Le régime applicable au consentement à l’acte médical des personnes vulnérables que sont les mineurs et les majeurs sous protection juridique est un sujet délicat pour le législateur. Ce dernier doit instaurer une législation conciliant protection de l’intégrité physique du patient, et respect de son autonomie. Le droit positif échoue à trouver cet équilibre. Les mineurs sont privés de leur capacité d’exercice à toutes les étapes de leur vie, quel que soit leur âge ou leur degré de maturité. Elle réserve également un traitement disparate aux majeurs protégés. Leur autonomie variant selon la prise en compte ou non de leur régime de protection par le Code de la santé publique. À ces difficultés s’ajoute celle de l’existence de nombreux actes spécifiquement réglementés dont les règles ne sont pas toujours cohérentes ni compatibles avec les réalités de la pratique médicale. Une réflexion est menée sur les limites du régime actuel ainsi que sur l’élaboration d’une nouvelle législation plus respectueuse de l’autonomie des mineurs et des majeurs protégés. La possibilité de consentir à un acte médical dépendra non pas du statut juridique du patient, mais de son « aptitude à consentir », notion tirée des législations suisse et québécoise. Toutefois, la volonté de protéger l’autonomie du patient ne devant pas conduire à une mise en péril de son intégrité physique, un encadrement de sa capacité d’exercice sera instauré selon que le soin est ou non requis par son état de santé. / The system of Consent to medical treatment for vulnerable persons – whether minors or adults without capacity – is a sensitive subject for legislator. The law has to combine protection of the patients’ physical integrity as well as the respect for their autonomy. The current state of law fails to achieve this purpose. Minors patients are deprived of their right to consent on their own, regardless of their age or level of maturity. Adults without capacity are treated in various ways depending on whether their legal protection is taken into account or not by the Public Health Code. An additional challenge is the existence of various medical acts that depend on specific regulations. Here we discuss the current limits of the law and propose a new system for the consent to medical treatment, which would be more respectful of the autonomy of minors patients or adults without capacity. Consent to medical treatment would depend on the ability to consent rather than on each patient’s legal status, such as stated in legislations from Switzerland or Quebec. However, the will to confer a larger autonomy should not put patient’s physical integrity at risk. Therefore, patients’ capacity for decision-making would depend whether the proposed care is required or not by their health state.

The murders and suspicious disappearances of women across Canada over the past forty years have received considerable national attention in the past decade. The disappearances and murders of scores of women in British Columbia, Alberta and Manitoba have highlighted the vulnerability of women to extreme violence. Girls and women of Aboriginal ethnicity have been disproportionally affected in all of these cases and have high rates of violent victimization. The current socio-economic situation faced by Aboriginal women contributes to this. To provide publicly available data of missing and murdered women in Canada, a database was created containing details of 3,329 women, including 824 who are Aboriginal. There are key risk factors that increase the probability of experiencing lethal violence: street prostitution, addiction and insecure housing. The vast majority of sex workers who experience lethal violence are street prostitutes. The dissertation examines the legal status and forms of prostitution in Canada and internationally, as well as the individual and societal impacts of prostitution. A review of current research on violence and prostitution is presented. The thesis provides summaries from 150 serial homicide cases targeting prostitutes in Canada, the U.S., and the U.K. The trends and questions posed by these cases are identified. The cases of the missing women of Vancouver and Robert Pickton are detailed. The key findings from the provincial inquiry into the missing women cases and an analysis of the most egregious failings of the investigations (Projects Amelia and Evenhanded) are discussed. Frequently encountered challenges and common errors, as well as investigative opportunities and best practices of police, and other initiatives and recommendations aimed at non-police agencies are evaluated. The three other RCMP-led projects, KARE, DEVOTE and E-PANA, which are large, dedicated units focused on vulnerable women, are assessed. All Canadian women deserve to live free of violence. For women with vulnerable life histories, violence is a daily threat and a common occurrence. More must be done to prevent violence and to hold offenders responsible when violence has been done. This dissertation is a plea for resources and attention; to turn apathy into pragmatic, concrete action founded on solid evidence-based research.

The murders and suspicious disappearances of women across Canada over the past forty years have received considerable national attention in the past decade. The disappearances and murders of scores of women in British Columbia, Alberta and Manitoba have highlighted the vulnerability of women to extreme violence. Girls and women of Aboriginal ethnicity have been disproportionally affected in all of these cases and have high rates of violent victimization. The current socio-economic situation faced by Aboriginal women contributes to this. To provide publicly available data of missing and murdered women in Canada, a database was created containing details of 3,329 women, including 824 who are Aboriginal. There are key risk factors that increase the probability of experiencing lethal violence: street prostitution, addiction and insecure housing. The vast majority of sex workers who experience lethal violence are street prostitutes. The dissertation examines the legal status and forms of prostitution in Canada and internationally, as well as the individual and societal impacts of prostitution. A review of current research on violence and prostitution is presented. The thesis provides summaries from 150 serial homicide cases targeting prostitutes in Canada, the U.S., and the U.K. The trends and questions posed by these cases are identified. The cases of the missing women of Vancouver and Robert Pickton are detailed. The key findings from the provincial inquiry into the missing women cases and an analysis of the most egregious failings of the investigations (Projects Amelia and Evenhanded) are discussed. Frequently encountered challenges and common errors, as well as investigative opportunities and best practices of police, and other initiatives and recommendations aimed at non-police agencies are evaluated. The three other RCMP-led projects, KARE, DEVOTE and E-PANA, which are large, dedicated units focused on vulnerable women, are assessed. All Canadian women deserve to live free of violence. For women with vulnerable life histories, violence is a daily threat and a common occurrence. More must be done to prevent violence and to hold offenders responsible when violence has been done. This dissertation is a plea for resources and attention; to turn apathy into pragmatic, concrete action founded on solid evidence-based research.

La communauté internationale considère certaines personnes déplacées comme étant des migrants irréguliers. Cette étude démontre le caractère contraint du départ pour trois catégories de personnes, à savoir les personnes fuyant les conséquences aveugles d’un conflit armé international ou non international, les personnes fuyant les catastrophes environnementales de causes anthropiques ou naturelles et les personnes fuyant une situation économique ou sociale désastreuse. L’approche catégorielle classique du droit international public ne permet pas de garantir une protection à ces personnes. Aucun statut particulier ne leur étant attribué, ces personnes se trouvent dans une situation de vulnérabilité. De quelle manière est-il alors possible d’assurer une protection effective à ces personnes vulnérables déplacées ? Actuellement, la plupart des Etats s’inscrivent dans une démarche sécuritaire, contrôlant strictement la gestion des flux migratoires et appliquant peu ou prou les instruments juridiques internationaux protecteurs. Une complémentarité des différents régimes juridiques (droit international des réfugiés, droit international humanitaire, droit international des droits de l’homme) est par conséquent nécessaire et une interprétation extensive des textes existants est recommandée. Pour pallier les insuffisances du droit positif, le recours à la notion de vulnérabilité, transversale à ces diverses situations, est invoqué, permettant ainsi de dépasser l’approche catégorielle classique. Pas encore reconnue comme une source du droit international, la notion est devenue, depuis quelques années, incontournable sur la scène internationale. Elle apparaît ponctuellement dans les textes conventionnels et est fréquemment utilisée dans les instruments de droit mou. Prise en compte progressivement par les jurisprudences internationales et régionales, mais aussi par la doctrine, elle figure allègrement dans le discours des organisations humanitaires et des médias. Le développement de la notion de vulnérabilité en droit mou, précisément en des lignes directrices garantirait une meilleure protection des personnes déplacées vulnérables permettant de prévenir le déplacement, d’octroyer un statut temporaire ou définitif ou encore de fournir des conditions d’accueil dignes dans les Etats ou les régions hôtes. Ces lignes directrices servant de guide aux Etats laissent envisager par la suite l’adoption de règles contraignantes protectrices de ces personnes déplacées. La distinction entre personnes vulnérables déplacées et personnes particulièrement vulnérables doit également être prise en compte à ce stade. De surcroît, il convient d’engager la responsabilité des auteurs ayant contribué au déplacement contraint ou ayant commis des exactions sur ces personnes déplacées devant des instances judiciaires internationales, régionales ou encore nationales pour lutter contre l’impunité. En conséquence, une réparation juste pour le préjudice subi doit être garantie à ces personnes. / The international community considers some displaced persons as irregular migrants. This study demonstrates that the departure is undeniably forced concerning three groups of people : the persons fleeing blind violence and the collateral effects of an international or non international armed conflict, the persons fleeing man-made or natural environmental disasters, and the persons fleeing difficult economical or social situations. The classical approach of public international law based on distinct categories does not guarantee effective protection to these persons. As no particular international status is given to these persons, they are in a situation of vulnerability. In which way an effective protection could be a guarantee to these vulnerable displaced persons? Currently, most of the States defend a safe approach, strictly controlling the management of migration flows and applying more or less protective international legal instruments. Complementarity of different legal systems (international refugee law, international humanitarian law, international law of human rights) is therefore necessary and a broad interpretation of existing texts is recommended. To overcome the shortcomings of positive law, the use of the concept of vulnerability, crossing different situations, is invoked, in order to exceed the traditional categorical approach. Not yet recognised as a source of international law, the term “vulnerability” has become an essential notion on the international scene in recent years. It appears occasionally in conventional instruments and is frequently used in soft law. It has been gradually developed through the international and regional jurisprudence and also by the doctrine. The discourse of humanitarian organizations and the media often refers to the notion. The development of the concept of vulnerability in soft law, specifically in the shape of guidelines would ensure a better protection of vulnerable displaced persons. In this regard, guidelines could prevent people fleeing, grant a temporary or a permanent status and provide dignified reception conditions in the host States or regions. This instrument of soft law would be used as a guide for States subsequent to the adoption of protective binding rules. The distinction between vulnerable displaced persons and particularly vulnerable persons has to be taken into account at this stage. Furthermore, the responsibility of the authors who have contributed to the forced displacement or who have committed atrocities against the displaced persons should be brought before the international, regional or national judicial authorities, in order to fight against impunity. Consequently, a fair compensation for the damage suffered must be guaranteed to these persons.