Exceptions to Obtaining Consent

Diseases that Must be Treated

Under review

CLINICAL CASE 
You make a diagnosis of pulmonary tuberculosis in a 40-year-old male patient from South America. The patient fears the side effects of the treatment and refuses it.
What do you do?  

The Public Health Act (R.S.Q., c. S-2.2) deals with the organization of public health, national and regional programs in public health, the responsibilities of the Minister and directors of public health in matters of promotion, prevention and protection of public health, as well as the obligations and powers to investigate and intervene which are entrusted to them.

Diseases requiring compulsory treatment  (ss. 83-88) and prophylactic measures (ss. 89-91) are dealt with in Chapter IX of the Act. It stipulates that the “Minister may, by regulation, draw up a list of the contagious diseases and infections for which any person affected is obligated to submit to the medical treatments required to prevent contagion.” (sec. 83). Pursuant to this list, any physician who observes that a person is likely suffering from an infection included on the list must take the required measures to ensure that the patient receives the care required by his condition. If the person refuses or neglects to be treated, the physician must notify as soon as possible the appropriate public health authority in the territory (ss. 84-86). The latter must then make an inquiry. If the person refuses to be examined or treated, “he may apply to the Court for an order enjoining the person to submit to such examination or treatment.” (ss. 87-88).

The Minister’s Regulation under the Public Health Act specifies the list of diseases that must be reported (maladies à déclaration  obligatoire—MADO) (Chapter I) and the diseases for which treatment is mandatory (maladies à traitement obligatoire—MATO) (Chapter II). At present, tuberculosis is the only disease for which treatment is mandatory. The Public Health Protection Act, repealed in 2002, considered gonorrhea and syphilis as diseases for which treatment was mandatory, but this is no longer the case. On the other hand, it is now possible to make treatment obligatory for any disease, simply by adding it to the list of diseases for which treatment is mandatory.

In fact, the new provisions give more powers to the director of public health. First, they give him investigative powers (sec. 100), allowing him to obtain information or even clinical samples, as needed, by court order; they then give him the power to intervene (sec. 106) if he judges that the health of the population is threatened. The director of public health may notably order a person to be placed in isolation for a maximum of 72 hours or “order any other measure he considers necessary to prevent a threat to the health of the population from worsening or to decrease the effects of or eliminate such a threat.”

These sweeping powers partly explain why the list of diseases for which treatment is mandatory is so short. However, they give  the public health director more flexibility, allowing him to individualize and confine these exceptional interventions to situations that really require them.

2011-04-04