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This article examines the judicial treatment of complaints of discrimination from workers with mental health issues. Equality protections promise full inclusion in social, work and community life. The principle of inclusion is understood in three inter-related parts: inclusion in the workforce, inclusion in decision-making and, in the most broad and prospective sense, inclusion in Canadian society. The current framework of equality protections has not effectively addressed these core values of inclusion for workers with mental health issues. The workplace continues to be a site of discrimination and harassment. Barriers prevent workers with mental health issues from getting or keeping employment, discourage their participation in decision-making, and entrench the devaluation, isolation and exclusion of persons with mental health issues. Accommodative measures must be alive to the concrete and attitudinal barriers experienced by workers with mental health issues.

This paper explores a grey area of psychiatric practice and, as with other challenging practices, the law is called upon to navigate conflicting legal issues. In particular, this paper explores the covert administration of medication: the concealment of medication in food or drink so that it will be consumed undetected. Rights-based approaches support nuanced understanding of the practices. Few policies, protocols or guidelines govern the practice in Ontario's psychiatric settings. While covert medication is understood to have “something to do” with rights, there is confusion about how those rights play out on the ground. Institutional silences underlie and reinforce the practice. Most pressing, the covert administration of medication warrants an overt discussion, including of its impact on the rights-experience of persons in psychiatric settings.

Drawing on the fields of human rights and public health, this research explores the covert administration of medication: the concealment of medication in food or drink so that it will be consumed undetected. Adopting a rights-based approach, it explores multiple understandings of the impact of the practice on inpatients' rights-experiences. Relying on critical approaches, it also explores the practice's underlying socio-political-legal structures. The common themes of policies, protocols or guidelines that govern its practice in Ontario are identified. Focus groups and individual interviews were held with three groups of stakeholders (nurses, legal experts and psychiatrists), relying on fictional clinical scenarios. Few policies, protocols or guidelines govern the practice in Ontario's psychiatric settings. The practice impairs access to knowledge by patients and substitute decision-makers. It also precludes healthcare practitioners' access to information about side effects and underlying reasons for medication refusal. It may interfere with therapeutic relationships and patients' meaningful recovery as they transfer from hospital without knowledge of the fact of the covert medication. It may be characterized as autonomy restoring since patients may become capable of making treatment decisions after having received the medication surreptitiously. Covert medication reflects an inflexible approach to capacity determination; it is distinguishable from approaches that imagine capacity as able to be fostered with support. It is primarily concerned with the management of "risky" inpatients in the short-term. The practice relies on a faith that medication will be effective, deferring to medical decision-making. While covert medication is understood to have "something to do" with rights, there is confusion about how those rights play out on the ground. Institutional silences underlie and reinforce the practice. This research will support the development of effective, safe and appropriate approaches to treatment non-adherence that maximize patient dignity. Most pressing, this research concludes that the covert administration of medication warrants an overt discussion.

In its 2008 decision in R v Kapp, the Supreme Court of Canada gave broad effect to the Canadian Charter of Rights and Freedom's ameliorative program provision, section 15(2). The Supreme Court's decision signalled that a government respondent's declaration that a program is “ameliorative” may shield it from further scrutiny under section 15(1). This Women's Court of Canada judgment takes the opportunity to reformulate the approach to section 15(2). Although the Charter provides express protection of ameliorative programs, such programs have sometimes been challenged by members of advantaged groups claiming “reverse discrimination.” We argue that such “equality regressive claims” should be caught by section 15(2). However, for challenges to “under-inclusive” programs, deference to the government on the development of ameliorative programs may perpetuate disadvantage experienced by excluded disadvantaged groups and should not be similarly shielded. This decision develops a contextual approach to section 15(2) that ensures that it does not become a loophole through which government respondents can avoid fulsome Charter scrutiny of claims of under-inclusivity. We outline a test that not only encourages government to take affirmative action but is also narrow enough to subject genuine equality claims to section 15(1) review.

Since the first publication of Medicine and Law thirty years ago, there have been significant international advances in patient rights and participant protections in clinical trials. Despite such advances, there are still alarming reports of actual or perceived breaches in ethical standards by Institutions, Investigators and Sponsors of pre-market drug clinical trials. This is particularly disturbing as these trials involve participants in the testing of an investigational drug before its full safety, effectiveness, and clinical outcomes are understood. Moreover, the study design may randomize participants (recruited because they have specific diseases or conditions) into a group receiving a placebo or comparator drug versus a group receiving the investigational drug. The proposed Charter of Participant Rights in Pre-Market Drug Trials reflects the growing trend towards a participant-centred approach to the implementation and enforcement of participant rights. The development and adoption of the Charter is the next natural step towards the guarantee of rights in pre-market clinical drug trials.

The specificity of the association between 9 Axis I psychiatric disorders and quality of the relationship with spouse, relatives, and friends was evaluated for married participants who completed the Ontario Health Survey Mental Health Supplement (N = 4,933). When the authors controlled for the quality of other social relationships, not getting along with one's spouse was related to 6 disorders, with the strongest associations found for generalized anxiety disorder, major depression, panic, and alcohol problems; 4 associations remained significant when they controlled for comorbid disorders. Not getting along with relatives and friends was generally unrelated to psychiatric disorders when they controlled for the other social relationships. Results indicate that the association between marital quality and psychiatric disorders is not an artifact of general social dissatisfaction and that this association is significant for several disorders. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

"This book provides a comprehensive overview of Canadian public health law and policy. Written and edited by leading health law scholars and featuring contributions from legal and health experts from across the country, it offers an in-depth analysis of current critical public health issues."-- Provided by publisher.