Psychiatric Confinement and Legal Rights

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Questions and Answers

What is required for a psychiatric assessment without patient consent?

  • A signed document from a family member
  • A court authorization (correct)
  • A verbal agreement from the patient
  • A request from the healthcare provider

Which of the following is NOT a type of psychiatric confinement?

  • Preventative confinement
  • Elective confinement (correct)
  • Provisional confinement
  • Authorized confinement

What role do peace officers typically play in preventative confinement?

  • Making custody decisions
  • Intervening in emergencies (correct)
  • Conducting psychiatric evaluations
  • Providing medical treatment

Which statement accurately reflects a patient's right during psychiatric confinement?

<p>Patients have the right to refuse treatment (D)</p> Signup and view all the answers

What is a significant legal consideration regarding patient privacy in psychiatric confinement?

<p>There are ethical limits on who can access patient’s medical records (B)</p> Signup and view all the answers

What happens when a patient refuses treatment while confined?

<p>Their confinement can be legally reassessed (A)</p> Signup and view all the answers

Which factor informs the termination of psychiatric confinement?

<p>Change in the patient's mental health status (B)</p> Signup and view all the answers

Which of the following best describes 'provisional confinement'?

<p>Temporary confinement pending further evaluation (C)</p> Signup and view all the answers

What happens if one of the psychiatrists concludes that confinement is unnecessary during a motion for authorized confinement?

<p>The person is immediately released. (B)</p> Signup and view all the answers

Within what timeframe must the first psychiatric assessment be conducted upon arrival?

<p>24 hours (C)</p> Signup and view all the answers

How long can the confinement be extended after the initial 30-day period?

<p>90 additional days (B)</p> Signup and view all the answers

What is required for a court to authorize confinement based on psychiatric assessments?

<p>Both psychiatric reports must indicate confinement is necessary. (D)</p> Signup and view all the answers

What must be served on 'reasonable' members of the patient's family or friends during the motion for confinement?

<p>The motion itself. (B)</p> Signup and view all the answers

What must the psychiatric assessment report cover according to CCQ article 29?

<p>The necessity of confinement and self-care capability. (B)</p> Signup and view all the answers

When must a second psychiatric evaluation be completed if the person was initially under preventive confinement and refused examination?

<p>Within 48 hours of court order. (A)</p> Signup and view all the answers

What is the primary criterion for the judge to authorize confinement, aside from psychiatric reports?

<p>Evidence that the person is dangerous. (A)</p> Signup and view all the answers

What must happen if the confinement exceeds 21 days?

<p>Periodic examinations are required. (B)</p> Signup and view all the answers

What occurs if a certificate confirming no longer needing confinement is issued?

<p>Confinement ends without further formalities. (D)</p> Signup and view all the answers

What action must a psychiatrist take to lift a patient's confinement?

<p>Conduct a psychiatric evaluation to determine if the patient is still a danger (D)</p> Signup and view all the answers

What information is NOT required to be documented in a patient's chart regarding confinement?

<p>Patient's family history of mental illness (A)</p> Signup and view all the answers

Which role is responsible for ensuring the patient is informed about the confinement process?

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

During the confinement renewal process, which document is handled similarly to the initial confinement?

<p>Psychiatric evaluation PSY 1 &amp; 2 (B)</p> Signup and view all the answers

What must occur if a patient does not consent to a psychiatric evaluation?

<p>Information regarding provisionary confinement must be documented (A)</p> Signup and view all the answers

What is a nursing implication during the psychiatric reevaluation process?

<p>To monitor patient’s responses and implement necessary interventions (B)</p> Signup and view all the answers

Who is primarily responsible for filing copies of PSYs to the DPS office?

<p>Unit Coordinator (A)</p> Signup and view all the answers

What is essential for the ANM/NM within 48 hours prior to a court hearing?

<p>Confirm the patient’s wishes regarding contesting the confinement (C)</p> Signup and view all the answers

What document must be kept in front of the patient’s chart regarding the confinement?

<p>Proof of faxes sent to the DPS office (B)</p> Signup and view all the answers

What is the role of the bailiff during the confinement process?

<p>To deliver all legal documents to the patient (A)</p> Signup and view all the answers

What is the maximum time a patient can be under preventative confinement without a renewal of orders?

<p>72 hours (D)</p> Signup and view all the answers

Under what condition can a patient leave the hospital grounds?

<p>With a medical order permitting it (D)</p> Signup and view all the answers

How long does a patient have to undergo a psychiatric assessment after a court order is obtained?

<p>Within 24 hours (D)</p> Signup and view all the answers

What happens if a patient refuses psychiatric evaluation regarding provisional confinement?

<p>They are confined provisionally (D)</p> Signup and view all the answers

What action is required when a patient is granted regular confinement?

<p>Two separate psychiatric evaluations are needed (D)</p> Signup and view all the answers

What rights does a patient have during a court hearing regarding confinement?

<p>Right to legal aid and to contest the confinement (D)</p> Signup and view all the answers

If a patient decides not to contest the confinement, what should be noted?

<p>They can change their mind at any time (B)</p> Signup and view all the answers

What must be completed before a patient is transported for a court hearing?

<p>Booking security and transportation arrangements (D)</p> Signup and view all the answers

What is the role of the nursing staff concerning confinement documents?

<p>They are responsible for sending and managing the documents (C)</p> Signup and view all the answers

What must happen following a court hearing regarding a patient’s confinement?

<p>The patient must return to the hospital (A)</p> Signup and view all the answers

How long can a patient be confined under regular confinement after court proceedings?

<p>Up to 30 days (C)</p> Signup and view all the answers

What is a requirement for a patient's accompaniment off the unit?

<p>Approval from the nursing staff assessment (B)</p> Signup and view all the answers

When documenting the patient's response to confinement, what must be included?

<p>Details regarding the patient's condition and behavior (D)</p> Signup and view all the answers

Under which condition can a minor aged 14 or older refuse care?

<p>If not in emergency situations or when life/integrity is threatened (D)</p> Signup and view all the answers

Who bears the burden of proof when seeking authorization for treatment?

<p>The healthcare establishment (C)</p> Signup and view all the answers

What is required for a person to be confined for psychiatric assessment without their consent?

<p>Two psychiatric evaluations by independent doctors (D)</p> Signup and view all the answers

What characterizes a preventive confinement?

<p>MD can order it without court authorization if danger is grave and immediate (C)</p> Signup and view all the answers

Which statement is true regarding the conditions of confinement?

<p>A person cannot be confined without legal authorization or consent for assessment (C)</p> Signup and view all the answers

What defines serious danger in the context of psychiatric confinement?

<p>A personalized and precise assessment of danger (A)</p> Signup and view all the answers

In the case of forced confinement, which scenario does not require a court order?

<p>Preventive confinement due to immediate danger (C)</p> Signup and view all the answers

What is a key requirement for a provisional confinement?

<p>The patient poses a serious danger that isn't necessarily immediate (A)</p> Signup and view all the answers

How long can the duration of an authorized confinement be set by the court?

<p>Up to 30 days (D)</p> Signup and view all the answers

What must happen upon a person’s arrival at a confinement facility?

<p>They must be evaluated by an MD within 24 hours if they consent (D)</p> Signup and view all the answers

What role does police play concerning psychiatric confine orders?

<p>They assist when a psychiatric danger is indicated (B)</p> Signup and view all the answers

Which of the following must be filed to support a motion for confinement?

<p>Two psychiatric reports by psychiatrists (B)</p> Signup and view all the answers

What is the purpose of the psychiatric assessment following a preventive confinement order?

<p>To ascertain if the person poses ongoing danger for confinement (D)</p> Signup and view all the answers

Which group is directly addressed in the context of past confinement issues within the psychiatric system?

<p>BIPOC, LGBTQ+, and immigrants (D)</p> Signup and view all the answers

Which condition is NOT considered necessary for a good death?

<p>Prolonging life unnecessarily (B)</p> Signup and view all the answers

What is the primary aim of palliative care according to the Canadian Palliative Care Nursing Association?

<p>To offer support and resources for comprehensive care (D)</p> Signup and view all the answers

In discussing end-of-life care, what does the term 'hermeneutical rapprochement' refer to?

<p>The interpretive retrieval of socio-historical contexts (B)</p> Signup and view all the answers

Which of the following is NOT supported by Bill 52 concerning end-of-life care?

<p>Legalizes euthanasia for minors (A)</p> Signup and view all the answers

What is the primary concern when communicating a child's record to the holder of parental authority?

<p>It could harm the health of the user. (C)</p> Signup and view all the answers

What aspect is emphasized as crucial when assessing a patient's request for MAID?

<p>The influence of total pain on the request (D)</p> Signup and view all the answers

What principle is particularly highlighted in 'Listening to Children’s Voices'?

<p>Children’s rights must be informed by evidence (D)</p> Signup and view all the answers

Under what condition can the Director of Youth Protection enter an institution to examine a child's record?

<p>If they believe the child's protection is needed. (C)</p> Signup and view all the answers

What must professionals do if they suspect a child's security or development is at risk?

<p>Report the situation to the Director of Youth Protection. (B)</p> Signup and view all the answers

Which of the following best describes the approach to end-of-life care for Indigenous peoples?

<p>Life is seen as a gift, with collective family involvement in decisions (A)</p> Signup and view all the answers

What does section 5 of the LSSSS ensure for individuals receiving health services?

<p>Personalized and safe health services. (A)</p> Signup and view all the answers

What is a common barrier faced by Indigenous families in end-of-life situations according to the content?

<p>Policies limiting family involvement in grieving rituals (B)</p> Signup and view all the answers

In the context of end-of-life care, what does the term 'echo pandemic' refer to?

<p>Increased visibility of palliative care needs brought by COVID-19 (A)</p> Signup and view all the answers

What was the court's ruling regarding the hospital's attempt to restrict access based on residence?

<p>The regulations were deemed discriminatory. (B)</p> Signup and view all the answers

What should not be a reason for someone choosing MAID according to palliative care principles?

<p>Access to comprehensive palliative care (B)</p> Signup and view all the answers

In the case of Noël-Voizard c.CSSS Lasalle et du Vieux-Lachine, what was significant about the delay a patient experienced?

<p>Delays were considered acceptable due to high demand. (C)</p> Signup and view all the answers

What does section 6 of the LSSSS allow individuals to do?

<p>Choose the health professional or institution for services. (B)</p> Signup and view all the answers

Which type of care can a hospital refuse based on availability?

<p>Only specialized services not routinely offered. (A)</p> Signup and view all the answers

What was required for the plaintiff in the emergency room lawsuit to win her case?

<p>Proof of a fault by the hospital. (C)</p> Signup and view all the answers

What is the role of the Commission des droits de la personne et des droits de la jeunesse?

<p>It protects the rights of children and youth. (A)</p> Signup and view all the answers

Under the Youth Protection Act, which of the following scenarios requires mandatory reporting?

<p>A child who is frequently absent from school. (D)</p> Signup and view all the answers

Which of the following is NOT a necessary requirement under the Youth Protection Act?

<p>Documenting every child's health records. (A)</p> Signup and view all the answers

What was a central issue in Jasmin c Cité de la santé de Laval concerning healthcare access?

<p>Residents were being prioritized unfairly. (A)</p> Signup and view all the answers

What is a potential consequence of a child leaving their home without authorization?

<p>Considered a case of potential abandonment. (B)</p> Signup and view all the answers

What must happen once the time limit for a court-ordered confinement expires?

<p>The court must authorize any further confinement. (C)</p> Signup and view all the answers

Under what condition can a person kept in confinement communicate with third parties?

<p>There are valid medical reasons to restrict communication. (D)</p> Signup and view all the answers

Which of the following must be communicated to a person receiving care while confined?

<p>Changes in their care or living conditions. (D)</p> Signup and view all the answers

If a patient is under 14 years old or incapable of giving consent, who should be informed of their care changes?

<p>A legal guardian or authorized person. (A)</p> Signup and view all the answers

What is required for a healthcare establishment to treat a confined person against their will?

<p>A court order authorizing treatment. (D)</p> Signup and view all the answers

What is a key factor that justifies confinement according to the content?

<p>A clear indication of danger to self or others. (C)</p> Signup and view all the answers

In the case of a patient refusing treatment due to side effects, what conclusion was drawn?

<p>The patient's legal capacity is not diminished by their refusal. (C)</p> Signup and view all the answers

Which of the following scenarios could allow a patient's testimony to be excused during a confinement application?

<p>The patient fled or cannot be found. (D)</p> Signup and view all the answers

What must a healthcare establishment do if a patient goes AWOL?

<p>Inform the police to retrieve the patient. (C)</p> Signup and view all the answers

How often can patients appeal a decision related to their confinement?

<p>Anytime they feel it is unjust. (A)</p> Signup and view all the answers

What is a significant ethical consideration mentioned in the context of COVID-19 testing during confinement?

<p>Preserving autonomy and informed consent. (A)</p> Signup and view all the answers

What was a critical factor in the decision to confine the patient in the case of JM?

<p>The recommendations of two independent psychiatrists. (C)</p> Signup and view all the answers

What is essential for restraints to be used during a patient's confinement?

<p>There must be an emergency or a specific order. (D)</p> Signup and view all the answers

What must healthcare providers ensure when applying confinement measures?

<p>There is a reasonable indication of danger to self or others. (B)</p> Signup and view all the answers

What was the main error made by the trial judge in the case of JM?

<p>Mistaking consent for preventive confinement as consent for a psych evaluation. (C)</p> Signup and view all the answers

How long can an individual be placed under preventative confinement without a court order?

<p>72 hours (B)</p> Signup and view all the answers

What is required for a psychiatric assessment to proceed?

<p>Informed consent from the individual. (C)</p> Signup and view all the answers

What must a health establishment do if consent for psychiatric evaluation is not obtained?

<p>File a motion for temporary confinement. (D)</p> Signup and view all the answers

What kind of information must psychiatric reports provide?

<p>Detailed explanations of the patient's dangerousness. (C)</p> Signup and view all the answers

Who has the right to access their own medical records?

<p>The patient themselves. (A)</p> Signup and view all the answers

Under what condition can a medical professional deny a patient access to their records?

<p>If it may harm the patient's health. (A)</p> Signup and view all the answers

What must healthcare professionals justify when denying access to a patient's records?

<p>An exception to the general rule. (D)</p> Signup and view all the answers

What is true about the heirs of a deceased patient concerning access to medical records?

<p>They can only access records needed to exercise rights. (A)</p> Signup and view all the answers

What rights do parents have regarding a minor’s health information?

<p>They may access records whether the minor consents or not. (A)</p> Signup and view all the answers

What happens if a user aged 14 or older refuses to allow their health record to be shared with parents?

<p>Access must be denied to the parents. (A)</p> Signup and view all the answers

What is the first phase in the process that might lead to medical assistance in dying?

<p>Pre-contemplative (D)</p> Signup and view all the answers

What conclusion did the court reach regarding JM's preventive confinement?

<p>It was unlawful after the 72 hours expired. (D)</p> Signup and view all the answers

What does the legal framework state regarding preventive confinement?

<p>It requires a formal assessment within the first 72 hours. (A)</p> Signup and view all the answers

Which value statement aligns with ethical objectors to MAiD on conditional grounds?

<p>Concerns about consequences (B)</p> Signup and view all the answers

What is necessary for a psychiatric evaluation to ensure its ethical standing?

<p>Informed consent from the individual being evaluated. (D)</p> Signup and view all the answers

What significant legal milestone was achieved with the passing of Bill 52 in Canada?

<p>Legalization of medical assistance in dying for terminally ill patients (D)</p> Signup and view all the answers

What action should healthcare workers take post-death in the MAiD process?

<p>Provide support to family (A)</p> Signup and view all the answers

In the context of MAiD, which ethical principle is focused on doing good or promoting welfare?

<p>Beneficence (C)</p> Signup and view all the answers

What was the court ruling in the case of Nancy Cruzan regarding artificial nutrition?

<p>Artificial nutrition is equivalent to other medical treatments (B)</p> Signup and view all the answers

Which ethical stance involves being ethically supportive of MAiD while able to assist only in a limited capacity?

<p>Ethically support, able to assist in a limited fashion (D)</p> Signup and view all the answers

What principle is at stake when considering the issue of autonomy in MAiD cases?

<p>The right to refuse treatment (B)</p> Signup and view all the answers

What major concern was raised in the Nancy B v. Hotel Dieu case?

<p>Life with a ventilator was not considered worth living (D)</p> Signup and view all the answers

What aspect of care is emphasized for healthcare providers regarding MAiD procedures?

<p>Overall care must be provided without judgment (C)</p> Signup and view all the answers

In the context of the legislation on medical assistance in dying, which statement is true about the time frame?

<p>MAiD legislation was only established in the 21st century (A)</p> Signup and view all the answers

Which historical case brought up significant discussions on the withdrawal of care?

<p>Karen Quinlan case (C)</p> Signup and view all the answers

What ethical principle refers to the obligation to avoid harm?

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

What must a nurse do if they have a conscientious objection to providing MAiD?

<p>Continue to treat the patient with respect (C)</p> Signup and view all the answers

At what age can an individual create an Advance Medical Directive (AMD)?

<p>18 years old (A)</p> Signup and view all the answers

In which situation does an Advance Medical Directive apply?

<p>The patient is suffering from a serious, incurable illness (B)</p> Signup and view all the answers

What should healthcare professionals ensure when a patient provides an AMD?

<p>The patient has capacity to consent to care (C)</p> Signup and view all the answers

What must a medical professional do when a patient lacks the capacity to consent?

<p>Follow the AMD registry's instructions (A)</p> Signup and view all the answers

Which of these treatments can a patient refuse in their AMD?

<p>Dialysis treatment (D)</p> Signup and view all the answers

What is a key difference between turning off a life-sustaining device and MAiD?

<p>Turning off a device is considered passive (D)</p> Signup and view all the answers

When is it considered morally acceptable for a nurse to experience moral distress?

<p>When they cannot respect a patient's wishes (A)</p> Signup and view all the answers

What ethical dilemma does a physician face regarding a patient wanting to withdraw treatment?

<p>Balancing autonomy and beneficence (A)</p> Signup and view all the answers

Which piece of information must be communicated during advance care planning?

<p>Risks and benefits of care (B)</p> Signup and view all the answers

What is a significant ethical question raised by Max's situation with the LVAD?

<p>Is there a difference between withdrawing treatment and MAiD? (B)</p> Signup and view all the answers

What is an essential action for healthcare professionals when a patient expresses a desire to stop treatment?

<p>Inform them of the risks of stopping (C)</p> Signup and view all the answers

How can an Advance Medical Directive be revoked?

<p>No formal steps are necessary (B)</p> Signup and view all the answers

What was the primary reason JO was not placed on the active kidney transplant waiting list?

<p>He had behavioral issues that made him an unsuitable candidate. (D)</p> Signup and view all the answers

Which factor contributed to JO's inability to continue receiving dialysis care at RVH?

<p>His abusive behavior towards hospital staff. (D)</p> Signup and view all the answers

What was emphasized regarding the relationship between patient and doctor in the context of transplant care?

<p>There should be mutual respect for successful long-term care. (C)</p> Signup and view all the answers

What did the tribunal conclude regarding the hospital's response to the patient's need for care?

<p>The hospital acted appropriately given its resources. (A)</p> Signup and view all the answers

What is a key principle of Jordan’s Principle in Canada?

<p>The first government to be contacted pays for the service. (D)</p> Signup and view all the answers

What does the Canadian Pediatric Society advocate regarding children's healthcare decision-making?

<p>Children with decision-making skills should have a significant role in their healthcare. (C)</p> Signup and view all the answers

Which statement reflects a common misconception about children's role in healthcare?

<p>Children's consent is irrelevant in medical decisions. (C)</p> Signup and view all the answers

What major issue influenced the implementation of Jordan’s Principle?

<p>Racial discrimination against Indigenous children. (B)</p> Signup and view all the answers

What challenge did JO face regarding his transfer to another healthcare establishment?

<p>He refused to allow professionals access to his medical file. (C)</p> Signup and view all the answers

What is a recommendation for nurses in communicating with children about their care?

<p>Practice active listening to understand the child's perspective. (A)</p> Signup and view all the answers

What is one criterion that should be considered when determining whether to provide therapies to a child?

<p>The child's best interests as a primary focus. (C)</p> Signup and view all the answers

What was the outcome for Mr. O at RVH?

<p>He remained calm and continued to receive care at RVH. (B)</p> Signup and view all the answers

What is a significant impact of not providing adequate healthcare services to Indigenous children?

<p>Reduced ability for children to participate in social activities. (D)</p> Signup and view all the answers

What is required for a minor aged 14 or older to give consent to care?

<p>They must have stayed in a health or social services establishment for 12 hours or more. (D)</p> Signup and view all the answers

What is stated about a doctor's ethical responsibilities towards abusive patients?

<p>Doctors can terminate a therapeutic relationship due to abusive behavior. (C)</p> Signup and view all the answers

How should healthcare professionals handle disagreements with families regarding medical decisions?

<p>They have a responsibility to support the patient's best interests. (C)</p> Signup and view all the answers

What determines a person's capacity to consent to treatment?

<p>Their ability to understand relevant information and foresee consequences. (D)</p> Signup and view all the answers

What was the primary concern regarding JO's request for a kidney transplant?

<p>His behavioral problems undermined the trust within the treating team. (D)</p> Signup and view all the answers

Which of the following is NOT a factor in determining the best interests of an incapable person?

<p>The financial cost of the treatment. (D)</p> Signup and view all the answers

According to pediatric ethical norms, when can children become the principal decision-makers for themselves?

<p>Once they demonstrate sufficient capacity to understand their situation. (B)</p> Signup and view all the answers

What did the parents in the story about Gabriel emphasize about their experience?

<p>They found their time with him to be valuable, despite challenges. (C)</p> Signup and view all the answers

Under what condition can a mature minor provide consent without parental involvement?

<p>If they demonstrate adequate decision-making capacity. (C)</p> Signup and view all the answers

What does the mention of 'coercive moral language' imply about communication with children?

<p>Excessive praise can manipulate children's behavior. (D)</p> Signup and view all the answers

What should professionals do when encountering protective secrets that parents wish to keep?

<p>Discuss the child's feelings with parents to determine a course of action. (D)</p> Signup and view all the answers

What is a possible outcome if a therapeutic relationship is systematically destroyed?

<p>Inability to provide ongoing treatment effectively. (A)</p> Signup and view all the answers

Which exception allows minors to receive treatment without parental consent?

<p>Emergency treatment. (A)</p> Signup and view all the answers

What underlies the challenge of consent for children under the age of 14 in healthcare?

<p>Parents can always legally override children's wishes. (A)</p> Signup and view all the answers

What is one exception to the confidentiality of patient information?

<p>Statutory duty to protect life. (C)</p> Signup and view all the answers

Which aspect is essential for successful kidney transplant procedures?

<p>Long-term collaboration and trust between the patient and treatment team. (A)</p> Signup and view all the answers

What might be a consequence of coercive language used by healthcare professionals?

<p>Heightened anxiety and resistance among children. (B)</p> Signup and view all the answers

What is required for a treatment to be considered in the best interest of an incapable person?

<p>It should have the potential to prevent deterioration of their condition. (C)</p> Signup and view all the answers

In the situation of JO, what legal action did the hospital take?

<p>They filed for a transfer order to send JO to another hospital. (D)</p> Signup and view all the answers

What is a common misconception about children with healthcare needs?

<p>They cannot articulate their thoughts and feelings. (A)</p> Signup and view all the answers

Why is it important to recognize the forms of oppression faced by children?

<p>It places accountability on society to counter oppression rather than viewing it as an inherent weakness in children. (C)</p> Signup and view all the answers

What does 'assent' imply when considering children in healthcare decisions?

<p>Children's understanding and cooperation are being prioritized. (B)</p> Signup and view all the answers

What is the primary focus when determining a patient's competency in making informed choices?

<p>Their capacity to understand and manipulate information (C)</p> Signup and view all the answers

Which ethical principle is primarily associated with respecting a patient's right to make autonomous decisions?

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

What is an ethical consideration in pediatric palliative care?

<p>The ethical principles of minimizing harm and maximizing benefit should guide decisions. (A)</p> Signup and view all the answers

Which of the following helps to mitigate inequities among children?

<p>Advocacy for disabled children and proper services. (A)</p> Signup and view all the answers

What should be included in the ethical decision-making process regarding a patient's care?

<p>Common understandings of the plan from all parties involved (A)</p> Signup and view all the answers

What scenario reflects the challenges surrounding moral awareness expressed by children?

<p>Children articulate their wishes, which can influence parents' decisions significantly. (B)</p> Signup and view all the answers

What does the principle of double effect allow in pediatric palliative care?

<p>Both good and bad effects can be weighed in specific circumstances. (D)</p> Signup and view all the answers

In the context of ethical nursing practices, what does 'voluntariness' refer to?

<p>The absence of coercion in a patient's decision-making process (B)</p> Signup and view all the answers

What is the primary focus when considering the moral voices of children during treatment decisions?

<p>Children’s personal experiences should be understood and valued. (B)</p> Signup and view all the answers

When considering long-term disability in children, what is often undervalued?

<p>The potential for meaningful lives and quality of life. (A)</p> Signup and view all the answers

What key aspect differentiates autonomy from paternalism in patient care?

<p>Autonomy is about self-rule, while paternalism often involves decision-making for the patient (B)</p> Signup and view all the answers

How should healthcare professionals approach potential conflicts between their values and those of the patient?

<p>By engaging in a dialogue to understand the patient's values and finding a suitable resolution (C)</p> Signup and view all the answers

Which statement about the test of capacity for consent in minors is true?

<p>It can be determined differently for various treatments. (D)</p> Signup and view all the answers

What impact did COVID-19 isolation have on children’s social conditions?

<p>It exacerbated existing social inequities. (D)</p> Signup and view all the answers

What legal principle does the QCC article 10 emphasize regarding personal care?

<p>Interventions can only occur with the individual's free and enlightened consent (A)</p> Signup and view all the answers

What does the CNA code of ethics state regarding informed consent in nursing care?

<p>Capable patients have the right to refuse information about their health (B)</p> Signup and view all the answers

What does MAID stand for in the context of Canada's end-of-life legislation?

<p>Medical Assistance in Dying (A)</p> Signup and view all the answers

Which of the following describes a potential risk to autonomy in mental health nursing?

<p>Engaging in coercion or using paternalistic approaches (C)</p> Signup and view all the answers

What is a key component mentioned in relation to social expectations and legal requirements in patient care?

<p>Understanding institutional policies related to similar past situations (B)</p> Signup and view all the answers

Which of the following is NOT typically considered a component of a good death?

<p>Prolonging life at all costs (D)</p> Signup and view all the answers

During the first wave of COVID, which issue was highlighted regarding family presence in healthcare settings?

<p>They were categorized as 'visitors' and denied access. (D)</p> Signup and view all the answers

Which ethical principle emphasizes the importance of providing pain relief and comfort care?

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

What challenge do caregivers often face that is exacerbated by long-standing systemic issues?

<p>Chronic fatigue and physical burdens (D)</p> Signup and view all the answers

In the case of Elena, what does her husband insist on despite the medical team's recommendation?

<p>That she should receive active curative treatment and ICU care. (B)</p> Signup and view all the answers

Which of the following best reflects the concept of procedural justice in nursing ethics?

<p>Following established legal and ethical procedures. (A)</p> Signup and view all the answers

What is a potential risk of demanding treatment that is outside the standard of care?

<p>Potential harm to the patient (D)</p> Signup and view all the answers

Which ethical principle requires respect for the patient's wishes in treatment decisions?

<p>Autonomy (D)</p> Signup and view all the answers

Which aspect of caregiving has been shown to disproportionately fall on women?

<p>Unpaid caregiving responsibilities (B)</p> Signup and view all the answers

What is a primary concern regarding the ethics of terminal interventions according to the content?

<p>Patients may feel they must choose death to avoid being a burden. (C)</p> Signup and view all the answers

What did the CHSLDs experience during the COVID pandemic?

<p>A total systems failure. (B)</p> Signup and view all the answers

What is a significant emotional factor that influences caregivers' experiences?

<p>Feelings of being a burden due to learned beliefs. (B)</p> Signup and view all the answers

Which statement best describes the intersection of healthcare access and ethical concerns?

<p>Access is influenced by social determinants and systemic oppression. (A)</p> Signup and view all the answers

What is the goal of palliative care?

<p>To help patients feel better and improve or maintain their quality of life (B)</p> Signup and view all the answers

Which principle is NOT associated with the Act Respecting End of Life Care?

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

What is required for a patient to be eligible for Medical Aid in Dying (MAID) in Quebec?

<p>Having a grave and irremediable illness (A)</p> Signup and view all the answers

What does continuous palliative sedation aim to achieve?

<p>To relieve suffering by keeping the patient unconscious until death (C)</p> Signup and view all the answers

What percentage of MAID cases in Quebec are in accordance with the law?

<p>99% (C)</p> Signup and view all the answers

What is one of the common eligibility changes introduced by Bill C11 in June 2023?

<p>Permitting nurse practitioners to assess for and administer MAID (B)</p> Signup and view all the answers

Which of the following underscores an important ethical issue surrounding MAID?

<p>Balancing autonomy and protection of vulnerable individuals (D)</p> Signup and view all the answers

What does Section 4 of the Act Respecting End of Life Care establish?

<p>Every person has the right to receive end-of-life care if they require it (B)</p> Signup and view all the answers

What is one consequence of the doctrine of double effect in medical ethics?

<p>Actions with good intentions may lead to harmful outcomes but can still be ethically permissible (B)</p> Signup and view all the answers

How does emotional and psychological support factor into palliative care?

<p>It is addressed alongside physical and practical issues (B)</p> Signup and view all the answers

Why might someone eligible for MAID not get it immediately?

<p>Their request must be evaluated by two physicians (A)</p> Signup and view all the answers

In what situation can family consent on behalf of a patient for continuous palliative sedation?

<p>In cases where the patient is unable to provide consent (B)</p> Signup and view all the answers

Which section of the Act mandates that institutions must offer end-of-life care?

<p>Section 7 (B)</p> Signup and view all the answers

What common misconception exists regarding the eligibility based on mental illness for MAID?

<p>Patients with any mental health condition qualify automatically (D)</p> Signup and view all the answers

What is a potential ethical concern related to coercion in mental health nursing?

<p>Patients may be infantilized, affecting their dignity. (C)</p> Signup and view all the answers

Which ethical principle may conflict with patient autonomy in mental health nursing?

<p>Beneficence (D)</p> Signup and view all the answers

In the context of trauma and violence-informed care, what is essential for ethical nursing practice?

<p>Understanding the impact of trauma on patient choices. (B)</p> Signup and view all the answers

What role does moral imagination play in ethical nursing practice?

<p>It helps nurses to challenge and reconsider ethical dilemmas. (A)</p> Signup and view all the answers

Why is autonomy considered essential in mental health nursing?

<p>It empowers patients to make their own decisions about care. (D)</p> Signup and view all the answers

Which concept indicates the ethical tension between a nurse's duty to act in a patient's best interest and the patient's right to make their own decision?

<p>Paternalism (C)</p> Signup and view all the answers

What ethical principle could support overriding a patient's wishes in some situations?

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

In nursing ethics, which of the following perspectives focuses on the outcomes rather than rules?

<p>Consequentialism (C)</p> Signup and view all the answers

Which understanding of dignity aligns with the capacity to act autonomously in mental health nursing?

<p>Respecting autonomy is a key aspect of honoring dignity. (A)</p> Signup and view all the answers

What does virtue ethics require from nurses in their practice?

<p>To respond reflectively and courageously to ethical dilemmas. (A)</p> Signup and view all the answers

What is a significant concern regarding the paternalistic approach in mental health care?

<p>It may neglect the voices of patients deemed incompetent. (D)</p> Signup and view all the answers

Which of the following factors can negatively affect a patient's ability to make autonomous decisions?

<p>Environmental influences and relationships. (A)</p> Signup and view all the answers

Which of the following best represents the tension between autonomy and non-maleficence?

<p>Respecting patient wishes can sometimes lead to harm. (A)</p> Signup and view all the answers

What is a key factor that differentiates relational autonomy from traditional views of autonomy?

<p>It considers the influence of interpersonal relationships on decision-making. (A)</p> Signup and view all the answers

Which ethical framework can guide nurses in balancing competing ethical principles?

<p>Four principles approach (C)</p> Signup and view all the answers

What principle should guide surrogate decision makers when making healthcare decisions for incompetent patients?

<p>Decisions must be made according to the patient's prior expressed wishes. (D)</p> Signup and view all the answers

What does the best interest standard entail in the context of healthcare decisions?

<p>Care should be beneficial and not overly burdensome. (A)</p> Signup and view all the answers

In the Hassan Rasouli case, what was the primary argument made by doctors regarding life support?

<p>Life support is considered medically ineffective in certain circumstances. (D)</p> Signup and view all the answers

Which of the following strategies are considered unhelpful when discussing end-of-life care?

<p>Delaying conversations about death and dying. (C)</p> Signup and view all the answers

What was a significant shift in bioethics cases by the 21st century?

<p>Moving from debates over life support to discussions of treatment withdrawal. (B)</p> Signup and view all the answers

What does the term 'futility' imply in medical ethics discussions?

<p>Futility encompasses considerable uncertainty regarding medical value. (B)</p> Signup and view all the answers

What approach is recommended when addressing disagreements about care at the end of life?

<p>Engage in regular meetings to discuss the care plan. (C)</p> Signup and view all the answers

How does access impact decisions regarding life support or end-of-life care?

<p>Access inequalities can lead to differing perspectives on care and quality of life. (D)</p> Signup and view all the answers

Which factor does NOT contribute to the complexity of defining 'quality of life' in medical ethics?

<p>Standardized medical definitions that apply to all. (A)</p> Signup and view all the answers

What is a critical element in achieving effective goals of care discussions?

<p>Incorporating the patient's values and wishes into the dialogue. (B)</p> Signup and view all the answers

What ethical consideration emerged from the Nancy B v Hotel-Dieu de Qc case?

<p>Patients' autonomy and privacy are paramount. (B)</p> Signup and view all the answers

What should be avoided in conversations concerning end-of-life care?

<p>Using vague language regarding the prognosis. (B)</p> Signup and view all the answers

What is a fundamental reason for why quality end-of-life care is just as crucial as curative care?

<p>It respects the patient's dignity and rights in their final days. (B)</p> Signup and view all the answers

What does practicing self-care and advocacy entail for healthcare providers?

<p>Engaging in activities that support well-being and prevent burnout. (C)</p> Signup and view all the answers

Why is humility important in discussions regarding quality of life?

<p>It encourages an understanding that perceptions of quality of life can vary significantly. (B)</p> Signup and view all the answers

Flashcards

Psychiatric Confinement

Hospitalization of a patient against their will for psychiatric care.

Court Authorization

Legal permission needed for psychiatric assessments and confinement without consent.

Types of Confinement

Different legal statuses for holding a patient, such as preventative, provisional, or authorized.

Patient Rights During Confinement

Patients maintain rights to refuse treatment, independent psychiatric evaluations, and communication/legal counsel during forced hospitalizations.

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Hospital Responsibility (Confinement)

Hospitals have obligations to provide ethical and legal care to patients under confinement, respecting rights and the legal process.

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Treatment Refusal Implications

A patient's decision to refuse treatment can influence the length of confinement, requiring a legal review.

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Peace Officer Involvement

Police officers/peace officers might play a role in preventative confinement, in certain situations.

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Confinement End Criteria

Specific criteria and situations determine when confinement legally ends, like the patient's improved mental state.

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Confinement Renewal

A process to extend a patient's confinement for another 90 days if deemed necessary.

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Psychiatric Re-evaluation (PSY)

A medical assessment to determine if a patient poses a danger to themselves or others, and if confinement is still required.

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Confinement Lifting

Release of a patient from confinement due to improving clinical condition and no longer posing a danger.

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Nursing Role in Confinement

Monitoring patient response, implementing interventions (safety measures), and supporting patient rights during confinement.

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Court Hearing Dates

Dates for patient court hearings for contesting a confinement order.

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Patient's Rights

Patient's right to contest the confinement process.

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DPS

The Department of Psychiatry/Psychology.

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Documentation requirements

Detailed record-keeping of confinement dates, rationale, patient information, and consent status.

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Confinement Process

A multi-step process involving psychiatric evaluations, court hearings, and patient rights protection

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Transport to court

Patient transportation to court hearings and processes related to confinement.

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Preventive Confinement

Patient is restricted to hospital grounds for 72 hours due to an imminent risk to self or others, with a medical order.

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Provisional Confinement

Patient cannot leave hospital grounds for up to 7 days, if refusing psychiatric evaluation. A court order is needed for assessment within 24 hours.

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Regular Confinement

Patient is confined to the hospital indefinitely upon two separate psychiatric evaluations showing danger to self/others. Requires court order.

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Nursing Implications (Confinement)

Inform patient, ensure safety measures, monitor response and document.

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Managing Confinement Documents

Nursing responsibility for ensuring confinement documents are handled properly (faxing, delivering).

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Court Documents (Confinement)

Documents indicating date of court hearing for confinement, provided by the legal office.

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Contesting Confinement

Patient's right to challenge the confinement in court and notify legal services.

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Court Hearing Preparation

Nursing responsibilities for transportation, medical support, security arrangements, and providing necessary information.

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Court Hearing Presentation

Patient and nursing staff need to be present at the court hearing. Patient must return to hospital after the hearing.

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Court Judgment

Formal decision by the court regarding the confinement, provided to patient or their legal representative.

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Psychiatric Reevaluation (Day 21)

Two psychiatric evaluations required 21 days after initial confinement to re-assess risk.

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Accompanying Patient Off Unit

Family members may accompany a patient, but only if deemed safe and appropriate by nursing staff.

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Court-ordered Psych Exam

A legal mandate for a psychiatric assessment of a person confined due to potential danger to themselves or others.

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CCQ Article 27

This article outlines the legal framework for ordering a person's temporary confinement for a psychiatric assessment if they are deemed a danger to themselves or others.

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First Psych Assessment (24 hours)

The initial psychiatric assessment must be completed within 24 hours of a person's arrival at the institution.

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Second Psych Assessment (96 hours or 48 hours)

A second, more comprehensive psychiatric evaluation must be completed within 96 hours of arrival or within 48 hours if the person was initially under preventive confinement and refused the first examination.

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Motion for Authorized Confinement

A formal application to the court seeking permission to confine a person in a psychiatric institution.

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Court Order Criteria (CCQ Article 30)

The court will only authorize confinement if two separate psychiatric reports conclude that confinement is necessary and the court itself has serious reasons to believe the person is a danger.

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Renewal of Confinement (90 days)

After the initial 30-day period, confinement can be extended for a maximum of 90 additional days with a new psychiatric evaluation.

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End of Confinement (Section 12, P-38)

Confinement ends when a medical doctor attests that it is no longer necessary or when the time limit set by the court expires, even without a psychiatric report.

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Psychiatric Assessment

A detailed examination by a mental health professional to evaluate an individual's mental state, including their risks and needs.

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Informed Consent

A patient's voluntary agreement to a medical procedure or evaluation, having received clear and understandable information about the risks, benefits, and alternatives. This applies to psychiatric assessments as well.

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Motion for Confinement

A formal request made to a court seeking legal authorization to confine someone against their will for their own safety or the safety of others.

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Court Order

A legal document issued by a court authorizing the confinement of a person for a specific period if they are deemed to be a danger.

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Denial of Access

A medical professional may deny a patient access to their medical records if there is a significant risk of harm to the patient or others.

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Correction Rights

Patients have the right to challenge and correct inaccurate, incomplete, or ambiguous information in their medical records.

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Heir Access

Heirs of a deceased patient have the right to access their medical records, provided they are fulfilling a legal obligation or it is necessary to protect their rights.

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Parental Access

Parents of minors generally have the right to access their child's medical records, except for cases of child protection or when a minor refuses such communication.

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Minor's Refusal

A minor over the age of 14 can refuse to allow their medical records to be shared with their parents or guardians.

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Youth Protection Act

A legal framework that protects children and youth at risk, which may limit parental access to a minor's medical information.

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Statutory Duties

Legal obligations for certain professionals to report suspected cases of child abuse, neglect, or other situations that require intervention.

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Confinement Duration

The time a person can be legally held in confinement is limited, ending when no longer justified, even before the set period expires.

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Confinement Extension

Any extension beyond the initial court-ordered confinement period requires new court authorization.

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Confinement Rights

A person confined has certain rights, including communication with others, legal counsel, and informed consent regarding their treatment.

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Confinement Communication

A person in confinement can communicate with others unless their health or safety requires restrictions.

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Appealing Confinement

An individual confined can appeal the confinement decision to an administrative tribunal or court of appeal.

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Consent to Care Under Confinement

Consent to treatment during confinement requires a special process through the Superior Court.

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Restraints in Confinement

Using restraints on a confined individual requires a court order or an emergency situation.

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Missing Patient Protocol

A specific protocol is followed if a patient goes missing while in confinement, involving contacting a designated service and potentially police.

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Legal Considerations in COVID-19 Confinement

COVID-19 testing and confinement raise legal issues, particularly regarding privacy, informed consent, and public health regulations.

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Ethical Considerations in COVID-19 Confinement

Confinement during COVID-19 raises ethical questions about patient autonomy, informed consent, confidentiality, and transparency.

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Judgement in Charles Le Moyne c.E.(F.)

The court ruled that confinement of a college student who acted hostilely and irrationally was justified for 21 days.

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Justification of Confinement

Confinement can be justified when a person's unpredictable behavior, potentially stemming from a psychotic state, poses imminent danger to self or others.

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Confinement and Prior Behavior

Past behavior alone cannot justify continued confinement. The danger must be present in the short or medium term.

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Refusal of Treatment in Confinement

A person with a psychiatric disorder retains the right to refuse treatment, even if it's deemed beneficial, unless they lack capacity to choose.

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CCQ Article 16: Refusal

This article addresses the situation where a capable person categorically refuses care, no representative can be found, or a minor 14+ refuses care (excluding emergencies or life/integrity threats).

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CCQ Article 17/18: Serious Risks

These articles apply when a minor's care presents serious health risks and potential grave, permanent effects, even if the minor is 14+.

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Director of Youth Protection

A government official responsible for overseeing child protection investigations and interventions.

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Treatment Order: Burden of Proof

The person requesting authorization for treatment must prove, on the balance of probabilities, that the patient lacks consent capacity and the proposed tx is in their best interest.

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Duty to Report

The legal obligation of professionals working with children to report suspected abuse or neglect to the Director of Youth Protection.

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Confinement: Exceptional Measure

Confinement is an exceptional measure, contradicting the right to integrity and inviolability guaranteed by the Charter.

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LSSSS (Act Respecting Health Services and Social Services)

A Quebec law that outlines the rights of patients in accessing healthcare and social services.

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Right to Choose

LSSSS guarantees patients the freedom to choose their healthcare provider or institution, within reasonable constraints.

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Confinement: Risk of Harm

Confinement is only justified when a person poses a serious and immediate risk of harm to themselves or others.

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Limited Resources & Patient Rights

The conflict between limited healthcare resources and the rights of patients to access care.

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Confinement: Legal Framework

Confinement is governed by the Civil Code of Quebec, the Code of Civil Procedure, and Act P-38.001.

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Jasmin c. Cité de la santé de Laval

A Quebec court case concerning a hospital's restrictions on access to healthcare services based on residency.

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Confinement: Burden of Proof (Institution)

The healthcare establishment seeking confinement must provide two psychiatric reports signed by psychiatrists to support their motion.

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Ultra Vires

A legal term describing an act exceeding the legal powers of an institution.

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Confinement: Facility Requirements

Confinement must occur in an institution with a local community service center and necessary facilities or in a hospital.

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Discriminatory Regulations

Rules or policies that unfairly treat certain individuals or groups based on factors like residency.

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Confinement: Voluntary vs. Forced

Voluntary confinement requires consent and capacity. Forced confinement can be preventive (immediate danger), provisional (potential danger), or authorized by court order.

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Confinement: Provisional vs. Preventive

Preventive confinement is for immediate danger, needing an MD order. Provisional confinement is for potential danger, requiring a court order on MD or interested person's request.

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

A Quebec court case examining the responsibility of a hospital for long wait times in the emergency room.

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Confinement: Authorized Confinement

Authorized confinement is a court-ordered measure, following two psychiatric evaluations, lasting up to 30 days. It's usually preceded by provisional or preventive confinement.

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Category 3 Emergency

A medical urgency that ideally requires attention within 30 minutes in an emergency room.

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Confinement: Grave/Serious Danger

The danger justifying confinement must be specific, personalized, precise, and not a mere possibility. The risk of future danger is insufficient.

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No-Fault Liability

A legal principle where a party cannot be held responsible for an injury without proving negligence.

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Preventative Confinement: Immediate Danger

If the danger is grave and immediate, any MD can order preventative confinement without court authorization, reporting to DPS at once.

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Limited Resources & Delays

How a hospital's limited resources can contribute to delays in patient care, particularly in emergency rooms.

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Emergency Room Wait Times

The duration that a patient waits in an emergency room before receiving medical attention.

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Preventative Confinement: MD Assessment & Court Authorization

After 72 hours, if the danger persists and the patient refuses assessment, court authorization is required to continue confinement, transitioning to provisional confinement for assessment.

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Hospital Responsibilities

Hospitals are legally required to provide the best possible care within their resource constraints.

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Preventative Confinement: Section 8 of Act P-38

Peace officers can take individuals to institutions without court authorization based on a crisis intervention unit member's assessment of grave/immediate danger or parental authority request.

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Preventative Confinement: Institution's Responsibility

Institutions receiving individuals must conduct an assessment by an MD, who can place the person under preventive confinement. Non-equipped institutions must redirect individuals to other facilities, ensuring continuity of care.

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Jordan's Principle

A policy that ensures Indigenous children have equal access to government-funded services, regardless of which level of government is responsible. It prioritizes the child's needs and resolves funding disputes later.

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Child's Best Interests

The principle that all decisions regarding a child's care should prioritize their well-being and what's best for them, even if it differs from parental wishes.

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Confidentiality in Pediatric Care

Protecting a child's privacy and keeping their medical information private, especially when they request it, even from their parents.

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Active Listening with Children

Paying full attention to a child's thoughts and feelings, using verbal and non-verbal cues to show understanding, and encouraging them to express themselves.

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Children's Moral Awareness

A child's understanding of right and wrong, and their ability to express their wishes based on ethical principles.

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Parents' Protective Secrets

Situations where parents withhold information from their child about their health or a difficult situation, motivated by a desire to protect them.

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Tension in Families with Children with Healthcare Needs

Stress and challenges that can arise within families due to the demands of caring for a child with complex medical needs.

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Child's Participation in Decision-Making

Involving children in medical decisions that affect them, based on their understanding and age-appropriate capabilities.

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Surrogacy in Children's Care

Parents acting as decision-makers on behalf of their children, particularly when they are too young to fully understand the situation.

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Assessing a Child's Capacity

Evaluating a child's ability to understand the nature of their illness, treatment options, and potential consequences of their decisions.

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Conflicting Values in Healthcare

Situations where a child's wishes, parental beliefs, and medical recommendations don't align, raising ethical dilemmas about who should decide the course of action.

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Dignity and Respect for All Children

Recognizing the inherent worth and value of every child, regardless of their physical or mental abilities, ensuring they receive appropriate care and respect.

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Informing Parents About Confidentiality

Openly communicating with parents about their child's right to privacy and explaining the limits of information sharing, while also ensuring the child's safety and well-being.

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Recognizing Oppression in Children's Healthcare

Acknowledging the systemic injustices and inequalities facing children, recognizing that they can be vulnerable to discrimination and marginalization.

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Extended Family

A broader definition of family that includes not only parents and siblings but also aunts, uncles, cousins, grandparents, and other relatives.

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Collectivism

A focus on the group's well-being and needs over individual goals and desires. Emphasis on interdependence and cooperation.

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Individualism

Prioritizes individual autonomy, self-reliance, and personal achievement. Emphasis on individual rights and independence.

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Pre-contemplative Phase

The initial stage where an individual is unaware of or not considering the possibility of Medical Assistance in Dying (MAiD).

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Contemplative Phase

A stage where an individual is actively exploring MAiD, weighing its pros and cons, and considering options.

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Determination Phase

A stage where an individual decides to pursue MAiD, meets eligibility criteria, and completes all required assessments.

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Action Phase

The finalization of MAiD arrangements, including attending the death and providing post-death support to family.

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Post-Death Phase

The time after MAiD, including providing support to the family, reporting according to legal guidelines, and debriefing for involved healthcare providers.

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Ethically Object to MAiD in Principle

A healthcare provider strongly opposes MAiD for moral or religious reasons and will not participate in any aspect of the process.

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Ethically Object to MAiD on Conditional Grounds

A healthcare provider is hesitant about MAiD due to concerns about possible negative consequences, such as a slippery slope leading to unintentional misuse.

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Not Assisting MAiD Based on Inadequate Info

A healthcare provider is unable to assist with MAiD due to insufficient information, practical obstacles, or personal reservations.

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Ethically Support MAiD with Limits

A healthcare provider believes MAiD is ethically acceptable but chooses to participate in a limited role, perhaps only providing information or support.

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Ethically Accept MAiD Fully

A healthcare provider fully accepts MAiD as ethically sound and is willing to be involved in all aspects of the process.

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MAiD Must Occur With Respect

Regardless of personal views, healthcare providers must ensure MAiD is administered with respect, dignity, and without judgment.

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Continuity of Care Responsibility

Healthcare providers have a responsibility to ensure continuity of care for patients, even when their personal beliefs differ from those of the patient or their family.

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Good Death

A death that is free from unnecessary suffering, where the dying person's needs are met and their wishes are respected. This includes physical and emotional comfort, access to spiritual support, and the ability to make decisions about their care.

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Palliative Care

A specialized approach to care that focuses on providing comfort and support to individuals with serious illnesses, their families, and caregivers. It addresses physical, emotional, spiritual, and social needs.

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Medical Assistance in Dying (MAID)

A legal medical procedure that allows a terminally ill person to receive a doctor's assistance in ending their life. It's a voluntary option for individuals who have made a conscious and informed decision to end their suffering.

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Autonomy in End-of-Life Care

The right of a person to make their own decisions about their end-of-life care, including accepting or refusing treatment, choosing where they want to die, and who they want to be with. It's about respecting their wishes and choices.

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Reconciliation in End-of-Life Care

The process of addressing and resolving ethical and cultural conflicts that arise in end-of-life care. It involves open communication, respectful dialogue, and a commitment to finding common ground.

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Hermeneutical Rapprochement Framework

A method of interpreting different perspectives and experiences in order to bridge gaps and reach a mutual understanding. It's a way to reconcile diverse views through careful interpretation and dialogue.

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Indigenous Perspectives on End-of-Life Care

Indigenous cultures often view life as a gift and death as a natural part of the life cycle. Decisions about medical interventions may be seen as interfering with the Creator's plan, emphasizing the need for family involvement and cultural rituals.

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Ethical Considerations in MAID

MAID raises important ethical questions about the role of healthcare providers, the importance of autonomy and choice, and the potential for abuse. It requires careful consideration of individual needs, informed consent, and compassionate care.

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Role of Nurses in End-of-Life Care

Nurses play a crucial role in providing compassionate care, supporting patients and families, facilitating communication, and advocating for their needs. They are essential in ensuring that patient wishes are respected and that a good death is facilitated.

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Challenges in Pediatric End-of-Life Care

Caring for dying children presents unique ethical challenges. It requires addressing the needs of children, who are moral agents, and respecting their right to participate in decision-making, while also respecting parental rights and cultural sensitivities.

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Consent for Care

A person 14 years or older can consent to their own healthcare, allowing them to make decisions about their treatment.

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Capacity to Consent

An individual is capable of consenting to medical treatment if they understand the information and consequences of their decision.

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Best Interests for Incapable Person

When someone is not capable of making their own decisions, someone else must make decisions in their best interests, considering their values, wishes, and treatment benefits.

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Mature Minor

A person under the legal age of majority, but with enough maturity to understand and make informed healthcare decisions.

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Assent in Healthcare

Gaining a child's voluntary cooperation and understanding of their medical situation, even if they cannot fully consent.

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Confidentiality in Healthcare

Keeping patient information private except in specific situations like court order, client consent, or serious risk to others.

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Principle of Double Effect

An ethical principle that allows actions with both positive and negative consequences, as long as the intention is good and outweighs the bad.

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Excessively Burdensome Resuscitation

Life-sustaining treatments that are unlikely to benefit a newborn and may cause unnecessary suffering.

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Quality of Life for Disabled Children

Recognizing that disabled children deserve meaningful lives and their quality of life should not be underestimated by adults.

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Moral Distress in Critical Illness

The emotional strain experienced by healthcare professionals when faced with difficult decisions involving critically ill patients.

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Inequities in Childhood Healthcare

Unfair differences in access to healthcare and social support for children, especially those with disabilities, hunger, or migrant backgrounds.

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Palliative Care Exceptions

Circumstances when life-sustaining treatments can be ethically withheld, focusing instead on comfort and quality of life.

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Pediatric Palliative Care

Specialized care for children with life-limiting illnesses, focusing on symptom management, emotional support, and quality of life.

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Social Supports for Vulnerable Children

The importance of social safety nets, financial stability, and access to education and healthcare to support children in need.

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End-of-Life Care

Care focused on improving quality of life for people with serious illnesses, including managing symptoms, emotional support, and addressing social and spiritual needs. It does not aim to cure or prolong life but to help the person feel as well as possible.

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Palliative Sedation

Using sedative medication to relieve suffering in individuals with a short prognosis and severe pain or discomfort that cannot be managed with palliative care. It aims to keep the person unconscious or asleep until death.

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Medical Aid in Dying (MAID)

A legal process in Canada that allows individuals with a grave and irremediable illness, in a state of advanced irreversible decline, experiencing unbearable suffering, and meeting specific eligibility criteria, to receive assistance in ending their life.

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Doctrine of Double Effect

A principle in medical ethics that explains the ethical dilemma of actions with both good and bad consequences. If a good effect outweighs the bad, the action may be justified even if the bad effect is unavoidable.

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Advance Directives

Legal documents that state a person's wishes regarding their healthcare in case they become unable to communicate their choices. These can include specific treatments, end-of-life care, or even MAID.

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Grave and Irremediable Illness

A serious illness with no cure, leading to an advanced state of irreversible decline and unbearable suffering. This is a requirement for MAID eligibility.

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Unbearable Suffering

The level of suffering a person experiences that they find unacceptable and cannot be adequately relieved by palliative care. This is a key factor in MAID eligibility.

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MAID Eligibility Criteria

Specific requirements that must be met for a person to be eligible for MAID, including having a grave and irremediable illness, being in an advanced state of irreversible decline, experiencing unbearable suffering, and meeting other conditions.

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Ethical Issues in MAID

Complex questions and concerns surrounding the ethical implications of MAID, such as the potential for coercion, ensuring informed consent, protecting vulnerable people, and balancing individual autonomy with societal values.

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Macro-Ethical Issues in MAID

Broad ethical concerns related to MAID, including the debate on eligibility for those with only a mental health condition, the ethical implications of advance directives, and the underlying reasons for pursuing MAID.

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Meso-Ethical Issues in MAID

Ethical considerations at a broader level, focusing on equitable access to healthcare services, resource allocation for MAID requests, and potential bias in how MAID is provided.

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Micro-Ethical Issues in MAID

Ethical dilemmas faced by healthcare professionals in the direct application of MAID, including individual patient needs, communication with family, and navigating emotional aspects of the process.

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Continuous Palliative Sedation

A specific form of palliative sedation where medication is continuously used to maintain a state of unconsciousness or deep sleep for a person at the end of life, with a goal of relieving unbearable suffering.

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Respect for Persons

A core principle of end-of-life care that emphasizes treating individuals with dignity and autonomy, respecting their choices and values, and providing them with information necessary to make informed decisions.

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Communication in End-of-Life Care

Open and honest communication between healthcare providers, patients, and families is critical for ensuring informed choices, addressing anxieties, providing support, and fostering a sense of trust throughout the care process.

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What's informed consent?

A person's voluntary agreement to a procedure or treatment after understanding the risks, benefits, and alternatives. It's key for respecting autonomy.

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Why is competence a continuum?

People might have the capacity to make some decisions but not others. It's not a simple 'yes' or 'no'.

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What does autonomy mean?

Self-rule. It's about individuals making choices free from controlling influence and limitations that prevent meaningful choices.

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What's paternalism in healthcare?

Making decisions for patients based on what the healthcare professional thinks is best, even if the patient disagrees.

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What are power dynamics in healthcare?

The uneven distribution of power between healthcare professionals and patients. It can impact decision-making and autonomy.

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What's the role of values in healthcare?

Values (moral, religious, cultural, personal, professional) influence healthcare decisions and can create conflicts between individuals and the healthcare team.

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How do ethical principles guide healthcare?

Principles like autonomy, beneficence, non-maleficence, and justice help guide decision-making to ensure ethical care.

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What's the difference between consent and capacity?

Consent is a person's agreement to something. Capacity is their ability to fully understand and make informed decisions.

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What's the role of social expectations in healthcare?

Social norms and legal requirements influence healthcare practices and can create tensions between what's expected and what's possible.

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What is 'free and enlightened consent'?

Consent given voluntarily and with a full understanding of the situation, including risks, benefits, and alternatives.

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Conscientious Objection (Nurse)

A nurse's refusal to participate in providing MAID due to personal values or beliefs.

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Conscientious Objection (Nurse): Responsibilities

When a nurse objects to MAID, they must continue treating the patient respectfully, ensure care continuity, and inform their manager ASAP.

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Advance Medical Directives (AMD)

Written documents outlining a person's preferences for life-sustaining treatments if they become unable to express those wishes.

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AMD: Formalities

AMDs must be completed with a notary or two witnesses, and can be sent to RAMQ or included in the medical record.

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AMD: Conditions of Application

AMDs in Quebec only apply when a patient lacks capacity to consent and is in one of three situations: serious incurable illness, coma/unconsciousness, or severe dementia.

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AMD: Healthcare Provider's Role

Healthcare providers must consult the AMD registry when the patient lacks capacity, provide information about treatment options, and ensure the patient understands those choices.

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AMD: Changing the Directive

Only the patient can change or cancel an AMD; healthcare providers cannot modify it.

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LVAD (Left Ventricular Assist Device)

A mechanical pump that assists a weakened heart in circulating blood.

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LVAD: Ethical Considerations

The decision to implant/remove an LVAD raises ethical dilemmas: autonomy vs. beneficence, and the moral distress of healthcare providers when patient wishes clash with their values.

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Withdrawing Life-Sustaining Treatment

A legally and ethically distinct process from MAID, involving stopping a treatment already in place.

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Professional Conscience

The clash between a healthcare provider's moral values and the demands of their profession.

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Advance Care Planning

An ongoing process where patients, with their healthcare team and loved ones, make decisions about future healthcare.

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Moral Distress

The psychological discomfort experienced by healthcare providers when they're unable to act in accordance with their ethical values.

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Transferring Care (Conscientious Objection)

When an MD refuses to provide treatment due to their conscience, the ethical obligation to transfer care to another provider arises.

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Surrogate Decision Maker

A person legally authorized to make medical decisions for an incompetent patient.

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Best Interest Standard

A legal framework for making decisions for incompetent patients, focusing on beneficial, advisable, and non-burdensome care.

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Futility in Healthcare

A contested concept where medical interventions are deemed ineffective or not worth doing, leading to ethical dilemmas.

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Hassan Rasouli Case

A landmark case where a patient's wife refused to withdraw life support deemed futile by doctors, highlighting conflicts between medical judgment and personal beliefs.

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Goals of Care Discussion

A crucial conversation between healthcare providers and patients to clarify aims and preferences for care.

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Quality End-of-Life Care

Providing compassionate support and comfort to patients in the final stages of life, focusing on quality over simply extending life.

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Shared Decision-Making

A collaborative approach where patients and healthcare providers work together to make medical choices.

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Self-Reflection in Healthcare

Healthcare providers critically examining their own biases, beliefs, and practices to ensure ethical and patient-centered care.

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Debriefing and Follow-Up

Analyzing previous situations to learn from mistakes, identify areas for improvement, and prevent similar challenges.

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Absence of Humility

A lack of awareness or acceptance of the limitations of medical intervention and the complexity of a good life.

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Curative Care

Medical treatments aimed at curing or reversing a disease.

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Death-Denying Society

A culture that avoids talking openly about death and dying, leading to difficulties in end-of-life care discussions.

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Trust and Respect

Fundamental principles in patient care that foster open communication and honest relationships between patients and healthcare providers.

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Autonomy in Mental Health

The patient's right to make choices about their treatment, even if it differs from the nurse's opinion.

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Beneficence in Mental Health

The ethical obligation of the nurse to act in the best interest of the patient.

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Non-Maleficence in Mental Health

The ethical duty of the nurse to avoid causing harm to the patient.

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Paternalism in Mental Health

When the nurse prioritizes the patient's well-being over their autonomy, sometimes overriding their choices.

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Coercion in Mental Health

Using power or authority to force a choice on a patient, even if it goes against their wishes.

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Dignity in Mental Health

Respecting the patient's individuality and treating them with value, regardless of their mental state.

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Consequentialism in Ethics

Judging ethical actions based solely on the outcome they produce.

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Deontologicalism in Ethics

Moral principles and rules should always be followed, regardless of the outcome.

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Professional Wisdom

The ability to identify ethical components in a situation, use moral imagination, and respond thoughtfully.

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Courage in Nursing

Acting on what is ethically right, even if it means being uncomfortable or facing opposition.

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Unequal Power in Mental Health

The inherent power difference between healthcare professionals and patients.

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Ethical Frameworks in Nursing

Structured approaches to guide nurses in making ethically sound decisions.

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Emotional Intelligence in Decision Making

Understanding your own emotions and how they influence your decisions, as well as being able to recognize and respond to the emotions of others.

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Trauma and Violence Informed Care

Applying an understanding of trauma and violence to inform patient care, respecting their experiences and helping them heal.

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AI Ethics in Mental Health

Considering ethical implications of using technology for mental health purposes.

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MAID

Medical Assistance in Dying, a legal process allowing individuals to end their lives with medical help if they meet certain criteria.

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Reasonably Foreseeable Death

A requirement in the original MAID legislation where a person's death needed to be predictable within a short period.

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Challenges of Dying at Home

Obstacles faced by individuals and families who choose end-of-life care at home, such as financial strain, caregiver burden, and lack of accessible services.

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Unpaid Caregiving

Providing care to loved ones without receiving financial compensation, often a significant burden for families, especially women.

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Systemic Failure in End-of-Life Care

Shortcomings in healthcare systems, including inadequate staffing, resources, and policies, which negatively affect the quality of care for dying individuals.

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Opportunity Cost in Triage

The ethical dilemma of choosing which patients to prioritize when resources are limited, leading to difficult decisions about who receives care.

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Futile Care

Medical interventions with no chance of improving the patient's condition, prolonging suffering without benefit.

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Do-Not-Resuscitate (DNR) Discussion

A crucial conversation between healthcare professionals and patients or their surrogates about the patient's wishes for life-sustaining treatment in the event of a cardiac arrest.

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Beneficence in End-of-Life Care

The ethical principle of acting in the best interest of the patient, providing comfort, pain relief, and emotional support during their final days.

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Non-Maleficence in End-of-Life Care

The ethical principle of avoiding harm, carefully considering the potential risks and benefits of any intervention, preventing unnecessary suffering.

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Quality of Life in End-of-Life Care

Focus on enhancing the patient's well-being and comfort in their final days, ensuring their dignity and quality of life remain central to their care.

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Sanctity of Life

Belief that all life is inherently sacred and valuable, influencing views on end-of-life choices, with some valuing life preservation at all costs.

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Procedural Justice in End-of-Life Care

Ensuring fairness in decision-making processes, adhering to established ethical and legal guidelines, and providing clear communication throughout difficult choices.

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Therapeutic Relationship

A close connection between a patient and their healthcare team, built on trust and open communication, crucial for effective treatment and long-term care.

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Unsuitable Transplant Candidate

A patient who is deemed not appropriate for a kidney transplant due to factors like their medical condition or behavioral issues.

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Injunction

A legal order from a court compelling someone to do or refrain from doing something.

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Dialysis

A medical procedure that filters the blood of people whose kidneys are failing, keeping them alive.

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Right to Choose Healthcare

A legal principle allowing patients to select their own healthcare provider and facility.

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Therapeutic Relationship Breakdown

When the trust and communication between a patient and their healthcare team deteriorates, making it difficult to provide effective care.

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Moral Agency of Children

The ability of children to make informed, ethical decisions about their own healthcare, recognizing their rights as individuals.

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Coercive Moral Language

Using language or tactics that pressure children into behaving a certain way, often by labeling them based on their obedience.

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Unspoken Diagnosis

Withholding medical information from a child about their diagnosis or prognosis, often due to fear of discouraging them.

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Children's Moral Worth

Recognizing the intrinsic value and worth of children, apart from any economic contributions they may make.

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Broad Conception of Consent

An approach to informed consent that takes into account the views and opinions of children, giving weight to their moral awareness and understanding.

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Narratives of Moral Experience

Stories and accounts that reveal how children make moral decisions and cope with challenges in their lives, showcasing their unique perspectives.

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Pepperoni Pizza and Sex

A metaphor used to describe a person's ability to find joy and meaning in life even during challenging circumstances, like facing a serious illness.

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Chez Gabriel

A pizzeria named in memory of Gabriel, a child who passed away, symbolizing how his life continued to impact his family and bring them joy.

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Canadian Pediatric Society

A professional organization that advocates for the health and well-being of children in Canada, promoting their rights and ethical treatment.

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Study Notes

  • Danger Thresholds for Confinement: Confinement requires a demonstrable, specific, and personalized risk to self or others. A potential future risk is insufficient.

  • Legal Process for Different Confinement Types:

  • Preventive Confinement: Immediate risk; no court order needed, just an MD order (72-hour limit).

  • Provisional Confinement: Grave but not necessarily immediate risk; requires a court order for a psychiatric assessment; a court order can be obtained if the patient refuses a psychiatric evaluation (up to 7 days from the time of request).

  • Authorized Confinement: Requires two separate psychiatric evaluations concluding danger to self or others. A court order sets a maximum duration (up to 30 days).

  • Court Authorization for Psychiatric Assessments: A court order is necessary for psychiatric assessments without consent, especially for provisional confinement.

  • Confinement Renewal: Every 30 days, further confinement requires new psychiatric evaluations. The entire process is repeated. The maximum extension is 90 days after the initial authorized confinement.

  • Confinement Termination: Confinement ends when a psychiatrist certifies the patient is no longer a danger, or the time limit set by the court expires. A periodic reevaluation ensures safety.

  • Patient Rights during Confinement: Patients retain the right to refuse treatment, seek legal counsel, and contest confinement in court. They also have a right to communication (unless medically contraindicated).

  • Hospital/Healthcare Worker Responsibilities: Hospitals must ensure patients are informed, safe, and receive appropriate medical and legal support. Safety measures and patient monitoring are paramount. Complete and accurate documentation is essential.

  • Treatment Refusal Implications: A patient's refusal of treatment does not automatically invalidate, or stop, a confinement, but refusal can be a factor in the determination of risk.

Similarities Between Psychiatric/Long-Term Care and Carceral Systems

  • Economic Considerations: Systemic injustices, resources, historical patterns potentially link to the rise of confinement orders.

  • Issues of Power and Control: Institutional power dynamics in psychiatric systems parallel those in carceral environments.

Role of Nurses in Confinement Situations:

  • Patient Education and Rights: Nurses must promptly inform patients about their rights related to confinement procedures, evaluations, and involvement at court hearings for authorized confinement.
  • Safety Measures: Nurses assess and implement appropriate safety measures (observation levels), ensuring patient safety and the safety of others.
  • Documentation: Nurses meticulously document patient responses and interventions. Details are significant for legal proceedings and future evaluations.

Patient Privacy and Medical Records Access:

  • Patient Rights: Individuals have the right to access their medical records.
  • Exceptions: Access can be limited if it risks substantial harm to the patient's/3rd party health.
  • Heirs/Minors/Deceased: Heirs have a right to relevant information, while minors' access is contingent on parental authority and potential harm considerations.

Director of Youth Protection:

  • Child Protection: The Director of Youth Protection investigates potential violations of a child's rights within an institution.

  • Mandatory Reporting: All professionals with reasonable suspicion of a child's harm (physical, sexual, emotional) have a mandated reporting obligation to the Director.

Limited Resources and Patient Rights:

  • Conflict Resolution: Healthcare institutions must navigate conflicts between patient rights and budgetary constraints.

  • Resource Allocation: Decisions must balance patient needs with limited financial and personnel resources.

Cases of Child Abuse, Neglect:

  • Report Triggers: Reports to the Director of Youth Protection regarding children are mandatory under specific criteria, as outlined by Youth Protection Act.

MAiD (Medical Assistance in Dying)

  • Eligibility Criteria (Canada): Age 18+, consent, grave and irremediable illness, advanced state of decline, constant and unbearable suffering, not just mental illness.

  • Conscientious Objection: Nurses and healthcare professionals have the right to object to participating in MAID for personal/moral/religious reasons. They must ensure continuity of care through referrals if they refuse to participate.

General End of Life Care (EOLC) Principles:

  • Good Care at EOL: Includes pain and symptom management, effective communication, spiritual/cultural practices, emotional support, and autonomy in decision-making.

Advance Care Planning:

  • AMD Function: A method for documented preferences regarding life-sustaining treatment if a person lacks the capacity to express their wishes.

  • Patient Agency: AMD recognizes that patients, within their capacity, want to direct their end-of-life treatment.

  • Legal Precedents: Court rulings in cases like Charles Le Moyne, CSSS Côte-de-Gaspé, and Hôpital Maisonneuve-Rosement provide guidance on determining and evaluating evidence of risk to self/others when considering confinement.

  • Informed Consent: Informed consent (oral or written) is a critical component for psychiatric assessment, treatment, and EOL care. Healthcare workers must inform the patient of their right to refuse any/all treatments. A patient should be able to voice consent/dissent at any time.

  • Capacity to Consent: Competent patients have the right to refuse any/all treatments. Capacity should not be age-based, nor should any patient be seen as incapable without a formal assessment of their capacity to consent.

  • Conflicting Values: The cases presented highlight the conflict between patient autonomy and the perceived need for protective confinement.

  • Conflict Resolution: Strategies for negotiating conflicting goals of care during EOLC include consensus medical opinions, psychosocial support, second opinions, and ethics consultations.

  • Futility: The concept of “futile” care is complex and often subjective. Discussions regarding futility can reveal and highlight underlying tensions and conflicts.

  • Advocacy: Advocacy plays an essential role when there is conflict between the healthcare team and patient/family/community regarding patient needs.

  • Equity: Existing systemic inequities can result in marginalized groups being overrepresented in psychiatric/long-term care systems.

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