The Written Word
for February 14, 2001

I suppose that, it being Valentine’s Day, I ought to be talking about everlasting brotherly love and things of that sort but I’m afraid my attention is still on an article I read in last week’s Sunday London Times which told of a miraculous cure for Parkinson’s disease. Well not exactly a cure but a technique that banishes all the manifestations of the dread ailment. It’s an electronic implant in the brain which removes the shaking and restores the muscular control. It is, in fact, a miracle for those who suffer. But there’s a snag – it costs $CDN 50,000. Assuming that Canada is about ½ the population of Britain we will have about 60,000 sufferers of Parkinson’s with 5000 new cases each year. You do the math – it’s awesome.

But the electronic gizmo for this disease is merely the harbinger of things to come. We will surely soon see mechanical organs to complement organ transplants the expense of which will be horrendous.

Now, one of the problems with our medicare system is that we’ve never come to grips with definitions. What is it that we, as a society, are prepared to pay for out of the public purse? Are there any limits? If there are, what are they and who makes the decisions?

This has immediate implications because these modern techniques are not only scarce – they’re expensive as hell. Doctors have, until now, made the decisions as to who qualifies for things like heart transplants based upon what they believe to be medically sound factors. If you were not in otherwise good health you wouldn’t get a new heart or lungs, for example. Because until recent times organ transplants were so rare no one thought to question medical decisions. Now, however, we have surgeons in Australia refusing heart and lung transplants to smokers on the ground that these organs are very rare and ought only to go to those who don’t abuse their bodies. Civil libertarians take issue with this and ask how the doctors can make these judgments which are moral as well as medical. It surely can’t be long before the Charter of Rights and Freedoms is invoked on behalf of an elderly person who smokes seeking a heart transplant.

But it’s not just in the area of spectacular surgery that decisions will have to be made. Everything is getting so expensive. How do we ration diagnostic services as more and more of us want MRIs as a matter of course and of right? How do we determine who will and will not get a referral to a specialist as people see that referral as a right not something to be left up to the GP?

And of course it leads directly to the debate on euthanasia which, until very recently, was mostly academic. Holland now has legislation on the subject and we surely won’t be far behind.

Medicare which is so popular, and rightly so, will come under attack because of the success of medical science and the expectations both new techniques and free medicine raise. The trick is for us to make some decisions before it’s too late for rational debate.

Or, is it perhaps too late already?

I fear very much that it just may be too late and that we will be forced to accept a private sector involvement in what used to be a publicly funded system with the private sector, not the Canadian public calling the shots.