Ethics in Health Care in Canada
• Health and social policy will be considered at three levels of analysis:
o Macro level: level of societal responsibilities for the health of the total
o Meso level: level of institutional responsibilities for programs of care
o Micro level: level of individual professional responsibilities for patients and
families receiving health care
Ethics and Human Reproduction—should we create life?
• Ethical issues in human reproduction include: contraception, sterilization and
abortion; care in childbirth; “test tube” babies
• Abortion was considered a violation of the Canadian Charter of Rights and
Freedoms because it violated a woman’s human right to life and personal security.
Thus, abortion became legalized in Canada.
• Protection of the fetus? birth is viewed as the necessary condition for personhood
and until birth the pregnant woman and her unborn child are legally one
• Ethical concerns in the use of new reproductive technologies (ovulation enhancement,
sex selection, surrogacy etc) continue to be shaped by language of rights
• Federal Minister of Health declared “voluntary moratorium” on applying
reproductive technology procedures regarding threat to human dignity and treating
women as commodities
• March 2004 an act respecting assisted human reproduction becoming law in Canada.
This law was designed to:
o Prohibit unacceptable practices such as human cloning
o Protect Canadian families using assisted human reproduction (AHR) to help
build their families in health and safety
o Ensure that research related to AHR which may facilitate the treatment of
infertility and other disorders takes place in a regulated environment
• This act prohibits a number of unacceptable activities in Canada:
o Human cloning, germ-line alterations, payment of surrogates, payment of
donors of egg, sperm or in vitro embryos, creating chimeras and using
someone’s reproductive material without their consent
Genetics and Genetic Testing—should we alter our genes?
• New genetic knowledge (large part by Human genome project) and techniques are
changing ways people think about health and illness, personal risk, and family
responsibility • As a result of this project, large number of genes have been identified and new
commercial tests becoming available for genetic screening purposes raises ethical
questions for health research, health care delivery and society
• Should researchers be setting boundaries in search for new genetic knowledge? Who
should oversee applications of this knowledge? How much funding should be devoted
to advancement of genetic science relative to other matters requiring research?
Organ Transplantation and Organ Donation: should we replace parts?
Societal Issues: th
• Organ transplantation has been declared one of the greatest achievements of the 20
century, offering people with end-stage organ failure “a gift of life”.
• Successful transplant offers some people virtually complete physical rehabilitation
and improvement in overall quality of life. However, others not so fortunate.
• Concern: transplantation consumes a large proportion of health care resources and
benefits only a few
• Fundamental questions at the macro or societal level about level of resources to be
allocated to life-saving technology
o Macro level: worldwide shortage of donor organs (strategies offering financial
incentives, buying and selling organs, using anencephalic infant donors, use of
xenografts (transplanting from one species to another), or cloning to solve
problem of shortage
o Meso/institutional level of health care system: type of patient who should be
recipients of organ transplantation?, and how selection criteria should be
developed?, proportion of institutional budget devoted to transplantation
compared with other programs
o Micro level: how health care providers decide whether or not a transplant is in
given patient’s best interest (related/unrelated donors)
End of Life Issues—should we interfere with “nature” at the end of life?
• Issue about quality of life while dying:
o Euthanasia: deliberate, rapid, and painless termination of a life of a person
afflicted with incurable and progressive disease
o Withholding and withdrawing treatment
o Concept of futility
o Attempts to provide meaningful end of life care
Assisted euthanasia: refers to advancing one’s own death by requesting help from others
either to provide lethal dosages of drugs with instructions about how to use them
effectively, or requesting others to administer drugs or other mechanisms to bring about
• Euthanasia and assisted suicide have been “officially tolerated and widely practiced”
in the Netherlands for almost two decades
• In 1994 Oregon became the first state to pass a law allowing assisted suicide Canadian Policy Responses:
• 1983, Law Reform Commission of Canada recommended against decriminalizing
euthanasia in any form
• Special Senate Committee on Euthanasia and Assisted Suicide recommended that
programs of palliative care be made available so all patients and families could be