Canada and it’s Values in Health Care

Ethical Dilemmas in the Current Health (are Environment

Dr. Nuala Patricia Kenny

The images that spring to mind when we think about ethical dilem-

mas in health care are those of drama and conflict: new reproductive

technologies, cloning, end-of-life care, unequal access to technology,

and inadequate resources. More recently, images of patients suffering

because of inadequate care, families burdened by increasing demands

for care, and patients dying because of unavailable care have domi-

nated the media and public discussion. These are not simply individ-

ual issues. Economic, political and social forces all shape this health

care environment. Each of these forces contains assumptions about

what values should count in decision-making. Some are explicitly

acknowledged in the formulation of policy, many are implicit, but gen-

erally, the values at stake in a particular decision are not clearly iden-

tified. While we can acknowledge that policy is often a short-term

political response, we must also ensure that it reflects key societal val-

ues because policy is focused on the common good. It is impossible to

determine what that “common good” is when there is no public forum

in which to identify commonly-held values and no clear and respect-

ful process for prioritizing values in real decisions.

Much of the discussion and debate in health care today centres

around whether there is enough money in the system. The question

itself is meaningless unless we can answer, “Enough money for what?”

We pay for what we value; we will scrimp, save and sacrifice for some-

thing highly valued. So before we can even begin to answer questions

about funding, we need to deal writh the fundamental question of

what we as individuals and communities value, how we might deter-

mine priorities, and who gets to sit at the decision-making table. This

is the stuff of good health policy.

History demonstrates that public policy can play a significant

role in clarifying the values of a society. The Canada Health Act

embodies a set of values which Canadians have understood to be



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