Chapter 8: Health and Health Care


Odette Madore, “The Canada Health Act: Overview and Options”

The Library of Parliament required that we reproduce this reading in full. The philosophically relevant parts are pp. 315–7 (stop at “The Role of Governments in Health Care in Canada”), 319–21 (the entire section called “The Requirements Stipulated in the Act”), and 324 (beginning with “The Issues of Privatization”) to 329 (ending at “Chronology”).


Understanding

  1. Madore cites two “economic and social equity factors” in favour of publicly-funded health care. What are they?
  2. The Canada Health Act contains five criteria: public administration, comprehensiveness, universality, portability, and accessibility. What does each of these mean?
  3. What is the difference between insured health services and extended health care services?
  4. What is privatization, when it comes to health care?
  5. What is active privatization? What is passive privatization?
  6. According to Madore, the National Forum on Health argues we should “fund the care, not the institution.” Why do they say this?
  7. What are the arguments in favour of privatization? What are the arguments against it?

Evaluation

  1. What are the arguments in favour of keeping the Canada Health Act as it is? What are the arguments in favour of amending it? What is your opinion, and why?
  2. The National Forum on Health says governments should “fund the care, not the institution.” What do they mean by this? Why do they say it? Do you agree with them? Why or why not?

Chaoulli v. Quebec (Attorney General)

Understanding

  1. What does the Supreme Court rule unconstitutional? What parts of the Canadian Charter and the Quebec Charter do the offending (that is, unconstitutional) sections violate?
  2. Why does Justice Deschamps begin the majority decision with the Quebec Charter?
  3. How do the unconstitutional sections of the laws violate section 1 of the Quebec Charter, according to Duchamps?
  4. Chief Justice McLachlin and two other justices also thought the laws violate section 7 of the Canadian Charter and was not saved by section 1. What were their reasons?
  5. Three justices disagree with the majority. Why do they think the Quebec laws do not violate section 7 of the Canadian Charter?

Evaluation

  1. Do you think patients should be allowed to seek private treatment for procedures covered by their provincial or territorial health care systems? Why or why not?
  2. Do you think allowing alternative private health care procedures would help, hinder, or have no effect on the public system? Why?

Susan Sherwin, “Theory versus Practice in Ethics: A Feminist Perspective on Justice in Health Care”

Understanding

  1. What is feminist reflective equilibrium? How does it differ from non-feminist reflective equilibrium?
  2. What do the traditional approaches to justice in health care cover? What is wrong with them, according to Sherwin?
  3. How do feminists respond to the argument of traditional ethicists that ethics should be done without any political commitments?
  4. What kinds of issues does Sherwin think should be added to the traditional health care agenda, and why?
  5. How does Sherwin think we ought to reconceive health care? How does she think we should reconceive justice?

Evaluation

  1. Sherwin argues that questions about access to health care services ought to include information about poverty, race, gender, and other kinds of social inequality. (These and other factors are called the social determinants of health, which are social and economic factors that influence health more than medical treatment and lifestyle choices combined, according to many international health studies; see, for example, Juha Mikkonen and Dennis Raphael, Social Determinants of Health: The Canadian Facts [Toronto: York University School of Health Policy and Management, 2010]; available at a href="http://www.thecanadianfacts.org/">http://www.thecanadianfacts.org/.) Why does Sherwin say we ought to include this information? Do you agree with her? Why or why not?
  2. Sherwin argues that a feminist perspective makes us rethink what we mean by justice. Why does she say this? Do you agree? Why or why not?
  3. Do you think Sherwin is a conservative, a centrist, or an egalitarian? Why?

Francoise Baylis, Nuala P. Kenny, and Susan Sherwin, “A Relational Account of Public Health Ethics”

Understanding

  1. What is the difference between public health and clinical health? What implications do these differences have for public health ethics, according to Baylis, Kenny, and Sherwin?
  2. How must public health ethics differ from clinical health ethics?
  3. What do Baylis, Kenny, and Sherwin think is wrong with the traditional liberal conception of the person?
  4. What is relational personhood? How is it an improvement on the individualistic conception of personhood, according to Baylis, Kenny, and Sherwin?
  5. Why do Baylis, Kenny, and Sherwin think the individualistic conception of personhood is inadequate for public health ethics?
  6. What is relational autonomy? How does it differ from individualistic autonomy?
  7. What is the difference between distributive justice and social justice? Why do Baylis, Kenny, and Sherwin think social justice is particularly relevant to public health ethics?
  8. What is relational solidarity, according to Baylis, Kenny, and Sherwin? How is it relevant to public health ethics?

Evaluation

  1. According to Baylis, Kenny, and Sherwin, public health ethics currently focusses too much on individual rights and autonomy. Why do they think this is a problem? Do you agree? Why or why not?
  2. Baylis, Kenny, and Sherwin argue that public health ethics requires a different basis than clinical health ethics. Why do they say this? Do you agree with them? Why or why not?
  3. Which of the ethical theories discussed in the Short Primer do you think most closely fits the views of Baylis, Kenny, and Sherwin? Do you think their view is conservative, centrist, or egalitarian? Why?

Comparisons

  1. Do you think Sherwin would agree with the majority decision in Chaoulli? Would she agree with the minority decision? Why? What is your view, and why?
  2. Do you think the Chaoulli decision is relevant to any of the five criteria of the Canada Health Act (public administration, comprehensiveness, universality, portability, and accessibility)? If so, which one(s), and why? If not, why not?
  3. The National Forum on Health’s argues that we should “fund the care, not the institution.” Do you think Sherwin would agree? Would Baylis, Kenny, and Sherwin? Why? What do you think, and why?
  4. Has Sherwin convinced you that philosophers should not distinguish conceptual from practical questions in ethics? Do any of the other readings in this book—especially chapter 5 Abortion, chapter 6 Animal Rights, and chapter 9 Assisted Suicide—make you more or less likely to agree with her? Why?
  5. Do you think using a relational conception of personhood might have changed the majority or dissenting arguments in Chaoulli? Why or why not?
  6. Do you think clinical health ethics would be improved if we used a relational conception of personhood? Why or why not?