Health care: when the person cannot express his or her wishes

Soins de santé: quand la personne ne peut pas exprimer ses volontés

The COVID-19 poses serious risks to the health of seniors. Many people must be hospitalized and, sometimes, be put on an artificial respirator in order to survive. In general, a person has the choice to consent to or refuse care. However, there are some exceptions.

Consent : a choice which must be free and informed

A person generally needs to express itself if it wishes to receive or not a form of health care. Its decision must be free and informed. That is to say that you can’t force someone to consent or refuse, but also that she must know all the medical information necessary. For example, the hospital staff should explain to him the consequences of a medical intervention so that she can decide whether to undergo it or not.

Verify that the person is capable of consenting

A person who does not understand what is happening cannot consent only. This is the case if she is unconscious or if his intellectual faculties are affected.

The doctor must verify if the person is truly capable of consenting. A person who is protected by a regime (guardianship, or tutelage) or a protection mandate is not necessarily incapable of doing so. The physician may consider that it can express its wishes, for example if it understands the treatment proposed and the risks associated. However, if the person refuses categorically to health care, it is up to the court to decide.

If the person cannot consent

When a person is not able to express his / her wishes, the medical staff must follow a particular procedure :

Check the medical Guidelines anticipated (DMA)

The medical staff checks to see if the person has written DMA. The DMA enable a person to predict whether or not it accepts some health care in the event that they lose capacity to consent to care. She may accept or refuse in advance certain treatments, such as cardio-pulmonary resuscitation and assisted ventilation by a respirator. However, the DMA shall apply only in specific situations : for example, if the person is in a coma or is suffering from a dementia that seriously affects his mental capacity, and no improvement of its state is possible.

Obtain substitute consent

If the person has not provided to the DMA or that DMA does not apply in the situation, someone else has to take a decision in its place. There is talk of a substituted consent. The substituted consent is given by the legal representative of the person incapable of consent (representative, guardian, trustee private), his or her spouse or a close relative. This representative shall take decisions only in the interest of the person he represents and must respect his / her wishes to the extent possible.

Consent in emergency situation

The medical personnel may provide care to someone without obtaining its consent, if :

  • his life is in danger or his integrity is threatened ;
  • his consent or substituted consent cannot be obtained in time.

If these conditions are met, the medical personnel can only give care necessary to protect the life or health of the patient (emergency care). It must also comply with the DMA of the person in a.

The health care in the event of a COVID-19 are they free ?

People who have contracted the COVID-19 can be treated free of charge. They can receive all the care necessary for their health, regardless of the place where they are given (e.g. : hospital, CLSC, CHSLD, private clinic).

The sick people, who need to be hospitalized do not have to pay unless they want a private room or semi-private.

If the sick person has to take medications, these are usually covered by the public system of drug insurance or by private insurance, if it has one.

Soins de santé: quand la personne ne peut pas exprimer ses volontés

Informational text – This text is not legal advice; it is recommended to consult with a lawyer or a notary public to such a notice. Éducaloi is a non-profit organization whose mission is to inform Quebecers of their rights and obligations in a clear language”.

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