Tubal ligations in humboldt

Analysing our ‘free’ health care system

STEVE MCCREARY

Overshadowed by the Montreal shooting and Canadian deaths in Afghanistan, a story emerged from rural Saskatchewan recently that received very little attention. St. Elizabeth’s hospital in Humboldt, Sask. stopped performing tubal ligations.

Tubal ligation — “getting your tubes tied” — permanently prevents women from becoming pregnant. Th e hospital’s board of directors made the decision because it apparently confl icts with the Catholic Health-Care Ethics Guide. Th e most common reactions to this story are more questions: how can a hospital refuse to provide what is generally considered a basic service? Aren’t hospitals publicly owned? Isn't this a violation of the constitution?

Th e fi rst thing we need to clarify is that, contrary to many people’s beliefs, the delivery of Canada’s health care is not public. Doctors in Canada are not government employees, but private businesspeople looking to make a profi t. When you go to the doctor and get “free” service, the doctor is still paid directly by your public insurance plan, to which every Canadian citizen has access. So while our health plan is universal, doctors are still paid, though it is not directly with a government paycheque.

Similarly, hospitals are not publicly owned facilities. Th ey do receive 90 per cent of their funds from public sources. According to a CBC report, St. Elizabeth’s alone received $8.3 million this year, but despite this St. Elizabeth’s, like most hospitals, is privately run by a board of directors.

The Canadian Health Care Consensus Group’s paper “Going Public on what is Private” clarifi es this complicated situation, distinguishing Canadian and American hospital operations. Unlike American hospitals where boards hold considerable power, in Canada, “hospital boards and hospital management have decision making authority only so long as the decisions they make are the decisions the provincial departments of health want them to make.” Sounds kind of like being a manager at McDonald’s. It continues: “Should a hospital board take a decision that the provincial department of health regards as politically troublesome, the department will intervene, and not uncommonly leave the board to take any fl ack that might follow.”

It would appear that this department intervention has already begun, as the board is now taking “the fl ack” in meetings with representatives from the Saskatoon Health Region.

It‘s not just the women aff ected and the general public that are outraged about this. Dr. Daniel Kirchgesner provided most of the tubal ligations at St. Elizabeth‘s, and stated that the doctors in the area disagree with the ruling and believe it is a right to have the procedure done at the hospital.

A doctor’s personal moral objection to a procedure could be seen as a legitimate reason not to perform it, but a board infl uenced by religious belief has no place forcing its views upon doctors and patients in the universal Canadian health care system.

Section 10 of the Canada Health Act reads: “In order to satisfy the criterion respecting universality, the health care insurance plan of a province must entitle one hundred per cent of the insured persons of the province to the insured health services provided for by the plan on uniform terms and conditions.” If any province fails to comply with the health act, the federal government may impose a penalty and withhold transfer payments to the health authority. Goodbye, St. Elizabeth’s!

Although women were denied tubal ligations at St. Elizabeth’s, they can easily drive about an hour to Saskatoon to get the procedure. However, any logical interpretation of the Canada Health Act would imply that every medical facility capable of providing the procedure should be providing it, regardless of the board’s personal views. One would assume that the Saskatchewan government is going to step in and right this wrong.

Then again, it is typically Canadian to play politics with such issues, and give up values in favour of compromise. Forcing a few people to drive an hour to Saskatoon is easier than fi ghting a court case against a board of directors.

Th e more you think about this story, a bigger question begins to emerge: under a “two-tier” health care system, would things be diff erent? One would assume that a private clinic, which charges patients directly and receives no public funding, would be able to decide which procedures it performs on whom, especially procedures not covered by provincial medicare. But the average Canadian would only feel safe in a two-tier system if the fi rst, “public tier” continued to exist in its current form. And if our universal system even now is fragile enough to be shattered by the religious beliefs of a board of directors in a small rural town, how much faith would one have in moving towards a two-tiered system?

Regardless of your opinion on two-tier health care or tubal ligations, it should be of concern to us all that a board of directors could deny access to provincially insured services based on their own religious beliefs. Stephen McCreary is a University 1 student.