Is health care a right? That question lies at the heart of 2 landmark cases heard by Supreme Court justices in early June. One case could open the way to 2-tier medicine, while the other, concerning payment for therapy for autistic children, could result in skyrocketing health care costs.
On June 8, Dr. Jacques Chaoulli and patient George Zeliotis asked Canada's highest court to overturn 2 earlier judgements by Quebec courts that upheld provincial laws limiting the use of private medical services or medical insurance. They contend that their rights under the Canadian Charter of Rights and Freedoms were breached by these prohibitions (CMAJ 2003;169 [2]:140). A ruling is expected in late fall or early winter.
Philippe Trudel, a lawyer for Zeliotis, said the justices must decide whether Canadians should be allowed to use their own money to buy care that the publicly funded system cannot provide and whether the state can prevent people from receiving the health care they need by buying it with their own money. He argued that Zeliotis' Charter rights were breached because of the pain he was forced to endure while awaiting a hip replacement, which resulted in dependency on pain medication.
Autism case
On June 9, another pivotal case involving payment for therapy for 4 BC children with autism was heard by the same 7 Supreme Court justices. A ruling is not expected for months. The behavioural intervention treatment developed by Dr. Ivan Lovaas, which costs up to $60 000 a year, was originally deemed “experimental and not a medically necessary service” by the BC government. Several parents sued, and BC courts ruled the government had violated the Charter's equality guarantees for the disabled.
During the hearing, 7 provinces and the federal government warned that allowing judges to order costly treatment would destroy the ability of provinces to run their health care systems, since a victory for the parents could result in similar requests on behalf of other patients. “Governments will have to have unlimited budgets in order to respond to that constitutional imperative,” said federal lawyer Graham Garton.
The children's lawyer argued that the therapy may allow them to lead meaningful, independent lives, instead of being institutionalized at a cost of $500 000 annually. — Barbara Sibbald, CMAJ, and Pat Sullivan, CMA