Exceptions to Obtaining Consent

Emergency Treatment

Under review

An emergency is defined as a situation in which the life (or integrity of a limb) of a person is in immediate danger. It is a condition where obtaining consent is excepted and not simply foregone. Indeed, whenever the patient’s consent is possible, even in an emergency, it is required. On the other hand, if there is an emergency, and the consent cannot be obtained in due time, the physician must act in the best interests of the patient.

Furthermore, the Civil Code of Québec stipulates in Article 13 that, even in an emergency, consent must be obtained (from the person or his representative) “where the care is unusual or has become useless or where its consequences could be intolerable for the person.” This explains the necessity of obtaining a specific consent in the context of a research protocol, even if the investigation methods are used to treat an emergency. As legislators have not  identified these terms, it is up to the physician to use his or her good judgment.

For a physician to declare that the state of emergency was such that consent (direct or substituted) could not be obtained in due  time, he or she must demonstrate the immediacy of the threat to the patient’s life or health. Note that it cannot be a question of convenience; the necessity to proceed at the precise point in time the professional act was performed must leave no room for doubt.

Furthermore, in an emergency situation, only the treatments immediately required by the emergency may be carried out. As soon as the patient can once again make decisions that concern him, the physician must obtain from him a free and informed consent before continuing or changing the treatment. It is up to the physician to record as soon as possible the circumstances that forced him or her to act without a valid consent. In other words, it is up to the physician to define the emergency.