{"id":4804,"date":"2026-08-25T08:38:54","date_gmt":"2026-08-25T07:38:54","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4804"},"modified":"2026-08-25T08:38:54","modified_gmt":"2026-08-25T07:38:54","slug":"british-columbias-mental-health-law-needs-to-carry-its-history-forward","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/08\/25\/british-columbias-mental-health-law-needs-to-carry-its-history-forward\/","title":{"rendered":"British Columbia\u2019s mental health law needs to carry its history forward"},"content":{"rendered":"

By Austin Lam<\/p>\n

On July 28, 2026, Justice Lauren Blake of the British Columbia (BC) Supreme Court ruled, in Council of Canadians with Disabilities v. British Columbia<\/a>, that BC\u2019s scheme for forcing psychiatric treatment on involuntary patients regardless of their capacity to consent<\/a> breaches the Charter\u2019s equality guarantee and its protection of life, liberty, and security of the person. The scheme perpetuates a stereotype, the Court found, that people with mental disorders lack capacity, and leaves BC an outlier: consent laws elsewhere in Canada are significantly less drastic<\/a>. The ruling struck related provisions of the Mental Health Act<\/a> (MHA), the Health Care (Consent) and Care Facility (Admission) Act<\/a> (HCCCFAA), and the Representation Agreement Act<\/a>, suspended six months for the legislature to respond.<\/p>\n

Government already tried once to head this off, repealing the Mental Health Act\u2019s \u201cdeemed consent\u201d wording<\/a> last December, signalled on the final day of closing submissions. That removed a phrase, not the underlying authority to treat without consent, and the Court confirmed it never answered the question. BC has six months to write a real answer, and risks treating that as a fresh drafting exercise rather than an inheritance carried forward mindfully.<\/p>\n

 <\/p>\n

Carrying history, not just having it<\/strong><\/p>\n

Heidegger\u2019s Being and Time<\/a> distinguishes merely having a past from historicity: the way we are our past, carry it forward as live possibility, and become ourselves only by actively owning that inheritance rather than repeating it unthinkingly or discarding it. Authentic \u201crepetition\u201d is a mindful, resolute retrieval of possibilities a tradition handed down but never finished deciding. Applied to law reform: BC needn\u2019t freeze on its past, but cannot build forward without first knowing what that past contains.<\/p>\n

This carries normative, not merely descriptive, weight. A statute drafted without reckoning with why its predecessor failed risks reproducing that failure in new language, as BC\u2019s December amendment illustrates: it repealed \u201cdeemed consent\u201d wording while the underlying authority to treat without consent survived intact. A past not actively taken up does not disappear; it keeps operating as an unexamined default. Retrieval is a condition of reflective legislative agency: choosing freely means owning what was tried, abandoned, or left unfinished, not inheriting the next iteration of an old pattern.<\/p>\n

That is not just a figure of speech. Heidegger\u2019s own account of tradition is that, left unexamined, it makes what it hands down so self-evident that it conceals its own origin, so that going back to it seems unnecessary. Applied to law reform, that names a specific risk: a scheme\u2019s underlying authority can survive an amendment untouched not because anyone defended it, but because it was never brought back into view to be defended or rejected. Retrieval is the alternative: a deliberate recovery of the possibilities a tradition once carried, not veneration of the past, so the choice can be made knowingly rather than inherited by default.<\/p>\n

 <\/p>\n

Three Acts, one unfinished history<\/strong><\/p>\n

Justice Blake\u2019s own reasons already model this: a full section traces the MHA back to 1964 before reaching any constitutional conclusion. BC\u2019s capacity law is not one clean lineage; it is several, tangled together. The HCCCFAA, passed in 1993, once had a real review board, a fast, three-member tribunal for incapability findings. Activated only in 2000, it was abolished within three years as part of a wider purge of quasi-judicial tribunals<\/a>, never fully implemented, per the BC Law Institute, before reliable conclusions could be drawn about its merits. Review reverted to the courts, so inaccessible a 2021 BCLI study called it unavailable to those who need it.<\/p>\n

The MHA carried a different history. Its \u201cdeemed consent\u201d provision, in use since at least 1981<\/a>, let a director treat a detained patient as consenting regardless of capacity, a rule BC kept for decades after most provinces moved on. The present Mental Health Review Board was established in 2005, succeeding an earlier review-panel system, but its mandate centred on detention criteria, not capacity to decide on treatment, since deemed consent foreclosed it. Only under pressure of this litigation did the legislature remove the wording last December; the ruling confirms removal was never an answer.<\/p>\n

The Adult Guardianship Act (AGA) supplies a third piece: not one of the statutes struck down, but a related regime showing the same pattern. Since 2000 it has opened with a presumption of capacity, every adult presumed capable \u201cuntil the contrary is demonstrated,\u201d and has never had a review board of its own; its emergency powers, for short-term abuse and neglect, have no built-in review at all. In A.H. v. Fraser Health Authority<\/a> (2019), those powers detained a vulnerable woman for nearly a year with no independent review, breaching her Charter rights against arbitrary detention. No tribunal caught it, only a lawsuit.<\/p>\n

None of this is dead history: three statutes, three answers to one question, developed across four decades with little cross-reference, illustrating the reckoning required, not its complete inventory. The common law of capacity and consent, and the Charter analysis Justice Blake herself conducted to strike the scheme down, carry their own unfinished histories a full retrieval would equally have to take up. It is closer to what Heidegger called a shared fate still asking to be decided than a museum exhibit.<\/p>\n

BC doesn\u2019t need a royal commission before the clock runs out. It needs the redraft to be a genuine retrieval, not another amendment under deadline pressure: why did BC\u2019s one consent review board get three years rather than a fair trial? Why did deemed consent survive decades after other provinces dropped it? Why did A.H.\u2019s year of unreviewed detention take a lawsuit, not a tribunal, to end? Answering those, and their counterparts across BC\u2019s capacity law, is what carrying history mindfully means: a legislature that can say why it keeps or discards each arrangement has a more defensible policy than one that cannot. We don\u2019t choose what BC\u2019s capacity law has been. In six months, we will find out whether the province has chosen to encounter its history.<\/p>\n

 <\/p>\n

Author<\/strong>: Austin Lam<\/p>\n

Affiliation<\/strong>: Psychiatry Resident Physician, Research Track, University of British Columbia<\/p>\n

Competing Interests<\/strong>: None.<\/p>\n

Social media account<\/strong>: @austinaldenlam<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

By Austin Lam On July 28, 2026, Justice Lauren Blake of the British Columbia (BC) Supreme Court ruled, in Council of Canadians with Disabilities v. British Columbia, that BC\u2019s scheme for forcing psychiatric treatment on involuntary patients regardless of their capacity to consent breaches the Charter\u2019s equality guarantee and its protection of life, liberty, and […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":503,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8053,2148,2152],"tags":[],"class_list":["post-4804","post","type-post","status-publish","format-standard","hentry","category-consent","category-law","category-mental-health"],"yoast_head":"\nBritish Columbia\u2019s mental health law needs to carry its history forward - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/08\/25\/british-columbias-mental-health-law-needs-to-carry-its-history-forward\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"British Columbia\u2019s mental health law needs to carry its history forward - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Austin Lam On July 28, 2026, Justice Lauren Blake of the British Columbia (BC) Supreme Court ruled, in Council of Canadians with Disabilities v. 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