Do We Care?: Renewing Canada’s Commitment to Health : Proceedings of the First Directions for Canadian Health Care Conference

185 Pages·1999·7.975 MB·English

by  John Ralston Saul, Richard Cruess, Bob Rae

Do We Care?
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)o We Care?
RENEWING CANADA'S
COMMITMENT TO HEALTH
proceedings of the first Directions for
Canadian Health Care conference
Margaret A. Somerville
Editor
John Ralston Saul
• Richard Cruess • Bob Rae
• Nuala Kenny • Raisa Deber
• Bernard Dickens
McGill-Queen's University Press
Montreal • Kingston • London • Ithaca
©1999 Merck Frosst Canada & Co.
All rights reserved
ISBN 0-7735-1877-0 (cloth)
ISBN 0-7735-1878-9 (paper)
Legal deposit first quarter 1999
Bibliotheque Rationale du Quebec
Printed in Canada
Canadian Cataloguing in Publication Data
Directions for Canadian Health Care Conference (1st: 1998: Toronto, Ont.)
Do we care?: renewing Canada's commitment to health
ISBN 0-7735-1877-0 (bound)
ISBN 0-7735-1878-9 (pbk.)
1. Medical policy — Canada. I. Somerville, Margaret A.-, 1942-
II. Saul, John Ralston, 1947- III. Title
RA449.D57 1999 362.1*0971 C99-900056-X
Book design by Deborah Hodgdon
Page make up by PAGEXPRESS
CONTENTS
Acknowledgments ix
Introduction, by Dr. Margaret A. Somerville xi
Sponsor's Address to the Conference xvii
Chapter I Health Care at the End of the Twentieth Century:
Confusing Symptoms for Systems, b Dr. John Ralston s i i
y au
Chapter 2 Clinical Considerations in Health Policy 21
• THE IMPACT OF HEALTH POLICY ON CLINICAL
DECISIONS AND THE DOCTOR-PATIENT RELATIONSHIP,
by Dr. Richard Cruess and Dr. Sylvia Cruess 23
• CREATING A SOUND CLINICAL BASIS FOR
HEALTH POLICY: THREE VIEWS
• Pat Kelly: Bringing the Patient on Board 36
• Dr. Terrence Montague: Closing the Care Gap 40
• Dr. Hugh Scully: Integrating Heart Care 44
• ADDITIONAL THOUGHTS ON How HEALTH POLICY
CAN RESPOND TO CLINICAL IMPERATIVES 47
v
Chapter ] Economic Considerations in Health (are 51
• THE USE AND MISUSE OF ECONOMICS,
by Dr. Raisa Deber 53
• WHERE DOES ECONOMICS BELONG IN HEALTH POLICY:
THREE VIEWS 69
• Nathalie St-Pierre: Who Bears the Burden
of Quebec's Universal Drug Plan? 69
• Dr. Devidas Menon: Changing the Idea of
Value in Economics 72
• Dr. John Wade: Economic Analysis
in the Policy-Making Process: An Inside Look 75
• ADDITIONAL THOUGHTS ON THE ASSUMPTIONS
BEHIND THE NUMBERS 81
Chapter^. Political Considerations in Health Care 87
• HEALTH POLICY IN THE CONSUMER ERA,
by the Honourable Bob Rae 89
• RECONCILING POLITICAL AND HEALTH CARE
AGENDAS: THREE VIEWS 95
• The Honourable Monique Begin:
Redefining Entitlement to Health Care 95
• Dr. Mark Wainberg: The Domestic and
International Politics of AIDS 98
• Senator Lois M. Wilson: Governing Health Care 101
• ADDITIONAL THOUGHTS ON CITIZENS,
CHOICE AND GOOD GOVERNANCE 103
vi/ Do We (are?
Chapter 5 Ethical Considerations in Health (are i o?
• ETHICAL DILEMMAS IN THE CURRENT
HEALTH CARE ENVIRONMENT, by Dr. Nuala P. Kenny 109
• CREATING A SOUND ETHICAL BASIS FOR
HEALTH CARE DECISIONS: THREE VIEWS 118
• Timothy A. Caulfield: Tensions in Ethics Policy:
The Consumer vs. the Citizen 118
• Dr. Maurice McGregor: The Ethics of Waiting 121
• Dr. Lesley Degner: Patient Choice as an Ethical
Basis for Treatment Decisions 125
• ADDITIONAL THOUGHTS ON MAINTAINING
ETHICAL PRACTICE IN A RATIONED ENVIRONMENT 129
Chapter 6 Legal Considerations in Health (are 13 5
• THE LAW'S CONTRIBUTION TO SOUND
HEALTH POLICY, by Dr. Bernard Dickens 137
• APPROPRIATE USES OF LAW IN
HEALTH POLICY: THREE VIEWS 144
• Dr. Marcia Rioux: An Appeal to the Charter
of Rights and Freedoms 144
• Dr. Jamie Cameron: Moving Beyond Reactive Law 148
• Dr. Margaret A. Somerville: Litigation:
A Saying-Sorry Way to Heal the Wounds 150
• ADDITIONAL THOUGHTS ON WHERE THE LAW
BELONGS IN HEALTH CARE 152
Contributors 159
Contents / vii
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ACKNOWLEDGMENTS
Special thanks are in order to Margaret A. Somerville for her dedicat-
ed work as Chair of the Directions for Canadian Health Care confer-
ence; Don Soule, Pierre Paquette and Kevin Skilton at Merck Frosst
Canada & Co. for the wonderful idea that sparked both the confer-
ence and this book; Susan Usher for chairing the conference planning
committee and leading the editorial team at Parkhurst Publishing,
which included Owen Dyer and Janalyn Prest; and Robb Beattie for
moulding the conference presentations into the following chapters.
ix