Legal and regulatory proceedings

Navigating legal or regulatory processes
Family disputes and the physician: Staying focused on safe care
Physicians can take reasonable steps to maintain the best interests of the patient in the midst of family disputes concerning the care of children or of elder patients.
Conscientious objection to medical assistance in dying: Protecting Charter rights
The Supreme Court of Canada’s decision declaring the prohibition on physician-assisted dying unconstitutional concerns some CMPA members who object for moral or religious reasons to helping patients end their lives.
Providing quality end-of-life care
End-of-life treatment decisions can be difficult for both physicians and patients, but many issues can be avoided by following the key concepts outlined.
Transparency of physician information: What members need to know
Medical regulatory authorities are making more information about physicians available to the public. This article provides an overview of this trend, and explains how the CMPA helps members.
"Dictated but not read": Unreviewed clinical record entries may pose risks
The practice of marking transcribed reports or entries “dictated but not read” gives rise to medical-legal risks and can create uncertainty for those relying on that information in providing patient care.
Completing medical certificates of death: Who’s responsible?
A discussion of physicians’ obligations when certifying a patient’s death.
Understanding the role of coroners and medical examiners
Physicians should understand the role of coroners and medical examiners in Canada, and how and when to provide information to them.
Fitness to drive: When do physicians have a duty to report?
An overview of medical-legal problems resulting from physicians' decisions on whether to report patients with medical conditions that may make it dangerous to drive, or from physicians' decisions on whether to support the reinstatement of a licence to drive.
Treating transgender individuals
Physicians who treat or who are asked to treat transgender individuals should be aware of the ethical and legal considerations in these circumstances to avoid allegations of discrimination.
Are there risks to acting as a good Samaritan?
Physicians providing emergency care as good Samaritans often have questions about their legal and ethical obligations and the liability protection available to them.
Age of consent for sexual activity and duty to report
Changes to the Criminal Code have raised the age of consent for sexual activity. Physicians should be guided by legislation in each province and territory on their duty to report such activity to the appropriate authorities if there are reasonable grounds to believe the child is being abused.
The Canadian medical liability system: What makes it work?
The Canadian medical liability system has evolved to meet the unique needs of Canadians, but there remains an opportunity to enhance its fairness and effectiveness.
Physicians and research: Understanding the legal, ethical, and professional obligations
Physicians participating in clinical research studies should be aware of their relevant legal, ethical, and professional obligations.
Hospital complaints: Understanding the process and reducing anxiety
Physicians named in a hospital complaint can feel reassured that due process exists and will be followed, and that the CMPA is available to help.
Medical marijuana: Considerations for Canadian doctors
Polices introduced by the medical regulatory authorities (Colleges) reflect concerns expressed by some in the medical community about the use of marijuana for medical purposes and the challenging role given to physicians and other healthcare providers.
Can a child provide consent?
Effective communication and awareness of legal requirements are key to obtaining consent for treatment of children.
Update on law for withdrawing treatment
While a Supreme Court of Canada decision clarifies that in Ontario, physicians must obtain consent before life support can be withheld or withdrawn, the effect of the decision in other jurisdictions is uncertain.
Physicians and nurse practitioners: Working collaboratively as independent health professionals
When working with nurse practitioners, physicians should understand the scope, responsibilities, and accountabilities of these independent healthcare providers, and should communicate clearly and in a timely manner.
Practical steps to support effective compliance
Administrative and management practices, data sharing agreements, confidentiality agreements, and privacy impact assessments can help physicians to achieve compliance with their privacy obligations.
Coping with a College complaint: Suggestions for reducing anxiety
Dealing with the stress of a College complaint is easier when a physician understands the complaint process and receives support, advice, and coping strategies from the CMPA.
Apology legislation in Canada: What it means for physicians
Certain provinces have legislation to prevent apologies for adverse events from being used in court proceedings.
Encryption just makes sense
Privacy legislation, regulatory policies and professional obligation require that CMPA members take reasonable measures to protect the privacy of their patients' personal health information. With the advent of electronic records, members should be cognizant that encryption can help secure personal health information and may be required by law.
The most responsible physician: A key link in the coordination of care
Clarity about who is responsible for the care of a patient at any given time improves patient safety and reduces medico-legal risk.
The changing practice of medicine: Employment contracts and medical liability
Physicians considering various arrangements for practising medicine, other than the privileges-based model, need to consider any medico-legal implications.
Understanding how Colleges handle complaints or allegations of professional misconduct
A complaint to a medical regulatory authority (College) initiates a process that warrants a physician's attention and timely response.
When a patient asks for another physician on cultural or religious grounds
Physicians can find themselves in a difficult ethical and legal position when patients refuse to be treated.
Changing physician-hospital relationships: Managing the medico-legal implications of change
Changes in the relationship between physicians and hospitals may have medico-legal implications that could lead to difficulties for physicians, institutions, and patients. Recommendations to address these implications are identified.
Clinical practice guidelines: What is their role in legal proceedings?
In legal proceedings where courts are determining if the care provided met the standard of care, authoritative clinical practice guidelines may be considered as one piece of evidence.
They can't sue me outside Canada, or can they? Considerations when treating non-residents
When treating non-resident patients, Canadian physicians are advised to ensure they have adequate liability protection.
Expectations for experts’ reports are changing
This article looks at the changes some provinces and territories have made or are considering making to the Rules of Procedure (also known as the Rules of Court or the "Rules") for expert witness reports in civil actions.
"Doc, I can't wear a seatbelt!"
Responding to patient requests for exemptions to wearing a seatbelt while driving.
What to do when facing a College complaint
For many physicians, having a complaint lodged against them with a regulatory authority (College) is stressful. If a College asks for a response to the complaint, either in writing or verbally, CMPA members should seek advice from the Association.
Reimbursement of CMPA fees: A benefit to physicians and their patients
Subpoenas — What are a physician's responsibilities?
A subpoena or summons to witness requires the person named to attend the court, tribunal, commission, inquiry, inquest or military board proceeding or hearing named in the subpoena.
The medical record: A legal document — Can it be corrected?
Physicians should exercise care in modifying or correcting medical records. Suggestions on when and how to go about this are provided.
Acting as an expert in medico-legal proceedings
Key issues for physicians to consider when deciding to provide medical expertise in medico-legal proceedings.
Indemnification clauses — What you need to know before you sign that contract
Physicians should carefully consider the meaning and implications of indemnification clauses in contracts with employers, research organizations, governments, health care agencies and others.
If a patient relies on your professional opinion, you may have a duty of care
Before giving advice on medical matters, even informally, physicians should be satisfied they have considered and documented the relevant information.
Put it in writing, with care
Documentation in clinical notes and in reports to third parties should be factual, objective, and appropriate to the purpose.
Physicians and the Firearms Act: a dilemma
Considerations in responding to patients' requests for support in acquiring firearms.
Effective testifying
Recommended ways to promote confidence and effectiveness when testifying in court.
A case for keeping good notes
Poor charting may be perceived as reflecting less attention to detail and risks the conclusion the care provided was poor.
Physicians and their patients' wills: issues to consider
Physicians may be asked to attest to the capacity of a patient if the patient's will is contested or at the time the will is being prepared.
Class actions: On the increase?
Class actions are becoming more common in Canada.
Natural justice - an obligation for "fair play"
When involved in administrative proceedings (e.g. College proceedings, hospital proceedings etc.), an individual is entitled to fairness. The principles of “natural justice” are explained, and a hospital proceeding is used as a case example.
How do the Courts determine standard of care?
The CMPA will seek expert opinion regarding a physician's standard of care.
Clinic held liable for a sexual assault
Ontario court decides that a medical clinic is liable for sexual assault committed by a technologist, who was an employee of the medical clinic.
House calls: What the courts have said
House calls place the doctor in an unfamiliar situation where it may be more difficult to obtain a history or to perform a physical examination.
Collaborative care: A medical liability perspective
Clinical care is increasingly provided by collaborative teams with the promise of better outcomes for patients. This document identifies potential medico-legal risks in collaborative care and proposes solutions to lessen those risks for patients and providers.
Estate planning — Prepare a will and make a plan
Certain practice management issues arise when a physician dies, and should be considered as part of estate planning.
International medical liability systems - A comparative view
The first paper in this series described the current Canadian medical liability system and how it responds to adverse medical events.

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.