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Prepared by the Task Force on Ethical Considerations
Required Medical Procedures
- All inmates at reception and at least annually are entitled to undergo a
psychiatric examination, including a complete assessment of the state of his
mental and emotional health.
- Inmates may be required to provide specimens and undergo such laboratory tests
and x-ray examinations that do not involve significant discomfort and are
usually medically indicated.
- Inmate-patients shall not be required, without their consent, to undergo
diagnostic tests that involve significant discomfort or risk; e.g,
pneumoencephalography.
Range of Services to be Provided
- Necessary psychiatric care to be made available to inmates shall be defined as
all such necessary services, the expenses of which are tax supported to all
citizens of Canada.
- Inmate-patients are entitled to quality health care by competent professionals.
The choice of professionals to provide these services rests with the Medical and
Health Care Services Branch of the Solicitor General, but the inmate-patient
shall retain the right of choice of his psychiatrist under circumstances
prescribed by the Commissioner and where feasible.
- The financial cost of any necessary psychiatric care shall not influence the
provision or extent of that care in penitentiaries, any more than for an
individual free in the community.
- Any form of generally accepted psychiatric therapy initiated prior to sentencing
shall, if still indicated, be continued or completed at the inmate's request,
under the health care staff of the institution. The existence of a right to
continuing treatment after admission should be made known to the inmate by the
medical staff.
- The Department of the Solicitor General shall be obliged to submit any
recommendations or orders of the court or its appropriate officers regarding any
mental health matter of a person to be sentenced or having been sentenced by the
court, to the health review board of the institution (see Recomm. #27) for
evaluation as to the availability and suitability of the treatment proposed or
ordered by the court.
- To ensure continuation or completion of psychiatric treatment initiated or
carried out during imprisonment, the treating professionals will, with the
inmate's permission, make an effort to arrange for continuing care when required
on release, parole, temporary absence, etc. This will be done in accordance with
the normal professional practice of referral to a suitable colleague.
- An inmate voluntarily seeking psychiatric care may refuse consent to any
specific form of therapy.
- Any inmate-patient who is deemed competent will have the same right to refuse
any or all treatment as he would outside a prison. Any inmate-patient who
refuses any procedure shall be provided with alternative care acceptable to
him/her, but must so signify by a written and witnessed signature.
- It is the duty of the health professional staff to be aware of the state of
health of all inmates. The health professional staff shall take all
professionally acceptable measures to maintain good emotional and mental health
except that he shall not intervene without the consent of the mentally competent
inmate-patient unless the situation is an emergency and the patient's life is
threatened.
Confidentiality
- Inmate-patients have the same rights to confidentiality of information obtained
by health professionals in the context of a therapeutic relationship as exists
in normal psychiatric practice. Selected information may be communicated to
prison authorities only with the patient's permission.
- Health professionals in the context of a therapeutic relationship shall breach
confidentiality only when they must report to the proper authorities, threats or
intentions which they judge likely to be carried into action that are dangerous
or a threat to the safety of others.
- Health professional staff when engaged in examination of inmates or
inmate-patients for purposes of classification, parole, or for prison discipline
or similar tasks shall inform the inmate of the purpose prior to the examination
and shall obtain consent to the examination.
Health professionals who are or have been in a therapeutic relationship with an
inmate should not act, without the patient's permission, in the above
professional administrative role for that inmate.
Psychiatric Care
- If an inmate is transferred to the regional psychiatric centre voluntarily and
with his written consent, there is no need to prepare any form of committal or
involuntary certificate.
- The preparation of certificates of involuntary admission of inmates to
psychiatric facilities either within or without the Department of the Solicitor
General shall not be completed when they would have been admitted as voluntary
patients in the community and they are not resistant to hospital care.
- If it is necessary for the protection of himself or others, consequent upon
behaviour arising because of possible mental disorder and if the inmate is
unwilling to enter the regional psychiatric centre, or another psychiatric
facility, then the procedure for involuntary admission recognized by the
provincial government of the province in which the receiving institution is
situated, will be completed.
- Inmate-patients admitted as involuntary to a psychiatric facility, within or
without the penitentiary service, shall be for the purposes only of diagnosis,
observation, safe custody, determination of disposition and treatment in that
facility to the extent that the provincial law permits in respect to that
institution. This guideline is subject to guideline 20 below.
- Inmate-patients who are mentally ill shall be examined as to competency to give
consent to both admission to a psychiatric facility and for specific treatment.
If in the opinion of the medical officer and the psychiatric consultant the
patient is believed to be incompetent, the director of the institution shall be
so informed.
The director will then call upon the local review board (described in detail
under Recommendation 27) which shall with due dispatch, advise the Commissioner
that:
- The person is incompetent to decide for himself;
- The person is dangerous and/or in danger without care and treatment;
- There is no equivalent alternative;
- The treatment is an established one recognized as likely to be effective for the
condition diagnosed.
- Where it is adjudged that appropriate isolation care is required because of
medical or psychiatric illness or the protection of others arising out of the
actions of such an ill prisoner, the director, only on the advice of the
attending physician, shall take the necessary steps to effect such care.
- Any prisoner at the termination of sentence who because of mental illness is
considered to be dangerous to himself or others, should be dealt with in
accordance with the mental health law of the province in which the facility is
situated.
If the inmate-patient is in a psychiatric facility at the termination of his
sentence he and his next of kin shall be fully informed of his new rights and
privileges in writing.
Proposed Regulations re Research and Innovative Treatment
- No inmate shall be asked, invited, requested, offered money to undertake,
persuaded for privileges or earlier release, to take part as a subject in any
clinical investigative procedure unrelated to some specific health need of the
inmate.
- Inmates may voluntarily consent to new, innovative or as not yet clearly
established treatments, provided:
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- the explanation of the objectives of the procedure or the treatment is clearly
explained to the inmate-patient;
- any known risks and dangers are also explained;
- the treatment is directed toward a clearly established abnormal health condition
suffered by the inmate;
- conditions (a) - (c) are presented in the presence of members of the review
board mentioned in Recommendation 27 below, who shall concur that the conditions
have been met and they are of the opinion that it is in the inmate- patient's
interest to be permitted the treatment.
- No health professional of the Canadian Penitentiary Service shall engage in any
involuntary, uninformed "treatments" for "social deviancy", "criminality", or
"correctional remedies".
- No scientific study of diagnostic or therapeutic procedures shall be undertaken
except under the aegis of a university- supported research project that has been
cleared under the normal procedures applicable across Canada in respect to
ethical clinical investigative projects.
Review Boards
- There shall be appointed for each region one or more review boards to advise the
director of each institution (where provincial review boards exist they may be
utilized for these purposes).
- To evaluate as to the availability and suitability of treatment proposed or
ordered by a court (Recommendation 8 above).
- To determine the capacity of an inmate believed to be incompetent to give or
refuse consent to therapy and when incompetent, to advise the director to order
the treatment that may be given (Recommendation 20 above).
- To advise the director regarding the use of innovative and as yet unestablished
treatments for any particular inmate whether he/she is competent or not
(Recommendation 24 above).
Each board should consist of a minimum of three persons chosen from a panel with
at least one member being a psychiatrist, one a member qualified in law and a
lay member who shall be chairman (none of whom may be a member of the
penitentiary staff or of a recipient psychiatric facility).
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