Source: https://www.leg.bc.ca/content/legacy/web/35th2nd/1st_read/gov51-1.htm
Timestamp: 2018-01-19 07:20:57
Document Index: 100798330

Matched Legal Cases: ['art 2', 'art 4', 'art 2', 'art 2', 'art 2', 'art 2']

BILL 51 -- 1993: HEALTH CARE (CONSENT) AND CARE FACILITY (ADMISSION) ACT
BILL 51 -- 1993
Part 2 -- Consent to Health Care
General rule - - consent needed
Exception - - if a substitute decision maker, guardian or representative consents
Exception -- emergency health care
Exception -- informed consent not required for preliminary examination
Exception -- major health care
Exception -- minor health care
Part 4 -- Reviews and Appeals
Health Care and Care Facility Review Boards
Decisions or orders of a board
Board's power to give directions on request
Appeal from board decisions
"board" means a Health Care and Care Facility Review Board established under section 27 (1);
(a) a facility licensed under the Community Care Facility Act and regulated under the Adult Care Regulations, B.C. Reg. 536/80,
(b) a private hospital licensed under Part 2 of the Hospital Act,
(c) an institution designated as a hospital under the Hospital Act for the treatment of persons referred to in paragraph (b) or (c) of the definition of "hospital" in that Act, or
(d) any other facility, or class of facility, designated by regulation as a care facility;
"designated agency" means a public body, organization or person designated as an agency under section 61 (a) of the Adult Guardianship Act for the purposes of Part 2 of that Act;
"facility care proposal" means a proposal described in section 20 (1);
"guardian" means a person appointed under the Adult Guardianship Act as a guardian;
"health care" means anything that is done for a therapeutic, preventive, palliative, cosmetic or other purpose related to health, and includes
(a) a course of health care, for example, a series of immunizations or dialysis treatments or a course of chemotherapy, and
(b) participation in a medical research program approved by an ethics committee designated by regulation;
"health care provider" means a person who, under a prescribed Act, is licensed, certified or registered to provide health care;
"representation agreement" means an agreement or other document registered under the Representation Agreement Act as a representation agreement;
"substitute decision maker" means a person appointed under the Adult Guardianship Act as a substitute decision maker.
(a) the admission of anyone to a Provincial mental health facility or psychiatric unit under section 20, 23, 24, 25 or 25.1 of the Mental Health Act,
(b) the provision of professional services, care or treatment to anyone detained in a Provincial mental health facility or psychiatric unit under section 20, 23, 24, 25 or 25.1 of the Mental Health Act, or
(c) the provision of professional services, care or treatment under the Mental Health Act to anyone on extended leave from a Provincial mental health facility or psychiatric unit under section 31 or 33 of that Act.
(b) deciding to apply for admission to a care facility, to accept a facility care proposal, or to move out of a care facility,
General rule -- consent needed
(f) the adult has an opportunity to ask questions and receive answers about the proposed health care. [For information rights relating to substitute consent, see section 17 (6) to (8) of this Act, section 18 of the Representation Agreement Act and section 27 of the Adult Guardianship Act.]
(b) may allow the adult's spouse, or any relatives or friends, who accompany the adult and offer their assistance, to help the adult to understand or to demonstrate an understanding of the matters mentioned in section 7.
(3) However, a health care provider may provide additional or alternative health care to an adult if
Exception -- if a substitute decision maker,
guardian or representative consents
(b) the adult's substitute decision maker, guardian or representative
(c) the adult does not have a substitute decision maker, guardian or representative who is authorized to consent to the health care, is capable of doing so and is available, and
(2) For the purpose of this section, a substitute decision maker, guardian or representative is available if it is possible for the health care provider, within a time that is reasonable in the circumstances,
(a) to determine whether the adult has a substitute decision maker, guardian or representative, and
(b) to communicate with the adult's substitute decision maker, guardian or representative.
Exception -- informed consent notrequired for preliminary examination
13 A health care provider may undertake triage or another kind of preliminary examination, treatment or diagnosis of an adult without complying with section 6 if the adult or his or her spouse, relative or friend indicates that the adult wants to be provided with the health care.
(a) after consulting with the adult's spouse, relative or friend or with any other person who has relevant information, the health care provider decides that the adult
(ii) is incapable of giving or refusing consent to it,
(b) the adult does not have a substitute decision maker, guardian or representative who is authorized to consent to the major health care, is capable of doing so and is available,
(d) the health care provider complies with subsections (4) and (7).
(2) However, if
(a) the adult or someone who is consulted under subsection (1) objects to the major health care, or
(b) the adult is not accompanied by a spouse, relative or friend,
(3) If an assessment under subsection (2) indicates that the adult needs the major health care and is incapable of giving, refusing or revoking consent to it, the health care provider may, subject to subsections (4) to (7), provide the health care if someone chosen under section 16 has authority to consent to the major health care and gives substitute consent.
(4) On choosing a person under section 16, the health care provider must
(a) inform the adult and any spouse, relative or friend of the adult who accompanies the adult of
(i) the decision or assessment that the adult is incapable,
(ii) the name of the person chosen under section 16, and
(iii) the right to request a review, under section 28, within 72 hours, and
(b) give the adult a written notice in the prescribed form containing the information listed in paragraph (a).
(5) In addition, the health care provider must notify a prescribed advocacy organization of the decision or assessment that the adult for whom the major health care is proposed is incapable, and of the other information listed in subsection (4) (a), if
(a) the adult objects to the major health care,
(c) any spouse, relatives or friends accompanying the adult dispute among themselves about the major health care, or
(d) the adult's rights under this Act may be at risk.
(6) After notifying the prescribed advocacy organization, the health care provider must allow someone from the advocacy organization to, in private,
(a) inform the adult for whom the major health care is proposed about the right to a review, and
(b) receive the adult's directions.
(7) The health care provider must not provide the major health care to the adult for whom it is proposed until
(a) the review period passes without a review being requested under section 28, or
(b) a final decision is made on a review requested under section 28.
(8) Subsection (7) does not prevent the health care provider from providing health care under section 12 in an emergency.
(9) A health care provider may notify the Public Trustee if the health care provider believes that an adult who is incapable of giving, refusing or revoking consent needs major health care that is of a type that
(a) the adult's substitute decision maker, guardian or representative is not authorized to consent to, or
(b) someone chosen under section 16 is not authorized to consent to.
(10) On being notified under subsection (9), the Public Trustee may apply to the court under the Adult Guardianship Act for
(a) the appointment of a substitute decision maker or guardian for the adult, or
(b) a change to an existing order appointing a substitute decision maker or guardian.
(b) the adult does not have a substitute decision maker, guardian or representative or the adult's substitute decision maker, guardian or representative is incapable of giving or refusing consent, and
(e) anyone else related by birth or adoption to the adult.
(3) If no one listed in subsection (1) is available or qualifies under subsection (2) or if there is a dispute about who is to be chosen, the health care provider must choose someone authorized by the Public Trustee.
Authority of a temporary
17 (1) A person chosen under section 16 has, for a period of 21 days from the date of being chosen, the authority to give or refuse substitute consent to health care for the adult.
(2) Subsection (1) applies even if the health care is for a continuous period that extends beyond the 21 day period so long as the health care begins before that period ends.
(3) Within the 21 day period, the person chosen under section 16 may apply to the court under the Adult Guardianship Act for an order appointing a substitute decision maker or guardian for the adult.
(4) If an application is made under the Adult Guardianship Act, the applicant's authority to give or refuse substitute consent under this Act extends beyond the 21 day period until a final order is made.
(5) On being told that a person chosen under section 16 wants to be relieved of the responsibility of giving or refusing consent, the health care provider may choose another person in accordance with that section to assume that responsibility for the remainder of the 21 day period.
(6) A person chosen under section 16 has the right to all the information necessary to make an informed decision under subsection (1) of this section.
(7) Anyone who has custody or control of the information referred to in subsection (6) must disclose that information to the person chosen under section 16.
(a) any claim of confidentiality or privilege other than a claim founded on solicitor client privilege, and
Restrictions on authority of a
18 (1) A person chosen under section 16 does not have authority to give substitute consent to any type of health care prescribed in the regulations.
(b) the person has made the decision in accordance with section 19 (1) and (2) (a).
(3) If any person referred to in subsection (2) does not agree on any matter referred to in subsection (2) (a) or (b), that person or the Public Trustee may apply under the Adult Guardianship Act for the appointment of a substitute decision maker or guardian for the adult.
Duties of a temporary
(ii) if the person chosen under section 16 is someone authorized by the Public Trustee, with any friend or relative of the adult who asks to assist, and
(2) If the adult's instructions or wishes are not known, the person chosen under section 16 must decide to give or refuse consent
(a) the adult's current wishes,
20 (1) The operator of a care facility must not admit an adult to live in the facility unless the adult or a person authorized under section 22 has accepted a facility care proposal that includes information about
(a) the types and levels of care and the activities provided in the facility,
(b) the policies followed in the facility, and
(c) any other prescribed subject.
(2) The operator of the care facility must explain the facility care proposal to the adult.
(3) When explaining the facility care proposal, the operator of the care facility
(b) may allow any spouse, relative or friend who accompanies the adult, or who offers assistance, to help the adult to understand or demonstrate an understanding of the proposal.
21 (1) If the adult rejects the facility care proposal, the operator of the care facility must inform the following of the adult's decision:
(a) the adult's spouse, relative or friend, if known to the operator;
(b) the adult's medical practitioner;
(c) the adult's substitute decision maker, guardian or representative.
(2) If the operator of the care facility has reason to believe that the adult
(a) needs and would benefit from admission to the care facility mentioned in the facility care proposal, and
(b) is incapable of deciding to reject the proposal,
any of the following may arrange for a designated agency to assess whether the adult is incapable of making that decision:
(c) a substitute decision maker, guardian or representative who is authorized to make decisions about the adult's personal care;
(d) the adult's spouse;
(e) a relative referred to in section 22 (2) (b) to (e);
(f) the Public Trustee, if no one else is available.
(3) In assessing whether the adult is incapable of deciding to reject the facility care proposal, the designated agency must
(a) comply with the regulations governing assessments, and
(b) consider whether the adult demonstrates that he or she understands the facility care proposal, and the reason for admission to the care facility.
Who can accept the proposal
if the adult is incapable
22 (1) If the designated agency decides that the adult is incapable of rejecting the facility care proposal, a substitute decision maker, guardian or representative who has authority to do so may accept or reject the proposal.
(2) If the adult has no substitute decision maker, guardian or representative with authority to accept a facility care proposal, the first, in listed order, of the following who is available and who qualifies under subsection (3) may accept or reject the proposal:
(3) To qualify to accept or reject a facility care proposal, a person must
(d) be capable of accepting or rejecting the proposal.
(4) Before accepting or rejecting the facility care proposal, a person authorized under this section must
(a) consult, to the greatest extent possible, with the adult and with any spouse, friend or relative of the adult who asks to assist, and
(b) decide to accept or reject the proposal, in the adult's best interests.
(5) In deciding whether the facility care proposal is in the adult's best interests, the person authorized under this section must consider
(a) the adult's current wishes, values and beliefs,
(b) whether the adult would benefit from admission to a care facility, and
(c) whether a less restrictive type of care facility would be as beneficial to the adult as the proposed care facility.
(6) If no one listed in subsection (2) is available or qualifies under subsection (3) or if there is a dispute about who is entitled to accept or reject the facility care proposal, the Public Trustee may
(a) accept the proposal, or
(b) apply to the court under Part 2 of the Adult Guardianship Act.
(7) A person who is authorized to accept or reject a facility care proposal has the right to all the information necessary to make an informed decision and section 17 (7) and (8) applies.
23 (1) If an adult is admitted to a care facility after a facility care proposal is accepted for the adult under section 22, the operator of the care facility must notify the following of the admission:
(a) the adult's spouse, or a relative or friend of the adult, if known to the operator;
(2) The notice of admission must be in the prescribed form and must be delivered within 72 hours after the adult's admission to the care facility.
(3) The operator of the care facility must notify a prescribed advocacy organization of the adult's admission if
(a) the adult objects to the admission,
(b) any spouse, relatives or friends accompanying the adult dispute among themselves about the admission,
(c) the adult has no spouse, relatives or friends and has been admitted by the Public Trustee under section 22 (6), or
(d) the operator has reason to believe that the adult's rights under this Act may be at risk.
(4) After notifying the prescribed advocacy organization, the operator of the care facility must allow someone from the prescribed advocacy organization to, in private,
(a) inform the adult who has been admitted about the right to a review, and
24 A person who is authorized under section 22 to accept or reject a facility care proposal for an adult is not authorized to give or refuse consent to health care for the adult unless that person is authorized under Part 2 of this Act.
25 (1) The operator of a care facility must not restrain, by physical, chemical or other means, the freedom of movement of an adult who is living in the facility unless
(a) all alternatives have been exhausted,
(c) the restraint has been approved by a person authorized under section 22 (1), (2) or (6) and by a medical practitioner whose approval is based on the opinion of another health care provider.
(2) A person authorized under section 22 (1), (2) or (6) may approve a decision to restrain the adult's freedom of movement if
(a) the person consults, to the greatest extent possible, with the adult and with any spouse, relative or friend of the adult who asks to assist, and
(b) the decision is in the adult's best interests or for the protection of others.
(3) The operator of a care facility may restrain the adult's freedom of movement, even though the restraint is not approved under subsection (1) (c), if
(a) the restraint is necessary to preserve the adult's life or to prevent serious physical harm to the adult or others,
(b) the adult is restrained for no longer than necessary and, at the most, for no longer than 72 hours,
(c) a health care provider reassesses the necessity for the restraint at least every 8 hours, and
(d) the operator ensures that the adult's comfort and safety is monitored in accordance with the regulations.
(4) If the adult is restrained under this section, the operator of the care facility must
(a) notify, in the prescribed form, any person who accepted a facility care proposal for the adult, and
(b) record the restraint in accordance with the regulations.
26 (1) An adult who has been admitted to live in a care facility has the right to move out of the facility unless he or she is incapable of making that decision.
(2) The adult's substitute decision maker, guardian or representative or the person who accepted the facility care proposal for the adult may remove the adult from the care facility if
(a) the adult is incapable of making the decision to move out of the facility, and
(b) removing the adult from the facility is in the adult's best interests.
27 (1) The minister must establish a Health Care and Care Facility Review Board for each prescribed region of British Columbia.
(2) Each board is to consist of the following members appointed by the minister:
(a) one health care provider;
(b) one member of the Law Society of British Columbia;
(c) one person who is neither a health care provider nor a member of the Law Society of British Columbia.
(3) The minister may designate one of the members to chair hearings and to supervise and direct the work of the board.
(4) The members of a board are entitled to be reimbursed by the minister for reasonable travelling and other out of pocket expenses necessarily incurred in discharging their duties, and may be paid remuneration set by the Lieutenant Governor in Council.
28 (1) A request may be made for a review of
(a) a decision that the adult to whom health care is provided or for whom health care is proposed is incapable of giving, refusing or revoking consent to health care,
(b) a decision to choose a particular person under section 16 to give, refuse or revoke substitute consent to health care,
(c) a decision to give, refuse or revoke substitute consent to health care,
(d) a decision that an adult is incapable of rejecting a facility care proposal,
(e) a decision to accept or reject a facility care proposal,
(f) a decision to restrain an adult's freedom of movement within a care facility, or
(g) a decision that an adult is incapable of deciding to move out of a care facility.
(2) Any of the following may request a review:
(a) an adult to whom health care is being provided or for whom health care is proposed;
(b) an adult who is living in a care facility or for whom a care facility is proposed;
(c) a spouse, relative or friend of anyone referred to in paragraph (a) or (b);
(d) the substitute decision maker, guardian or representative of anyone referred to in paragraph (a) or (b);
(e) a prescribed advocacy organization;
(f) the Public Trustee.
(3) A request for a review made under subsection (1) (a) must be accompanied by the report of an assessment arranged under section 14 (2).
(4) The request must be in writing and must be delivered to the board for the region where
(a) the health care is provided or is to be provided, or
(b) the care facility or proposed care facility is located.
(5) The request must be delivered to the board within 72 hours after the decision is made.
(6) The board must give the parties written notice of the request for a review and of the time, date and place of the hearing.
(7) The parties to a review are
(a) the person who requested the review,
(b) the adult
(i) to whom health care is provided or for whom health care is proposed, or
(ii) who is living in the care facility or for whom a care facility is proposed, and
(c) the person whose decision is being reviewed.
29 (1) The board must hold a hearing to review the decision referred to in the request, unless the request is withdrawn before the day set for the hearing.
(2) The hearing must be held within 7 days after the board receives the request.
(3) A party is entitled to be represented by counsel or agent at the hearing.
(4) The board may inform a prescribed advocacy organization if the board is of the opinion that any of the following need assistance at the hearing:
(a) an adult to whom health care is provided or for whom health care is proposed;
(b) an adult who is living in a care facility or for whom a care facility is proposed.
(5) Before the hearing, a party must be given an opportunity to examine and copy those parts of any document or electronic recording that another party intends to introduce as evidence at the hearing.
(6) A party is entitled to present any evidence that the board considers relevant and to question witnesses.
(7) The standard of proof at the hearing is proof on a balance of probabilities.
(8) The board must fully inform itself of the facts at the hearing.
(9) For the purpose of subsection (8), the board may summon witnesses to the hearing, in addition to the witnesses called by the parties, and has the powers of a commissioner under sections 15 and 16 of the Inquiry Act.
30 (1) After holding a hearing, a board may confirm the decision under review or substitute its own decision.
(2) When substituting its own decision, a board must comply with any provision of section 19 or 22 that is relevant to the decision.
(3) A decision of a board must be in writing and include reasons and the board must give copies of the decision to all parties.
31 (1) In addition to its powers and duties with respect to reviews, a board may, if requested, give advice or directions on the following:
(a) the scope of a person's authority under this Act;
(b) whether health care is major health care or minor health care;
(c) whether health care is of a type that someone chosen under section 16 is authorized to consent to;
(d) whether health care is of a type that a representative is authorized to give or refuse consent to;
(e) whether it is appropriate to refuse substitute consent under section 18 (2) to health care necessary to preserve life;
(f) any other matter relating to the provision of health care to an adult who is incapable of giving, refusing or revoking consent.
(2) Any of the following may request advice or directions from the board:
(b) a substitute decision maker;
(d) a representative;
(e) a person chosen under section 16;
(3) The request for advice or directions must be in writing and must be delivered to the board for the region where the health care is provided or is to be provided.
32 (1) Within 30 days after a decision is made by a board, a party may appeal the decision to the court on a question of law or fact or both.
(2) The Rules of Court apply to an appeal under this section to the extent that they are consistent with this section.
(3) The appeal is to consist of a new hearing unless the appeal is restricted to a question of law.
(4) The appeal suspends the effect of the decision being appealed.
(5) On application, the court may make an interim order authorizing health care to be given to a person if the health care is necessary to prevent physical or mental harm to the person.
(6) After hearing the appeal, the court may do one or more of the following:
(a) confirm or rescind the decision of the board;
(b) exercise all the powers of a board and substitute the court's decision for the board's decision;
(c) refer all or part of the matter back to the board for rehearing with any directions the court considers appropriate.
(2) A person who is a health care provider or the operator of a care facility is entitled to rely on the accuracy of the information given to that person to establish
(c) someone's authority to accept or reject a facility care proposal,
34 The Lieutenant Governor in Council may make regulations, including regulations
(a) designating any facility or class of facility as a care facility for the purpose of paragraph (d) of the definition of "care facility",
(b) designating ethics committees for the purpose of paragraph (b) of the definition of "health care",
(c) prescribing Acts for the purpose of the definition of "health care provider",
(d) designating any type of health care as major health care for the purpose of paragraph (d) of the definition of "major health care",
(e) prescribing advocacy organizations for the purposes of sections 14 (5) and (6), 23 (3) and (4), 28 (2) (e) and 29 (4),
(f) prescribing types of health care for which substitute consent may not be given under section 18,
(g) governing assessments under sections 14 (2) and 21,
(h) prescribing information that must be included in a facility care proposal under section 20,
(i) prescribing the duties of an operator of a care facility who restrains an adult's freedom of movement in the facility,
(j) prescribing the regions of British Columbia for which review boards are to be established under section 27,
(k) prescribing forms for the purpose of requesting a review under section 28 or requesting advice or directions under section 31 or for any other purpose, and
(l) governing hearings before boards.
35 Section 5 of the Offence Act does not apply to this Act or the regulations.
36 The Good Samaritan Act, R.S.B.C. 1979, c. 155, is amended by adding the following section:
Application of the Health Care (Consent)
and Care Facility (Admission) Act
37 The Health Act, R.S.B.C. 1979, c. 161, is amended by adding the following section:
124 The Health Care (Consent) and Care Facility (Admission) Act does not affect anything in section 5, 7, 9, 12, 69 or 70 of this Act or in a regulation made under this Act.
38 Section 14 of the Human Tissue Gift Act, R.S.B.C. 1979, c. 187, is amended by renumbering the section as section 14 (1) and by adding the following:
39 The Venereal Disease Act, R.S.B.C. 1979, c. 422, is amended by adding the following section:
Application of the Health Care (Consent) Act
18 The Health Care (Consent) and Care Facility (Admission) Act does not affect anything in this Act or in a regulation made under this Act.
This Bill codifies and clarifies important common law principles. It also provides a legal basis for several common practices of the medical profession for which none presently exists. In addition, the Bill incorporates safeguards to ensure that basic human rights are followed by health care providers.
The Bill is based on a Joint Community and Government Report entitled "How Can We Help?".
the common law presumptions that everyone is capable of giving and refusing consent to health care and that no health care should normally be provided to anyone without that person's informed consent are codified;
the exceptions to the rule that informed consent must normally be obtained are more clearly defined;
procedures for determining incapability to give consent and who gives substitute consent are included;
the duties of substitute decision makers and the restriction on their authority are clearly set out;
procedures for admission of individuals to care facilities are included;
dispute resolution mechanisms for resolving disagreements among family members and others are incorporated;
the functions family members usually perform with respect to health care consent and care facility admissions are recognized.