NUR1 424 Law 2: Confinement & Privacy
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Questions and Answers

What should be evaluated to determine if a person understands the proposed treatment options?

  • Their previous experiences with medical treatment
  • Their understanding of the benefits and risks involved (correct)
  • Their emotional state and current mood
  • Their financial situation and insurance coverage
  • Which of the following is a dangerous misconception about consent capacity?

  • Legal incapacity and capacity to consent are interchangeable terms (correct)
  • A person can be incapable of consenting to one treatment but capable for another
  • Cognitive impairment affects the ability to communicate
  • All individuals with vulnerabilities lack the ability to consent
  • What is a primary condition that justifies confinement in an institution?

  • The person prefers to be in a controlled environment
  • The person's decision-making abilities are questioned
  • The person poses a serious and immediate danger to themselves or others (correct)
  • The person has a history of non-compliance with treatment
  • Which type of confinement requires consent from the patient?

    <p>Voluntary confinement (B)</p> Signup and view all the answers

    What document is typically required for preventive and provisional confinement?

    <p>A written Motion for Authorized confinement (C)</p> Signup and view all the answers

    Which legal principles govern confinement in an institution?

    <p>Civil Code of Québec and Code of Civil Procedure (D)</p> Signup and view all the answers

    What is a requirement for authorized confinement facilities?

    <p>They must be equipped with necessary facilities (D)</p> Signup and view all the answers

    What is NOT a common consequence of not assessing capacity in individuals with cognitive impairments?

    <p>Accurate identification of risks of treatment (D)</p> Signup and view all the answers

    What is the maximum duration for a motion for authorized confinement?

    <p>30 days (B)</p> Signup and view all the answers

    Who must be served with the Motion for Confinement aside from the patient?

    <p>The Public Curator (C), A close family friend (D)</p> Signup and view all the answers

    Under what condition can confinement in an institution be authorized by the court?

    <p>If both psychiatric reports recommend confinement (C)</p> Signup and view all the answers

    What criteria must a psychiatric examination report address according to Art 29 CCQ?

    <p>The necessity of confinement if the person is a danger to self or others (B)</p> Signup and view all the answers

    What discretion do judges have regarding the duration of confinement?

    <p>Judges can specify a shorter duration if 30 days is not necessary (B)</p> Signup and view all the answers

    Who is referred to as the 'Mise-en-cause' in the context of Motion for Confinement?

    <p>A reasonable family member or close friend (A)</p> Signup and view all the answers

    What is a significant factor the court considers before authorizing confinement?

    <p>Serious reasons to believe the person is dangerous (B)</p> Signup and view all the answers

    What happens if reasonable members of the patient's family do not exist for the service of the Motion?

    <p>The Public Curator is served (B)</p> Signup and view all the answers

    What is required once the 72-hour period expires if a physician determines that danger still exists?

    <p>A court order for provisional confinement (A)</p> Signup and view all the answers

    Under what condition can a peace officer take a person to an institution without court authorization?

    <p>Upon request from a member of a crisis intervention unit (B)</p> Signup and view all the answers

    What must the institution do upon the arrival of the person taken by a peace officer?

    <p>Examine the individual by a physician (D)</p> Signup and view all the answers

    What provision allows for preventive confinement according to Section 8?

    <p>A physician's determination of danger (A)</p> Signup and view all the answers

    Who can request the intervention of a peace officer for a minor?

    <p>The person having parental authority or the tutor (C)</p> Signup and view all the answers

    What is the primary purpose of obtaining a court order for provisional confinement?

    <p>To extend the time for a psychiatric assessment (B)</p> Signup and view all the answers

    Which of the following best describes the term 'preventive confinement'?

    <p>Temporary confinement while assessing immediate danger (D)</p> Signup and view all the answers

    What is required from the peace officer before taking an individual without court authorization?

    <p>Good reason to believe the individual presents danger (B)</p> Signup and view all the answers

    How often must a person under confinement be examined if the duration exceeds 21 days?

    <p>Every three months (D)</p> Signup and view all the answers

    What is required before a person can be confined for a duration exceeding 21 days?

    <p>The court must set the duration of confinement (C)</p> Signup and view all the answers

    Which of the following rights is guaranteed to a person under confinement?

    <p>The right to counsel at all stages (C)</p> Signup and view all the answers

    When can the testimony of a person under confinement be exempted?

    <p>If the person is not located or has fled (D)</p> Signup and view all the answers

    What must health establishments provide to a confined person?

    <p>Information about their care program and any changes (B)</p> Signup and view all the answers

    Consent to care during confinement must be sought from which authority?

    <p>The Superior Court (D)</p> Signup and view all the answers

    What is the protocol regarding the use of restraints in confinement?

    <p>They can only be used if ordered or in an emergency (C)</p> Signup and view all the answers

    If a person under confinement is under 14 years of age, who gets informed about their care?

    <p>A guardian authorized to give consent (B)</p> Signup and view all the answers

    What is the main conflict arising in the health care system described in the content?

    <p>Demand for healthcare services and limited budgets (B)</p> Signup and view all the answers

    According to the content, what right do patients have in terms of communication?

    <p>Receive services in English (A)</p> Signup and view all the answers

    What does Article 5 emphasize in the rights of patients?

    <p>The continuity and safety of services (D)</p> Signup and view all the answers

    Which of the following is NOT a right listed in the content for patients?

    <p>Receive treatment without consent (A)</p> Signup and view all the answers

    What role does LSSSS play in the healthcare system described?

    <p>To mediate conflicts between rights and realities (C)</p> Signup and view all the answers

    Which article allows patients to choose a medical professional?

    <p>Article 6 (A)</p> Signup and view all the answers

    What common issue is highlighted in the cases referenced (e.g., Jasmin c Cité de la santé de Laval)?

    <p>Conflicts between patient rights and resource limits (D)</p> Signup and view all the answers

    In what manner should health services be provided according to Article 6?

    <p>In a scientifically and humanly safe manner (B)</p> Signup and view all the answers

    Under what circumstance can a medical professional deny a patient's access to their medical records?

    <p>If there is significant likelihood of adverse effects on the patient's health (D)</p> Signup and view all the answers

    Which statement reflects the conditions under which access to medical records may be temporarily denied?

    <p>Access may be denied based on the recommendation of a physician if it is deemed prejudicial to health (C)</p> Signup and view all the answers

    In McInerney v. MacDonald, what did the Supreme Court establish regarding a doctor's discretion to deny record access?

    <p>The onus lies on the doctor to justify exceptions to general access rules (B)</p> Signup and view all the answers

    What is a requirement for medical professionals when denying access to patient records?

    <p>They must have a continuing need for access to provide proper treatment (B)</p> Signup and view all the answers

    At what age does an individual generally gain the right of access to their medical records without any special conditions?

    <p>14 years (A)</p> Signup and view all the answers

    Why might an institution temporarily deny access to a patient's medical records?

    <p>If the access is believed to cause prejudice to the patient's health (D)</p> Signup and view all the answers

    What does the principle of 'right of access not absolute' imply in a medical context?

    <p>Medical professionals can deny access under specific circumstances (A)</p> Signup and view all the answers

    What role does the attending physician play in the context of a patient requesting access to their medical records?

    <p>The physician may recommend denying access based on health concerns (A)</p> Signup and view all the answers

    Flashcards

    Treatment Authorization

    Assessing a person's ability to understand proposed treatment, its options, benefits, risks, and consequences of refusal.

    Capacity to Consent

    The ability to understand information relevant to a decision and make a reasoned choice regarding treatment. Distinguish from legal incapacity.

    Forced Confinement

    Confinement of a person against their will, usually when they pose a serious and immediate danger to themselves or others.

    Preventive Confinement

    A preliminary, temporary form of forced confinement, a step towards Potential Authorized Confinement.

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    Provisional Confinement

    A preliminary, temporary form of forced confinement, a step towards Potential Authorized Confinement.

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    Authorized Confinement

    Formal, legally authorized confinement in a facility deemed suitable by law.

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    Confinement Facility Requirements

    Essential infrastructure required for appropriate confinement, including community services or hospital facilities.

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    Institutional Confinement

    Confinement in an institution, an exceptional measure used as a last resort. It's considered a threat to patient rights.

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    72-hour Period

    The maximum time a person can be held in preventative confinement without a court order

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    Psychiatric Assessment (PSY)

    A professional evaluation to determine a person's mental state and needs.

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    Grave and Immediate Danger

    A situation where a person poses a serious and immediate risk to themselves or others.

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    Peace Officer

    A law enforcement official authorized to take action in crisis situations.

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    Crisis Intervention Unit

    A specialized unit for assessing and addressing mental health crises.

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    Section 8 (Act P-38)

    Section outlining the circumstances in which police can take someone to an institution without a court order.

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    Motion for Confinement

    A legal request to a court to authorize the confinement of a person in an institution.

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    Service Time (Motion for Confinement)

    Within 2 days, the motion must be served on the patient and an appropriate "Mise-en-cause" (family member or friend).

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    Mise-en-cause

    A "reasonable" family member or friend, or Public Curator if none is available, notified of the confinement motion.

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    Maximum Confinement Duration

    30 days, unless a judge decides a shorter period is sufficient.

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    Psychiatric Examination Report (PSY)

    A report needed to assess danger to self or others, ability to care for self, and possible need for protective supervision.

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    Court Authorization (Confinement)

    Requires agreement from two psychiatric reports and a valid reason that confinement is necessary for safety.

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    Judge's Discretion (Confinement)

    Judges have significant latitude in deciding confinement, even if there aren't opposing medical reports.

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    Art 396 CCP

    Code of Civil Procedure article covering the timeframe for serving a motion for confinement.

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    Confinement Period Review

    When a person is confined for longer than 21 days, their need for continued confinement is regularly assessed.

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    Confinement Records

    Psychiatric examination reports are kept by the institution as part of the confined person's record.

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    Patient Rights

    Confined patients have specific rights detailed in a schedule of the Act.

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    Confinement Application Service

    The person under confinement must be served the application for confinement, with rare exceptions.

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    Patient Testimony

    Confined patients are required to provide testimony unless specific circumstances prevent it.

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    Patient Communication

    Confined patients have the right to communicate with others, unless there's a medical reason preventing it.

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    Patient's Right to Counsel

    Confinement does not strip a person of their right to legal representation.

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    Information on Care

    Confined patients must be informed about their care program and any changes.

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    LSSSS

    The Act Respecting Health Services and Social Services, which outlines the rights and obligations of individuals in Quebec's healthcare system.

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    Right to Choose Healthcare Providers

    Individuals have the right to choose the healthcare professional or institution they wish to receive services from.

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    Right to Continuity of Care

    Individuals are entitled to receive healthcare services in a continuous and personalized manner.

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    Right to Safe and Scientifically Appropriate Care

    Individuals are entitled to receive healthcare services that are scientifically sound, humane, and socially appropriate.

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    Right to Services in English

    Individuals are entitled to receive healthcare services in English.

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    Jasmin c Cité de la santé de Laval

    A landmark case showcasing the importance of respecting patient rights in Quebec's healthcare system.

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    Noël-Voizard c.CSSS Lasalle et du Vieux-Lachine

    Another important case demonstrating the balance between patient rights and resource limitations.

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    JO vs.Hôpital Royal Victoria

    A case that underscores the importance of respecting patient autonomy and informed consent.

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    Right of Access to Medical Records

    Patients generally have the right to access their medical records. However, medical professionals can restrict access if it poses a significant risk to the patient's health or the health of others.

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    Medical Professional's Discretion

    A healthcare provider can deny a patient access to their medical records if they believe it could harm the patient's physical, mental or emotional well-being, or if it could harm someone else.

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    Onus of Justification

    When a healthcare provider restricts a patient's access to their medical records, they must prove why it's necessary, not the patient proving why they need access.

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    Continued Access for Treatment

    Medical professionals need ongoing access to patient records to provide appropriate care. This is a reason why access might be limited temporarily.

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    McInerney v. MacDonald

    A Supreme Court case that established medical professionals have the right to deny access to medical records, but their decision must be justified and limited.

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    Temporary Denial of Access

    Access to medical records might be temporarily denied if a healthcare provider believes it could harm the patient. The patient will be informed when they can access the records.

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    AHSSS Article 17

    A legal document that confirms a patient's right to access their medical records, and outlines when a healthcare provider can deny access.

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    Medical Records: Who Has Access?

    Patients generally have the right to access their medical records, but medical professionals have the authority to restrict access if it's deemed unsafe for the patient or others.

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    Study Notes

    Law 2 - Confinement, Privacy & Confidentiality, and Resources

    • Course: NUR1 424, Fall 2024
    • Lecturer: Daria Kapnik

    Plan

    • Authorization for Treatment:
      • Recap of Court Orders under CCQ
      • Treatment order
    • Confinement Law:
      • General Principles
      • Parameters
      • Types of Confinement
        • Preventative Confinement
        • Provisional Confinement
        • Authorized Confinement (Institutional)
          • Motion for Authorized Confinement (process, duration, PSY content, court order criteria, renewal, end of confinement, longer confinement)
      • Rights of the person under confinement
      • Potential issues in confinement
    • Privacy, Confidentiality, and Resources:
      • Patient access to and medical records
        • General
        • Deceased patients
        • Confidentiality and care issues regarding minors
      • Management of Limited Resources and Patient Rights
        • Key provisions
        • Caselaw

    Outline

    • Authorization for Treatment
      • Recap of Court Orders under CCQ
      • Treatment order
    • Confinement in an Institution
      • General Principles
      • Parameters
      • Types of Confinement
        • Preventative Confinement
        • Provisional Confinement
        • Authorized Confinement (Institutional)
          • Motion for Authorized Confinement - Process
          • Motion for Authorized Confinement - Duration
          • Motion for Authorized Confinement - PSY content
          • Motion for Authorized Confinement - Court order criteria
          • Motion for Authorized Confinement - Renewal
          • Motion for Authorized Confinement - End of Confinement
          • Motion for Authorized Confinement - Longer Confinement
      • Rights of the person under confinement
      • Potential issues in confinement
    • Caselaw
      • Charles Le Moyne c. E.(F.)
      • CSSS Côte-de-Gaspé c.P(C)-EYB 2013-227952
      • J.M. c. Hôpital Jean-Talon du (CIUSSS) du Nord-de-l'Île-de-Montréal, 2018
    • Privacy - Patient access and medical records
      • General
      • Deceased patients
    • Management of Limited Resources and Patient Rights
      • Key Provisions
      • Caselaw
        • Jasmin c Cité de la santé de Laval (AZ-90021046)
        • Noël-Voizard c. CSSS Lasalle et du Vieux-Lachine (2007)
        • J.O. vs. Hôpital Royal Victoria (2011)

    Recap of Court Orders under CCQ (page 5)

    • Article 16 CCQ: Person of full age incapable of giving consent, categorically refuses care, or no representative can be found for delegated consent.
    • Article 16 CCQ: Minor over 14 refuses care (not in cases of emergency & life/integrity threat)
    • Article 17/18 CCQ: Care entails serious risk for minor's health and potentially grave, permanent effects (even if over 14)
    • Treatment order (page 7)
      • The party seeking authorization (usually the health establishment) has the burden of proof
      • Must prove, on the balance of probabilities: (1) person lacks capacity to consent; (2) person is categorically refusing treatment; (3) proposed treatment is in patient's best interest
      • How? Motion + expert reports
    • Nova Scotia criteria (page 8)
      • Understanding the nature of the illness
      • Understanding the proposed treatment and other options
      • Understanding the benefits and risks of treatment
      • Understanding risks and consequences of not undergoing treatment
      • Patient's ability to understand affected by illness

    Confinement in an Institution (page 10-11)

    • General Principles: Confinement is exceptional, violating integrity and inviolability; person must be a serious and immediate danger to themselves or others
    • Types of Confinement:
      • Voluntary (patient consents)
      • Forced (preventive, provisional, authorized)
    • Location: Institution operating a local community service centre, or hospital
    • No one: may be confined in a health or social services institution without consent
    • Danger: must be specific and detailed, not just a general statement, present and imminent danger
    • Preventive: A physician can authorize without a court order if danger is grave and immediate

    Specific Confinement Processes (various pages)

    • Process and Procedures: Detailed motions for authorized confinement, with specific timeframes (e.g., 24-48-72-96-hours) and requirements for physicians performing examinations and documentation.
    • Renewal: Procedures and legal basis for renewing confinement for up to 90 days after an initial 30-day period
    • End of Confinement: How confinement ends, including court, tribunal, and physician actions
    • Longer Confinement: Periodic re-evaluations with specific timelines
    • Rights of a person in confinement: the use of restraint
    • AWOL: communicating with DPS, returning to hospital

    Privacy/ Confidentiality/ Care Issues Regarding Minors

    • Parental access: Parental authority has access to a minor’s health information
    • Access by other bodies: Other bodies have access to minor's health information (determined by the statutory duties of disclosure)
    • Exceptions to access in regard to minors:
    • Duty to report: Professionals are required if a minor’s security or development is at risk. Examples of specific actions needing reporting
    • Consent: Minors under 14 years of age require consent from parental authority or tutor
    • Minors over 14 years of age: capable of giving their own consent

    Management of Limited Resources/Patient Rights

    • Limited budgets in health sector and aging population create challenges
    • Specific Acts: Rights and obligations in Act Respecting Health Services and Social Services, details of the act
    • Caselaw: Legal conflicts, regulations and limitations of access to services
    • Case Example Issues: Discriminatory regulations, inadequate access, procedural errors, and the right to seek judicial review. Patient rights and access to services.

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    Description

    Test your knowledge on key concepts related to confinement, privacy, and confidentiality in healthcare law. This quiz covers important topics such as authorization for treatment, types of confinement, and rights of individuals under confinement. Prepare for discussions on managing resources and patient access to medical records.

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