1. Current Ethical Issues in Canadian Healthcare

2. Introduction Welcome to the SFU Health Ethics Club!
The SFU Health Ethics Club was established in the summer of The club provides a medium for students to discuss and explore ethical issues in public health, medicine, and health policy.
Our Mandate:
We foster community among students in Heath Sciences at SFU and enhance moral leadership
We promote critical thinking and dialogue around complex health issues
We liaise with health organizations and researchers to help further ethical policy-making and practice

3. Outline of Today’s Meeting
How to approach ethical arguments
Current issues:
Physician-assisted suicide
Mental health ethics
The role of culture and religion in healthcare
Current State of Healthcare in Canada
Single versus two-tiered debate

4. Why Talk About Ethics?
Our actions are guided by a moral code which we abide to, whether we consciously deliberate it or simply act based off of instinct
Our own moral principles and values have the illusion of being self-evident—but are they?
If we acknowledge that there are people who hold radically different moral principles than we do, then we must also acknowledge that they have likely come to their own positions through the same means that we have, i.e. rationalisation, culturalisation, “gut instinct”
If that’s true, how do we come to terms with our inevitably conflicting moral positions with one another?

5. “It’s [Not] All Relative”
If we can figure out the logical basis for why we hold our own beliefs, then we can begin to engage in discussion with others and resolve ethical dilemmas
Not all ethical positions are equally valid—sometimes we may be tempted to say that differences in culture, religion, or upbringing validates a person’s position (moral relativism), but this is not necessarily true
Ethical positions are subject to respectful debate, and as with any debate, some arguments are better than others
This doesn’t necessarily mean that there is “One True Morality” i.e. Universal Morality but it also doesn’t mean that we have to live in a moral void
Therefore, we must critically evaluate and challenge our own beliefs in order to better understand (and argue) the situations we will inevitably face

6. How to Talk About Ethics
Express the case concisely and objectively
What is the dilemma? What is the decision that ultimately needs to be made?
Apply 3 general considerations:
Autonomy: what are the patient’s capable wishes and values?
Beneficence: what is the best thing that can be done for the patient?
Justice: is the patient receiving what is fair?
Consider the third parties involved (e.g. experts, family members, etc.) and professional and cultural norms, legal precedents
Propose a resolution that is based on a coherent ethical framework—what principles are you applying? What assumptions are you making by applying these principles?
Consider your choice critically. Why do you believe the things you believe? If you believe them and are a rational person, shouldn’t everyone else? Under what circumstances would you change your recommendation?

7. Physician-assisted Suicide
Physician-assisted suicide (PAS) is the act of a physician providing a lethal dose to a patient wishing to end his or her life. PAS differs from euthanasia in that the patient self- administers the drug
Ethical issues arise from the extent to which one must be ill in order to qualify
Disability ethics: Prejudices that may arise against disabled individuals who have chosen not to end their lives
Religious ethics: Religious qualms against those who opt to end their lives
Human integrity: All life fundamentally sacred and inherently valuable
But does this mean we should preserve life at all costs, or does it mean that we allow for the possibility that ending suffering is an act of upholding sanctity of human life?

8. PAS in Canada
26th February 2015: Canadian Supreme Court overturned the ban on physician-assisted suicide
16th June 2016: Parliament passes legislation that grants the legality of physician-assisted suicide provided the patient meets all of the following necessary conditions:
Must be an adult capable of making decisions regarding their health
The request is voluntary and without external pressures
They have a grievous and irremediable medical condition
The procedure will be covered by the Canadian healthcare system

9. “Grievous and Irremediable”
An illness is “grievous and irremediable” only if:
The illness is severe and incurable
They are in the advanced stages and demonstrate irreversible decline in capabilities
“that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved”
Death is in the foreseeable future, but a specific prognosis is not necessary

10. Procedure
Requires written consent of the patient and a 10 day waiting period between approval of request and administration of lethal dose, within which the patient must be given plenty of opportunity to opt-out
Signed informed consent, requires two witnesses
Requires confirmation from two physicians that the patient meets all the requirements

11. Special Cases
The legislation allows for the possibility of PAS under special considerations
Mature minors
Mental illness
Requests made before the loss of capacity is to occur
These considerations, however, have yet to determined and are currently under independent review by the Ministers of Health and Justice
They must provide a conclusion by December 2018
What are your thoughts? Can we allow a “mature minor” to opt-into assisted dying? Does severe mental illness provide enough grievousness to mandate assisted dying?
Learn more:

12. Problems
Doctors, nurses, and facilities are all granted the right to opt-out of performing physician- assisted dying (much like the case of abortion)
Potential for inaccessible treatment
Does not ensure a coherent moral standard within the Canadian healthcare system if its providers are free to refuse a legal procedure on moral grounds
Should doctors, as representatives of the Canadian healthcare system, be obligated as a matter of professional ethics to adhere to the policies and rights that the healthcare system grants its patients?
Or do doctors have a personal right to abide by their own moral code and opt-out?

13. Culture and Religion
Do cultural or religious rights supersede other obligations?
If a potentially life-saving practice
“Traditional medicine” versus chemotherapy?
What would you say to a young, underage patient with diagnosed leukemia who refused chemotherapy in favour of traditional medicine for cultural or religious reasons? Is this her prerogative?
What role do the parents have in this decision? If they agree with her religious motivations, is there anything you can do? If they disagree with her religious convictions, is it permissible that they force her to undergo chemotherapy?

14. Mental Health Ethics
The Mental Health Act of BC allows for the involuntary admission and treatment of people with mental disorders
Physician ordered
Police Intervention
Judge ordered
This means that a person deemed to be mentally ill can be involuntarily committed and forced to take medication
Draconian laws?
In September of 2017, Canada will have to report to the UN to prove that they are compliant with the UN’s Convention for the Rights of Persons With Disabilities, which Canada signed in 2010
What are some of the serious ethical issues that arise as a consequence of this?

15. Mental Health Ethics
Ms Smith was given a prescription for antipsychotics, but chose not to take them because she didn’t like the way they made her feel. The police were called one day because Ms Smith was making a lot of noise in her apartment and disrupting neighbours.
Should Ms Smith be forced to comply with her medication?
Would BC’s Mental Health Act allow the police to force her to take her medication?

16. Healthcare in Canada- Background
2009 Poll from the Canadian Health Coalition (lobby group dedicated to preserving Canadian public healthcare) showed that 86% of Canadians support “public solutions” to issues in healthcare
27.6% of Canadians’ healthcare is paid for through the private sector currently- including prescription drugs, dentistry, optometry

17. Dr. Brian Day’s Landmark Lawsuit
Dr. Day is an orthopedic surgeon and Medical Director of the Cambie Surgery Centre in Vancouver. CSC currently is restricted on how many private insurance cases they can take
This case emerged due to an audit of the CSC where it was found to have illegally charged patients more for health services than medicare permits
He is challenging the provincial Medicare Protection Act’s ability to restrict residents from privately accessing medically necessary services
Day says Canada is the only country in the world where patients are prevented from using their own money “to look after their own bodies with their own resources.”

18. Dr. Brian Day’s Landmark Lawsuit
He is a proponent of a Two-Tiered Healthcare system- some European countries have this which features a parallel public and private system
He is invoking section 7 of the Canadian Charter as the basis of his claim- our right to life, liberty, and security of person
In the end, this is not about patients but about doctor billing practices

19. What would this mean?
Allowing privatization would allow providers to set any price on care that the market would allow
In the US, private health insurance through employers costs $16,000 for an average family of four, with employees paying over $4000 for family insurance with a $2000 deductible
The main claim of Dr. Day regarding reduced wait times would only apply for those that can afford private insurance
As this is a Supreme Court case, if Day wins, laws would be changed across Canada

20. Ethical Issues
Day’s case shows no concern for the rights of those who are ineligible for or cannot afford private health insurance or private care
England’s two-tiered system shows its failures
Conflict of interest- Doctors can’t work in both private and public sector. What would this mean for the public sector?

21. Conclusions
Yes, our current health care system has issues BUT these can be solved within the public system
Examples:
“first available surgeon” and a centralized wait list
Home and community care
“one-stop-shop” clinics
Learn more:

22. Thanks for Coming! Blog: Facebook Group: Twitter:
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SFU Health Ethics Club
Twitter:
@sfu_ethics