Debating the Merits of Assisted Suicide

New polls in Manitoba reveal public support for assisted suicide and the debate is making headlines throughout the country. Additionally, there have been several appeals to grant this right in recent years, one of which the Supreme Court of Canada will rule on later this year. Indeed, advancements in healthcare and changes in societal values since the Rodriguez decision twenty years ago, at which point the Supreme Court deemed unconstitutional doctor-assisted suicide, have been plenty and renewed inquiry is defensible.

Today, individuals with terminal illnesses stand a greater chance of living much longer than before. Importantly, though, it is not mandatory for them to accept provisions–refusing treatment, similar to suicide, is legal. By extension, assisted suicide, especially for those suffering without possibility of recovery, seems reasonable.

In any case, introducing the right of assisted suicide to the Canadian legal system deserves sincere scrutiny and consideration. Determining whether it is a legal procedure, as opposed to murder, for instance, requires specific determinants that ensure judicious use.  Designing and implementing the necessary regulations will, therefore, likely take a considerable amount of time, not to mention that the entire process will be controversial.

Canadians have supported euthanasia and assisted suicide for decades and several individuals and groups have pressed for its legalization. This month, for instance, polls showed that roughly 63 per cent of Manitobans support assisted suicide and a nationwide survey taken last year revealed that 68 per cent of Canadians support it. The Province of Quebec is currently debating legislation that would legalize physician-assisted suicide and, in 2012, the British Columbia Supreme Court ruled that assisted suicide was a right. Judges in British Columbia’s appeal court overturned this ruling in 2013 however, fearing that its acceptance could put some vulnerable people at risk and devalue human life.

On the other hand, several American states and European countries have passed legislation allowing individuals to exercise their right to die, albeit with varying stipulations. Furthermore, several individuals travel to countries where assisted suicide is legal as a means of ending their life peacefully. While these regions have experienced increasing numbers of assisted suicides, the totals remain dramatically low. For example, these methods only accounted for 2.35 deaths per 1,000 in Oregon in 2012 and the total rose from 41 to 53 in the Netherlands between 2003 and 2011.

Advances in healthcare and medicine provide terminal individuals with additional options to prolong their life. However, this can be emotionally burdensome, not to mention that it has a cost. In 2010, CBS ran a story titled, “The Cost of Dying,” which reported that 20-30 per cent of the $55 billion in medical expenditures on those in their final months had no meaningful impact on their overall livelihood. As the population ages, ailments and the medical costs associated with them are sometimes too onerous. For those who would rather end their life peacefully, as opposed to suffering, assisted suicide is a viable alternative.

Canadians are asking tough questions and policymakers can no longer avoid them. Indeed, determining whether assisted suicide fits Canada’s values is paramount, however, with proper regulations and sound methods of ensuring physicians and patients follow them, it could be beneficial. The debate will continue long after the Supreme Court rules on the matter, yet, Canadians obviously want an answer and the majority want to see change.

Rachel Lowe is a 2013-2014 Atlantic Institute for Market Studies’ Student Fellow. The views expressed are the opinion of the author and not necessarily the Institute

On Health Insurance in Canada

Canada’s healthcare system is a source of pride for many citizens–it forms a strong part of our national identity. Indeed, the universality of health insurance, which provides services free at the point-of-care, seems like a noble goal.

Because Canadians value healthcare so much, it is worth asking what the dangers of the current system are. Frankly, it could save lives.

Currently, as stipulated by the Canada Health Act, each province receives federal funds to run a public health insurance agency: Medicare. These funds can be subject to certain reductions in proportion to the amount of private healthcare activity occurring in a province. Thus, provincial health policy freedom is somewhat fiscally constrained by the federal government.*

Medicare tends to be associated with long waiting lists for healthcare. The Canadian Wait Time Alliance (WTA) tracks wait times in Canada, as do the Canadian Institute for Health Information (CIHI) and the Fraser Institute. These studies all suggest that wait times for medical care, while already substantial, have been slowly increasing. While difficult to objectively measure, it is entirely probable that Canadians suffer, get sicker, or die while waiting for medical care.

In parallel, the labour market for Canadian doctors is sometimes poor. About 16–20% of new medical specialists in Canada, according to the Royal College of Physicians and Surgeons, cannot find work every year.

Herein lays the paradox of Canadian health policy as it exists today. How can there be potentially thousands of unemployed Canadian doctors looking for patients and, at the same time, close to a million patients waiting for medical procedures?

Opponents of a parallel private healthcare system are right to question whether it would reduce waitlists–after all, a private system would pull doctors from the public system. However, the implicit assumption here is that every doctor starts out employed. In the current state of affairs, a modest proposal would be to allow doctors for which there is “no room” to start accepting private health insurance payments. This would not require a cent of government expenditure, and may actually help government balance sheets–the only thing that would be drawn from the public system is patients on waitlists. Additionally, this could increase access to care for those who remain in the public system.

Surely, there are better ways of retaining universal health insurance coverage for all Canadians, while addressing the systematic harms it can produce. That sounds like the kind of Canadian innovation I am proud of.

Mike Craig is a 2013-2014 Atlantic Institute for Market Studies’ Student Fellow. The views expressed are the opinion of the author and not necessarily the Institute

*A previous edition of this piece stated that, in 2014, the Canada Health Act is up for renegotiation, when in fact it is the Canada Health Accord. In addition, the Canada Health Act does not explicitly ban private health insurance at the provincial level, although this is subject to interpretation of Section 12.

Thanks, Dad

The McGuinty Liberals in Ontario have had a good time changing the way public services operate.  Although in history he intends to go down as “The Education Premier,” or the “Healthcare Premier,” he may better go down as the “ORNGE Premier”, or better yet, “Premier Dad.”  It is one thing to read about a change of policy in the news and another to see its impact on your day-to-day life.  Although we are aware that Premier McGuinty has introduced all day kindergarten (another service that Ontario can not afford), cancelled a power plant (to win an election), and engaged in the infamous scandal that is ORNGE, it is one of his changes to healthcare that has frustrated me the most.

Today I called my family doctor to book an annual physical.  Although I must say, most people do not look forward to their annual physicals, as society we have come to view it as necessary.  Better to have a quick check up and nip any problems in the bud, than to let them fester, grow, and eventually require treatment. When I got on the phone with the receptionist I stated, “I would like to book my physical”.  And she said no.  When I inquired as to why, she said that annual physicals were delisted by OHIP, and are now only covered for those under 18 and over 65.  “That’s not a concern, I would still like to book it.  My family has insurance.”  Again, she said no.  I inquired as to why, and she told me that it was actually illegal for them to charge me for a physical, under the new health care laws and that thus I could not have one (unless I were to go to a private practice, I suppose).

On one hand, I was (and still am) frustrated.  Why can’t I get an annual physical with the doctor that I have had since birth?  I have a comfortable relationship with her, which is important.  I am comfortable telling her about concerns and questions I may have.  Does this mean that I should get a different doctor who I don’t know to do so?  Does this mean that as a taxpayer, I must both pay into OHIP, and for a private practice to preform an annual physical?  I should think that if I am willing to pay for her services, I should be able to receive the same level of service that I did before the delisting.  I understand that Ontario is billions in debt, and cost saving measures are necessary.  On the other hand, I have seen my provincial taxes rise, and my services fall as the debt increases.  This may be a cost saving measure, and for Ontario’s Liberals, any step forward is a good step.  However there are billions in spending that could easily be cut, or at very least have implemented a better policy.  This is a direct result of the financial mismanagement of Ontario’s Liberals, who claim to hold healthcare so dear to their heart.

Upon further research I learned that the Liberals were planning to replace the annual physical with a new type of physical.  I find it odd that they did not introduce the new type of physical the day they delisted the current physical.  Perhaps this is an instance where the Liberals need a dash of common sense, something often lacking in government policy.  Would it not make sense to the average person that when one changes front line services, it is better to introduce the changes at once than it is to cancel it, and re-introduce it months later?  I suppose we will have to wait and see what new government policy rolls out.  I hope that it will not leave those from 19-64 without access to an annual physical with a family doctor.

Although I applaud McGuinty’s Liberals for trying to find a cost saving measure I have a few suggestions of areas where they can “trim the fat” and go on a New Year’s Resolution. I suggest scrapping all day kindergarten, paying down the debt, and reducing regulations on businesses. Within the health care sector, they must let the private sector take on a greater responsibility.  Individuals should have the choice as to where they receive their treatment, and from whom. The private sector should be permitted to provide any service the public sector can. I bet that, given the opportunity, the private sector would not only find ways to improve services, but also find ways to reduce costs.  As long as the government stifles innovation, and lacks accountability to patients (both consumers and tax payers), we will continue to find not only inconveniences in day-to-day living, but also a set of government services that Ontario tax payers just can’t afford.

-Alanna Newman