Law #3 - Mental Health and consent

Question 1

Capacity in the eyes of the law?

Answer 1

A persons ability to exercise his or her legal rights: Include right to consent or refuse treatment

Question 2

Capacity presumed unless?

Answer 2

1. minor under 14 years old

2. Person of full age incapable of giving consent either temporarily or pursuant to a Court order

Question 3

Informed consent criteria’s:

Answer 3

1. CAPACITY to consent
2. GIVEN FREELY, no manipulation
3. ENLIGHTENED, all info necessary given

Question 4

Criteria’s of a person’s lack of capacity in a medical context?

Answer 4

1. Does pt understand: the condition, purpose of the treatment and the risk of treatment.
2. Is pts consent affected by his or her medical condition?

Question 5

Information required for informed consent (6)?

Answer 5

Dx
Nature/goal of treat.
Risk/consequences
Procedure itself
Consequence of non-treatment
Alternative treat. if available

Question 6

Defects of Consent (not valid) (2)?

Answer 6

Fear: under pressure
Error: consent based on misrepresentation

Question 7

C.C.Q. two requirements to the ER exception to obtain informed consent?

Answer 7

1. Persons life or integrity in danger

2. Consent cannot be obtained in time in order to avoid threat to person.

Question 8

Delegated consent ladder?

Answer 8

“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.

Question 9

Duty to inform = enlightened consent. Sign doc enough?

Answer 9

No

Question 10

Care givers must ensure that?

Answer 10

Pt understand, receive all info and had opportunity to ask questions.

Question 11

Duty to inform in Ethic code OIIQ?

Answer 11

Yes

Question 12

Research context?

Answer 12

Aware of objective
Consent in writing
can revoke anytime

Question 13

Consent and mental health balance between?

Case?

Answer 13

personal autonomy and effective medical treatment.

Starson v Swayze: If person incapable or incompetent, law may override personal decision

Question 14

Court hearing motion for treatment/placement?

Answer 14

Superior court

Question 15

Court hearing for confinement/psyc evaluation?

Answer 15

Court of Qc

Question 16

Authorization for treatment, when need court order?

Answer 16

1. Person of full age refuse
2. NO representative
3. Minor over 14 refuse care
4. Care entails serious risks.

Question 17

Authorization for treatment, person seeking treatment must prove (2)?

Answer 17

1. Person does not have capacity to consent
2. Proposed treatment is in the best interest of pt.

Expert report for both.

Question 18

Confinement general principles (4)?

Answer 18

1. Exceptionnal
2. Person in state that represent IMMEDIATE danger for themselves or others
3. Burden of proof on HCP.
4. Must file 2 psy reports

Question 19

Generousness assessment?

Answer 19

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

Question 20

Types of confinement?

Answer 20

voluntary

Forced: preventive, temporary, motion for confinment

Question 21

preventive characteristics?

Answer 21

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

Question 22

Temporary Characteristics?

Answer 22

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

Question 23

Motion for confinement process?

Answer 23

1. If 2 psy request confinement b/c necessary. Must be presented in court within 48hours. Court can still refuse.
2. Motion must be presented to pt and “reasonable” family member or Public Curator (“Mise-en-cause)

Question 24

Motion for confinment duration?

Answer 24

max 30days, pt released as soon as deemed not dangerous. Judge can reduce duration.

Question 25

Dx of mental illness sufficient for confinement?

Answer 25

NO

Question 26

Renewal of confinment?

Answer 26

Can extent 90days more. Need 2 new psy eval within 21days of court order. and every 90days thereafter.

Question 27

Need to warn DPS at discharge?

Answer 27

yes

Question 28

Confinement ends when?

Answer 28

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

Question 29

Rights of person under ALL confinement?

Answer 29

1. Must be served the application 2. Testimony of person required if possible 3. Allowed to communicate with outside persons unless valid medical reason not to. 4. Right to counsel 5. Can appeal decision 6. Informed of any changes

Question 30

Cases Charles Le Moyne c. E.(P.) (QC)

Answer 30

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.

Question 31

CSSS Cote-de-Gaspe c. P. (C.) (QC)

Answer 31

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.

Question 32

Hopital Maisonneuve-Rosemont c. H.(M.)

Answer 32

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.