Health law in Canada最新文献

Researchers and research subjects are reporting that the results of genetic testing, including testing conducted using sequencing technology, could inform reproductive decisions. Thus far unacknowledged are the out-of-pocket expenses often associated with genomics-enabled reproductive planning. These expenses will render this benefit of medical technology inaccessible to many people. No word currently exists for the mistaken assumption that the typical person has significant financial resources or the construction of policies and practices with that assumption baked in. In this essay, I propose the term "plutonormativity" to illuminate these often unacknowledged inequities. I then show how plutonormative thinking is operating in one particular context: access to reproductive planning within current discussions of the benefits of the genetic testing.

This is the final in a series of three papers addressing common occupational disability entitlements from an Ontario motor vehicle accident (MVA) perspective, which are also applicable to long-term disability cases. The first paper supported using a holistic model in the assessment of accident injured persons who are unable to return to the pre-accident occupation (pre- 104 disability/"own occupation") because of accident-caused impairments. The second paper discussed case law, best practice and the Post-104 Week IRB Disability ("any occupation") test and demonstrated the difficulties individuals face when they are unable to return to work in the aftermath of a debilitating motor vehicle accident. In this third and final paper, the purposes and roles of the Situational Work Assessment and Simulated Work/Academic Trials are critically evaluated in the occupational disability context. These methodologies are used to determine an individual's capacity to competitively meet the physical, cognitive and interpersonal/behavioural demands of his or her pre-condition occupation, or any occupation for which he or she is suited by education, training or experience, thereby addressing entitlement to income replacement benefits (IRB). It is vital that occupational disability assessments are comprehensive, holistic, include an undestanding of the synergistic impact of the impairment on the individual's physical, cognitive and psychosocial work capacities, and are conducted through multi-modal means. To conclude, the overriding principles and themes of all three articles are synthesized.

In Canada, gamete donation can be known or anonymous. When a child is conceived using anonymously donated gametes, that child does not have a right to know the identity of their donor. Currently, there is no registry storing gamete donor information accessible to donor-conceived persons and no legislation or judicial precedent protecting a donor-conceived person's right to know the identity of their biological parent(s). With third party reproduction now regularly shifting the traditional outlines of family, these practices are increasing- ly attracting judicial oversight. This paper examines the consequences of the Supreme Court of Canada's Reference re Assisted Human Reproduction Act, S.C. 2004, c. 2 (AHRA), which identified donor anonymity as a matter of provincial jurisdiction. The paper argues that the Supreme Court's decision defined the future of anonymous gamete donation in Canada by strongly protecting anonymity.

At the heart of high stakes end of life (EOL) decisions such as withdrawal of life-sustaining treatments (WLST) or medical assistance in dying (MAiD), are concerns that vulnerable people in our society need to be legally protected from prematurely ending their own lives or from having their lives inappropriately ended by healthcare teams predisposed to negatively assess their quality of life. Recently, two Supreme Court of Canada rulings in Rasouli and Carter (MAiD) have clearly emphasized the role of consent in providing legal protections to people at the end of life. The role of the medical standard of care is less clear: though the Supreme Court in Rasouli was careful to state there had been no ruling on the medical standard of care with respect to WLST, the Court did state that standard of care considerations would be important in such decisions. In contrast to Rasouli, the result of the Carter ruling was that consent alone is insufficient protection for physician assisted death without a medical standard of care. Subsequently, in its new legislation, the Canadian Government restricted access to MAiD on the grounds that some people - those who lose capacity, with mental illnesses and mature minors - are so vulnerable that this potential choice at the EOL must be denied. In simple terms, for some, consent and the medical standard of care are insufficient protections. Such claims and their consequences are a sign of an emerging and significant problem: the reduction of medicine to a mere contractual relationship while disregarding its fiduciary nature simply because the courts have, in the words of Chief Justice McLachlin, "never reviewed physicians' good faith treatment decisions on the basis of fiduciary duty". The goals of this article are to explore issues of vulnerability and equality, the existing protections in both medicine and law and the emerging need for courts to evaluate physicians' fiduciary duties in high stakes EOL decisions in order to resolve conflicts with respect to WLST, to ensure access to MAiD and to promote the future aualitv of EOL care for all Canadians.

Canada is the only country with a universal public health care system that does not include coverage for prescription drugs; lack of drug coverage leads to underuse of necessary medications. Arguments have been advanced for and against a national pharmacare plan. This article investigates six commonly cited reasons for not introducing such a program in order to determine their validity - private plans are doing a good job, public plans should only cover the poor, strengthening the pan-Canadian Pharmaceutical Alliance is all that is needed, a public plan will deny people access to important new drugs, pharmacare will cost too much and pharmacare is just about money. The evidence presented shows that these are just myths.

As the participants in the Canada Health Act, Version 2.0 conference made clear, there is a strong case to be made that this key piece of legislation no longer captures some key challenges to managing health care in Canada. Particular issues include 'portability' across provincial/territorial boundaries, and the definition of insured services. However, the CHA is not a barrier to reform; it acts as a floor, rather than a ceiling. Health reform may thus require a combination of new legislation to set conditions for which new services should be insured, and developing mechanisms to identify priorities, ensure appropriateness, and improve efficiency, which are unlikely to be addressed through overarching legislation. The CHA should thus be maintained, recognizing that it is necessary, but not sufficient.

The Canada Health Act was passed in the run-up to the 1984 Federal Election to meet a political problem - perceived inequities in access to care due to extra-billing by physicians and hospitals. At that time, health care as a right of citizenship was still a topic of debate. Health care was for the sick, and effective interventions were few and inexpensive. The provision of health care was seen as a morally justified social cost. Today the problem is different. We are in the midst of the largest transformation in biological understanding since the invention of the microscope. New treatments are being found powerfully effective, yet costly. A new, high value added, economic sector has developed: health innovation. Health care is an unquestioned social right. Yet, although a disproportionate amount of the foundational science has come from Canada, increasingly we are unable to access the medical, economic and social benefits of a global health economy. We need a permissive, catalytic, legislative framework (CHA 2.0) that will bring together the economic strength of health innovation and the delivery of its benefits to the health and wellness of Canadians. It would espouse the following seven principles: 1. Health care and health innovation are parts of a nationally critical health economy, with a global perspective. 2. Public and private sector involvement and accountability. 3. Change and innovation mandated and rewarded. 4. Labour mobility across jurisdictions, and role mobility across professions. 5. Patient-centred care. 6. Holistic and comprehensive, based on evidence. 7. Outcome (not process) driven, and transparent in implementation.

For over 70 years, since the Dominion Provincial Conferences at the end of the Second World War, Canadians have viewed health care as a right of citizenship. The Canada Health Act (CHA, 1984) formally entrenched the five principles that guide our current publicly operated, single payer, provincially managed system: public administration, comprehensiveness, universality, portability and accessibility. The health care system that has sprung up around the CHA has become increasingly complex, costly and strained. Our gradual descent through the rankings of major health care suggests that we are reaching the limits of what the current health care system can provide. Unfortunately, constructive political debate around this issue is often choked by intense ideological positioning. System reform is urgently needed to address the rapidly changing biological and demographic drivers of health. We do not feel that diverting ever larger flows of money into the status quo is a sustainable solution. Our nation's health and the means to advance it must be seen as assets rather than costs. We believe it is possible to meet increasing demands by expanding the supply and acknowledging the wealth of resources (scientific, human, managerial and educational) that we currently possess. In this paper we propose a cultural shift from an institution-centered system bent on cost control, to a patient-centered system that fosters a true health economy. We identify a series of interventions (some bold and others less so) to achieve a clear and evaluable goal: maximizing the well-being and debility-free life expectancy of each individual. To achieve a patient-centred system-we discuss strategies to address costs and utilization, the setting of real performance standards, the elimination of conflicts of interest and the provision of truly accessible care for all Canadians. To create a health economy, we discuss the importance of innovation, the need for a reinvigorated public health system and steps to overhaul the health care human resources environment. The goal of health care reform in Canada should be a system that is dynamic, evidence based, wealth creating and a global leader. We believe that, with leadership and vision, this goal is eminently achievable.