Law #3 - Mental Health and consent Flashcards
Capacity in the eyes of the law?
A persons ability to exercise his or her legal rights: Include right to consent or refuse treatment
Capacity presumed unless?
- minor under 14 years old
2. Person of full age incapable of giving consent either temporarily or pursuant to a Court order
Informed consent criteria’s:
- CAPACITY to consent
- GIVEN FREELY, no manipulation
- ENLIGHTENED, all info necessary given
Criteria’s of a person’s lack of capacity in a medical context?
- Does pt understand: the condition, purpose of the treatment and the risk of treatment.
- Is pts consent affected by his or her medical condition?
Information required for informed consent (6)?
Dx Nature/goal of treat. Risk/consequences Procedure itself Consequence of non-treatment Alternative treat. if available
Defects of Consent (not valid) (2)?
Fear: under pressure
Error: consent based on misrepresentation
C.C.Q. two requirements to the ER exception to obtain informed consent?
- Persons life or integrity in danger
2. Consent cannot be obtained in time in order to avoid threat to person.
Delegated consent ladder?
“In the client best interest”.
mandatory, tutor or curator.
married, civil union or de facto spouse. If no spouse close relative or person with a special interest in the person of full age.
Duty to inform = enlightened consent. Sign doc enough?
No
Care givers must ensure that?
Pt understand, receive all info and had opportunity to ask questions.
Duty to inform in Ethic code OIIQ?
Yes
Research context?
Aware of objective
Consent in writing
can revoke anytime
Consent and mental health balance between?
Case?
personal autonomy and effective medical treatment.
Starson v Swayze: If person incapable or incompetent, law may override personal decision
Court hearing motion for treatment/placement?
Superior court
Court hearing for confinement/psyc evaluation?
Court of Qc
Authorization for treatment, when need court order?
- Person of full age refuse
- NO representative
- Minor over 14 refuse care
- Care entails serious risks.
Authorization for treatment, person seeking treatment must prove (2)?
- Person does not have capacity to consent
- Proposed treatment is in the best interest of pt.
Expert report for both.
Confinement general principles (4)?
- Exceptionnal
- Person in state that represent IMMEDIATE danger for themselves or others
- Burden of proof on HCP.
- Must file 2 psy reports
Generousness assessment?
Danger immedaite
Doubt does not constitute real danger
Danger such that confinment is justified
Fact that pt may become dangerous when leaving is not sufficient
Types of confinement?
voluntary
Forced: preventive, temporary, motion for confinment
preventive characteristics?
W/O court order, max 72hours, ordered by physician, report to Director of Professional Services stat. Pt can refuse anything.
If person accept evaluation: must be done within 24hours
POlice can bring client to ER against their will if: Request of crisis intervention unit, request parental authoriry
Temporary Characteristics?
Court order to force psychiatric eval. when person refuses to be assessed and still represent immediate danger.
1st psy eval done within 24hours. 2nd must be done within 96 hours of arrival at hospital, but if initially under preventive confinment, within 48 hours
Motion for confinement process?
- If 2 psy request confinement b/c necessary. Must be presented in court within 48hours. Court can still refuse.
- Motion must be presented to pt and “reasonable” family member or Public Curator (“Mise-en-cause)
Motion for confinment duration?
max 30days, pt released as soon as deemed not dangerous. Judge can reduce duration.
Dx of mental illness sufficient for confinement?
NO
Renewal of confinment?
Can extent 90days more. Need 2 new psy eval within 21days of court order. and every 90days thereafter.
Need to warn DPS at discharge?
yes
Confinement ends when?
physisian says so when no longer justified
expiry date
if no new psy eval done in time
Upon decision by Administrative tribunal of Qc or court of justice
Rights of person under ALL confinement?
- Must be served the application
- Testimony of person required if possible
- Allowed to communicate with outside persons unless valid medical reason not to.
- Right to counsel
- Can appeal decision
- Informed of any changes
Cases Charles Le Moyne c. E.(P.) (QC)
20 college student male member of reserves. Brought by police b/c paranoiac, no history of mental illness. Family testify that he does not represent danger.
Decision: Psy eval too general, but court ordered confinment for 21 days b/c client acted weirdly. When pt act on basis of their delusion they become dangerous.
CSSS Cote-de-Gaspe c. P. (C.) (QC)
She is bipolar, hospital want to renew confinement after she spent 60days in. Psy feel lack of insight + irritability = danger.
Decision = Dismissed. B/C no longer aggressive, want to go home and accept treat., past behavior does not justify continued confinement. Confinement must not be used to attain more optimal treatment. Court di not see dangerous sign of pt in court.
Hopital Maisonneuve-Rosemont c. H.(M.)
Fact: 33 schizo. +personality disorder men, refuse psy treatment b/c side effects, never been Rx in the past, very active lifestyle.
Decision: Psy order does not = person lack legal capacity. Client excentric but not dangerous. Court says it ok for client to refuse treatment.
