Health Law - SCC

Physicians sought to withdraw life support from an incapable patient while the substitute decision-maker refused consent.

The Court held, by majority, that withdrawal of life support in the circumstances constituted treatment under Ontario’s Health Care Consent Act, 1996 and therefore required consent under the statutory regime.

The majority concluded that disputes over refusal of consent must be addressed before the Consent and Capacity Board, which may substitute its decision if statutory best-interests criteria are not met.

Dissenting reasons would have resolved the dispute under the common law rather than the statutory board process.

The appeal was dismissed, with dissent.

The appellants, a mother and infant who suffered brain damage during a vaginal birth after caesarean section (VBAC), appealed a Court of Appeal order setting aside a trial judgment due to the trial judge's extensive copying of the plaintiffs' submissions.

The Supreme Court held that incorporating the material of others in reasons for judgment does not, without more, require the decision to be set aside; the presumption of judicial integrity is rebutted only where copying would lead a reasonable person to conclude the judge did not independently consider the issues.

On the merits, the Court affirmed liability against the prenatal obstetrician for failure to obtain informed consent to VBAC, but set aside findings of liability against the hospital, nurse, and other physicians for lack of causation.

The appellant sought to block disclosure of portions of drug submission records requested under federal access to information legislation.

The Court clarified notice obligations, severance duties, and the evidentiary burden on a third party resisting disclosure under statutory exemptions for trade secrets, confidential information, and probable harm.

The majority held that the third party had not proven that the remaining redacted material met the claimed exemptions on the record.

The Court affirmed that appellate intervention was available where the reviewing judge did not adequately apply governing legal principles to the evidence.

The appeals were dismissed and disclosure orders stood, subject to redactions already accepted.

The Attorney General of Canada appealed a decision granting a constitutional exemption to Insite, a safe injection facility in Vancouver, from federal drug possession and trafficking laws.

The Supreme Court of Canada held that while the Controlled Drugs and Substances Act is valid federal criminal legislation that applies to provincial health facilities, the federal Minister of Health's refusal to grant an exemption under section 56 of the Act violated the claimants' section 7 Charter rights.

The Court found the Minister's decision was arbitrary and grossly disproportionate in its effects, as it denied life-saving medical care to vulnerable individuals without a corresponding benefit to public safety.

The Court ordered the Minister to grant the exemption forthwith.

The appellant government appealed a decision upholding the certification of a class action brought by elderly residents of long-term care facilities.

The residents alleged the government artificially inflated accommodation charges to subsidize medical expenses, claiming breach of fiduciary duty, negligence, bad faith, unjust enrichment, and a section 15 Charter violation.

The Supreme Court of Canada allowed the appeal in part, striking the claims for breach of fiduciary duty, negligence, and bad faith, finding that the government did not owe a fiduciary duty or a private duty of care to the residents in these circumstances.

However, the Court allowed the unjust enrichment and Charter claims to proceed to trial, and declined to decertify the class action.

The Attorney General of Canada appealed a decision of the Quebec Court of Appeal which held that several provisions of the federal Assisted Human Reproduction Act were ultra vires Parliament.

The Supreme Court of Canada allowed the appeal in part.

A majority of the Court found that the provisions regulating controlled activities (such as clinical practice and research) exceeded Parliament's criminal law power and intruded into provincial jurisdiction over health and property and civil rights.

However, provisions prohibiting specific negative practices, such as the use of reproductive material without consent, were upheld as valid criminal law.

A 14-year-old Jehovah's Witness was apprehended by child protection services after refusing a potentially life-saving blood transfusion.

The applications judge ordered the transfusion under s. 25(8) of the Child and Family Services Act, which allows a court to authorize treatment in the best interests of a child under 16.

The adolescent appealed, arguing the legislation violated her Charter rights by irrebuttably presuming she lacked capacity to make medical decisions.

The Supreme Court of Canada dismissed the appeal, holding that the legislation is constitutional when the 'best interests' standard is interpreted as a sliding scale that gives increasingly determinative weight to the young person's views depending on their maturity.

The Attorney General of Canada appealed a decision striking down portions of the Tobacco Act and the Tobacco Products Information Regulations.

The respondent tobacco manufacturers cross-appealed the provisions upheld by the lower court.

The Supreme Court of Canada held that while the restrictions on tobacco advertising, sponsorship, and the requirement for 50% health warning labels infringed the manufacturers' freedom of expression under s. 2(b) of the Charter, these limits were demonstrably justified under s. 1.

The Court found that Parliament's objectives of protecting public health and preventing youth smoking were pressing and substantial, and the measures chosen were proportional and minimally impairing.

The appellant, who was found not criminally responsible on account of mental disorder, was detained at a forensic psychiatric hospital.

The Review Board ordered that he continue to be held in custody but imposed conditions requiring the hospital director to review his treatment plan, provide an independent risk assessment, and explore culturally appropriate treatment.

The Court of Appeal struck the conditions, finding the Board lacked jurisdiction to impose medical treatment or bind parties other than the accused.

The Supreme Court of Canada allowed the appeal, holding that while Review Boards cannot prescribe medical treatment, they have the authority under the Criminal Code to make conditions regarding or supervising medical treatment that are binding on hospital authorities.

The appellants challenged the constitutional validity of the Tobacco Damages and Health Care Costs Recovery Act, which allows the government of British Columbia to sue tobacco manufacturers to recover health care costs related to tobacco exposure.

The appellants argued the Act was ultra vires due to extra-territoriality, violated judicial independence, and offended the rule of law.

The Supreme Court of Canada dismissed the appeals, holding that the Act's pith and substance is property and civil rights in the province, it does not interfere with the adjudicative role of the courts, and it does not violate the unwritten constitutional principle of the rule of law.

The appellants challenged the validity of provisions in Quebec's Health Insurance Act and Hospital Insurance Act that prohibit residents from purchasing private health insurance for services covered by the public health care plan.

They argued that waiting times in the public system deprived them of access to timely care, violating their rights under the Quebec Charter and the Canadian Charter.

The Supreme Court of Canada allowed the appeal.

A majority found that the prohibition violates the right to life and personal inviolability under s. 1 of the Quebec Charter and is not justified under s. 9.1.

Three of the judges also found that the prohibition violates s. 7 of the Canadian Charter because it arbitrarily deprives individuals of life and security of the person by forcing them to endure unreasonable waiting times without the option of seeking private care.

The plaintiff sued her attending physicians and a prosthesis manufacturer for medical malpractice, claiming damages for pain, suffering, and reactive depression.

During examination on discovery, the defendants sought disclosure of the plaintiff's psychiatric records.

The plaintiff refused, citing professional secrecy.

The Supreme Court of Canada held that by claiming damages for psychological harm, the plaintiff implicitly waived the confidentiality of her medical records.

The defendants demonstrated the apparent relevance of the records for their defence, and the trial judge correctly dismissed the plaintiff's objection to disclosure.

The appellant, an adult in need of protection, was subject to a plan of care proposed by the Minister of Health.

The Family Court judge approved the plan but added a condition prohibiting placement outside the Halifax region.

The Court of Appeal held the Family Court exceeded its jurisdiction, ruling it could only accept or reject the Minister's plan.

The Supreme Court of Canada allowed the appeal, holding that the Family Court's statutory duty to ensure the adult's best interests includes the jurisdiction to attach reasonable terms and conditions to the Minister's proposed plan of care.

The respondent tobacco company sought a declaration that s. 6 of the Saskatchewan Tobacco Control Act, which bans the display of tobacco products in premises where persons under 18 are permitted, was inoperative due to the federal paramountcy doctrine.

The respondent argued it conflicted with s. 30 of the federal Tobacco Act, which allows retailers to display tobacco products.

The Supreme Court of Canada held that the provincial legislation was not inoperative.

The Court found no operational conflict, as retailers could comply with both by either not admitting minors or not displaying the products, and the provincial law did not frustrate the federal legislative purpose of addressing a national public health problem.

The infant respondents suffer from autism and sought funding from the Province of British Columbia for applied behavioural analysis (ABA) or intensive behavioural intervention (IBI) therapy.

The Province refused to fund the therapy, arguing it was an emergent and controversial treatment and citing financial constraints.

The respondents argued this refusal violated their equality rights under section 15(1) of the Charter.

The Supreme Court of Canada held that the legislative scheme does not promise funding for all medically required treatment, but only for core services provided by medical practitioners.

Since ABA/IBI therapy is a non-core service and the Province had not designated its providers as health care practitioners, the benefit claimed was not provided by law.

The Court concluded there was no discrimination and allowed the Province's appeal.

The appellant, who was found not criminally responsible by reason of mental disorder, was transferred from a medium security facility to a maximum security facility by order of the Ontario Review Board.

The Review Board concluded that the 'least onerous and least restrictive' test under s. 672.54 of the Criminal Code did not apply to the specific conditions of the disposition.

The Supreme Court of Canada allowed the appeal, holding that the 'least onerous and least restrictive' requirement applies to the disposition order as a whole, including its conditions.

The Court found that the Review Board committed an error of law and that the Crown failed to demonstrate that no substantial wrong occurred, entitling the appellant to a re-hearing.

The respondent, who suffers from bipolar disorder, refused proposed medical treatment.

The attending physician found him incapable of making this decision, and the Consent and Capacity Board confirmed this finding.

On judicial review, the Superior Court of Justice overturned the Board's decision, finding it unreasonable and based on a misapplication of the statutory test for capacity.

The Court of Appeal upheld this decision.

The Supreme Court of Canada dismissed the appeal, holding that the Board's finding of incapacity was unreasonable because it conflated the respondent's best interests with his capacity to decide, and failed to recognize that the respondent understood his condition and the consequences of refusing treatment.

The appellant was severely injured in a car accident and treated by the respondent orthopaedic surgeon.

The respondent failed to diagnose a spinal fracture, leading to delayed immobilization, and the appellant was eventually diagnosed with paraparesis.

The trial judge found no fault and no causation.

The Court of Appeal found the respondent committed a fault by failing to conduct proper neurological tests and immobilize the patient, but upheld the trial judge's conclusion that the accident itself, not the medical fault, caused the paraparesis.

The Supreme Court of Canada dismissed the appeal, affirming the Court of Appeal's intervention on the standard of care and its factual findings on causation, and declined to apply a presumption of causation.

The appellant underwent surgery to relieve facial neuralgia, which was unsuccessful and caused serious sequelae.

She sued the respondent physicians, alleging the surgery served no purpose and that she did not give informed consent because she was not told the specific surgeon who would perform the nerve sectioning, nor was she provided with a consulting neurologist's negative report.

The Supreme Court of Canada dismissed the appeal, upholding the trial judge's findings that the surgery was medically justified, the appellant was informed of the surgical team's roles, and she was sufficiently aware of the consulting neurologist's negative opinion before consenting to the risks.