Medical Crisis in Canada

A letter from the Moncton Hospital to a New Brunswick heart patient in need of an electrocardiogram said the appointment would be in three months. It added: “If the person named on this computer-generated letter is deceased, please accept our sincere apologies.” The patient wasn’t dead, according to the doctor who showed the letter to The Associated Press on condition of anonymity. But there are many Canadians who claim the long wait for the test and the frigid formality of the letter are indicative of a health system badly in need of emergency care.

Americans who flock to Canada for cheap flu shots often come away impressed at the free and first-class medical care available to Canadians, rich or poor. But tell that to hospital administrators constantly having to cut staff for lack of funds, or to the mother whose teenager was advised she would have to wait up to three years for surgery to repair a torn knee ligament. “It’s like somebody’s telling you that you can buy this car, and you’ve paid for the car, but you can’t have it right now,” said Jane Pelton. Rather than leave daughter Emily in pain and a knee brace, the Ottawa family opted to pay $3,300 for arthroscopic surgery at a private clinic in Vancouver, with no help from the government.

“Every day we’re paying for health care, yet when we go to access it, it’s just not there,”

The average Canadian family pays about 48 percent of its income in taxes each year, partly to fund the health care system. Rates vary from province to province, but Ontario, the most populous, spends roughly 40 percent of every tax dollar on health care, according to the Canadian Taxpayers Federation.
The system is going broke, says the federation, which campaigns for tax reform and private enterprise in health care. The federal government and virtually every province acknowledge there’s a crisis: a lack of physicians and nurses, state-of-the-art equipment and funding. In Ontario, more than 10,000 nurses and hospital workers are facing layoffs over the next two years unless the provincial government boosts funding, says the Ontario Hospital Association, which represents health care providers in the province.

In 1984 Parliament passed the Canada Health Act, which affirmed the federal government’s commitment to provide mostly free health care to all, including the 200,000 immigrants arriving each year. The system is called Medicare (no relation to Medicare in the United States).

“Canadians are very proud of the fact that if they need care, they will get care,” Of the United States, I don’t understand how they got to this worship of markets, to the extent that they’re perfectly happy that some people don’t get the health care that they need.”Canada does not have fully nationalized health care; its doctors are in private practice and send their bills to the government for reimbursement. “That doctor doesn’t have to worry about how you’re going to pay the bill, He knows that his bill will be paid, so there’s absolutely nothing to stop any doctor from treating anyone.”

We must acknowledge problems in the system…

In Alberta, a conservative province where pressure for private clinics and insurance is strong, a nonprofit organization called Friends of Medicare has sprung to the system’s defense. It points up the inequities in U.S. health care and calls the Canada’s “the most moral and the most cost-effective health care system there is in the world.” “Is your sick grandchild more deserving of help than your neighbor’s grandchild?” It asks.

Yes, says Dr. Brian Day, if that grandchild needs urgent care and can’t get it at a government-funded hospital. He says he got so frustrated at the long delays to book surgeries at the public hospitals in Vancouver that he built his own private clinic. A leading advocate for reform, he testified last June before the Supreme Court in a landmark appeal against a Quebec ruling upholding limits on private care and insurance.

Canadians can buy insurance for dental and eye care, physical and chiropractic therapy, long-term nursing and prescriptions, among other services. But according to experts on both sides of the debate, Canada and North Korea are the only countries with laws banning the purchase of insurance for hospitalization or surgery.

Meanwhile, the average wait for surgical or specialist treatment is nearly 18 weeks, up from 9.3 weeks in 1993, according to the Fraser Institute, a right-wing public policy think tank in Vancouver. A Fraser study last year said the average wait for an orthopedic surgeon was more than nine months.

An estimated 4 million of Canada’s 33 million people don’t have family physicians and more than 1 million are on waiting lists for treatment, according to the Canadian Medical Association. Meanwhile, some 200 physicians head to the United States each year, attracted by lower taxes and better working conditions. Canada has 2.1 physicians per 1,000 people, while Belgium has 3.9, according to the Organization for Economic Cooperation and Development.

The World Health Organization in 2000 ranked France’s health system as the best, followed by Italy, Spain, Oman and Australia. Canada came in 30th and the United States 37th. It is your right as a Canadian and Human being, to hold Doctor’s accountable for their actions, the time has come to say ‘Enough is Enough’! How many more Mother’s, Father’s, Son’s or Daughter’s do we have to lose before we stand up and demand what is rightfully ours….

CMA Code of Ethics

(Update 2004 )

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This Code has been prepared by the Canadian Medical Association as an ethical guide for Canadian physicians, including residents, and medical students. Its focus is the core activities of medicine –such as health promotion, advocacy, disease prevention, diagnosis, treatment, rehabilitation, palliation, education and research. It is based on the fundamental principles and values of medical ethics, especially compassion, beneficence, non-maleficence, respect for persons, justice and accountability. The Code, together with CMA policies on specific topics, constitutes a compilation of guidelines that can provide a common ethical framework for Canadian physicians. Physicians should be aware of the legal and regulatory requirements that govern medical practice in their jurisdictions. Physicians may experience tension between different ethical principles, between ethical and legal or regulatory requirements, or between their own ethical convictions and the demands of other parties. Training in ethical analysis and decision-making during undergraduate, postgraduate and continuing medical education is recommended for physicians to develop their knowledge, skills and attitudes needed to deal with these conflicts. Consultation with colleagues, regulatory authorities, ethicists, ethics committees or others who have relevant expertise is also recommended.

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Preface

This Code has been prepared by the Canadian Medical Association as an ethical guide for Canadian physicians, including residents, and medical students. Its focus is the core activities of medicine –such as health promotion, advocacy, disease prevention, diagnosis, treatment, rehabilitation, palliation, education and research. It is based on the fundamental principles and values of medical ethics, especially compassion, beneficence, non-maleficence, respect for persons, justice and accountability. The Code, together with CMA policies on specific topics, constitutes a compilation of guidelines that can provide a common ethical framework for Canadian physicians. Physicians should be aware of the legal and regulatory requirements that govern medical practice in their jurisdictions.

Physicians may experience tension between different ethical principles, between ethical and legal or regulatory requirements, or between their own ethical convictions and the demands of other parties. Training in ethical analysis and decision-making during undergraduate, postgraduate and continuing medical education is recommended for physicians to develop their knowledge, skills and attitudes needed to deal with these conflicts. Consultation with colleagues, regulatory authorities, ethicists, ethics committees or others who have relevant expertise is also recommended.

Fundamental Responsibilities

1. Consider first the well-being of the patient.

2. Treat all patients with respect; do not exploit them for personal advantage.

3. Provide for appropriate care for your patient, including physical comfort and spiritual and psychosocial support even when cure is no longer possible.

4. Practice the art and science of medicine competently and without impairment.

5. Engage in lifelong learning to maintain and improve your professional knowledge, skills and attitudes.

6. Recognize your limitations and the competence of others and when indicated, recommend that additional opinions and services be sought.

7. Resist any influence or interference that could undermine your professional integrity.

8. Contribute to the development of the medical profession, whether through clinical practice, research, teaching, administration or advocating on behalf of the profession or the public.

9. Refuse to participate in or support practices that violate basic human rights.

10. Promote and maintain your own health and wellbeing.

Responsibilities to the Patient

1. Recognize and disclose conflicts of interest that arise in the course of your professional duties and activities, and resolve them in the best interest of patients.

2. Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants.

3. Do not exploit patients for personal advantage.

4. Take all reasonable steps to prevent harm to patients; should harm occur, disclose it to the patient.

5. Recognize your limitations and, when indicated, recommend or seek additional opinions and services.

6. In determining professional fees to patients for non-insured services, consider both the nature of the service provided and the ability of the patient to pay, and be prepared to discuss the fee with the patient.

General Responsibilities

Initiating and Dissolving a Patient-Physician Relationship

1. In providing medical service, do not discriminate against any patient on such grounds as age, gender, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, sexual orientation, or socioeconomic status. This does not abrogate the physician’s right to refuse to accept a patient for legitimate reasons.

2. Provide whatever appropriate assistance you can to any person with an urgent need for medical care.

3. Having accepted professional responsibility for a patient, continue to provide services until they are no longer required or wanted; until another suitable physician has assumed responsibility for the patient; or until the patient has been given reasonable notice that you intend to terminate the relationship.

4. Limit treatment of yourself or members of your immediate family to minor or emergency services and only when another physician is not readily available; there should be no fee for such treatment.

Communication, Decision Making and Consent

1. Provide your patients with the information they need to make informed decisions about their medical care, and answer their questions to the best of your ability.

2. Make every reasonable effort to communicate with your patients in such a way that information exchanged is understood.

3. Recommend only those diagnostic and therapeutic services that you consider to be beneficial to your patient or to others. If a service is recommended for the benefit of others, as for example in matters of public health, inform your patient of this fact and proceed only with explicit informed consent or where required by law.

4. Respect the right of a competent patient to accept or reject any medical care recommended.

5. Recognize the need to balance the developing competency of minors and the role of families in medical decision-making. Respect the autonomy of those minors who are authorized to consent to treatment.

6. Respect your patient’s reasonable request for a second opinion from a physician of the patient’s choice.

7. Ascertain wherever possible and recognize your patient’s wishes about the initiation, continuation or cessation of life-sustaining treatment.

8. Respect the intentions of an incompetent patient as they were expressed (e.g., through a valid advance directive or proxy designation) before the patient became incompetent.

9. When the intentions of an incompetent patient are unknown and when no formal mechanism for making treatment decisions is in place, render such treatment as you believe to be in accordance with the patient’s values or, if these are unknown, the patient’s best interests.

10. Be considerate of the patient’s family and significant others and cooperate with them in the patient’s interest.

Privacy and Confidentiality

1. Protect the personal health information of your patients.

2. Provide information reasonable in the circumstances to patients about the reasons for the collection, use and disclosure of their personal health information.

3. Be aware of your patient’s rights with respect to the collection, use, disclosure and access to their personal health information; ensure that such information is recorded accurately.

4. Avoid public discussions or comments about patients that could reasonably be seen as revealing confidential or identifying information.

5. Disclose your patients’ personal health information to third parties only with their consent, or as provided for by law, such as when the maintenance of confidentiality would result in a significant risk of substantial harm to others or, in the case of incompetent patients, to the patients themselves. In such cases take all reasonable steps to inform the patients that the usual requirements for confidentiality will be breached.

6. When acting on behalf of a third party, take reasonable steps to ensure that the patient understands the nature and extent of your responsibility to the third party.

7. Upon a patient’s request, provide the patient or a third party with a copy of his or her medical record, unless there is a compelling reason to believe that information contained in the record will result in substantial harm to the patient or others.

Research

1. Ensure that any research in which you participate is evaluated both scientifically and ethically and is approved by a research ethics board that meets current standards of practice.

2. Inform the potential research subject, or proxy, about the purpose of the study, its source of funding, the nature and relative probability of harms and benefits, and the nature of your participation including any compensation.

3. Before proceeding with the study, obtain the informed consent of the subject, or proxy, and advise prospective subjects that they have the right to decline or withdraw from the study at any time, without prejudice to their ongoing care.

Responsibilities to Society

1. Recognize that community, society and the environment are important factors in the health of individual patients.

2. Recognize the profession’s responsibility to society in matters relating to public health, health education, environmental protection, legislation affecting the health or well-being of the community and the need for testimony at judicial proceedings.

3. Recognize the responsibility of physicians to promote equitable access to health care resources.

4. Use health care resources prudently.

5. Recognize a responsibility to give generally held opinions of the profession when interpreting scientific knowledge to the public; when presenting an opinion that is contrary to the generally held opinion of the profession, so indicate.

Responsibilities to the Profession

1. Recognize that the self-regulation of the profession is a privilege and that each physician has a continuing responsibility to merit this privilege and to support its institutions.

2. Be willing to teach and learn from medical students, residents, other colleagues and other health professionals.

3. Avoid impugning the reputation of colleagues for personal motives; however, report to the appropriate authority any unprofessional conduct by colleagues.

4. Be willing to participate in peer review of other physicians and to undergo review by your peers. Enter into associations, contracts and agreements only if you can maintain your professional integrity and safeguard the interests of your patients.

5. Avoid promoting, as a member of the medical profession, any service (except your own) or product for personal gain.

6. Do not keep secret from colleagues the diagnostic or therapeutic agents and procedures that you employ.

7. Collaborate with other physicians and health professionals in the care of patients and the functioning and improvement of health services. Treat your colleagues with dignity and as persons worthy of respect.

Responsibilities to Oneself

1. Seek help from colleagues and appropriately qualified professionals for personal problems that might adversely affect your service to patients, society or the profession.

2. Protect and enhance your own health and wellbeing by identifying those stress factors in your professional and personal lives that can be managed by developing and practicing appropriate coping strategies.