TORONTO – An Ontario Superior Court Justice has granted an urgent request from a physician at the Centre for Addiction and Mental Health, authorizing the involuntary treatment of a patient with antipsychotic medication while he awaits an appeal1. The patient, identified only as J.J., had been found incapable of consenting to treatment by a provincial tribunal, a decision he is now challenging.
The ruling, delivered by Justice L. Brownstone on September 3, 2025, lifts an automatic stay on treatment that was triggered when J.J. filed his appeal. The court found that the patient’s condition and the significant risk of violence he posed made it necessary to administer the medication before his appeal could be heard.
The case stems from J.J.’s admission to CAMH on June 12, 2025. His sister had sought an order for a psychiatric examination from a justice of the peace after a concerning period of two months during which J.J. lived on her porch without permission. She reported that his mental state was deteriorating and that he had become aggressive, banging on her door and making threats against her and her daughter, causing her to fear for their safety.
Upon his arrival at CAMH, J.J. was placed on a certificate of involuntary admission. Hospital records described him as agitated, hostile, and argumentative. He was deemed a safety risk to others and required seclusion and chemical restraints in the emergency department. According to a psychiatrist, he was experiencing severe decompensation and delusions. He was placed in the high-intensity side of the psychiatric intensive care unit and was documented making threats to kill hospital staff if they attempted to medicate him.
On June 23, 2025, the Consent and Capacity Board held a hearing to review J.J.’s status. Dr. Park, a psychiatrist, testified that without treatment, there was a likely risk of serious bodily harm to another person. The Board observed that J.J. remained untreated and was exhibiting symptoms of schizophrenia during the hearing. It ultimately confirmed his involuntary status and upheld the treating physician’s finding that he was incapable of providing or refusing consent for treatment with antipsychotic medications.
The very next day, J.J. served a notice of appeal on the hospital. Under Ontario’s Health Care Consent Act, filing an appeal automatically stays the Board’s decision, meaning the proposed treatment could not be administered until the appeal was resolved. J.J., who is representing himself, had not taken any steps to move the appeal forward, prompting his physician, Dr. Jason Joannou, to seek an urgent court hearing to lift the stay. The court also appointed David Shannon as amicus curiae, an impartial friend of the court, to provide assistance on the motion.
In the period following the Board’s decision, several serious incidents occurred at the hospital. On June 25, J.J. was shouting and threatening staff, which led to him being physically escorted to a step-down area and placed in mechanical restraints.
A more severe event took place on July 20, when J.J. assaulted another patient without provocation, prompting a “Code White” emergency response. Court documents state that J.J. kicked the other patient in the head, face, wrist, and back. The victim’s injuries were serious enough to require transfer to a medical hospital and included multiple facial fractures and a fractured wrist. As a result of this incident, J.J. is now facing a criminal charge of assault.
Later, on August 7, staff observed J.J. writing disorganized text on the wall of his room, covering an area approximately 15 feet wide by 7 feet high. On the same day, he was seen naked and exposing himself through his window to staff and the public while being unresponsive to redirection.
Dr. Joannou stated in an affidavit that J.J. continues to be psychotic and paranoid and poses an extreme risk of violence. His opinion was that J.J. remains a high risk for assaulting staff, leading to a directive for staff to minimize interactions and only approach him in groups or with security present.
The court also heard evidence about J.J.’s medical history. He was diagnosed with schizophrenia in 2006 and has been hospitalized five times since 2015. During previous hospitalizations, he frequently required seclusion and restraints. In one instance, he assaulted a psychiatrist in a secure area of a hospital, an act he later described as justified because the psychiatrist had diagnosed him and was attempting to treat him. His medical records indicated that while he had a severe reaction to one antipsychotic medication, he tolerated and responded well to Paliperidone, the long-acting injectable medication proposed by Dr. Joannou.
In his decision, Justice Brownstone reviewed the stringent four-part test under section 19 of the Health Care Consent Act, which allows a court to override the automatic stay of treatment pending appeal. The physician bears the burden of proving that the exceptional circumstances warrant such an order, which interferes with a patient’s fundamental right to bodily integrity and autonomy.
First, the court had to be satisfied that the treatment would likely improve the patient’s condition substantially, and that the condition was unlikely to improve without it. Justice Brownstone accepted Dr. Joannou’s evidence that with treatment, J.J. would likely become less paranoid, more organized, and less of a risk to others, which could eventually lead to his discharge. Without treatment, his condition had not improved since June and was unlikely to do so.
Second, the judge weighed the expected benefits against the potential risks. The court found the benefits, including a reduction in J.J.’s distress and risk of violence, outweighed the potential side effects. Justice Brownstone noted that J.J. had tolerated the medication well in the past and would be under close medical supervision at the hospital to manage any adverse reactions.
Third, the treatment had to be the least restrictive and least intrusive option. The court determined that while administering the injections might require restraints, this would be infrequent compared to the ongoing and significant restrictions J.J. was currently under, including isolation and seclusion. With no other viable medication alternatives, this criterion was met.
The final and most contested criterion was whether J.J.’s condition made it necessary to administer the treatment before the final disposition of his appeal. The amicus curiae, Mr. Shannon, argued that the court must be extremely cautious not to circumvent a patient’s right to appeal and that J.J. was in a secure environment where he could be managed pending the hearing. J.J. himself told the court he did not want the treatment, did not believe he was paranoid, and felt the hospital staff wished to treat him for financial gain.
Justice Brownstone acknowledged these crucial arguments about patient autonomy but was ultimately persuaded by the evidence of necessity. He pointed to the opinion of the very experts charged with managing J.J., who advised the court that immediate treatment was necessary. The judge found that a combination of factors, including the risk of psychosis becoming treatment-refractory, the ongoing severe restrictions on J.J.’s liberty, his recent assault on another patient leading to criminal charges, and his continued agitation and threatening behavior, made the intervention necessary before the appeal could be heard.
The motion was granted, and Justice Brownstone authorized treatment with Paliperidone, a long-acting injectable medication, pending the final outcome of the appeal. The patient’s sister, who is his substitute decision-maker, consented to the treatment plan.
In a concurrent order, the judge also ensured J.J.’s right to appeal would be protected by expediting the hearing. The appeal has been scheduled for two hours on October 3, 2025, with deadlines set in September for all parties to serve and file their legal arguments.
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