Health Care Rights & Resource Allocation – Core Points

Supreme Court & Canadian Charter

  • Chaoulli v. Quebec (2005): Unconstitutional ban on private insurance when public care fails to deliver.
  • Based on Charter s. 7 (life, liberty, security of person): "waiting list \u2260 health care".
  • Creates limited private care access, challenging Canada Health Act.

Scarcity & Public Goods

  • Health care common good, managed collectively due to high cost.
  • Single-payer reduces costs (economy-of-scale); multi-payer increases them.
  • Patents impact drug prices.
  • End-of-life care: \approx 25\% of total health spending in final year.

Key Statistics

  • U.S.: \approx 40\% global health spend for \approx 4\% population; low life expectancy/high infant mortality (OECD rankings).
  • Medicare: sickest 5% (dying within year) use \approx 1/3 of budget.
  • Canada per-capita: avg. \$6{,}000; ages 80{+} cost \$20{,}000+.

Ethical Frameworks

1. Utilitarianism
  • Maximize overall benefit; risk of inequality.
2. Kantian
  • Universal rules; never use persons as means; favors random/first-come allocation.
3. Virtue Ethics
  • Aligns with natural limits; avoids extreme life-prolongation.
4. Feminist / Care Ethics
  • Focus on relationships, dependency, context; questions pure autonomy.

Allocation Models in Practice

  • Pandemic triage: "save most lives" (e.g., first responders).
  • Lifeboat analogy: Utilitarian (picks survivors); Kantian (random/all drown).

Age-Based Rationing Proposals

  1. **Fair-Innings**
  • Normal lifespan entitlement; then palliative care.
  1. **Life-Cycle Allocation Principle**
  • Prioritize interventions for decent old age; shift funds from very old to young.
  1. **Investment-Refinement**
  • Prioritize those with unfulfilled life plans (e.g., 20-year-olds).
  1. **Prudential Life-Span (Daniels)**
  • Rawls' "veil of ignorance": rational choice to fund early life, ration late-life high costs.

Critiques of Age Rationing

  • Ageism (denies care based on age).
  • Ignores unequal life opportunities.
  • Costs driven more by technology, pharma, admin, not just demographics.

Exam Cues

  • \text{Section 7} Charter: private-care ruling basis.
  • Utilitarian: efficiency; Kantian: fairness; Virtue: natural limits; Feminist: relational.
  • End-of-life: \approx 25\% total cost; Medicare: 5% sickest get \approx 33\% spend.
  • Fair-innings: normal lifespan, then palliative.
Supreme Court & Canadian Charter
  • Chaoulli v. Quebec (2005): Ruled an unconstitutional ban on private insurance when public care fails to deliver timely services.
  • Based on Charter s. 7 (life, liberty, security of person): Interpreted "waiting list
    eq health care" as a denial of security of person.
  • This ruling creates limited private care access, challenging the monolithic public system principles of the Canada Health Act by allowing a 'private safety net'.
Scarcity & Public Goods
  • Health care is considered a common good, managed collectively due to its high cost and essential nature, often likened to public safety or education.
  • Single-payer systems reduce costs through economy-of-scale (centralized purchasing, administration) and stronger bargaining power; multi-payer systems increase them due to administrative overhead from billing, marketing, and profit motives.
  • Patents significantly impact drug prices, leading to higher costs until generics are available.
  • End-of-life care: \approx 25\% of total health spending occurs in the final year of life, highlighting significant resource allocation at this stage.
Key Statistics
  • U.S.: Accounts for \approx 40\% of global health expenditure for only \approx 4\% of the world's population; consistently lags behind other developed nations (OECD rankings) in key health outcomes like life expectancy and infant mortality.
  • Medicare: The sickest 5% of beneficiaries (often those dying within a year) utilize \approx 1/3 of the program's total budget.
  • Canada per-capita: Average health spending is \$6\,000 per person; for ages 80{+}, costs escalate to over \$20\,000 per person annually.
Ethical Frameworks
1. Utilitarianism
  • Aims to maximize overall well-being or