Treating visitors to Canada

Medicare: 'universal' for whom?

Foreign sick kids get sympathy vote, visiting adults get the go-by

By Marjo Johne

"The answers depend on a number of factors," says Dr Allister Browne, chair of the Philosophy Department at Langara College in Vancouver and ethics consultant to the Vancouver General Hospital. "There are visitors who fall ill and have medical insurance, those with the money to pay for treatment, and those who don't even have insurance in their home country. You have to look at the particulars of each person's circumstances."

TOUGH CALLS
In the case of Ms Proctor, whose colon cancer was diagnosed while she was visiting her son in Toronto, the complex surgery required to treat her wasn't covered by the Ontario Health Insurance Plan because she wasn't a resident and she didn't have any other medical insurance. So after her condition was stabilized, doctors and administrators at the Toronto General Hospital had no choice but to send her home.

"It's a tough call," says Dr Michael MacDonald, founding director of the W Maurice Young Centre for Applied Ethics at UBC. "You've got someone you know you can help, but there are lots of other Canadians who are entitled to healthcare."

Should limited healthcare resources be reserved for the Canadians who pay for it? What about the value of all human life? Sometimes Canada comes through, as with the nine-year-old Afghan boy, Djamshid Popal, who was flown recently to an Ottawa hospital and then transferred to the Hospital for Sick Children in Toronto for heart surgery. But how can doctors and hospital administrators decide who to treat?

THE LUCKY ONES
For Djamshid, help came through the Hospital for Sick Children's Herbie Fund for underprivileged children who need specialized treatment. "The fund pays for surgical care and treatment in hospital," says Helen Simeon, a spokesperson for the Hospital for Sick Children. "Families pay for their own transportation, expenses and accommodation fees while in the city."

The decision to help a child through the Herbie Fund is based on a number of guidelines, including the child's age (the cut-off is 14 years), the family's financial circumstances, and the type of treatment required. "We don't accept cases that require chemotherapy or a lot of complex follow-up care," adds Ms Simeon. Treatment for a Canadian resident will never be delayed to accommodate a Herbie patient and the hospital provides assistance only to as many patients as the fund can cover.

ETHICAL DILEMMAS
If only there was a similar fund for people like Claudette Proctor. Dr Browne says the heartache of not always being able to help sick visitors to Canada is something we'll just have to live with. "Your heart goes out to them," he says. "But your heart goes out to the whole world, and you just can't help everyone."

Are there any circumstances where we have a responsibility to treat visitors � on medicare's dime? Yes, says Dr MacDonald, in cases where Canada has a unique medical expertise. When a condition is so critical the patient faces imminent death, Canadian hospitals must open their doors to visitors � whether or not they're covered by insurance, and even when our emergency rooms are full (of tax-paying Canadians). But we have to draw the line somewhere and once an emergency patient is stabilized, says Dr MacDonald, they should be sent back to their countries for treatment. "The heartbreaking fact is, in many cases we know they're not going to get the appropriate care when they go home," he adds.