Exceptions to Obtaining Consent

Confinement in an Institution

Under review

CLINICAL CASE
Mr. Louis P., forty years old, is brought in by the police because he broke everything in his apartment. He is very aggressive, suffers from paranoid schizophrenia and stopped taking his medication a few weeks ago. He claims he is Jesus and categorically refuses to remain in hospital. He does not understand why the police brought him in, and he threatens to hit you. 
What do you do? 

The Act respecting the protection of persons whose mental state presents a danger to themselves or to others (R.S.Q. c. P. 38.001) complements the provisions of the Civil Code of Québec (Articles 26 and 27). All of these legal provisions are intended to protect persons, notably by allowing confinement in an institution against their will, while respecting their rights as much as possible. To this effect, the legislation provides for three types of confinement: preventive confinement, temporary confinement and authorized confinement.

Preventive confinement may be ordered by a physician practicing in an institution, despite a lack of consent from the person concerned, without a court order and without any psychiatric examination, if the physician judges that the person presents a grave and immediate danger to himself or to others.

This preventive confinement may last no longer than 72 hours, unless the court orders that the confinement be extended so  that the person concerned may undergo psychiatric assessment. However, if this  period ends on a Saturday or on a nonjuridical day so that no judge having jurisdiction in the matter is able to act, and if termination of confinement presents a danger, the confinement may be extended until expiry of the next juridical day.

Temporary confinement is a confinement ordered by the court so as to submit the person to a psychiatric assessment. This temporary confinement should not normally exceed seven days, taking into account the time required to perform a psychiatric assessment and submit a report to the court.

Authorized confinement is ordered by the court, if two psychiatric assessment reports conclude that it is necessary. The duration of the confinement is also fixed by the court. In a case where the confinement is longer than 21 days, a report must be submitted to the court 21 days after the court order authorizing the confinement, and
every three months thereafter.

Mr. Louis P. is dangerous, at least to you,  because he is threatening you; he may be a danger to himself as well. You may admit Mr. Louis P. to preventive confinement. For immediate emergency reasons, you are also  authorized to administer medication to him. However, once the agitation is controlled by the emergency treatment and the immediate danger eliminated, the patient may not be kept and treated against his will.

 

2011-04-04