Patient failed to appreciate manifestations of his mental condition: court
In a recent case, the Ontario Superior Court of Justice affirmed a board decision to find a patient incapable of giving informed consent due to a mental disorder.
In T.S. v. Moise, 2022 ONSC 1553, the respondent, a psychiatrist, diagnosed the appellant with schizophrenia in 2003. He has been treating the appellant for 15 years. In 2019, the police brought the appellant to the Ottawa Hospital and admitted him under the respondent’s care because his wife had already become fearful of his behaviour.
The appellant’s wife reported that the appellant talked to himself, ignored his personal hygiene, strangely swore at her, displayed anger, and planned to cancel an appointment with a specialist regarding his Crohn’s disease. After assessing the appellant, the respondent certified him as an involuntary patient and found him incapable of consenting to treatment with antipsychotic medication.
The appellant requested that the Consent and Capacity Board review the respondent’s finding. The board sided with the respondent. The appellant then appealed from the board decision before the Superior Court, alleging that the board committed an error in upholding the respondent’s finding of incapacity.
In dismissing the appeal, the court ruled that the board decision finding the appellant incapable of giving informed consent was reasonable.
The court agreed with the board that the appellant’s mental disorder symptoms had impaired his ability to make informed treatment decisions and appreciate the reasonably foreseeable benefits and risks of engaging, or not engaging, in treatment.
According to the court, the evidence established that the appellant had a history of noncompliance with his medication, resulting in his mental condition deterioration and failure to manage his other health conditions.
“Since the appellant discontinued treatment, he had not showered in months, had trouble sleeping, had decreased energy, and was unable to feel pleasure when using his computer,” the court said.
The evidence also confirmed that the appellant had become increasingly hostile, verbally aggressive, and paranoid and could no longer realize the impact of these behavioural changes on his marriage.
Moreover, the court considered the appellant’s statements that the voices he heard were at a level where he could cope without medication, that even though he would further decompensate without treatment, it was of his right to refuse treatment, and that his hostility, social isolation, and his lack of personal hygiene and self-care were not related to his mental condition.
“The evidence before the board in my view supported the proposition that the appellant did not recognize that certain aspects of his behaviour (hostility, lack of self-care, etc.) were symptoms of his mental condition,” the court said. “This speaks to his inability to appreciate all the manifestations of his mental condition and his inability to fully appreciate the reasonably foreseeable consequences of a treatment decision.”