Parens patriae is Latin for "parent of the nation." In law, it refers to the public policy power of the state to intervene against an abusive or negligent parent, legal guardian or informal caretaker, and to act as the parent of any child or individual who is in need of protection.
Calvin's case.
The law of nature is that which God at the time of creation of the nature of man infused into his heart, for his preservation and direction; and this is lex æterna, the moral law, called also the law of nature. And by this law, written by the finger of God in the heart of man, were the people of God a long time governed, before the law was written by Moses, who was the first reporter or writter of law in the world. The Apostle in the Second Chapter to the Romans saith, Cum enim gentes quæ legem non habent naturaliter ea quæ legissant faciunt. And this is within the command of that moral law, honora patrem, which doubtless doth extend to him that is pater patriæ.
Sir Edward Coke
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A loss of fundamental rights and freedoms to a medical professional, presumably under section 1 on balance in the interest of society, who has a very specific duty is not to be taken lightly. The best possible outcome, in terms of due process and fundamental justice, can only be no harm.
Generally, disclosure of confidential clinical material to someone other than the patient will be an actionable breach of confidence. There are, however, three circumstances when clinicians can release confidential information:
Ontario Mental Health Act Regulation 741 makes things very clear for a physician attending under statute. The physician can either fill out a Form 1 to involuntarilly admit a person for observation or they can decide not to. Should a licensed professional decide to incarcerate a person based on their medical opinion, they must sign their name and take responsibility for the detainment of a citizen based on their professional opinion regarding a defect of the individuals mind leading to an immediate safety concern.The courts have set out circumstances in which concern for public safety may warrant the disclosure of confidential information to reduce or eliminate risk of harm. The factors for consideration are as follows:
Reports should include only the information necessary to prevent harm to others. CPSO Policy #6-12: Mandatory and Permissive Reporting
- there is a clear risk to an identifiable person or a group of persons;
- there is a risk of serious bodily harm or death; and
- the danger is imminent.
| Criterion | Patient's Task | Physician's Assessment Approach | Questions for Clinical Assessment | Comments |
|---|---|---|---|---|
| Communicate a choice | Clearly indicate preferred treatment option | Ask patient to indicate a treatment choice | Have you decided whether to follow your doctor's [or my]
recommendation for treatment? Can you tell me what that decision is? [If no decision] What is making it hard for you to decide? |
Frequent reversals of choice because of psyhiatric or neurologic conditions may indicate lack of capacity |
| Understand the relevant information | Grasp the fundamental meaning of information communicated by physician | Encourage patient to paraphrase disclosed information regarding medical condition and treatment | Please tell me in your own words what your doctor [or I] told you about: The problem with your health now The recommended treatment The possible benefits and risks (or discomforts) of the treatment Any alternative treatments and their risks and benefits The risks and benefits of no treatment |
Information to be understood includes nature of patient's condition, nature and purpose of proposed treatment, |
| Appreciate the situation and its consequences | Acknowledge medical condition and likely concequences of treatment options | Ask patient to describe views of medical condition, proposed treatment, and likely outcomes | What do you believe is wrong with your health now? Do you believe that you need some kind of treatment? What is treatment likely to do for you? What makes you believe it will have that effect? What do you believe will happen if you are not treated? Why do you think your doctor has [or I have] recommended this treatment? |
Courts have recognized that patients who do not acknowledge
their illnesses (often referred to as "lack of insight") cannot
make valid decisions about treatment Delusions or pathalogic levels of distortion or denial are the most common causes of impairment |
| Reason about treatment options | Engage in a rational process of manipulating the relevant information | Ask patient to compare treatment options and consequences and to offer reasons for selection of option | How did you decide to accept or reject the recommended treatment? What makes [choose option] better than [alternative option]? |
This criterion focuses on the process by which a decision is reached, not the outcome of the patient's choice, since patient's have the right to make "unreasonable" choices |
The above table assumes a competent, truthful, unimpaired practitioner. A more comprehensive and formalized examination originally found in an appendix of the Journal of Psychiatric Research is marketed and sold as the Mini-Mental State Examination. Further studies have produced a product sold as the MacArthur Competence Assessment Tool for Treatment.
Some of the authority, none of the responsibility.
Elizabethan Poor Law of 1601Hark! Hark! The dogs do bark!
Elizabethan era nursery rhyme
The beggars are coming to town:
Some in rags, some in tags
And one in a velvet gown