Date:
20060726
Docket: A-580-05
Citation: 2006 FCA 265
CORAM: DÉCARY
J.A.
LINDEN J.A.
SHARLOW
J.A.
BETWEEN:
SHAUN JOSHUA DEACON
Appellant
and
ATTORNEY GENERAL OF CANADA
Respondent
REASONS FOR JUDGMENT
LINDEN J.A.
I. Introduction
[1]
This
appeal raises the issue of the jurisdiction of the National Parole Board, in
the case of long-term offenders, to require the taking of medication as a
condition for release, without the consent of the offender. If such
jurisdiction exists, this Court must then determine whether such a condition
complies with the rights guaranteed under the Canadian Charter of Rights and
Freedoms.
[2]
This is an appeal by Shaun
Joshua Deacon (the appellant) from a decision of the Federal Court dated
November 4, 2005 (reported at (2005), 67 W.C.B. (2d) 738, 2005 FC 1489), dismissing the appellant’s application for judicial review in
respect of a decision of the National Parole Board (NPB or Board), dated
February 8, 2005, which had confirmed all the conditions of the appellant’s
long-term supervision order.
[3]
The appellant challenges the condition of his
long-term supervision order requiring him to “take medication as prescribed by
a physician”. The medication prescribed by the appellant’s physicians consists
of psychopharmacological therapy designed to address his sexual fantasies,
urges and behaviours, his post-traumatic stress disorder and his anxiety. In
particular, the appellant has been prescribed anti-androgen medication,
sometimes dramatically described as “chemical castration”.
[4]
For the
following reasons, we conclude that the condition challenged by the appellant
in this case falls within the jurisdiction of the Board. In addition, we find
that although the condition at issue engages the appellant’s constitutional
rights to liberty and security of the person, the limitation of these rights is
in accordance with the principles of fundamental justice, and therefore does
not infringe section 7 of the Charter. Accordingly, we would dismiss the
appeal.
II. The
Facts
[5]
The appellant has been
diagnosed as a homosexual pedophile, and has a lengthy history of sexual
offences against children. The appellant’s criminal history is set out in some
detail by the British Columbia Court of Appeal in R. v. Deacon (2004),
182 C.C.C. (3d) 257 at paras. 4-14. For the purposes of this appeal, it is
sufficient to note that the appellant’s offences follow a predictable pattern
in which the appellant wins the affection and confidence of children and then
sexually abuses them.
[6]
The appellant was
declared a long-term offender, pursuant to s.753.1(1) of the Criminal Code,
on August 4, 1998. The predicate offences for the long-term offender application,
which involved an 11-year-old boy, occurred while the appellant was on
probation after serving a two-year sentence for a previous offence of sexual
interference with a child. The appellant was sentenced to three years’
imprisonment for these offences, and was made subject to a long-term
supervision order for the ten year maximum period available.
[7]
The appellant was
released on long-term supervision for the first time on August 2, 2001. At that
time, the conditions of the appellant’s long-term supervision order included a
prohibition from having any contact with children under 16 years, and a
requirement that he live at a specified community residential facility. The
long-term supervision order did not include the condition challenged on this
appeal.
[8]
Three weeks after being
released on long-term supervision, the appellant initiated a relationship with
a 10 year-old boy. This conduct, which involved contact with a child consistent
with the appellant’s modus operandi, resulted in the appellant’s conviction for
breach of his long-term supervision order, for which he was sentenced to two
years imprisonment (R. v. S.J.D., [2002] B.C.J. No. 2745 (QL) (B.C.
Prov. Ct. (Crim. Div.)), sentence aff’d (2004), 182 C.C.C. (3d) 257
(B.C.C.A.)).
[9]
The appellant resumed serving
under his long-term supervision order on November 12, 2004. Prior to his
release from custody, the Board conducted a review of the appellant’s circumstances to determine
what special conditions might be appropriate. This time, in its pre-release decision of October 22,
2004, the Board established the following new conditions for the appellant’s
long-term supervision:
1.
To reside
at a CRF/CCC [Community Residential Facility / Community Correctional Centre].
2.
Participate
in community based sex offender program and psychological counselling.
3.
Take
medication as prescribed by a physician.
4.
Report all
relationships to your Parole Supervisor.
5.
Not to
attend places where children under the age 16 are likely to be. .
.
6.
No
indirect or direct contact with your victims unless pre-approved by your Parole
Supervisor in writing. . .
7.
No direct
or indirect contact with any child under the age of 16 and women or guardians
of children under the age of 16 unless pre-approved by your Parole Supervisor.
[10]
Pursuant
to condition 3 of the Board’s long-term supervision order, the appellant’s
physicians have prescribed five different prescription medications: Lupron,
received monthly by intramuscular injection, to lower libido and control sexual
fantasies; Topiramate, taken daily by mouth, to treat post-traumatic stress
disorder; Zoloft, taken daily by mouth, to treat anxiety and lower libido;
Lipitor, taken daily by mouth, to lower the appellant’s high cholesterol, a
side effect of the other medication; and, Prometrium, taken daily by mouth, to
treat the side effects of Lupron, which can cause the development of female
characteristics. The appellant is also required to take Tums calcium tablets
and multi-vitamins, due to the calcium and vitamin deficiencies caused by the
other medications.
[11]
The
appellant complains of numerous side effects caused by the prescribed
medications, including mood swings, drowsiness, vomiting, nausea and changes to
bone density which over many years can bring on osteoporosis. The medications
also cause large discolourations to appear on the appellant’s body.
[12]
On January
27, 2005, the appellant applied to the Board for a variation of certain
conditions of his long-term supervision order and, in particular, sought the
deletion of the condition that required him to take medication as prescribed by
a physician.
III. The
Issues
[13]
The
following issues are raised by this appeal:
(A)
Does the
National Parole Board have statutory jurisdiction to impose, on a long-term
offender subject to a long-term supervision order after the expiry of his
warrant of committal, a special condition to take medication as prescribed by a
physician?
(B)
Does the
special condition to take medication as prescribed by a physician constitute an
infringement of the appellant’s rights under section 7 of the Canadian
Charter of Rights and Freedoms?
(C)
If yes, is
the limitation one which is reasonable, prescribed by law and demonstrably
justified pursuant to section 1 of the Charter?
IV. Constitutional
and Statutory Provisions
[14]
The
Board’s statutory jurisdiction to impose conditions upon long-term offenders,
to govern the supervision period following the expiry of the offender’s
sentence, is set out in subsection 753.2(1) of the Criminal Code and
subsection 134.1(2) of the Corrections and Conditional Release Act, S.C.
1992, c. 20 (CCRA):
753.2 (1) Subject to subsection (2), an offender
who is required to be supervised by an order made under paragraph 753.1(3)(b)
[long term offender supervision order] shall be supervised in accordance with
the Corrections and Conditional Release Act when the offender has
finished serving
(a) the sentence for the offence for which the offender
has been convicted; and
(b)
all other sentences for offences for which the offender is convicted and for
which sentence of a term of imprisonment is imposed on the offender, either
before or after the conviction for the offence referred to in paragraph (a).
|
753.2 (1) Sous
réserve du paragraphe (2), le délinquant soumis à une ordonnance de
surveillance aux termes du paragraphe 753.1(3) [ordonnance de surveillance de
longue durée] est surveillé au sein de la collectivité en conformité avec la Loi
sur le système correctionnel et la mise en liberté sous condition
lorsqu’il a terminé de purger :
a) d’une
part, la peine imposée pour l’infraction dont il a été déclaré coupable;
b) d’autre part, toutes autres peines
d’emprisonnement imposées pour des infractions dont il est déclaré coupable
avant ou après la déclaration de culpabilité pour l’infraction visée à
l’alinéa a).
|
134.1 (2) The Board may
establish conditions for the long-term supervision of the offender that it
considers reasonable and necessary in order to protect society and to
facilitate the successful reintegration into society of the offender.
|
134.1 (2) La
Commission peut imposer au délinquant les conditions de surveillance qu’elle
juge raisonnables et nécessaires pour protéger la société et favoriser la
réinsertion sociale du délinquant.
|
[15]
Pursuant
to subsection 134.1(1) of the CCRA, long-term offenders subject to
long-term supervision orders are also deemed to be subject to the conditions
prescribed in subsection 161(1) of the Corrections and Conditional Release
Regulations, SOR/92-620, “with such modifications as the
circumstances require”. Subsection 161(1) of the Regulations sets out the
following conditions:
161. (1) For the purposes of subsection 133(2) of the Act, every
offender who is released on parole or statutory release is subject to the
following conditions, namely, that the offender
(a) on release, travel directly to the offender's place
of residence, as set out in the release certificate respecting the offender,
and report to the offender's parole supervisor immediately and thereafter as
instructed by the parole supervisor;
(b) remain at all times in Canada within
the territorial boundaries fixed by the parole supervisor;
(c) obey the law and keep the peace;
(d) inform the parole supervisor immediately on arrest or
on being questioned by the police;
(e) at all times carry the release certificate and the
identity card provided by the releasing authority and produce them on request
for identification to any peace officer or parole supervisor;
(f) report to the police if and as instructed by the
parole supervisor;
(g) advise the parole supervisor of the offender's
address of residence on release and thereafter report immediately
(i) any change in the offender's address of residence,
(ii) any change in the offender's normal occupation, including
employment, vocational or educational training and volunteer work,
(iii) any change in the domestic or financial situation of the
offender and, on request of the parole supervisor, any change that the
offender has knowledge of in the family situation of the offender, and
(iv) any change that may reasonably be expected to affect the
offender's ability to comply with the conditions of parole or statutory
release;
(h) not own, possess or have the control of any weapon,
as defined in section 2 of the Criminal Code, except as authorized by
the parole supervisor; and
(i) in respect of an offender released on day parole, on
completion of the day parole, return to the penitentiary from which the
offender was released on the date and at the time provided for in the release
certificate.
|
161. (1) Pour
l'application du paragraphe 133(2) de la Loi, les conditions de mise en
liberté qui sont réputées avoir été imposées au délinquant dans tous les cas
de libération conditionnelle ou d'office sont les suivantes :
a) dès sa mise en liberté, le délinquant doit
se rendre directement à sa résidence, dont l'adresse est indiquée sur son
certificat de mise en liberté, se présenter immédiatement à son surveillant
de liberté conditionnelle et se présenter ensuite à lui selon les directives
de celui-ci;
b) il doit rester à tout moment au Canada, dans
les limites territoriales spécifiées par son surveillant;
c) il doit respecter la loi et ne pas troubler
l'ordre public;
d) il doit informer immédiatement son
surveillant en cas d'arrestation ou d'interrogatoire par la police;
e) il doit porter sur lui à tout moment le certificat
de mise en liberté et la carte d'identité que lui a remis l'autorité
compétente et les présenter à tout agent de la paix ou surveillant de liberté
conditionnelle qui lui en fait la demande à des fins d'identification;
f) le cas échéant, il doit se présenter à la
police, à la demande de son surveillant et selon ses directives;
g) dès sa mise en liberté, il doit communiquer
à son surveillant l'adresse de sa résidence, de même que l'informer sans
délai de :
(i) tout changement de résidence,
(ii) tout changement d'occupation habituelle,
notamment un changement d'emploi rémunéré ou bénévole ou un changement de
cours de formation,
(iii) tout changement dans sa situation
domestique ou financière et, sur demande de son surveillant, tout changement
dont il est au courant concernant sa famille,
(iv) tout changement qui, selon ce qui peut
être raisonnablement prévu, pourrait affecter sa capacité de respecter les
conditions de sa libération conditionnelle ou d'office;
h) il ne doit pas être en possession d'arme, au
sens de l'article 2 du Code criminel, ni en avoir le contrôle ou la
propriété, sauf avec l'autorisation de son surveillant;
i) s'il est
en semi-liberté, il doit, dès la fin de sa période de semi-liberté,
réintégrer le pénitencier d'où il a été mis en liberté à l'heure et à la date
inscrites à son certificat de mise en liberté.
|
[16]
The
following Charter provisions are also relevant to the issues raised in
this appeal:
1.
The Canadian Charter of Rights and Freedoms guarantees the rights
and freedoms set out in it subject only to such reasonable limits prescribed
by law as can be demonstrably justified in a free and democratic society.
7. Everyone has the right to life, liberty and
security of the person and the right not to be deprived thereof except in accordance
with the principles of fundamental justice.
|
1. La Charte
canadienne des droits et libertés garantit les droits et libertés qui y
sont énoncés. Ils ne peuvent être restreints que par une règle de droit, dans
des limites qui soient raisonnables et dont la justification puisse se
démontrer dans le cadre d'une société libre et démocratique.
7. Chacun a droit à la vie, à la liberté et à la
sécurité de sa personne; il ne peut être porté atteinte à ce droit qu'en
conformité avec les principes de justice fondamentale.
|
V. Judicial
History
(a) The
Board’s pre-release and post-release decisions
[17]
The
special conditions governing the appellant’s long-term supervision were set by
the Board in its pre-release decision of October 22, 2004. Following the appellant’s
application for a variation to his long-term supervision order, these
conditions were confirmed by the Board in its post-release decision of February
8, 2005. The judicial review of this latter decision forms the basis for the
current appeal.
[18]
In its
pre-release decision, the Board concluded that the prescribed special
conditions “are each reasonable and necessary to manage your risk and to assist
in your reintegration, and in the absence of these special conditions you pose
a substantial risk to the community” (Appeal Book Vol. 1, p. 56). In
determining that the conditions were necessary to manage the appellant’s risk,
the Board took into account the individual circumstances and history of the
appellant, noting in particular that in the past the appellant had “shown no
willingness to abide by the release conditions imposed upon [him]”, that the
appellant had not participated in any programming to address his risk factors
since he last reoffended, and that actuarial measures and psychological assessments
indicated that the appellant posed a moderate to high risk to reoffend
violently and a high risk to reoffend sexually (Appeal Book Vol. 1, p. 55-56).
[19]
With
respect to the special condition concerning medication, the Board explained its
reasons as follows (Appeal Book Vol.1, p. 57):
You have indicated a dissatisfaction with
the level and type of medications prescribed to reduce your deviant arousals. You
have threatened to stop taking these medications when you become frustrated. Your
risk of reoffend [sic] will greatly escalate in the absence of taking these
medications.
[20]
In its
post-release decision, the Board repeated many of the factors noted in the
pre-release decision. In addition, the Board observed that “nothing has changed
in the area of program participation to this date”, and that the appellant
“continue[s] to refuse to sign the consent form that will allow [him] to begin
National Sex Offender Maintenance Program in the community” (Appeal Book Vol.
1, p. 75). With regard to medication, the Board commented as follows (Appeal
Book Vol. 1, p. 75):
You show a dangerous and erratic attitude
towards abiding by a medication regime to manage deviant sexual arousals. In a
memo to file dated October 8, 2004, the psychiatrist noted that when you were
confronted with situations where you perceived that you had little control or
in which you felt things were going badly, you resorted to threats to stop your
medication. This attitude indicates you have not internalized any commitment to
managing your deviant arousals towards children, and use your potential for
violence as a way to manipulate outcomes for your own benefit.
[21]
The Board
concluded by confirming the condition concerning medication, “for the reasons
described in the [pre-release] decision” (Appeal Book Vol. 1, p. 76).
(b) The Federal Court
decision
[22]
The
Federal Court determined that the question of the Board’s jurisdiction to
impose the medication condition was to be reviewed on the standard of
correctness. Relying in large part on the analysis provided in Normandin v.
Canada, [2005] 2 F.C.R. 373 (F.C.), aff’d [2006] 2 F.C.R. 112 (F.C.A.) and
in R. v. V.M., [2003] O.T.C. 97 (Ont. Sup. Ct.), the Applications Judge concluded that
the Board’s jurisdiction under subsection 134.1(2) of the CCRA includes
the power to impose a medical treatment condition in a long-term supervision
order when the Board considers such a condition to be reasonable. In the
appellant’s case, the Applications Judge noted, the Board found that the
medical treatment would reduce the appellant’s risk to reoffend.
[23]
The
Applications Judge then considered whether the medical treatment condition
violated the appellant’s rights under section 7 of the Charter. The
Applications Judge concluded that the condition at issue “may violate the
principle of fundamental justice that individuals should be free from unwanted
medical treatment” (Reasons, para. 88). By virtue of the condition, the
Applications Judge reasoned, the appellant is forced to choose between his
right to security of the person and his liberty interest. The Applications
Judge therefore concluded that the condition constitutes a prima facie
violation of the appellant’s section 7 Charter rights, as “[t]he choice
between the losses of section 7 Charter rights is not a choice that the
State should normally be imposing on an individual” (Reasons, para. 88).
[24]
However,
the Applications Judge was satisfied that the section 7 violation was justified
under section 1, as in his view the protection of the public provides the
required pressing and substantial objective, the condition in question is
rationally connected to this objective, and the condition also minimally
impairs the appellant’s section 7 rights. The Applications Judge noted in
particular that “it is highly unlikely that the Applicant would have gained
supervised release without the condition that he takes medication as prescribed
by a physician” (Reasons, para. 89).
[25]
The
Applications Judge thus declined to interfere with the condition set by the
Board. I agree with this decision, but for slightly different reasons on one
aspect of the decision.
VI. Analysis
(A) Does the National Parole
Board have statutory jurisdiction to impose, on a long-term offender subject to
a long-term supervision order after the expiry of his warrant of committal, a
special condition to take medication as prescribed by a physician?
[26]
This Court
must first consider whether, at the administrative law level, the Board
possesses the statutory jurisdiction to impose the condition at issue. In other
words, apart from the question of Charter rights, does the condition
fall within the jurisdiction of the Board? If the Board is found to have acted
within its administrative law jurisdiction, this Court must then consider
whether the condition is nevertheless inconsistent with the Charter (Ross
v. New Brunswick School District No. 15, [1996] 1 S.C.R. 825 at paras.
31-33).
[27]
As the
Applications Judge rightly noted, the applicable standard of review is
correctness. The question of the Board’s administrative law jurisdiction to impose
the condition at issue calls for an interpretation of the applicable statutory
provisions. This is a question of pure law, which the Court is in a better
position to decide than the Board. While the Board is entitled to deference in
its determination of the conditions necessary to fulfil the purposes of the CCRA
in relation to a particular offender, its jurisdiction to impose any given
condition must be correctly established.
[28]
The scope
of the Board’s jurisdiction to impose conditions on long-term offenders is set
out in subsection 134.1(2) of the CCRA, which for convenience’s sake I
reproduce again:
134.1 (2) The Board may
establish conditions for the long-term supervision of the offender that it
considers reasonable and necessary in order to protect society and to
facilitate the successful reintegration into society of the offender.
|
134.1 (2) La
Commission peut imposer au délinquant les conditions de surveillance qu’elle
juge raisonnables et nécessaires pour protéger la société et favoriser la
réinsertion sociale du délinquant.
|
[Emphasis
added.]
[29]
It is
clear that Parliament intended to grant the Board a broad discretion to set
conditions for the long-term supervision of offenders such as the appellant. It
is also clear that the statute does not expressly confer upon the Board the
jurisdiction to impose medical treatment conditions. The appellant argues that there
exists a common law right to refuse medical treatment, and therefore, in the
absence of an express conferral of jurisdiction on the Board, the power to
impose medical treatment conditions was not properly conferred on the Board.
[30]
The proper
approach to statutory interpretation is well-established, as Sharlow J.A.
observed in Rooke v. Minister of National Revenue (2002), 295 N.R. 125
(F.C.A.) at para. 10:
10 The principles to be applied in
interpreting a statute have been stated many times, most recently by the
Supreme Court of Canada in Bell ExpressVu Limited Partnership v. Rex,
[2002] S.C.J. No. 43, 2002 SCC 42, at paragraph 26:
In Elmer Driedger's definitive formulation,
found at p. 87 of his Construction of Statutes (2nd ed. 1983):
Today there is only one principle or approach,
namely, the words of an Act are to be read in their entire context and in their
grammatical and ordinary sense harmoniously with the scheme of the Act, the
object of the Act, and the intention of Parliament.
Driedger's modern approach has been repeatedly cited by this Court
as the preferred approach to statutory interpretation across a wide range of
interpretive settings: see, for example, Stubart Investments Ltd. v. The
Queen, [1984] 1 S.C.R. 536, at p. 578, per Estey J.; Québec (Communauté
urbaine) v. Corp. Notre-Dame de Bon-Secours, [1994] 3 S.C.R. 3, at p. 17; Rizzo & Rizzo Shoes Ltd. (Re), [1998] 1 S.C.R. 27, at para. 21; R.
v. Gladue, [1999] 1 S.C.R. 688, at para. 25; R. v. Araujo, [2000] 2
S.C.R. 992, 2000 SCC 65, at para. 26; R. v. Sharpe, [2001] 1 S.C.R. 45,
2001 SCC 2, at para. 33, per McLachlin C.J.; Chieu v. Canada (Minister of Citizenship and
Immigration), [2002] S.C.J. No. 1, 2002 SCC 3, at
para. 27. I note as well that, in the federal legislative context, this Court's
preferred approach is buttressed by s. 12 of the Interpretation Act, R.S.C.
1985, c. I-21, which provides that every enactment "is deemed remedial,
and shall be given such fair, large and liberal construction and interpretation
as best ensures the attainment of its objects".
The suitability of this approach to statutory interpretation
was also recently reaffirmed by the Supreme Court of Canada in Mazzei v.
British Columbia (Director of Adult Forensic Psychiatric Services), 2006
SCC 7, a case involving the interpretation of the jurisdiction of the British
Columbia Review Board to set conditions under Part XX.1 of the Criminal Code,
concerning persons found not criminally responsible on account of mental
disorder.
[31]
The
interpretation of subsection 134.1(2) must therefore start with an analysis of
the purpose and object of the long-term supervision order, as established by
the CCRA and Part XXIV of the Criminal Code.
[32]
The object
of the statutory regime for long-term offenders established by Part XXIV of the
Criminal Code was considered by the Supreme Court of Canada in R. v.
Johnson, [2003] 2 S.C.R. 357. The Court concluded that “Parliament did not
intend the dangerous offender provisions and the long-term offender provisions
to be considered in isolation of one another” (para. 39). Interpreting these
provisions together, the Court noted (at para. 30-31) their potential
overlapping application. Almost all dangerous offenders will satisfy the first
two criteria for long-term offender designation set out in subsection 753.1(1),
that is, facing a sentence of two years or more of imprisonment, and posing a
substantial risk of re-offending, but only a smaller group of offenders will
satisfy the third condition, namely offering a reasonable possibility of
eventual control of risk. According to the Court, this reasonable possibility
of eventual control of the risk in the community is a defining feature of the
long-term supervision provisions:
The very purpose of a long-term
supervision order, then, is to protect society from the threat that the
offender currently poses – and to do so without resort to the blunt instrument
of indeterminate detention. If the public threat can be reduced to an
acceptable level through either a determinate period of detention or a
determinate period of detention followed by a long-term supervision order, a
sentencing judge cannot properly declare an offender dangerous and sentence him
or her to an indeterminate period of detention. (para. 32)
[33]
More
recently, in Normandin v. Canada, [2006] 2 F.C.R. 112, this Court articulated
a similar view of the purpose of the long-term supervision provisions (at para.
40):
Before this scheme [for long-term
offenders] was established, a sexual offender could be sentenced as a dangerous
offender for an indefinite period or a longer prison sentence. The scheme
established by Parliament for long-term offenders within the community is a
more flexible scheme that is more beneficial for them. Its purpose is to
enhance the offender’s social integration but without compromising the
protection of society and the victims.
[34]
The stated
purpose and guiding principles enunciated in sections 100 and 101 of the CCRA,
which are expressly made applicable to long-term supervision orders by
virtue of section 99.1,
support this interpretation. Section 100 states that the purpose of long-term
supervision is
“to contribute to the maintenance of a just, peaceful
and safe society by means of decisions on the timing and conditions of release
that will best facilitate the rehabilitation of offenders and their
reintegration into the community as law-abiding citizens”.
[35]
Among the mandatory principles provided in section 101 to guide
the Board in its decisions concerning release, paragraph 101(a) states that
“the protection of society [shall] be the paramount consideration in the
determination of any case”, and paragraph 101(d) states that “parole boards
[shall] make the least restrictive determination consistent with the protection
of society”. .
[36]
In
my view, the purpose of the long-term offender provisions is therefore clear. An
offender whose conduct or behaviour is not “pathologically intractable”, in
that there is a reasonable possibility that the offender can eventually reach a
stage where, although not curable, his or her risk can be controlled in the
community, will now qualify for long-term offender status. Under the former
provisions, such an offender – for example, a repeat sexual offender – might
have been found to be a dangerous offender. Long-term supervision orders thus
pursue two main objects: first, protecting society, and second, enhancing the
social reintegration of long-term offenders, whenever possible, by granting
release under the least restrictive conditions consistent with the protection
of society.
[37]
The
jurisdiction conferred on the Board by virtue of the specific wording of
subsection 134.1(2) must be read against this backdrop of general statutory purpose.
As this Court held in Normandin, supra, the plain wording of
subsection 134.1(2) “grants the Board a general power to set conditions for
long-term offenders without restrictions as to their content and nature other
than the requirement that they be necessary, reasonable and limited in
duration” (para. 39). The jurisdiction granted to the Board by subsection
134.1(2) is necessarily “a broad and flexible discretionary authority” (Normandin,
para. 44), designed to enable the Board to achieve the objectives of the
long-term offender provisions.
[38]
The
interpretation suggested by the appellant would disregard the clearly-stated
objectives of this statutory scheme. If the statutory purposes of protecting
society and enabling social reintegration of long-term offenders through
supervised release with the least restrictive conditions possible are to be
achieved, the Board must possess the power to impose a medical treatment
condition in appropriate circumstances. Such conditions, when necessary to
control the offender’s risk of re-offending, fall within the Board’s
jurisdiction under subsection 134.1(2) of the CCRA to impose “reasonable
and necessary” conditions.
[39]
This broad
interpretation of the Board’s jurisdiction under subsection 134.1(2) also
represents the interpretation most favourable to accuseds in a global sense. As
Décary J.A. observed in Cartier
v. Canada (Attorney General), [2003] 2 F.C. 317 at para. 19, this
principle of statutory interpretation is somewhat modified in the penal context
of conditional release:
19
The proposition that in the event of ambiguity the Act should be interpreted
in the offender’s favour is correct in so far is it means that once society’s
protection is guaranteed the Board should, in a given case, choose the solution
which is less injurious to the offender’s freedom. However, it is incorrect in
so far as the Act has to ensure at the outset that society is protected: if
there is any ambiguity in that regard, it will operate in favour of the public
interest rather than in the interest of the offender. . .
An interpretation of subsection 134.1(2)
that enables the Board to impose a medical treatment condition in appropriate
circumstances ensures that an accused will be given the benefit of available
treatment options, both when a Court is considering whether the long-term
offender designation is appropriate in a particular case, and later when the
Board is considering what conditions are necessary to manage the offender’s
risk. The Board’s ability to consider such treatment options ensures at each
stage of the sentencing process that an offender will have access to the least
restrictive sanction possible, consistent with the protection of the public. Thus,
contrary to the appellant’s assertion, the absence of an express conferral of
jurisdiction with respect to medical treatment conditions in subsection
134.1(2) does not preclude the Board from imposing such conditions.
[40]
The Board
is not in this case ordering the forcible administration of medication to the appellant.
The common law right concerning non-consensual medical treatment (Fleming v.
Reid (1991), 4 O.R. (3d) 74 at 84; Starson v. Swayze, [2003] 1
S.C.R. 722 at para. 75) is therefore not being violated in this case. The
appellant is at liberty to refuse to take the prescribed medication. However,
if he does, there will be consequences for such a refusal: the appellant will
be in breach of his long-term supervision order and therefore liable to
commitment under section 135.1 of the CCRA or imprisonment pursuant to
section 753.3 of the Criminal Code. The basis and authority for these
consequences is the appellant’s status as a long-term offender, which status in
turn was predicated on the Court’s finding that the appellant satisfied the
criteria prescribed by subsection 753.1(1).
[41]
As a
long-term offender, the appellant “retain[s] the rights and
privileges of all members of society, except those rights and privileges that
are necessarily removed or restricted as a consequence of the sentence” (CCRA,
s.4(e)). In my view, the appellant’s complaint in respect of the medical
treatment condition imposed by the Board relates to a restriction necessarily
consequent upon his sentence as a long-term offender. As a long-term offender,
the appellant has been found to pose a substantial risk of re-offending, but
one that has been judged reasonably capable of eventual control in the
community. To
fulfil the dual purposes with which it is charged under the long-term offender
provisions, the Board must be able to consider all reasonable conditions that
might be reasonably capable of rendering the risk posed by him eventually
manageable in the community. In the appellant’s case, the Board has concluded –
significantly, only after the appellant breached a previous long-term
supervision order that did not include a medication condition – that medication
is necessary to control the risk he poses. If the appellant does not want to
take this medication, he may choose to refuse, but he thereby chooses also to
face the consequences flowing from that decision, given his status as a
long-term offender.
[42]
Like
the British Columbia Court of Appeal in R. v. Goodwin (2002),168 C.C.C.
(3d) 14 at para. 32, I would therefore endorse the following analysis of Mr.
Justice Hill in R. v. Payne, [2001] O.T.C. 15 (Ont. Sup. Ct.) at para.
138:
138 In my view, an offender on
conditional release by way of a long-term supervision order may be compelled by
a term of the order to undertake treatment and related pharmaceutical
intervention where essential to management of the accused’s risk of
re-offending. In other words, the offender’s consent to such a condition is not
required. Should the offender breach terms of the order respecting treatment or
medication, he or she is subject to apprehension with suspension of the order
pursuant to s. 135.1 of the Act or to arrest and prosecution pursuant to s.
753.3(1) of the Code. The entire object of the long-term offender regime would
be undermined by providing the offender the ability to defeat risk management. Accordingly,
mandatory treatment and medication conditions in an order are a proportionate
response to protecting the public from a person who, by definition, is a
substantial risk to reoffend.
[43]
The
appellant argues that this Court should follow the approach adopted in R. v.
Kieling (1991), 64 C.C.C. (3d) 124, in which the Saskatchewan Court of
Appeal concluded that the Court had no jurisdiction to impose medical treatment
as a condition of probation under then paragraph 737(2)(h) of the Criminal
Code (now substantially re-worded as paragraph 732.1(3)(h)). In my
view, however, Kieling is easily distinguishable from the current
appeal. First, the principles of sentencing applicable to an offender on
probation are different from those applicable to long-term offenders, for whom
protection of the public is the paramount consideration. Second, the wording of
the jurisdiction-granting provision at issue in Kieling is materially
different from subsection 134.1(2) of the CCRA.
[44]
At the
time of Kieling, the Court was empowered under then subsection 737(2) to
specify in a probation order any of the conditions listed in paragraphs 737(2)(a)
through (h). Paragraph 737(2)(h) further empowered the
Court to set in probation orders “such other reasonable conditions as the court
considers desirable for securing the good conduct of the accused and for
preventing a repetition by him of the same offence or the commission of other
offences”. The Saskatchewan Court of Appeal interpreted the words “such other
reasonable conditions” as restricted by the common meaning of the conditions
listed in the previous paragraphs, which all referred to either affirmative
conduct or abstention from conduct, and of which none presented any risk to the
accused. Therefore, compelling the accused to take medication as a condition
of probation was found not to be within the jurisdiction of the judge. However,
subsection 134.1(2), the jurisdiction-granting provision in the current appeal,
does not employ the “such other” wording, nor any other restrictive wording of
this kind. In my opinion, therefore, the Kieling precedent does not
assist the appellant.
[45]
I note
that the appellant is not in this appeal challenging the specific medication
prescribed by his physicians, or arguing that another form of medical or other
treatment would be more effective or less injurious. He is also not contesting
the Board’s determination concerning the reasonableness or necessity of a
medical treatment condition in his particular case. If these issues had been
raised in this case, the analysis might have proceeded differently, and
according to a more deferential standard of review. However, the appellant’s
sole assertion in this appeal is that a medical treatment condition is, in all
cases of long-term supervision, outside the statutory jurisdiction of the
Board. The particularities of the appellant’s circumstances – his history and
risk profile, the medical regimen prescribed to him, its effectiveness and side
effects – have not been raised here and are therefore largely irrelevant to
this appeal as it has been argued.
[46]
I conclude
that the Applications Judge correctly decided that the condition at issue falls
within the jurisdiction of the Board under subsection 134.1(2) of the CCRA.
Accordingly, this ground of appeal fails.
(B) Does the special condition
to take medication as prescribed by a physician constitute an infringement of
the appellant’s rights under section 7 of the Canadian Charter of Rights and
Freedoms?
[47]
Having
concluded that the Board acted within its jurisdiction in imposing the medical
treatment condition at issue, this Court must now consider whether the
imposition of that condition is nevertheless a breach of the appellant’s Charter
rights.
[48]
The
three-stage approach for determining whether there has been a breach of section
7 was set out as follows by the Supreme Court of Canada in R. v. White,
[1999] 2 S.C.R. 417 at para. 38:
Where a court is
called upon to determine whether s. 7 has been infringed, the analysis consists
of three main stages, in accordance with the structure of the provision. The
first question to be resolved is whether there exists a real or imminent
deprivation of life, liberty, security of the person, or a combination of these
interests. The second stage involves identifying and defining the relevant
principle or principles of fundamental justice. Finally, it must be determined
whether the deprivation has occurred in accordance with the relevant principle
or principles: see R. v. S. (R.J.), [1995] 1 S.C.R. 451, at p. 479, per
Iacobucci J. Where a deprivation of life, liberty, or security of the person
has occurred or will imminently occur in a manner which does not accord with
the principles of fundamental justice, a s. 7 infringement is made out.
[49]
In the
current appeal, the respondent has conceded that requiring the appellant, a
competent adult, to take medication on pain of re-incarceration or prosecution
constitutes a violation of the “liberty” and “security of the person” elements
of section 7. The first stage of the section 7 analysis is therefore satisfied.
[50]
The second
stage of the analysis involves the identification of the relevant principles of
fundamental justice. The concept of “principle of fundamental justice” was
defined as follows by Gonthier and Binnie JJ. in R. v. Malmo-Levine,
[2003] 3 S.C.R. 571, at paras. 112-113:
112 In Re
B.C. Motor Vehicle Act, supra, Lamer J. (as he then was) explained that the
principles of fundamental justice lie in "the basic tenets of our legal
system. They do not lie in the realm of general public policy but in the inherent
domain of the judiciary as guardian of the justice system" (p. 503). This
Court provided further guidance as to what constitutes a principle of
fundamental justice for the purposes of s. 7, in Rodriguez, supra, per
Sopinka J. (at pp. 590-91 and 607):
A mere common law rule does not suffice to constitute a
principle of fundamental justice, rather, as the term implies, principles upon
which there is some consensus that they are vital or fundamental to our
societal notion of justice are required. Principles of fundamental justice must
not, however, be so broad as to be no more than vague generalizations about
what our society considers to be ethical or moral. They must be capable of
being identified with some precision and applied to situations in
a manner which yields an understandable result. They must also, in my view, be legal
principles.
. . .
While the principles of fundamental justice are concerned
with more than process, reference must be made to principles which are
"fundamental" in the sense that they would have general acceptance
among reasonable people. [Emphasis added.]
113 The
requirement of "general acceptance among reasonable people" enhances
the legitimacy of judicial review of state action, and ensures that the values
against which state action is measured are not just fundamental "in the
eye of the beholder only": Rodriguez, at pp. 607 and 590
(emphasis in original). In short, for a rule or principle to constitute a
principle of fundamental justice for the purposes of s. 7, it must be a legal
principle about which there is significant societal consensus that it is
fundamental to the way in which the legal system ought fairly to operate, and
it must be identified with sufficient precision to yield a manageable standard
against which to measure deprivations of life, liberty or security of the
person.
[51]
In Canadian
Foundation for Children, Youth and the Law v. Canada (Attorney General), [2004] 1 S.C.R. 76, the
Court affirmed this three-pronged definition of “principles of fundamental
justice” (at para. 8):
8 Jurisprudence
on s. 7 has established that a "principle of fundamental justice"
must fulfill three criteria: R. v. Malmo-Levine, [2003] 3 S.C.R. 571,
2003 SCC 74, at para. 113. First, it must be a legal principle. This serves two
purposes. First, it "provides meaningful content for the s. 7
guarantee"; second, it avoids the "adjudication of policy
matters": Re B.C. Motor Vehicle Act, [1985] 2 S.C.R. 486, at p.
503. Second, there must be sufficient consensus that the alleged principle is
"vital or fundamental to our societal notion of justice": Rodriguez
v. British Columbia (Attorney General), [1993] 3 S.C.R.
519, at p. 590. The principles of fundamental justice are the shared
assumptions upon which our system of justice is grounded. They find their
meaning in the cases and traditions that have long detailed the basic norms for
how the state deals with its citizens. Society views them as essential to the
administration of justice. Third, the alleged principle must be capable of
being identified with precision and applied to situations in a manner that
yields predictable results. Examples of principles of fundamental justice
that meet all three requirements include the need for a guilty mind and for
reasonably clear laws.
[52]
Before
considering the specific principles of justice advanced by the appellant
against the above standard, I begin with a few general observations concerning
the specific context in which the Charter issue arises in this case,
namely Part XXIV of the Criminal Code, which contains both the long-term
offender and dangerous offender provisions. The special condition challenged by
the appellant is imposed in the context of the long-term offender regime, which
itself is part of a larger set of provisions crafted to deal with the small
group of offenders who pose an extraordinary, continuing risk to the public,
and are therefore subject to preventive conditions and sanctions of various
forms. As the Supreme Court of Canada observed in Johnson, supra,
“Parliament did not intend the dangerous offender provisions and the long-term
offender provisions to be considered in isolation of one another” (para. 39).
[53]
This
specific context must be borne in mind when considering whether the condition
at issue breaches the appellant’s section 7 rights. We cannot deal with
long-term offenders as if there are no constitutional Charter rights;
equally, we cannot consider Charter rights as if there are no long-term
offenders. “[W]here the regime involves a comprehensive administrative and
adjudicatory structure. . . it is appropriate to look at the regime as a whole.
One must consider the special problem to which the scheme is directed” (Winko
v. British Columbia (Forensic Psychiatric Institute), [1999] 2 S.C.R. 625
at para. 65). The principles of fundamental justice may be affected by this
context, for it is recognized that “the requirements of fundamental justice are
not immutable; rather, they vary according to the context in which they are
invoked” (R. v. Lyons, [1987] 2 S.C.R. 309 at para. 85; see also Winko,
supra at para. 66). In particular, context is important to the balancing
of individual and societal interests within section 7, a consideration
comprising a recognized part of the process of elucidating the content and
scope of a particular principle of fundamental justice (Winko, supra at
para. 66; Malmo-Levine, supra at paras. 98-99; R. v. Demers,
[2004] 2 S.C.R. 489 at para. 45). As the Supreme Court stated in Malmo-Levine,
supra, “[t]he delineation of the principles of fundamental justice must
inevitably take into account the social nature of our collective existence”
(para. 99).
[54]
The
appellant submits that the special condition of his long-term supervision
order, requiring him to take medication as prescribed by a physician, violates
two principles of fundamental justice: first, the principle that medical
treatment must be expressly authorized by legislation; and, second, the
principle that all competent adults have the right to refuse medical treatment.
I will consider each of these alleged principles in turn.
(i) Express legislative authorization of
medical treatment
[55]
The
appellant asserts that in the context of a delegated, statutory decision-maker
such as the Board, it is a principle of fundamental justice that the
decision-maker may only deprive a person of his or her security of the person
if the legislature has expressly provided such authority in clear statutory
language. In other words, the appellant contends that the principles of
fundamental justice require that there be express statutory authorization if
non-consensual medical treatment is to be imposed.
[56]
I cannot
accept the appellant’s submission in this regard. In my view, while the state
cannot impose non-consensual medical treatment without authorization by law,
there exists no principle of fundamental justice requiring that such
authorization occur by express statutory language. In the current appeal, the
required authorization by law is found in subsection 134.1(2) of the CCRA,
which confers jurisdiction on the Board to impose a medical condition in a
long-term supervision order, when “reasonable and necessary in order to
protect society and to facilitate the successful reintegration into society of
the offender”. The Board exercised this jurisdiction in the case of the appellant,
and the appellant has not in this appeal challenged the reasonableness of the
Board’s decision in this regard. In my view, therefore, the positive law
requirement of the principles of fundamental justice has been met in this case.
[57]
My
conclusion that the principles of fundamental justice do not require express
statutory authorization is supported by the Malmo-Levine three-part test
for principles of fundamental justice, by the case law concerning deprivations
of bodily integrity under section 7, and by the case law concerning such
searches under section 8 of the Charter. I will briefly explain each of
these bases for my conclusion.
[58]
As set out
in Malmo-Levine, supra, a principle of fundamental justice must
satisfy three criteria: it must be a legal principle, there must be significant
social consensus that it is fundamental to the way in which the legal system
ought fairly to operate, and it must be capable of
being identified with precision and applied to situations in a manner that
yields predictable results. The principle suggested by the appellant, that
medical treatment must be expressly authorized by legislation, might satisfy the
first criterion. The third criterion might also be met. However, the second
criterion is not satisfied: there is no “significant social consensus” that the
requirement of express statutory authorization for medical treatment is
fundamental to the way in which the legal system ought fairly to operate. A
general authorization by way of a reasonable law is, in my view, sufficient to
conform to the principles of fundamental justice. The principles of fundamental
justice may well impose procedural and substantive constitutional limitations
on the state’s ability to compel medical treatment, but the requirement of
express statutory authorization proposed by the appellant is not among these
constitutional limitations.
[59]
It is
significant that the appellant is unable to point to any precedent concerning a
deprivation of bodily integrity in which express statutory authorization has
been mentioned as a requirement for conformity with the principles of
fundamental justice under section 7. Many of the cases concerning medical
treatment conditions have been decided on the basis of an interpretation of
statutory jurisdiction, and not constitutional analysis: see, for example, R.
v. Kieling (1991), 64 C.C.C. (3d) 124; R. v. J.J.L. (2001), 153 Man.
R. (2d) 153; R. v. Shoker (2004), 206 B.C.A.C. 266 at para. 6, re
medical treatment condition. The two appellate cases concerning medical
conditions decided upon section 7 grounds provide little analysis of the
precise requirements of fundamental justice in this context, and make no
mention of a requirement of express statutory authorization. In R. v. Rogers
(1990), 61 C.C.C. (3d) 481, a case concerning a medical treatment condition in
a probation order, the British Columbia Court of Appeal concluded that such a
condition was “an unreasonable restraint upon the liberty and security of the
accused person”, and was “contrary to the principles of fundamental justice
and, save in exceptional circumstances, cannot be saved by s. 1 of the Charter”
(p. 488). Such “exceptional circumstances” were held not to exist in Rogers, but were invoked by the same
Court in R. v. Goodwin (2002), 168 C.C.C. (3d) 14, a case concerning a
long-term offender. Neither case provided much analysis of the requirements of
the principles of fundamental justice in this context, nor mentioned express
statutory authorization.
[60]
Express
statutory authorization also receives no mention in other cases in which
deprivations of bodily integrity were challenged under section 7. In Jackson v. Joyceville Penitentary, [1990] 3 F.C. 55 (T.D.) and Re
Dion and The Queen (1986), 30 C.C.C. (3d) 108 (Qc. Sup. Ct.), inmates challenged regulations
authorizing mandatory urine sampling for the detection and deterrence of drug
and intoxicant use in prisons, and providing for consequences for positive test
results. In both cases, the regulations were held to contravene the principles
of fundamental justice under section 7. Neither case, however, makes any
mention of a requirement of express statutory authorization. Rather, it was the
absence of any standards or criteria limiting the arbitrary use of the power
that was found to offend the principles of fundamental justice (Jackson
at paras. 97-98, Dion at 119-125).
[61]
The
appellant also draws this Court’s attention to the caselaw concerning section 8
of the Charter, and in particular the requirements that a constitutional
search must be authorized by law, and such law must itself be reasonable (R.
v. Collins, [1987] 1 S.C.R. 265 at para. 23). These requirements, the
appellant submits, should be imported by analogy into the principles of
fundamental justice of section 7. The appellant argues that to have any value
as a constitutional requirement, the authorization by law requirement under
section 7 must have content. Such content is provided, he submits, by requiring
express statutory authorization.
[62]
In my
view, however, the section 8 jurisprudence cited by the appellant is
insufficient to support his argument. Section 8 does indeed require
authorization by law for any search or seizure, and this limitation has been
further amplified by the requirement that such authorizing law must itself be
reasonable. However, I am aware of no section 8 authority prescribing a
constitutional requirement of express statutory authorization as a feature of
such reasonableness. In fact, searches incident upon lawful arrest conducted
pursuant to the common law power – even when intruding into privacy and bodily
integrity – have been recognized as constitutional, provided certain conditions
are met: Cloutier v. Langlois, [1990] 1 S.C.R. 158 (common law power to
“frisk” incident upon arrest recognized as constitutionally reasonable); R.
v. Stillman, [1997] 1 S.C.R. 607 (common law power found not to extend to
seizure of bodily samples); R. v. Golden, [2001] 3 S.C.R. 679 (common
law power to strip search incident upon arrest recognized as constitutionally
reasonable; search in that case found to be unreasonable).
[63]
In these
cases, after defining the scope of the common law power at issue, the Supreme
Court has expressly considered whether this common law rule was itself
constitutional, according to the standard of reasonableness applicable under
section 8: see Golden, supra at paras. 25 and 104; Stillman,
supra at para. 49. Clearly, therefore, there is no constitutional
requirement under section 8 that a deprivation of bodily integrity must be expressly
authorized by statute in order to meet the requisite constitutional standard of
reasonableness. Rather, section 8 requires that the authorizing law must be
reasonable, and this necessary reasonableness can be satisfied by common law or
statutory rules.
[64]
In my
view, the requirement of reasonableness can be imported from section 8 into the
section 7 analysis of the principles of fundamental justice. The deprivation,
through imposed medication, of a person’s liberty or security of the person
must, if it is to conform to the principles of fundamental justice, occur
pursuant to an authorizing law, and such law must itself be reasonable. Reasonableness
does not, however, require that the authorizing law consist of an express
statutory authorization.
[65]
The
specific requirements of reasonableness in the context of the principles of
fundamental justice will fall to be determined in future cases in which this
question arises. I am satisfied, for the purposes of the current appeal, that
the authorizing law in this case – namely subsection 134.1(2) of the CCRA and
its attendant procedures under subsection 134.1(4) concerning Board review of
long-term supervision conditions – meets the constitutional standard of
reasonableness. The Board’s jurisdiction to set conditions is limited, by the
wordings of subsection 134.1(2), to conditions “reasonable and necessary
in order to protect society and to facilitate the successful reintegration into
society of the offender”. This limitation ensures that, in the context of the
long-term offender regime, the proper balance is struck between the societal
interest in public protection and the individual interests of the offender in
gaining release under the least restrictive conditions consistent with the
protection of society.
[66]
The
wording of subsection 134.1(2) also limits the specific medical treatment
condition at issue in this appeal: the medication prescribed to the appellant
by his physicians must also be “reasonable and necessary in order to
protect society and to facilitate the successful reintegration into society of
the offender”. An extensive array of procedural protections are afforded to the
appellant to ensure compliance with this limitation: the conditions of his long-term
supervision order are set by the Board based on a review of his complete file,
including written submissions by the appellant’s counsel, the appellant has a
right to a hearing before the Board (which he chose to waive in this case), and
judicial review of the Board’s decision is available. In addition, under
subsection 134.1(4), the Board is empowered to review and vary the conditions
of a long-term supervision order. The appellant availed himself of this
procedure to mount the current appeal, and could do so again if necessary, for
example if the appellant’s circumstances or treatment requirements change,
rendering the treatment currently prescribed unreasonable and unnecessary. Given
these procedural protections, and given the special context and purpose of the
long-term offender regime, the condition at issue is consistent with the
constitutional standard of reasonableness under the principles of fundamental
justice.
[67]
For these
reasons, I conclude therefore that express statutory authorization for medical
treatment is not a principle of fundamental justice under section 7. The
positive law requirement of the principles of fundamental justice is satisfied
in this case by the statutory jurisdiction conferred on the Board by subsection
134.1(2) of the CCRA.
(ii) The right to refuse medical
treatment
[68]
The
appellant also submits that it is a principle of fundamental justice that all
competent adults have the right to refuse medical treatment. Any exceptions to
this rule, he argues, must be upheld under section 1, if at all. In the
circumstances of this case, the appellant is required, as a result of the medical
treatment condition in his long-term supervision order, to choose between his
right to liberty and his right to security of the person, in a manner that
engages his ability to refuse unwanted medical treatment. Further, it is urged
that, if the right to refuse medical treatment constitutes a principle of
fundamental justice, then the medical treatment condition imposed upon the
appellant might violate section 7.
[69]
However,
in my view this second rule proposed by the appellant also fails to satisfy the
second branch of the Malmo-Levine test for a principle of fundamental
justice. There exists no significant social consensus in favour of an absolute
rule concerning the right to refuse medical treatment in every situation, and
such a principle is not considered “vital or fundamental to our societal notion
of justice” (Rodriguez v. British Columbia (Attorney General), [1993] 3
S.C.R. 519 at 590, cited in Canadian Foundation, supra at para.
8).
[70]
The right
of a competent adult to refuse unwanted medical treatment is clearly
“fundamental to a person’s dignity and autonomy” (Starson v. Swayze,
[2003] 1 S.C.R. 722 at para. 75). However, respect for human dignity and
autonomy is not itself a principle of fundamental justice (Rodriguez, supra
at 592). Moreover, although the right to refuse treatment may well be a right
“deeply rooted in our common law” (Fleming v. Reid (1991), 4 O.R. (3d)
74 at 85), it is recognized that “a mere common law rule does not suffice to
constitute a principle of fundamental justice” (Rodriguez, supra
at 590). The principles of fundamental justice are also not simply “vague
generalizations about what our society considers to be ethical or moral” (Rodriguez,
supra at 591): significant social consensus is required.
[71]
Contrary
to the appellant’s assertion, I do not think the requisite broad societal
consensus is present concerning an absolute right to refuse unwanted medical
treatment in every situation for the latter to be recognized as a principle of
fundamental justice. Rather, the right to refuse medical treatment, while
perhaps accepted as the general rule, is also recognized as properly subject to
limitations in certain contexts.
[72]
The
authorities cited by the appellant do not support an unqualified constitutional
right to refuse medical treatment. In Starson v. Swayze, supra,
which concerned the judicial review of a finding of incapacity under the Ontario Health Care Consent Act,
the constitutionality of the legislative scheme at issue was neither raised nor
addressed (see para. 75). The dispute in that case thus centred around the
statutory test for capacity and its application, it being established by the
legislation itself that unless incapacity was found, medical treatment could
only be administered with the patient’s consent.
[73]
The
constitutional question was addressed in Fleming v. Reid, supra. In
that case, the Ontario Court of Appeal found the common law right to bodily
integrity and personal autonomy – of which the right to refuse medication was
held to a part – to be “fundamental and deserving of the highest order of
protection”, and “co-extensive” with the constitutional right to security of
the person (at p. 88). Ultimately, the legislative scheme at issue in Fleming
v. Reid was found inconsistent with the principles of fundamental justice,
not simply because it mandated that the prior competent wishes of psychiatric
patients be overridden, but because the statute did not allow such competent
wishes to be considered at all by the review board in its determination of the
patient’s course of treatment (see para. 93). As a result, the treatment orders
made by the board were held to be “arbitrary and unfair”, and were therefore
set aside (at para. 95). The Court expressly noted the relevance of context to
its conclusion, observing that “[n]o emergency is claimed here, and it is not
suggested that the appellants are a threat to themselves or anyone else” (at para.
94). It is thus apparent that Fleming v. Reid was dealing with a
particular fact situation and did not suggest that an unqualified or
absolute right to refuse medication in all situations is a principle of
fundamental justice under section 7.
[74]
In the
case at bar, in contrast with both Fleming v. Reid and Starson v.
Swayze, the appellant poses a danger to others: he is a long-term
offender who by definition is likely to re-offend, and has a lengthy history of
offences against children, including while on probation and long-term
supervision. Moreover, the medical condition at issue in the current case has
been imposed for the purpose of rendering this risk manageable in the
community, thereby granting the appellant release under the least
restrictive conditions consistent with the protection of the public. In further
contrast to Fleming v. Reid and Starson v. Swayze, the case at
bar does not involve the forcible administration of medication: as explained
above, the appellant may choose not to take the medication prescribed to him,
although he thereby also chooses to face the consequences of his decision. These
contextual factors are critical, and are properly considered within the process
of determining the content and scope of a particular principle of fundamental
justice (Winko, supra at para. 66; Malmo-Levine, supra
at paras. 98-99; R. v. Demers, [2004] 2 S.C.R. 489 at para. 45). Given this
context, which includes both the long-term offender statutory regime and the
particular history and risk profile of the appellant, I conclude that the
condition of the appellant’s long-term supervision order requiring him to take
medication as prescribed by a physician, imposed by the Board without the
appellant’s consent, does not violate the principles of fundamental justice
under section 7 of the Charter.
[75]
I conclude
that an absolute right to refuse unwanted medical treatment in all situations is
not a principle of fundamental justice under section 7. The medical treatment
condition at issue is consistent with the principles of fundamental justice,
and does not violate section 7 of the Charter.
(C) If yes, is the limitation
one which is reasonable, prescribed by law and demonstrably justified pursuant
to section 1 of the Charter?
[76]
As I have
concluded that the condition at issue does not infringe the appellant’s rights
under section 7 of the Charter, there is no need to consider
justification under section 1.
VI. Conclusion
[77]
For the
above reasons, the appeal will be dismissed. As the respondent has not
requested costs in this Court, and has indicated that it will not be seeking
costs for the proceedings before the Federal Court, there will be no order with
respect to costs.
“A.M.
Linden”
“I
agree
Robert
Décary J.A.”
“I
agree
K.
Sharlow J.A.”