To uphold your rights, you have to know what they are.
Everyone who receives services or care from the health and social services network has rights under the Act respecting health services and social services (ARHSSS). To uphold your rights, you have to know what they are.
1. The right to be informed
… about services and resources available un your community
Everyone has the right to be informed of the health and social services and resources available in their community and of how to access them.
Institutions that are unable to provide certain services must refer individuals to another institution, organization, or person who can provide those services, so that users know where to go and how to access the services required by their condition.
… about the state of your health and well-being
Before consenting to care, every user of health services and social services is entitled to be informedof their state of health and welfareand to be acquainted with the various options open to them and the risks and consequencesgenerally associated with each option.
Users also have the right to be informed, as soon as possible, of any accidents that occur during the provision of services that may impact or have impacted their health as well as any measures taken to remedy such consequences, where appropriate, or to prevent such an accident from happening again.
2. The right to receive adequate services
… that are scientifically, humanly and socially appropriate and are offered with continuity and in a personalized and safe manner
Scientifically appropriate services:
Institutions and professionals must provide scientifically recognized services that meet the criteria of objectivity, rigour, and scientific method. Physicians must practice their profession in accordance with the highest possible current medical standards […] (Code of ethics of physicians(CEP) ref. s. 44) and make their diagnosis with the greatest care, using the most appropriate scientific methods […] (CEP ref. s. 46).
Humanly and socially appropriate services:
Respect for users and recognition of their rights and freedoms must inspire every act performed in their regard. Users must be treated, in all interventions, with courtesy, fairness, and understanding, and with respect for their dignity, autonomy, needs, and safety.
Institutions and professionals must provide follow-up in accordance with the state of the user’s health and well-being.
Safe, personalized services:
Professionals must take into account the values, culture, religion, and other personal beliefs of users when providing care and services.
Available resources must be taken into account when exercising this right.
3. The right to choose the professional and institution
Everyone has the right to choose the professional and institution from whom or which they wish to receive health or social services.
For various reasons, users may feel more or less comfortable with certain professionals who provide services. In interventions that are crucial to a person’s health and well-being, a harmonious and satisfactory relationship between users and professionals is very important. For example, users may decide that a particular institutions is better suited to their needs because they can access the professional of their choice. Others users may find it useful to get a second opinion about their health and well-being.
However, this right cannot infringe upon a physician’s freedom to agree or refuse to treat a user. Therefore, “A physician may put an end to a therapeutic relationship when there is a reasonable and just cause for doing so, particularly when the normal conditions required to establish or maintain mutual trust are absent, or if such trust no longer exists. Inducement on the part of the patient to perform illegal, unjust or fraudulent acts constitutes a reasonable and just cause.” (Code of ethics of physicians, s. 19).
This right to choose is always exercised within the limits defined by section 13 of ARHSSS, in particular in accordance with (…) human, material, and financial resources available to the institution.
4. The right to receive the care
... your condition requires
Everyone whose life or bodily integrity is in peril is entitled to receive the care required by their condition. Every institution shall, where requested, ensure that such care is provided.
The right to assistance is a fundamental right recognized by the Charter of Human Rights and Freedoms(R.S.Q., c. C-12, s. 2). When applied in the health and social services sector, it means that professionals must provide the care users require in emergency situations, an obligation that takes precedence over professionals’ freedom to refuse to treat someone.
This obligation is not only individual—it is also binding on the institution, which is responsible for ensuring that care is provided to the user whose life or bodily integrity is endangered. Furthermore, the Act entrusts each integrated health and social service centre (CISSS) and integrated university health and social service centre (CIUSSS) with various duties related to coordinating services with the specific aim of distributing emergency cases and ensuring users’ needs are met quickly and adequately.
5. The right to accept or refuse care
Users cannot be made to undergo care or any other intervention without their free and informed consent
Users must not be coerced or threatened, and their faculties cannot be impaired.
Users must understand the nature of the illness to be treated, the nature, purpose and effects of the treatment, and any possible alternatives. Users must also be informed of the procedure that will be used and of the risks and possible consequences, and be aware of the consequences of refusing treatment.
Users can ask any question they deem important and must obtain all answers in plain and understandable language. Note that written consent is a formality in certain circumstances only: anesthesia, organ donation surgery, and experimental treatment.
Refusal of treatment
Users may, at any time, refuse treatment or part of a treatment.
Ability to consent to care
To be able to consent to care, users must be able to understand the information the physician gives them, assess its consequences, and make a decision. Otherwise, the physician must obtain substituted consent from a designated or presumed representative. Note that court authorization is not required to administer emergency or hygiene care that an unfit patient refuses. In these cases, health professionals may go against the patient’s wishes.
6. The right to participate in any decision
… affecting your health or well-being
In particular, users have the right to help develop their intervention plan or individualized service plan, when such plans are required. The same applies to any changes made to these plans.
The Act recognizes that users have an active role to play in making decisions that may impact their health or well-being. The right of users to participate in decisions that concern them is also consistent with certain of the rights described above, including the right to information and the right to give or withhold consent.
The right to participate in decisions is key when developing an intervention plan or an individualized service plan to meet the needs of a user.
7. The right to be accompanied and assisted
All users have the right to be accompanied and assisted by a person of their choice when they want to obtain information or take steps in relation to any service provided by or on behalf of an institution or by any professional practicing their profession in a centre operated by the institution.
The accompanying person can be a spouse, relative, friend, CAAP advisor, user committee representative, or any other person of the user’s choice.
Some users may be worried and uncertain and find it difficult to take steps to get information about the services they need. That is why the Act gives users the option of being assisted and accompanied by a person of their choice. This reassures and comforts users and gives them confidence. Note that accompaniment cannot be provided as part of care and services such as consultations, medical examinations, and therapy.
However, recognizing the user’s right to be accompanied and assisted does not exempt the user from explaining, if necessary, their reasons for requesting such assistance. This is part of the normal communication that must exist between users and institutions or between users and the professionals they contact to obtain information or services.
8. The right to be represented
The rights of any person under this Act may be exercised by a representative. The following people are presumed to be representatives, depending on the circumstances and subject to the priorities provided for in the Civil Code:
- The parental authority or legal guardian of a user who is a minor;
- Thetrustee, legal guardian, spouse, or close relative of an unfit adult user;
- The person authorized by a protection mandate given by the incapable user before their incapacity;
- The person who has a special interest in an unfit adult user.
It is important to note that a person who accompanies and assists a user does not at any time replace the user, although a representative speaks and acts in place of the user. Representatives can therefore exercise all the rights users are entitled to when they are unable to give or refuse to give consent. Representatives must be informed, and they are the ones who participate in decisions and who can avail themselves of the right to be accompanied or assisted.
9. The right to stay at a hospital or institution
… if one’s condition requires it
An institution cannot cease to lodge a user who has been discharged unless the user’s condition allows them to return home or receive care at home, or unless their admission to another institution or intermediate or family-type resource where the user can receive the services they require is assured.
Subject to the first paragraph, a user must leave the institution where they are in-patient immediately upon being discharged […].
Example: an elderly woman is unable to return home after being hospitalized because she has lost a significant degree of autonomy and requires extensive care. The hospital plans to transfer her to a CHSLD. She is temporarily admitted to another CHSLD because there is no space available in the desired institution, where she is on the waiting list. Despite the woman’s right to choose the institution of her choice, Ministère de la Santé et des services sociaux (MSSS) must transfer her to a CHSLD that can provide care immediately until a place becomes available at the CHSLD of her choice.
10. The right to receive services in English
English-speaking people are entitled to receive health and social services in English, in keeping with the organizational structure and human, material, and financial resources of the institutions providing such services and to the extent provided for by an access program referred to in section 348 of the Act respecting health services and social services(ARHSSS).
- Some institutions are designated and required to make all their services available in English;
- Other institutions may make some of their services available in English;
- Access programs have been developed in each region through integrated health and social services centres (CISSSs) and integrated university health and social service centres (CIUSSSs).
These services are offered in keeping with the human, material, and financial resources of the designated institutions.
11. The right to seek remedy
Nothing in the Act restricts the right of a person or their successors to seek remedy against an institution, its directors, employees or attendants or a professional by reason of a professional or other fault. In no case may such remedy be waived.
The same applies to the right to seek remedy against a family-type resource.
In addition to establishing a comprehensive complaint examination process, the Act recognizes that nothing can prevent users from exercising legal or other remedies if they believe that a mistake has been made. Regardless of the form it takes, a user’s undertaking to waive a potential remedy would therefore be null and void even if it were made in writing.
12. The right to access<br /> and correct your records, and the right to confidentiality
Each institution has an individual who is responsible for access to documents and the protection of personal information.
Users (or their representatives):
- Are entitled to access their records in a timely manner;
- Are entitled to have a qualified professional help them fully understand the information contained in their records;
- Have the right to review an institution’s decision to refuse to grant them access to their records or the information contained therein, by means of a remedy provided for by Commission d’accès à l’information.
Restrictions to the right of access
- Institutions may refuse to grant access to records if, in the opinion of a physician, disclosing the information is likely to cause serious harm to the user’s health;
- Institutions may also refuse to grant access if information about the user comes from a third party, unless the information does not identify the third party or the third party consents in writing.
- Users may make a request to correct inaccurate, incomplete, or ambiguous information in a record;
- Users may also add written comments to their records to clarify and complete them;
- Users have the right to review an institution’s decision to refuse to make the requested corrections to the information.
- Everyone has the right for their records to remain confidential. However, restrictions may apply under the provisions of Section 19 of the Act.
13. The right to receive end-of-life care
The End-of-Life Care Actconcerns the organization and management of palliative care, so that everyone has access to quality care, adapted to their needs, throughout the course of their illness.
Palliative care is a form of care provided to people with life-limiting diseases. Without hastening or delaying death, the objective is to maintain the best quality of life possible for the person and to provide them and their close relations with the support they need.
Medical aid in dying
Medical aid in dyingmeans care consisting in the administration by a physician of medications or substances to an end-of-life patient, at the patient’s request, in order to relieve their suffering by hastening death. Medical aid in dying is an exceptional procedure and patients must meet very restrictive conditions. This procedure is strictly regulated and defined by law. Only someone who meets all of the following conditions can obtain medical aid in dying:
- Be an insured person within the meaning of the Health Insurance Act;
- Be of legal age;
- Be capable of giving consent to care, i.e., be able to understand the situation and the information provided by healthcare professionals, as well as make decisions;
- Be at the end of life;
- Have a serious or incurable illness;
- Be in an advanced state of irreversible decline in capability;
- Experience constant and unbearable physical or psychological suffering that cannot be relieved in a manner the patient deems tolerable.
Advance Medical Directives
Advance medical directives are written instructions set down in advance by an adult who is capable of consenting to care, indicating what medical care they accept or refuse to receive in the event that they become incapable of consenting to care in specific clinical situations. The directives have the same value as the wishes expressed by someone who is capable of consenting to care.
14. The right to file a complaint
... under the complaint examination process
The Act respecting health services and social services states that users may file complaints when they are dissatisfied with the services they received or should have received from the health and social services network. This procedure may also be used by residents of private seniors’ residences and anyone who makes use of drug and gambling addiction resources, community organizations, and pre-hospital emergency services. The Centre de communication santé (CCS) and private seniors residences are also covered by the complaint examination process.
Special measures are in place so that users exercising this right have the option of requesting:
- Help from a community organization such as a CAAP, which is designated in each region to assist and support users filing complaints with an integrated health and social services centre (CISSS), an integrated university health and social services centre (CIUSSS)the Québec Ombudsman, or Conseil des médecins, dentistes et pharmaciens de l’établissement;
- Assistance and support from the institution’s users’ committee, if such a committee exists.