2011 Karen Selick
An edited version of this article first appeared in the September 2, 2011 issue of
the National Post under the headline "Medicare, Heal Thyself".
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Medicine Is Unethical, and Possibly Unconstitutional
Pediatrician Karen Dockrill of Whitby, Ontario will go on trial in early October before the disciplinary committee of the College of Physicians and Surgeons of Ontario, charged with conduct that is “disgraceful, dishonourable or unprofessional”.
But Danielle Martin, spokeswoman for Canadian Doctors for Medicare, piled on yet another epithet in a recent National Post article, calling Dr. Dockrill’s alleged conduct “unethical.”
What are the heinous deeds of which Dr. Dockrill stands accused?
She owned and operated a facility called Mom and Baby Depot. For an annual $1,500 membership fee, the Depot provided parents with access to a team of child-care professionals, including breastfeeding consultants, nurses, nutritionists, social workers and a chiropractor. Members could phone in 24 hours a day for medical advice, including from Dr. Dockrill herself—reportedly a godsend to inexperienced parents.
Because of the membership fee, Dr. Dockrill was able to offer longer office appointments than the standard well-baby check-up for which OHIP (the Ontario Health Insurance Plan) pays practitioners only $32. But those longer appointments and all that telephone advice (for which OHIP pays nothing) also meant that she had to limit the number of patients in her practice. The College alleges that only babies whose parents paid membership fees were accepted as regular patients.
Ms. Martin, the medicare cheerleader, says it’s unethical to “require people to pay again” for something that is already paid for by tax dollars.
But what if taxpayers aren’t really getting what they’re supposedly paying for? Ontario residents might pay several thousand dollars per year into Ontario’s coffers but still find that a 10-minute appointment—all the doctor can afford to give them at OHIP rates—is insufficient to answer all their questions or resolve their children’s health problems. Other taxpayers—roughly 7% of Canadians—can’t find a family doctor at all. They spend hours waiting with sick infants at overcrowded hospital emergency rooms or walk-in clinics.
No discussion of ethics can ignore the distinction between coercion and voluntariness. Coercion is the very essence of socialized medicine. Under Canadian medicare, extra-billing is verboten. User fees—verboten. Competing with the government’s monopoly health insurance plan—verboten. Withholding your tax payments until you get the promised services—verboten.
Forcing people to pay for services and then not providing them is tantamount to theft or fraud. It is the state system of coercive public health care that is unethical.
And not just unethical—there’s a good chance it’s also unconstitutional. In the Chaoulli decision of 2005, three Supreme Court justices pronounced Quebec’s health insurance monopoly to be a violation of the rights to life and security of the person under the Charter, saying: “Access to a waiting list is not access to health care.” Cases pending in Ontario and British Columbia courts seek similar rulings for their respective provinces.
Dr. Dockrill’s service, by contrast, was entirely voluntary. She couldn’t force anyone to join. Members who felt they weren’t getting value for money simply need not renew. A voluntary transaction between consenting adults, with no harm to third parties and a high probability of significant benefits to those involved—how can that be unethical? Forbidding people from using their own hard-earned money to optimize their family’s health is what’s unethical.
Of course, in the topsy-turvy moral code of socialists, anything that might produce inequality is abhorrent. By their logic, we should shut down all private schools—after all, customers are paying twice—and permit only hamburger to be sold until filet mignon is affordable to all.
Inexorably, the defects in socialized medicine become obvious. Contrary to official Canadian mythology, our healthcare system is far from the best in the world. Among 28 OECD countries, we are the 6th highest spender relative to GDP. However, we rank 20th out of 22 in the ratio of doctors to population, and 17th in the availability of CT scanners and MRI machines.
Yet we are the only OECD country to ban private medical insurance, and one of only four countries that do not require patients to contribute something towards the cost of using a public hospital, a general practitioner or a specialist. Are those other 24 OECD countries all unethical for having user fees?
Perhaps when Canada finally realizes the folly of demonizing innovative physicians like Dr. Dockrill, the 12,000-plus Canadian-educated doctors who have taken refuge from our decrepit system in foreign countries will feel more inclined to return.
Karen Selick is the litigation director for the Canadian Constitution Foundation, which is sponsoring a court challenge against Ontario’s healthcare laws.
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January 2, 2012