The dispute between l'Hôpital Laval and the cardiologists: the final outcome of ten years of legal wrangling

January 1, 2001

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May 6, 2026

Eight partners recognized as leaders in Canada for their expertise in infrastructure, according to Lexpert

On May 6, 2026, Lexpert recognized the expertise of five of our partners in its 2026 Lexpert Special Edition:Infrastructure. Laurence Bich-Carrière, Jean-Sébastien Desroches, Christian Dumoulin, Nicolas Gagnon, Édith Jacques, Marc-André Landry, Ouassim Tadlaoui and André Vautour now rank among Canada’s leaders in supporting economic players in the infrastructure industry. Laurence Bich-Carrière, is a member of the Quebec and Ontario Bar Associations, Laurence Bich-Carrière practices within the Litigation and Dispute Resolution group, in a versatile civil and commercial litigation practice specializing in complex litigation (class actions, appeals, extraordinary remedies, private international law). Jean-Sébastien Desroches practises business law and focuses primarily on mergers and acquisitions, infrastructure, renewable energy and project development as well as strategic partnerships. He has had the opportunity to steer several major transactions—complex legal operations, cross-border transactions, reorganizations, and investments—in Canada and at an international level on behalf of Canadian, American, and European clients and international corporations and institutional clients in the manufacturing, transportation, pharmaceutical, financial, and renewable energy sectors. Christian Dumoulin is a partner in the firm’s Business Law Group. He served as Managing Partner of the Sherbrooke office from 2015 to 2023 and sat on the firm’s Board of Directors from 2015 to 2017, and again in 2024. He specializes in mergers and acquisitions, commercial law and real estate law, and acts as a business and strategic advisor to clients of all sizes. Recognized for his rigour and practical approach, he supports clients in complex transactions (reorganizations, financings, sales and acquisitions, shareholder disputes). He has also been advising on infrastructure projects for more than fifteen years, including public-private partnerships, as well as on all aspects of commercial real estate law. Nicolas Gagnon focuses his practice on construction law and suretyship. He counsels contractors, public and private sector clients, professional services firms as well as surety companies at every stage of construction projects. He advises clients on the public bidding and procurement processes and participates in the negotiation and drafting of contractual documents involving various project delivery methods, such as public-private partnership projects and design, construction, financing and maintenance contracts. In addition to advising various construction industry stakeholders on construction management and any claims that may arise, he also assists them with dispute resolution processes. Édith Jacques is a partner in the Business Law Group in Montréal. She specializes in mergers and acquisitions and commercial and international law. Édith acts as strategic business advisor for medium to large private companies. Marc-André Landry is a member of the Litigation and Conflict Resolution group and focuses his practice on commercial litigation. He frequently assists his clients in resolving their disputes through negotiation, mediation or arbitration, or before the various courts of law. Over the years, he has represented businesses in many sectors, including construction, real estate, renewable energy, conventional energy, new technologies, financial services and pharmaceuticals. Ouassim Tadlaoui is a partner in the firm’s Litigation and Dispute Resolution Group and focuses his practice on banking litigation, restructuring, bankruptcy and insolvency, as well as construction surety. He represents chartered banks and other financial institutions and alternative lenders as creditors, as well as certain debtors, in bankruptcy and restructuring proceedings. He also represents and advises surety companies, as well as national and international businesses, in insolvency, bankruptcy and restructuring matters in the construction industry. André Vautour practises corporate law and commercial law, and is specifically interested in corporate governance, strategic alliances, joint ventures, investment funds, and mergers and acquisitions of private companies. He also practises technology law (drafting technology development and transfer agreements, licensing agreements, distribution agreements, outsourcing agreements, and e-commerce agreements). About Lavery Lavery is the leading independent law firm in Quebec. Its more than 200 professionals, based in Montréal, Québec City, Sherbrooke and Trois-Rivières, work every day to offer a full range of legal services to organizations doing business in Quebec. Recognized by the most prestigious legal directories, Lavery professionals are at the heart of what is happening in the business world and are actively involved in their communities. The firm’s expertise is frequently sought after by numerous national and international partners to provide support in cases under Quebec jurisdiction.

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April 20, 2026

Professional disciplinary matters: The Professions Tribunal reiterates the conditions required to accept a guilty plea

In the Henry decision rendered on January 16, 2026,1 the Professions Tribunal reiterated what framework applies to a guilty plea in disciplinary matters. In this case, the professional had pleaded guilty during his conviction hearing. After having ascertained that his pleas were made freely and voluntarily, the Disciplinary Council of the Ordre des dentistes (the “Council”) declared him guilty. However, the Council had not ensured that the professional admitted to the facts relating to the key elements of the offences at issue. During the penalty hearing, the professional raised questions about his guilty pleas. Although the Council had considered whether his pleas were valid and whether to withdraw them and return the case to a conviction hearing, the hearing continued and penalties were imposed on the professional. On appeal of the Council’s decision, the Professions Tribunal concluded that the Council had erred in accepting the professional’s guilty pleas when it had become clear that he denied the facts put forward in support of the charges against him. The Professions Tribunal concluded that the Disciplinary Council of the Ordre des dentistes had erred in accepting the appellant’s guilty plea when it had become clear that he denied the facts put forward in support of the charges against him. The Professions Tribunal reasons were based on the following: The Professional Code2 contains no specific provisions governing the entering of a guilty plea.3 In the absence of specific rules, disciplinary law can draw inspiration from the criteria developed in criminal and penal law.4 By pleading guilty, the professional waives their right to a formal investigation and associated procedural safeguards.5 Pleading guilty is a significant decision in disciplinary proceedings, as it inevitably brings the investigation to a close and has detrimental consequences on the professional who pleads guilty.6 This decision serves as a reminder of the two-prong test7 a Disciplinary Council must use to accept a guilty plea: Admission by the professional: The professional must have formally admitted to the key legal elements of the offence.8 To be valid, a guilty plea must be voluntary, unequivocal and made with full knowledge of its effects and consequences.9 Acceptance by the Council: The Council may only accept the plea after ensuring that the professional knows and understands the nature of the offence they are charged with and the effects of their guilty plea. The Council must also confirm that the professional admits to the facts relating to the key elements of the offence in question.10 This decision also introduces the requirement to submit a joint statement of the facts11 or provide an account of the facts that led to the offences in order to properly contextualize them.12 Failure to comply with these requirements could result in the professional’s guilty plea being contested or dismissed by the Disciplinary Council. More recently in the Fernandez decision,13 the Disciplinary Council of the College des médecins was called upon to rule on whether the requirements of the Henry decision applied, in particular regarding the filing of a joint statement or account of the facts giving rise to the offences. In this case, the Council had taken cognizance of the Henry decision after having accepted the professional’s guilty plea, and no joint statement had been filed. After allowing the parties to present their observations, the Council declared itself satisfied with the parties’ claims that the Fernandez case differed from the Henry case in that Dr. Fernandez had admitted to the facts relating to the essential elements of the charge, that he had filed a 17-page statement, and that the Syndic had filed documents containing the accounts of eight patients. It will be interesting to follow how case law will develop on this issue to confirm what direction the various disciplinary councils will take. The members of Lavery’s professional and disciplinary law team regularly represent professional orders and professionals. They are available to advise you and answer your questions. Summary A guilty plea may expedite the disciplinary process, but it has the effect of depriving the accused professional of certain procedural safeguards. It is important to ensure that the conditions of validity and acceptance of a guilty plea are met, otherwise it may be dismissed or overturned on appeal. Summary evidence must be taken before a professional pleads guilty, whether it be through the filing of a joint statement of facts, the presentation of an account of the facts by one of the parties or the submission of documentary evidence. Henry c. Dentistes (Ordre professionnel des), 2026 QCTP 1 2 CQLR C-26. Henry c. Dentistes (Ordre professionnel des), 2026 QCTP 1, para. 24 Id. Id. Id., para. 27 Id., para. 25 Id., para. 26 Id., para. 28 Id., para. 27 and 29. Id., para. 30 Id., para. 31 Médecins (Ordre professionnel des) c. Fernandez, 2026 QCCDMD 5

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December 10, 2025

Occupational health and safety: Understanding employers’ new obligations

The reform of the occupational health and safety system that was initiated in 2021 has reached one of its final steps as new obligations for employers come into force. As of October 6, 2025, employers must comply with several provisions of the Act to modernize the occupational health and safety regime (“the AMOHSR”), as well as the Regulation respecting prevention and participation mechanisms in an establishment (“the Regulation”), in effect since October 1, 2025. As concerns about psychosocial risks are growing in our society and, in particular, in the workplace, the need, or even the obligation, for employers to take reasonable measures to protect the health, safety and physical and psychological integrity of workers has become very important. In fact, according to a study conducted by the Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST), statistics on psychosocial risks (violence, stress, harassment) show that there has been a 71.4% increase in injuries attributable to this type of risk since 2020.1 Thus, recent legislative and regulatory changes aim to strengthen the protection of workers’ physical and psychological health. They require employers to take a proactive approach in order to adapt to societal changes. It goes without saying that this approach also promises to reduce the costs arising from legal action, complaints, and claims for employment injuries made to the CNESST. Psychosocial risks in the workplace The recent amendments made by the AMOHSR explicitly recognize the importance of employers identifying, correcting and controlling psychosocial risks in the workplace, on the same footing as all other risks that may affect the health and safety of workers. The main new features of the permanent regime The permanent regime establishing prevention and participation mechanisms in an establishment is enacted by the Regulation, under the Act respecting occupational health and safety (AMOHSR). It replaces the “interim mechanisms” that initially applied when the AMOHSR came into force. The main changes concern the obligations to prepare a prevention program or action plan, to implement it and to update it. The obligations of establishments with 19 or fewer workers a) To prepare and implement an action plan. The action plan is a prevention tool intended to eliminate, at the source, dangers to the health, safety, and physical and mental well-being of workers.2 The AMOHSR stipulates that the action plan must, at a minimum, include the following elements:3 “the identification of the risks that may affect the health of the establishment’s workers, including the chemical, biological, physical, ergonomic and psychosocial risks related to the work, as well as the risks that may affect the workers’ safety; the measures and priorities for action to eliminate or, failing that, to control the identified risks, giving precedence to the hierarchy of preventive measures established by regulation as well as the scheduling to accomplish the measures and priorities; the supervision and maintenance measures to ensure that the identified risks are eliminated or controlled; the identification of the individual protective means and equipment that, in addition to being in compliance with the regulations, are those best adapted to meet the needs of the establishment’s workers; and the occupational health and safety training and information.” b) To designate a health and safety liaison officer. The liaison officer plays a key role in the establishment’s worker participation mechanism. In particular, this person collaborates on the preparation and implementation of the action plan. The liaison officer issues written recommendations to the employer and participates in the identification and analysis of risks, including psychosocial risks, that may affect the health and safety of workers.4 Obligations of establishments with 20 or more workers a) To prepare and implement a prevention program. The prevention program includes all the elements of the action plan, but is more complex and offers a long-term overview of how prevention is organized in the workplace.5 The AMOHSR specifies the minimum elements that the prevention program must include.6 In short, this program includes the following in addition to what is provided for in the action plan: Pre-employment medical checkups and medical examinations during employment Establishing and updating a list of dangerous substances and contaminants Maintaining an adequate first aid service to respond to emergencies The AMOHSR amended this program, which was initially provided for under the AROH, to explicitly include the protection of workers’ mental health by adding the analysis of psychosocial risks. b) To establish a health and safety committee. The health and safety committee (“HSC”) plays an important role, particularly in developing the prevention program, identifying risks, including psychosocial risks, and analyzing the workplace; it proposes measures to correct and control these risks.7 In the absence of an agreement between the employer and the workers, the Regulation provides for the makeup of the HSC, the procedures and methods for appointing the workers’ representatives, and the rules of operation of the HSC. c) To designate a health and safety representative. The health and safety representative is a member of the HSC and assists it in its mandates, including workplace inspections, receiving and analyzing accident reports, and identifying hazards, including psychosocial risks, for workers.8 In the absence of an agreement between the members of the HSC, the Regulation stipulates the minimum time required for the performance of the health and safety representative’s duties (which depends on the number of workers and the level of the establishment).9 The training obligation The health and safety liaison officer must participate in a theoretical training course developed by the CNESST within one year of their appointment as liaison officer.10 The health and safety representative and the members of the HSC must also complete a theoretical training course of a minimum duration of one day, delivered by the CNESST or by a person or organization recognized by it, within 120 days of their appointment.11 Note that the CNESST offers employers an information tool through its occupational health program which focuses on three increasingly prevalent psychosocial risks: violence, harassment and exposure to a potentially traumatic event. This program provides an overview of the identification of these risks and offers, as an example, a table of preventive measures that can be taken depending on the risk and the psychosocial factor concerned. 12 Conclusion By putting an emphasis on psychosocial risks and adapting the prevention mechanisms, these additions to the health and safety regime aim to guarantee a healthy and safe working environment. The legislation gives employers a transition period to comply with the new obligations. As of October 6, 2025, employers have one year to implement either the prevention program or the action plan.13 Both must be updated annually.14 These new obligations are part of a trend among legislators to enhance workplace prevention measures, focusing in particular on worker participation, training, and information sharing. To that end, the Regulation respecting the measures to prevent or put a stop to sexual violence was published in draft form on October 29, 2025.15 Employers will have new obligations regarding the information they must provide to workers, particularly concerning workplace risks that have been identified or analyzed in relation to situations of sexual violence.16 Furthermore, under this draft regulation, a procedure for handling complaints or reports will need to be established, as well as specific training on situations of sexual violence.17 Companies must assess and adjust their practices in order to meet these new obligations. Commission des normes, de l’équité, de la santé et de la sécurité du travail, Statistiques sur les risques psychosociaux liés au travail (statistics on work-related psychosocial risks), October 2025. S. 147 AMOHSR inserting s. 61.2 of the Act respecting occupational health and safety (“the AROH”). Ibid; CNESST, Contenu du plan d’action (content of an action plan). S. 167 AMOHSR inserting s. 97.2-97.3 of the AROH. CNESST Comment se préparer à nos nouvelles obligations en santé et en sécurité au travail? (how to prepare for the new occupational health and safety obligations) October 2025, p. 7. S. 144 AMOHSR amending s. 59 of the AROH; CNESST. Contenu du programme de prévention. S. 150 AMOHSR replacing s. 68 of the AROH; s. 154 AMOHSR amending s. 78 of the AROH. S. 161 AMOHSR replacing s. 87 of the AROH; s. 163 AMOHSR amending s. 90 of the AROH. Section 7 of the Regulation. S. 167 AMOHSR inserting s. 97.5 of the AROH. Sections 34-36 of the Regulation. CNESST. Programme de santé au travail(occupational health program), October 2025. Section 4 of the Regulation. Section 5 of the Regulation. GAZETTE OFFICIELLE DU QUÉBEC, October 29, 2025, Vol. 157, No. 44 Section 3 of the draft Regulation respecting the measures to prevent or put a stop to sexual violence (“Draft Regulation”). Sections 4-6 of the Draft Regulation.

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February 11, 2025

New developments in mental health diagnostics: what employers need to know

Employers are regularly faced with complex mental health situations, particularly when their employees are absent due to illness or injury, or when accommodation measures need to be considered. In such cases, they usually request supporting documentation specifying the diagnosis in question. Diagnosing a mental disorder used to be an act reserved exclusively for doctors,1 although the Code of ethics of psychologists does mention “psychological diagnosis.”2 The Act to amend the Professional Code for the modernization of the professional system and to broaden certain professional practices in the field of health and social services,3 also known as Bill 67, which received assent on November 7, recognizes that certain health professionals other than physicians are qualified to make mental health diagnoses. These legislative changes are in keeping with the goal of making professional care and services more accessible to the public, and are in line with the position the Collège des médecins du Québec has taken in recent years.4 The professionals involved and the new authority granted in terms of diagnosis5 Psychologists (including neuropsychologists): Mental disorders Neuropsychological disorders, if a training certificate has been issued to the professional Guidance counsellors: Mental disorders, if a training certificate has been issued to the professional Intellectual disability Speech therapists and audiologists: Language disorders and learning disorders related to language Sexologists: Sexual disorders, if a training certificate has been issued to the professional Nurses: Mental disorders, with the exception of intellectual disability, if the nurse has university training and clinical experience in psychiatric nursing It should be pointed out, however, that this legislative change is not intended to create a new activity reserved for these professionals. Rather, its aim is to recognize that some mental health assessments, and the clinical conclusions arising from them, are really diagnoses.6 Impact on employers When a diagnosis of a mental disorder is made, it is possible that the professional concerned, such as a psychologist or neuropsychologist, might recommend the appropriate treatment, including stopping or returning to work.7 These legislative changes8 could make it more complicated for employers and insurers to refuse to implement this recommendation solely because the healthcare professional is not a physician. We believe it is also possible that these changes will lead to new requests for reasonable accommodation with regard to several increasingly frequent mental issues (e.g. attention deficit disorder with or without hyperactivity, autism spectrum disorder, intellectual giftedness, major depressive disorder, etc.), without a physician necessarily being involved at the diagnosis stage. The expansion of professional practices to promote access to care and services for employees could therefore have the effect of increasing the number of requests submitted to employers in connection with mental disorders. It will be important to monitor how employers and others position themselves and adapt their policies in relation to diagnoses established by the professionals concerned. By way of illustration, it’s possible that some employers may decide to require that an employee with a mental health issue undergo more frequent medical examinations, insofar as circumstances allow. Entry into force The changes introduced by Bill 67 came into force on November 7, 2024.9 Professionals who already met the regulatory requirements on that date are deemed to be qualified to make diagnoses.10 Medical Act, CQLR, c. M-9, s. 31; Professional Code, CQLR, c. C-26, s. 31 to 34; Bernard Cliche, Éric Latulippe, François Bouchard, Paule Veilleux and Isabelle Royer, Le harcèlement et les lésions psychologiques, 2nd ed., Cowansville, Éditions Yvon Blais, 2012, p. 329 and 330: [translation:] “The diagnosis of a mental disorder is reserved exclusively to physicians.” See also the arbitration case law, including Gatineau (Ville de) et Association des pompiers et pompières de Gatineau, 2016 QCTA 236. Code of ethics of psychologists, CQLR, c. C-26, r. 212, s. 38. SQ, 2024, c. 31. Collège des médecins du Québec, Projet de loi no 67 et élargissement des pratiques : notre position (Bill 67 and the expansion of practices: our position), September 18, 2024 [online: Projet de loi no 67 et élargissement des pratiques : notre position | Collège des médecins du Québec]. Bill 67, s. 4 and 45. Remarks by the sponsor of Bill 67, Ms. Sonia Lebel, during the bill’s committee stage, October 10, 2024. In the case of psychologists, for example, section 37(e) of the Professional Code already stipulated that they could “determine, recommend and carry out interventions or treatments with a view to fostering the psychological health and restoring the mental health of a person”. Before Bill 67 came into force, an arbitration award established a link between a professional’s ability to make a diagnosis and their ability to recommend a work stoppage: Aliments Cargill ltée et T.U.A.C., section locale 500, D.T.E. 2010T-817 (Arbitration Tribunal), par. 98 to 103. Bill 67, s. 87. Bill 67, s. 85.

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October 2, 2024

Proof of incapacity: analysis of CIUSSS de L’Ouest-de-L’île-de-Montréal (ST. Mary’s Hospital Center) c. R.C.

PROOF OF INCAPACITY: ANALYSIS OF CIUSSS DE L’OUEST-DE-L’ÎLE-DE-MONTRÉAL (ST. MARY’S HOSPITAL CENTER) c. R.C.1 Summary The authors comment on this decision rendered on September 20, 2024, in which the Court of Appeal ruled on the capacity to consent to care in the presence of a psychiatric disorder. The Court of Appeal overturned the first instance decision, which had found the respondent capable of refusing treatment with antipsychotic medications even though he had refuted his diagnosis, because he understood the benefits that antipsychotic medications could afford him and refused to take them because of their side effects. The Court of Appeal rather concluded that the trial judge had misapplied the five criteria to be used to assess whether a person is capable of consenting to care, particularly in the context where (i) the trial judge’s conclusion ran counter to the uncontradicted opinion of an expert; and (ii) there was much evidence supporting the fact that the respondent was incapable of making an informed decision. INTRODUCTION In this case, the Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l'Île-de-Montréal (the “CIUSSS”) appealed a decision rendered by the Superior Court on March 14, 2024, dismissing its application for an authorization to provide care to R.C., a 51-year-old man. The Superior Court had concluded that the CIUSSS had not proven that the respondent was incapable of consenting to care. The Court of Appeal was thus called upon to review the trial judge’s answer to the first question (incapacity to consent) in the analytical framework2 surrounding the test that has now been used for three decades.3 THE FACTS R.C. has a complex medical history. He was hospitalized several times between 2007 and 2019 for mental health issues, including suicidal ideation and personality disorders. In 2021, he was admitted to the CHUM for COVID-19-related complications having resulted in brain damage caused by hypoxia. From 2022 onwards, he made repeated visits to the emergency room, often to obtain benzodiazepines, leading him to become addicted. Even though he adhered to treatment with antipsychotic medication for a time, R.C. stopped taking his medication because of undesirable side effects. In January 2024, after an episode of confusion, he was taken to hospital where he was diagnosed with late-onset schizophrenia. However, R.C. refuted the diagnosis, claiming that his health problems were caused by an artificial intelligence device he believed had been implanted in his body. The psychiatrists who assessed him concluded that he was incapable of consenting to care. On February 16, 2024, the CIUSSS filed an application for authorization to re-hospitalize R.C. and administer antipsychotic medications, despite his categorical refusal. After analyzing the evidence, which essentially consisted of R.C.’s testimony and that of the CIUSSS psychiatrist, the Superior Court concluded that R.C. understood the nature of his condition and the benefits of the proposed treatment, despite his refusal to accept his diagnosis. The Court was of the opinion that the CIUSSS psychiatrists, in their analysis of R.C.’s capacity, had erroneously and repeatedly carried over his rejection of the diagnosis in a cascading fashion in their analysis of the five criteria from the decision in A.G.,4 thereby making the same error as the one that the Court of Appeal had identified in the M.H. decision.5 Despite the absence of a second opinion on R.C.’s capacity, the Superior Court had determined that he was able to consent to his care. According to the trial judge, in keeping with the teachings of the Court of Appeal in the F.D. decision,6 he therefore lacked jurisdiction to order care. For this reason, he dismissed the application for an authorization to provide care. THE COURT OF APPEAL’S DECISION The Court of Appeal began by reiterating the five criteria for assessing a person’s capacity, namely: Does the person understand the nature of the illness for which treatment is proposed? Does the person understand the nature and purpose of the treatment? Does the person understand the risks and benefits involved in undergoing the treatment? Does the person understand the risks involved in not undergoing the treatment? ls the capacity to consent to treatment affected by the patient's illness?7 It pointed out that the criteria are not cumulative and that it is incumbent upon the trier to assess them as a whole.8 Moreover, the mere fact that a person refuses care that would be in their best interest is not enough to conclude that the person is incapable,9 nor is their mere rejection of their diagnosis.10 In this case, the Court of Appeal considered that the Superior Court judge had committed a palpable and overriding error making its intervention warranted. It stated that the trial judge was obliged to express an opinion on whether the evidence proffered was sufficient, adding that the judge had a proactive role to play in protecting the interests of the person involved. If the trial judge felt that a point that had not been the subject in a genuine adversarial debate raised a problem in his view, it was up to him to ask questions.11 Subsequently, the court took extracts from the evidence consisting of a psychiatric report and the testimony of its author and went on to note that the evidence did not allow the trial judge to conclude that R.C. was capable of consenting or refusing the proposed treatment plan, on the contrary. Based on the same evidence, the Court declared R.C. incapable of consenting to care and sent the case back to the Superior Court so that it could determine whether there was indeed categorical refusal and assess the terms of the treatment plan sought. AUTHORS’ COMMENTS This decision of the Court of Appeal follows approximately 20 other decisions12 respecting orders authorizing care handed down by this same court, which have all further established and clarified the guiding principles surrounding such orders since the F.D. decision of 2015.13 These successive decisions have not only added to case law, they have refined the assessment criteria and legal requirements pertaining to applications for authorization to provide care. Such a development in case law shows that the courts are committed to circumscribing complex healthcare situations. Doing so involves striking a balance between the rights to freedom and self-determination and the protection of those who are vulnerable or otherwise unable to consent. On July 6, 2015, the Court of Appeal of Quebec marked a decisive turning point where orders authorizing care are involved by rendering a decision that sent a clear message to the Superior Court, namely F.D. c. Centre universitaire de santé McGill (Hôpital Royal-Victoria).14 In that decision, an analytical framework was established to ensure compliance both with the provisions of the law and the spirit of the law. Since then, the Court has handed down some 20 other significant decisions, each shedding additional light. The guiding principles derived from these decisions can be summarized under the following themes: Rights relating to the judicial process Every person has the fundamental right to contest an application for a order authorizing care, to be heard and to be represented.15 The judge must proactively protect the user’s interests and ensure that they are represented by a lawyer.16 Scope of the care plan Requiring a definite care plan does not mean dictating which medication should be administered in a limitative way.17 A judge may remove certain substances from a treatment plan if they deem that to be in the patient’s best interest.18 It is crucial to draw a distinction between preventive care and a treatment plan that includes various alternatives as the situation evolves.19 For a future hospitalization clause to be valid, there must be a reasonable foreseeability of hospitalization.20 When a patient is to be placed, the application for authorization must indicate where they are to be placed.21 Physical restraint may only be used if it is necessary to avoid serious harm, and must be limited to the minimum.22 A parent’s refusal to consent to a treatment plan may not be warranted if the plan is in the child’s best interests.23 Duration of the authorization When the person concerned is not cooperating and access to their previous medical records is not available, the judge must be especially careful in assessing whether the proposed care plan is legal, in particular in terms of its duration and scope.24 The duration of the care order should be as short as reasonably possible, without compromising the effectiveness of the treatment.25 When a future hospitalization is contemplated, the judge must take into account the time required to stabilize the patient.26 The 30-day period for a future hospitalization should not be considered an absolute limit, as a longer period may be deemed necessary after a thorough analysis.27 The evidence The mere fact that a relationship exists between an expert and a party does not make the expert’s testimony inadmissible: The circumstances surrounding the expert’s role must be reviewed.28 An expert who does not know a patient’s reasons for refusing treatment is not deemed to have breached their duty to inform.29 An expert may testify to reported facts without the possibility of anyone opposing them; however, this does not mean that reported facts are proven, as the rules of evidence remain stringent in this context.30 An expert report may suffice as testimony; the judge need not require the patient’s testimony if the patient cannot understand the issues at hand.31 Applications for safeguard orders may be unsuccessful where there is no expert report and it is not demonstrated that the matter is urgent.32 This review highlights the significant advances that the courts have made in overseeing applications for orders authorizing care and protecting vulnerable people. The analytical framework established in the F.D. decision remains relevant, and subsequent decisions have further refined its questions. The decision that the Court of Appeal handed down in Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l'Île-de-Montréal c. R.C. is milestone in the jurisprudence on court orders authorizing care. By overturning the lower court’s judgment, the Court of Appeal reaffirmed the need for a thorough assessment of the capacity to consent, emphasizing that the work of medical teams and applications made by healthcare institutions are important to ensure appropriate care. This decision not only underscores the fact that it is important to protect the rights of users, but also that the work of the court is crucial, for it must ensure that the criteria are met without substituting its opinion for that of the experts heard. CONCLUSION The decision discussed in this paper is part of a series of decisions that have clarified and enhanced the guiding principles established since the F.D. decision was handed down in 2015.33 The Court of Appeal has provided valuable guidelines for judges, institutions and healthcare professionals to use in their assessment of applications for authorization to provide care. Through a careful review of the circumstances of each case, the courts have shown that they are committed to effectively circumscribing complex health situations by ensuring that institutions have the tools they need to respond appropriately. Lastly, we must recognize that while progress has been made, there are still unresolved issues that need to be addressed. Recent court decisions, including the one that led to the R.C. decision,34 illustrate the importance of constant dialogue between those involved in the legal aspect of cases and those dealing with clinical realities. As jurisprudence continues to develop, paying close attention to future developments will be key to ensuring that healthcare institutions can act effectively in consideration of patients’ needs. 2024 QCCA 1231. F.D.c. Centre universitaire de santé McGill (Hôpital Royal-Victoria), 2015 QCCA 1139. See the landmark decision, Institut Philippe Pinel de Montréal c. A.G., 1994 CanLII 6105 (QC CA). Institut Philippe Pinel de Montréal c. A.G., 1994 CanLII 6105 (QC CA). M.H. c. Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2018 QCCA 1948, para. 57. F.D. c. Centre universitaire de santé McGill (Hôpital Royal-Victoria), 2015 QCCA 1139. This decision, para. 13; with reference to Institut Philippe Pinel de Montréal c. A.G., 1994 CanLII 6105 (QC CA), pp. 28 to 33. This decision, para. 14; with reference to M. B. c. Centre hospitalier Pierre-le-Gardeur, 2004 CanLII 29017 (QC CA), para. 45; M.C. c. Service professionnel du Centre de santé et de services sociaux d’Arthabaska-et-de-L’Érable, 2010 QCCA 1114, para. 13. This decision, para. 14; with reference to M. B. c. Centre hospitalier Pierre-le-Gardeur, 2004 CanLII 29017 (QC CA), para. 46. This decision, para. 14, with reference to Starson v. Swayze, 2003 SCC 32, para. 79 and M.H. c. Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2018 QCCA 1948, paras. 61–62. This decision, para. 18. We have excluded the following decisions from our analysis: Bédard c. Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal, 2023 QCCA 508; M.G. c. Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2019 QCCA 203; S.F. c. CIUSSS de Centre-Ouest-de-l’île-de-Montréal – Hôpital général juif – Sir Mortimer B. Davis, 2021 QCCA 1531; P.L. c. Centre intégré de santé et de services sociaux de la Montérégie-Centre, 2018 QCCA 318; N.G. c. Sir Mortimer B. Davis Jewish General Hospital, 2021 QCCA 1892; F.D. c. Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2017 QCCA 1206. F.D.c. Centre universitaire de santé McGill (Hôpital Royal-Victoria), 2015 QCCA 1139. Ibid. M.H.c. Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2018 QCCA 1948, paras. 68 and 69. A.N. c. Centre intégré universitaire de santé et de services sociaux du Nord-de-l’île-de-Montréal, 2022 QCCA 1167 , para. 30. Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale c. D.M., 2017 QCCA 1333, para. 25. Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean c. O.G., 2018 QCCA 345, paras. 15 and 16. C.R.c. Centre intégré de santé et de services sociaux du Bas-St-Laurent, 2017 QCCA 328, para. 28. G.J. c. Centre intégré de santé et de services sociaux de Laval, 2021 QCCA 1944, paras. 24 to 26. Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ) c. J.B., 2017 QCCA 1638,, paras. 30 to 35. X.Y.c. Hôpital général du Lakeshore, 2017 QCCA 1465, para. 20. A.P. c. Centre hospitalier universitaire Sainte-Justine, 2023 QCCA 58, para. 19. L.C. c. Centre hospitalier de l’Université de Montréal (CHUM), 2015 QCCA 1139, paras. 4 and 5. D.A. c. Centre intégré de santé et de services sociaux des Laurentides, 2016 QCCA 1734, para. 31. T.F. c. CIUSSS de l’Est-de-l’île-de-Montréal , 2022 QCCA 1306, para. 25. N.M. c. Centre intégré de santé et de services sociaux de la Montérégie-Centre, 2022 QCCA1567, para. 17. M.G. c. Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal , 2021 QCCA 1326, para. 11. Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’île-de-Montréal (Douglas Mental Health University Institute) c. I.A., 2023 QCCA 1100, para. 30. Institut universitaire en santé mentale Douglas c. W.M., 2016 QCCA 1081, para. 5 A.D. c. Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’île-de-Montréal, 2023 QCCA 1240, paras. 50, 56–57. A.F. c. Centre intégré de santé et de services sociaux des Laurentides, 2021 QCCA 928, para. 50. F.D. c. Centre universitaire de santé McGill (Hôpital Royal-Victoria), 2015 QCCA 1139. CIUSSS de l'Ouest-de-l'Île-de-Montréal (St. Mary’s Hospital Center) c. R.C.,2024 QCCA 1231.

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