treatments and to admission to a hospital, psychiatric or other health facility?

Answer 49

yes
unless an incapable patient 16 or older objects to admission to a psychiatric facility, then an SDM can’t admit them voluntarily

Question 50

When can an SDM apply to the CCB to challenge a patient’s prior expressed wish?

Answer 50

if its applicability in the circumstances or the patient’s capacity when the wish was expressed is unclear or if the patient was now capable they would probably consent because the outcome is significantly better than he or she would’ve anticipated

Question 51

Name the 5 ways in which someone can obtain legal authority to make person care decisions on behalf of an incapable person in descending order

Answer 51

Court-appointed guardian of the person 
POA for personal care 
personal representative 
family members and other named under the HCCA section 20 
Public Guardian and Trustee

Question 52

What is the hierarchy of SDMs under the HCCA?

Answer 52

1) court-appointed guardian of the person
2) POA for personal care
3) personal representative appointed by the CCB
4) spouse or partner
5) child, parent or guardian
6) parent with only a right of access
7) siblings
8) other relatives related by blood, marriage, adoption
9) PGT

Question 53

What is considered a spouse under the HCCA?

Answer 53

married, living together for at least a year, are the parents of a child together or have a cohabitation agreement under section 53 of the Family Law Act
lived together for at least a year and have a close personal relationship that is of primary importance in both of their lives
Note: are not a spouse if they are living separate as a result of a breakdown in their relationship

Question 54

What happens if 2 or more people at the same level disagree when making a substitute decision?

Answer 54

the PGT makes the decision

Question 55

What are the 5 ways to obtain authority to exercise substitute consent on behalf of an incapable person?

Answer 55

1) court-appointed guardian of property
2) POA for property under the Powers of Attorney Act
3) POA for property under the Substitute Decisions Act
4) statutory guardian pursuant to the Mental Health Act
5) statutory guardian pursuant to a certificate of incapacity

Question 56

What are the obligations of guardians and powers of attorney for property?

Answer 56

must make decision in good faith for the incapable person’s benefit
must explain their powers and duties and encourage the incapable person to participate to the extent possible
encourage regular contact with supportive family and friends
must keep proper accounts for all transactions
if compensated must do a job equal to ppl who are compensated
are liable for damages resulting from a breach in their duties
in expenditures, priority must be given to the incapable person’s care and support
gifts, loans and charitable donations are limited
PGT must keep an updated list of guardians and give it to anyone who requests it

Question 57

What does the legal concept of custody refer to?

Answer 57

a bundle of decision making rights and responsibilities regarding a child including where they live, religious upbringing, education, day-to-day parenting decisions, authority to make treatment, counselling and care decisions
but only if a child is incapable of making these decisions for themselves or if a a statute authorizes the parent to make the decisions on behalf of the child

Question 58

What does an access parent have authority to?

Answer 58

rights to visit and be visited by the child

the same rights as the custodial parent to information about the child’s health, education and well-being

Question 59

Who has legal custody of a child?

Answer 59

both parents unless a separation agreement or court order provides otherwise
if the parents don’t live together the custodial parent is deemed to be the one the child lives with

Question 60

What 4 factors do the courts recognize that can negate consent?

Answer 60

mistake - mistaken belief that a health professional was responsible for creating
fraud - fraudulent belief that either the health professional made or was aware of, however only if it went to the NATURE of the act and not a collateral matter (except in HIV cases etc then it is to the harmful consequences of the act)
duress - compulsion/coercion, narrowly defined as a threat of immediate physical force
public policy - consent may be negated if it would be unfair or unconscionable to allow the defendant to raise the defence or if the consent was obtained by exploiting a relationship of trust

Question 61

When does the Criminal Code permit treatment without consent? (federal)

Answer 61

• taking blood samples from unconscious impaired driving suspects in cases involving death or bodily injury
• judges can issue warrant fir taking blood, hair or saliva samples for DNA testing from individuals who are reasonably believed to have committed a specified sexual or other designated offence

Question 62

When does the Quarantine Act allow treatment without consent? (federal)

Answer 62

travellers can be detained, medically examined and treated without consent in order to prevent introduction or spread of a communicable disease
Note: travellers are those arriving in or leaving Canada

Question 63

When does the Ontario Health Protection and Promotion Act allow treatment without consent?

Answer 63

• a MOH can order someone to submit to an examination and/or treatment for a communicable disease or order them to refrain from specific conduct
• if they fail to comply the MOH can apply for a court order for a virulent disease
• the court can order the, to be detained and treated for up to 6 months

Question 64

When does the Immunization of School Pupils Act allow treatment without consent?

Answer 64

it doesn’t really
students need to be immunized or exempted (religious, conscientious or medical grounds) or else an MOH can require a school to suspend them

Question 65

What does the Child and Family Services Act do?

Answer 65

authorizes Children’s Aid Societies to apprehend and detain children in need in specified situations
does NOT give them the right to consent or refuse on the child’s behalf, it merely transfers the decision making authority the parents had to them

Question 66

What are the common law rights with respect to life-prolonging treatment?

Answer 66

there is a common law right to refuse and withdraw from life-prolonging treatment and to demand that a third party withdraw life prolonging treatment (regardless of consequences)
there is NO common law right to demand life-prolonging treatment be initiated or demanding that it be continued

Note: that the SCC interpreted the HCCA as requiring consent to withdraw life prolonging treatment though (Cuthbertson v Rasouli)

Question 67

What can physicians do regarding DNRs?

Answer 67

may issue a DNR if resuscitation is medically inappropriate, but may need consent of the patient, the SDM, CCB or a court

Question 68

How is assisted suicide differentiated from euthanasia?

Answer 68

usually euthanasia if the doctor were to play a direct physical role i.e. inject the substance etc

Question 69

What is euthanasia considered?

Answer 69

both voluntary and involuntary euthanasia are considered to be first-degree murder under sections 229 and 231(2) of the Criminal Code
may have a defence in certain circumstances given Carter v Canada

Question 70

What is Bill 52?

Answer 70

a bill enacted in Quebec requiring that all institutions provide end-of-life care, which includes terminal palliative sedation and medical aid in dying
must be 18 or older, capable, insured and have an incurable serious illness, be in an advanced state of irreversible decline in capability and suffer constant and unbearable physical or psychological pain that cannot be relieved

Question 71

When is an accused found unfit to stand trial?

Answer 71

if they are unable, because of a mental disorder, to understand the nature or possible consequences of the proceedings or to communicate with counsel

Question 72

What happens if an accused is found to be unfit?

Answer 72

they are detained and treated without their consent for up to 60 days
after that if they are still unfit the trial is stayed
trial can continue if/when their condition improves and they become fit

Question 73

When can someone be NCR?

Answer 73

if they were suffering from a mental disorder that made them incapable of appreciating the nature and quality of the act or of knowing that it was wrong both legally AND morally (R v Chaulk)
party raising the issue must prove it

Question 74

What happens if the accused is NCR?

Answer 74

absolute discharge, conditional discharge or detention in a hospital
must do the least restrictive one
cannot be treated against their will even if its in their best interests
Criminal Review Boards maintain authority over them until they are absolutely discharged

Question 75

What are high-risk accuseds?

Answer 75

designation for ppl found to be NCR for a serious personal injury offence
are not eligible for absolute or conditional discharge
must be detained in hospital until a court removes the designation based on a Criminal Review Board’s recommendation

Question 76

What are general factors associated with mental health and sentencing?

Answer 76

psychiatric and psychological issues
willingness to address these issues
ongoing risk

Question 77

What are aggravating factors associated with mental health and sentencing?

Answer 77

history of violence
refusal to seek responsibility
failure to seek or accept assistance for an underlying psychiatric, psychological or other problem

Question 78

What are mitigating factors associated with mental health and sentencing?

Answer 78

having a physical or mental disability
acceptance of responsibility
commitment to address psychiatric, psychological or other problem

Question 79

Can participation in treatment be a condition of probation, parole or conditional discharge?

Answer 79

yes

they can refuse consent however they will probably not get parole etc then

Question 80

What are dangerous offenders?

Answer 80

must be convicted of sexual, violent or other serious offence whose persistent aggressive conduct or brutality indicates that they pose an ongoing threat to the life and safety of others
are subject to indeterminate imprisonment and restricted parole eligibility (if/when paroled are put on lifetime supervision)

Question 81

What are long-term offenders?

Answer 81

must be convicted of sexual, violent or other serious offence that warrants at least 2 years imprisonment and the accused poses a substantial risk of reoffending that may eventually be controlled in the community
are subject to a long-term supervision order of up to 10 years after release and parole has ended

Question 82

What are voluntary patients?

Answer 82

capable individuals who are admitted to a psychiatric facility on their own behalf
cannot be detained, however their status can be changed if they meet the criteria

Question 83

What are informal patients?

Answer 83

incapable individuals who are admitted under their SDM’s authority and consent
16 and older cannot be admitted against their will by their SDM except in limited circumstances

Question 84

What are involuntary patients?

Answer 84

individuals detained in a psychiatric facility under a certificate of involuntary admission or renewal
admission is based on statutory authority and not their SDM

Question 85

When does section 15 of the MHA allow a physician to apply for psychiatric assessment of a person? (and similar circumstances for police, justices of the peace and judges)

Answer 85

physician needs to have REASONABLE cause to believe that one of the criteria was met:

(a) threatened or attempted to cause bodily harm to him/her self
(b) has behaved violently towards another person or has caused another person to fear bodily harm from him or her
(c) has shown a lack of competence to care for him/her self

also needs to be of the opinion that the person’s mental disorder would LIKELY result in one of the following:

(d) serious bodily harm to the person
(e) serious bodily harm to another person
(f) serious physical impairment of the person

physician then must fill out a Form 1 and sign within 7 days
this completed form allows them to be detained and assessed in a psychiatric facility for up to 72 hours (does not let you treat)
after assessment physician must decide if they are to be released, admitted as voluntary, informal or involuntary

Question 86

What section of the MHA sets out the criteria for involuntary admission? What are they? Then what?

Answer 86

section 20(5)
physician must be of the opinion after assessing that he/she is both:
(a) suffering from a mental disorder of a nature or quality that likely will result in
serious bodily harm to the patient, another person or serious physical impairment of the patient
and
(b) that the patient is not suitable for admission or continuation as a informal or voluntary patient

then fill out a Form 3
can then detain, restrain, observe and examine the patient for up to 2 weeks

then for 1 month, then 2, then 3, then 3 thereafter

Question 87

When can a CTO be issued?

Answer 87

need to meet the criteria for involuntary admission
must within the past 3 years have been admitted to a psychiatric facility 2 or more times or for a cumulative period of at least 30 days or have been the subject of a previous CTO
physician must have examined them in the last 72 hours and believe that they have a mental disorder, such that the patient needs continuing treatment, supervision or care while living in the community
also need consent of the patient or SDM, consult broadly in developing the community treatment plan and inform their patient of their legal rights

Question 88

When does a CTO expire?

Answer 88

after 6 months if not renewed or terminated

can be terminated at the patients request or if they withdraw (or SDM withdraws) consent to the treatment plan

Question 89

What happens if the treatment plan of a CTO is breached?

Answer 89

physician can issue an order which authorizes police to apprehend them
once returned to the facility physician must examine them and see if they should be released, held for an assessment or subject to another CTO

Question 90

When must a rights adviser be notified?

Answer 90

when a certificate of involuntary admission is issued or renewed or when (with some exceptions) a patient between the ages of 12 and 16 is admitted as an informal patient

Question 91

What governs consent to psychiatric treatment?

Answer 91

the HCCA not the MHA

Question 92

When does the MHA allow patients to be restrained?

Answer 92

only involuntary patients

however you have a common law power to restrain any patient to prevent them from seriously injuring themselves or others

Question 93

What is not included in psychosurgery?

Answer 93

electroconvulsive therapy and specified neurological procedures

Question 94

Neto vs Klukach

Answer 94

Neto bipolar, doesn’t like Li
3 criterion for determining if they have the ability to evaluate the relevant information
1) need to acknowledge that they have what others may call a mental illness
2) need to understand how treatment and alternatives can affect their quality of life
3) decision must not be based substantially on delusional thinking
court granted her appeal because she was okay on all 3 of these

Question 95

Park v Park

Answer 95

husband POA for care, daughter for property
husband wanted to be both, tried to have her declared incapable
capacity assessor indicated that Mrs. Park had shown a clear understanding of her financial decisions and an appreciation of why her decisions were correct
her appeal was granted

Question 96

Scardoni v Hawryluck

Answer 96

on ventilator doctors wanted to take her off, daughters did not, said it was because she was a devout Roman Catholic
Court set aside the CCBs decision and wouldn’t let the doctors terminate her treatment because:
-it is based on values and beliefs not church doctrine
-statements about life should be considered general expressed wishes even though they weren’t precise enough to be binding
-may have misapprehended evidence thinking she was suffering more than she was

Question 97

Hamilton Health Sciences v D. H.

Answer 97

11 yo with leukaemia, mother withdrew from chemo
Court did not allow the the order bc she was a loving parent and protected by aboriginal beliefs
except it doesn’t matter that she was a caring parent and the mother’s cultural beliefs are not relevant to making treatment decisions for a child
eventually had an addendum in which she got chemo and the traditional therapy

Question 98

R vs Mabior

Answer 98

HIV and consent based on a fraudulent belief
needed to use a condom and have a low viral load
6 charges, acquitted on 4, then 3 were reinstated

Question 99

Norberg v Wynrib

Answer 99

doctor having sex with addicted patient in exchange for drugs 
majority said battery 
1 said negligence
2 said breach in fiduciary duty 
(supreme court)

Question 100

Nancy B v Hotel dieu

Answer 100

capable 25 yo, couldn’t move, wanted to be taken off the ventilator
court granted her injunction
judge ignored another case the criminal code

Question 101

Rotaru v Vancouver General Hospital

Answer 101

wanted to resume treatment of terminally ill mother even though doctors were against it
court didn’t allow it because it would be an abuse of its power to require doctors to act contrary to their fundamental duty to their patients
medical records were released for a second opinion

Question 102

IHV Estate v

Answer 102

S. C. wanted to become court-appointed guardian of her mother and sought an injunction preventing her ventilator from being removed
became guardian, injunction not given
didn’t want to require doctors to treat contrary to their view
medical records were released and SC had to be notified 72 hours before ventilator was removed

Question 103

Cuthbertson v Rasouli

Answer 103

in PVS his wife didn’t want to consent to withdrawal of life support and giving only palliative care
majority Supreme Court upheld that this was considered treatment under the HCCA and thus consent was required and the doctors couldn’t do it
2 dissenting justices said that HCCA didn’t have anything to do with this

Question 104

Carter v Canada

Answer 104

ss. 14 and 241(b) and physician-assisted suicide

Question 105

R vs Chaulk

Answer 105

15 and 16 year old broke into house and killed owner

found NCR because they understood it was legally wrong but not that it was morally wrong

Question 106

Re W.J.K.

Answer 106

42 yo women with schizophrenia and history of violence and non-compliance with meds
involuntary patient, appealed certificate of renewal
which was granted
had been charged with assault but there wasn’t evidence that she actually caused bodily harm
also no evidence she hurt anyone in the hospital
said if she found her imaginary children she would call a lawyer
evidence fell short that it was “likely” that she would cause serious bodily harm to another

Question 107

Re N.O.

Answer 107

16 yo, schizophrenia
challenged involuntary admission
certificate was granted
even though he hadn’t hurt anyone yet, he had a history of violence, wouldn’t take medication would probably hurt someone