Redefining the practice of medicine
Winks and nods and euthanasia in Quebec
Bill 52: An Act respecting end-of-life care (June, 2013)
Note: Bill 52, a bill
intended to legalize euthanasia by physicians in the province of Quebec, was
introduced by the Parti Quebecois government and debated in the Quebec
National Assembly in 2013. It failed to pass before an election was
called, and the legislature was dissolved. While the Parti Quebecois
was defeated and replaced by the Liberal Party of Quebec, in 2014 the
Liberal party reintroduced Bill 52 as it stood when the legislature was
dissolved. The bill passed on 5 June, 2014.
The original and final
texts of the bill are available in parallel columns
This commentary was
based on the text of the bill as originally introduced in 2013.
A new commentary
reviews the text of the new law enacted in 2014.
Appendix "B": Disciplinary and Complaint Procedures
B1.1 Physicians or dentists must apply for privileges to practice or to
renew their privileges with the executive director of an institution. If the
council of physicians, dentists and pharmacists recommends the application,
the director must submit the application to the board of directors. The
board may grant privileges, but (except in emergencies, or to replace
personnel) not without the approval of the regional health agency.
B1.2 A resolution granting privileges to a physician or dentist must
include, among other things, their undertaking " to fulfil the obligations
attached to the enjoyment of the privileges." The physician or dentist must
provide written proof that he has read the resolution.
B1.3 Pharmacists must also apply to the executive director to practise of
an institution, and a similar process is followed in processing the
B1.4 Midwives must apply to boards of directors, which, upon the
recommendation of the council of midwives, may contract with her for three
years, the terms of the contract specifying her rights and obligations.
B2.1 The board may refuse to grant privileges based on the needs of the
institution, qualifications, scientific competence or conduct, and
"fulfilment of the obligations attached to the enjoyment of the privileges
B2.2 In emergencies, professional privileges of physicians, dentists and
pharmacists can be suspended for up to ten days pending a decision by the
board of directors "by the director of professional services, the chairman
of the council of physicians, dentists and pharmacists, the head of the
clinical department concerned or, if these persons are absent or unable to
act, or fail to act, the executive director." The same actions can by taken
in urgent situations with respect to midwives by the midwifery services
coordinator, chairs of the professional council having jurisdiction, or, in
their absence or as a result of their failure to act, by the executive
B2.3 Directors of nursing may limit or suspend a nurse's right to engage
in some advanced practices; in urgent cases, if they fail to act, directors
of professional services or clinical department heads may do so.
B3.1 Every regional health and social services agency and every
institution must appoint a service quality and complaints commissioner to
investigate complaints concerning health care delivery (See
The regional complaints commissioner is responsible for responding to
complaints about community organizations or private facilities or seniors'
residences that are regulated by the regional agency or formally associated
with it by accreditation or agreement. Local complaints commissioners must
investigate complaints about the institutions for which they are
B3.2 Complaints commissioners may address complaints about administrative
or organizational problems involving medical, dental or pharmaceutical
services that do not result from the conduct of a physician, pharmacist,
dentist or medical resident. Complaints about physicians, pharmacists,
dentists or medical residents must be referred to the institutional Medical
Examiner for investigation. The Medical Examiner also has sole jurisdiction
over complaints involving the supervision or assessment of medical, dental
or pharmaceutical acts.
B3.3 Complaints at both levels can be dismissed by the Complaints
Commissioners if they are "frivolous, vexatious or made in bad faith." On
the other hand, neither regional nor local complaints commissioners need
wait until they receive complaints before taking action. Both may commence
investigations on their own initiative "when there are reasonable grounds to
believe that the rights of a user or group of users are not being enforced."
B3.4 Complaints Commissioners can access most documents and
communications relevant to the subject of a complaint and require anyone
involved to provide information or attend meetings. If they uncover apparent
breaches of discipline by professionals or others, they report them to the
highest responsible authority within the institution or organization in
question. Those authorities are then responsible for investigating the
alleged breach and must keep the complaints commissioners apprised of the
progress and the outcome of their investigations, including any disciplinary
measures taken. That information is, in turn, communicated to complainants
by the complaints commissioners.
B4.1 A Medical Examiner who receives a complaint concerning a physician,
dentist or pharmacist, or a medical resident may dismiss the complaint if
satisfied that it is "frivolous, vexatious or made in bad faith." In other
cases, the Examiner must
a) investigate the complaint himself
b) refer the complaint to the institutional council
of physicians, dentists and pharmacists, which must form a committee to
c) in the absence of a council of physicians,
dentists and pharmacists, handle the complaint as directed by government
d) in cases involving a medical resident, refer the
complaint to the authority designated by government regulation.
B4.2 If a Medical Examiner begins an investigation, he may, at any point,
decide that it should be referred as indicated in (b), (c) or (d) above.
Investigations must be completed within 45 days.
B5.1 A review committee must be established for every local authority
operating a local health and social services network (See
Appendix A5) and
may be established by a public institution. Review committees act as
tribunals hearing appeals from the decisions of medical examiners concerning
complaints that have not been referred for disciplinary investigation.
B6.1 When a complaint is referred to the Council of Physicians, Dentists
and Pharmacists by the Medical Examiner or Review Committee, the Council
must form a committee to investigate the complaint in accordance with
government regulations. If the committee concludes that discipline is
warranted, it must communicate its opinion to the board of directors and
other interested parties.
B7.1 A board that receives a complaint against an employee who is a
member of a professional order or against a midwife may, if the gravity of
the complaint warrants, forward the complaint to the professional order.
B7.2 In other cases, following procedures authorized by government
regulation, boards of directors can discipline physicians and dentists for
"lack of qualifications, scientific incompetence, negligence, misconduct"
and "non-compliance with the by-laws of the institution." Discipline can
take the form of reprimand, changes in status, withdrawal, suspension or
restriction of privileges and compulsory refresher training. When
disciplinary action is taken, the professional regulator must be notified.
B7.3 Boards can use the same process to discipline pharmacists after
seeking the opinion of the institutional council of physicians, dentists and
pharmacists. Disciplinary measures may range from reprimand to dismissal,
and, again, the professional regulator must be notified.
B7.4 The board of directors may discipline midwives for "lack of
qualifications, incompetence, negligence, misconduct, non-compliance with
the regulations of the institution" or failure to meet contractual
obligations. Discipline can include "reprimand, modification or withdrawal
of one or more rights under the contract and cancellation of the contract."
The disciplinary process is similar to that for pharmacists.
B8.1 No legal proceedings may be brought against Complaints Commissioners
and their assistants, Medical Examiners, Review Committees, Councils of
Physicians, Dentists and Pharmacists (individually or corporately), or
Boards of Directors (individually or corporately) for acts or omissions done
in good faith in the exercise of their responsibilities.
B8.2 Except with respect to a question of jurisdiction, courts may not
issue injunctions against any of the entities or persons in B8.1, even "when
the enactment upon which the proceedings have been based or the judgment
rendered is null or of no effect" or "there has been a violation of the law
or an abuse of authority amounting to fraud and of such a nature as to cause
a flagrant injustice."
B9.1 People who are not satisfied with the handling of their complaints
at the institutional or regional level may appeal to the Health and Social
B9.2 The Ombudsman may intervene on his own initiative if he "has
reasonable grounds to believe that a natural person or a group of natural
persons has been or may likely be wronged by an act or omission" of an
institution or agency or their employees or resources. However, he may not
assume any control over "the supervision or assessment of medical, dental or
B9.3 The Ombudsman intervenes by bringing to the attention of the highest
authority in the institution in question "the act or omission that is the
subject of the intervention and the facts or reasons warranting the
intervention" and recommendations. It is expected that the institution will
collaborate in resolving the issue within 30 days.
B9.4 If the Ombudsman is not satisfied with the response, he may make a
written report to the government and may also report the case to the
B10.1 The Professional Code requires each order to adopt a code of ethics
by regulation and sets out the complaints and disciplinary procedures that
are to be followed. Every professional order has a disciplinary council
chaired by government appointee.
B10.2 The board of directors of each order must appoint a "syndic" (the
term used for an official investigator) and, if need be, assistant and
corresponding syndics who will form the "office of the syndic" of the order.
Syndics must lodge complaints of professional misconduct with the
disciplinary committee if requested to do so by the board of directors, and
may do so upon their own initiative. Any other person may also lodge a
B10.3 Of particular interest, anyone who "knowingly helps or, by
encouragement, advice or consent" leads a member to violate the order's code
of ethics can be fined not less than $1,500.00 and not more than $20,000.00
for each day the violation continues. In the case of an incorporated entity,
the minimum and maximum fines are $3,000.00 to $40,000.00 per day.
An Act Respecting Health Services and Social Services, (R.S.Q.
Chapter S-4.2) (Hereinafter "ARHS&SS) Section 237. (Accessed 2013-06-18)
ARHS&SS, Section 240. (Accessed 2013-06-18)
ARHS&SS, Section 242. (Accessed 2013-06-18)
ARHS&SS, Section 243. (Accessed 2013-06-18)
Sections 246-247. (Accessed 2013-06-18)
ARHS&SS, Sections 259.2. (Accessed 2013-06-18)
ARHS&SS, Sections 259.3, 259.5. (Accessed 2013-06-18)
ARHS&SS, Section 238. (Accessed 2013-06-18)
ARHS&SS, Sections 251. (Accessed 2013-06-18)
ARHS&SS, Sections 259.7. (Accessed 2013-06-18)
ARHS&SS, Section 207.1. (Accessed 2013-06-18) The activities are set
out in Section 36.1 of the
Nurses Act. (Accessed 2013-06-18)
ARHS&SS, Section 60. (Accessed 2013-06-20)
ARHS&SS, Section 45. (Accessed 2013-06-20)
ARHS&SS, Sections 35, 68. (Accessed 2013-06-20)
ARHS&SS, Sections 33(7) 66(7). (Accessed 2013-06-18)
ARHS&SS, Section 36, 69. (Accessed 2013-06-20)
ARHS&SS, Sections 33(5). 66(5)(Accessed 2013-06-20)
ARHS&SS, Sections 37, 70. (Accessed 2013-06-20)
ARHS&SS, Section 44(4). (Accessed 2013-06-20)
ARHS&SS, Sections 46(1), 47. (Accessed 2013-06-20)
ARHS&SS, Section 46(2). (Accessed 2013-06-20)
ARHS&SS, Section 46(2). (Accessed 2013-06-20)
ARHS&SS, Section 46(3). (Accessed 2013-06-20)
ARHS&SS, Section 48. (Accessed 2013-06-20)
ARHS&SS, Section 47. (Accessed 2013-06-20)
ARHS&SS, Sections 51-59. (Accessed 2013-06-20)
ARHS&SS, Section 58. (Accessed 2013-06-20)
ARHS&SS, Sections 39, 59. (Accessed 2013-06-18)
ARHS&SS, Section 506. (Accessed 2013-06-18)
ARHS&SS, Section 249. (Accessed 2013-06-18)
ARHS&SS, Sections 39, 249. (Accessed 2013-06-18)
ARHS&SS, Section 250. (Accessed 2013-06-18)
ARHS&SS, Section 259.6. (Accessed 2013-06-18)
ARHS&SS, Section 75. (Accessed 2013-06-18)
ARHS&SS, Section 76. (Accessed 2013-06-18)
Code of Civil Procedure (R.S.Q. c C-25) Section 846(2).
Code of Civil Procedure (R.S.Q. c C-25) Section 846(4).
An Act respecting the Health and Social Services Ombudsman
(R.S.Q. c P-31.1) (Hereinafter "HSSO") Section 8. (Accessed
HSSO, Section 20. (Accessed 2013-06-20)
HSSO, Sections 21, 24, 25. (Accessed 2013-06-20)
HSSO, Section 26. (Accessed 2013-06-20)
Professional Code (R.S.Q. c C-26) (Hereinafter "Prof.
Code")Section 87. (Accessed 2013-06-20)
Prof. Code, Section 116-182. (Accessed 2013-06-20)
Prof. Code, Section 116. (Accessed 2013-06-20)
Prof. Code, Section 117-118. (Accessed 2013-06-20)
Prof. Code, Section 121. (Accessed 2013-06-20)
Prof. Code, Section 128. (Accessed 2013-06-20)
Prof. Code, Sections 188, 188.2.1. (Accessed 2013-06-20)