Priority-setting and public law: Potential realised or unfulfilled?

Medical Law International

Volumn 7, Issue 3, 2006, Pages 265-279

  Syrett, Keith ^a  

^a UNIVERSITY OF BRISTOL   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

CANADA; DECISION MAKING; GOVERNMENT; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HEALTH SERVICE; HUMAN RIGHTS; LAW; PUBLIC HEALTH; RESOURCE ALLOCATION; REVIEW; STANDARD;

EID: 33645723157     PISSN: 09685332     EISSN: None     Source Type: Journal    
DOI: 10.1177/096853320600700307     Document Type: Review

References (59)

1. D. Longley, 'Diagnostic dilemmas: accountability in the National Health Service' [1990] Public Law 527 at 539.
2. See D. Longley, Public Law and Health Service Accountability (Buckingham: Open University Press, 1993), passim, but especially Chapters 1 and 4;
3. R. James and D. Longley, 'Judicial Review and Tragic Choices: ex parte B' [1995] Public Law 367.
4. For discussion, see C. Ham and A. Coulter, 'Explicit and implicit rationing: taking responsibility and avoiding blame for healthcare choices' (2001) 6 Journal of Health Services Research and Policy 163.
5. N. Daniels, 'Accountability for reasonableness in private and public health insurance' in A. Coulter and C. Ham (eds), The Global Challenge of Healthcare Rationing (Buckingham: Open University Press, 2000) at 89. For a full account of the 'legitimacy problem', see
6. N. Daniels and J. Sabin, 'Limits to Healthcare: Fair Procedures, Democratic Deliberation, and the Legitimacy Problem for Insurers' (1997) 26 Philosophy and Public Affairs 303.
7. J. Freedman, Crisis and Legitimacy: The Administrative Process and American Government (Cambridge, Cambridge University Press, 1978) at 10.
8. D. Longley, review of C. Newdick, Who Should We Treat? (1996) 4 Medical Law Review 224 at 225.
9. (2000) 78 BCLR (3d) 55 (BCSC); (2002) 6 BCLR (4th) 201 (CA) (BC); [2004] 3 SCR 657 (SCC) (hereafter, Auton).
10. See especially D. Longley, Healthcare Constitutions (London: Cavendish, 1996).
11. H. Leichter, 'Comparative Approach to Policy Analysis: Healthcare Policy in Four Nations' (Cambridge: Cambridge University Press, 1979) at 272.
12. For general discussions of 'policy learning', see, inter alia, H. Heclo, Modern Social Politics in Britain and Sweden (New Haven: Yale University Press, 1974);
13. R. Rose, Lesson-Drawing in Public Policy (New York: Chatham House, 1993).
14. Auton, BCSC at para. 18 (Allan J).
15. Auton, CA at para. 73 (Saunders JA).
16. Auton, BCSC, at paras. 143-151.
17. ibid, at para. 59.
18. [1989] 1 SCR 143.
19. Auton, SCC at para. 43.
20. ibid, at para. 61.
21. See eg Stein v. Quebec (Regie de ÃAssurance-maladie) (1999) RJQ 2416.
22. D. Greschner, How Will the Charter of Rights and Freedoms and Evolving Jurisprudence Affect Healthcare Costs? Discussion Paper No. 20 (Ottawa: Commission on the Future of Healthcare in Canada, 2002), Appendix II.
23. [2000] RJQ 786, affirmed [2002] RJQ 1205. In a highly controversial judgment, the Supreme Court of Canada has recently overturned these decisions: see [2005] SCC 35.
24. Greschner, op. cit., n. 19 at 5.
25. ibid at 19.
26. (1999) 177 DLR (4th) 611 (CA) (NS) at 667.
27. See Irwin Toy Ltd. v. Quebec (Attorney General) [1989] 1 SCR 927.
28. [1995] 3 SCR 199 at para. 136.
29. P. Hogg and A. Bushell, 'The Charter Dialogue between Courts and Legislatures (Or Perhaps the Charter isn't Such a Bad Thing After All)' (1997) 35 Osgoode Hall Law Journal 75 at 79. For a recent defence of the dialogic approach in the face of criticism, see
30. K. Roach, 'Dialogic Judicial Review and its Critics' (2004) 23 Supreme Court Law Review (2nd) 49.
31. See L. Weinrib, 'Learning to Live with the Override' (1990) McGill Law Journal 541.
32. Auton, BCSC at para. 143.
33. [1998] 1 SCR 493 at para. 54.
34. Auton, CA at paras. 56-57.
35. For endorsement of the Supreme Court's decision along such lines, see A. Picard, 'Nobody said drawing the line is easy', The Globe and Mail (25 November 2004).
36. R. Klein, 'Setting Priorities: What is Holding Us Back - Inadequate Information or Inadequate Institutions?' in Coulter and Ham (eds), op. cit., n.4 above at 25
37. See especially Daniels and Sabin, op. cit., n.4.
38. N. Daniels and J. Sabin, 'The Ethics of Accountability in Managed Care Reform' (1998) 17 Health Affairs 50 at 58.
39. N. des Rosiers, 'The Courts in a Deliberative Democracy... Asking the Right Questions', speech to the Conference of Appeal Courts, Montreal (April 24, 2001), available at http://www.lcc.gc.ca/president/speeches-en.asp?id=28 (accessed 16 September 2005).
40. James and Longley, op. cit., n.2 at 373.
41. See R v North West Derbyshire Health Authority, ex parte Fisher (1997) 8 Med LR 327 and R v North West Lancashire Health Authority, ex parte A, D and G [2000] 1 WLR 977 and, for discussion, C. Newdick, Who Should We Treat? (Oxford: Oxford University Press, 2nd edition 2004) at 100-107.
42. Notably R (on the application of Pfizer Ltd.) v Secretary of State for Health [20031 1 CMLR 19, discussed in K. Syrett, 'Impotence or Importance? Judicial Review in an Era of Explicit NHS Rationing' (2004) 67 Modern Law Review 289.
43. To adopt the phraseology of Laws J at first instance in R v Cambridge HA, ex parte B [1995] 1 FLR 1055 at 1064.
44. Auton, BCSC at para. 52. See further D. Greschner and S. Lewis, 'Auton and Evidence-Based Decision-Making: Medicare in the Courts' (2003) 82 Canadian Bar Review 501 for a powerful critique of the inadequacies of the reasoning and evidentiary analysis of the provincial courts.
45. Auton, CA at para. 49.
46. Auton, BCSC at para. 50.
47. A variety of interest groups were given intervener status at the Supreme Court, including Autism Society Canada, the Canadian Association for Community Living and Council of Canadians with Disabilities, Disabled Women's Network Canada, Families of Children with Autism, Families for Early Autism Treatment and the Women's Legal Education and Action Fund. Groups lobbying for autism treatment to be publicly funded have been especially active in litigation: a representative of Autism Society Canada observed that 'up to 1600 parents may be in front of the courts at a given time' (L. Fleming, personal communication to author, 12th October 2005).
48. Auton, SCC at para. 55.
49. ibid.
50. Greschner and Lewis, op. cit., n.40 at 523.
51. Auton, BCSC at para. 144.
52. ibid at para. 147. Emphasis added.
53. Auton, CA at para. 65.
54. Auton, SCC at para. 61.
55. For example, a petition requesting that Lovaas Therapy be made available on Medicare had been tabled in the Canadian House of Commons on fifty-three occasions as at 8 July 2005: see http://www.canadaautism.com/Portals/1/MP_ petition_release_V4(2).doc (accessed 13 September 2005).
56. See especially Daniels and Sabin, op. cit., n.34 above.
57. Greschner and Lewis, op. cit., n.40 at 531.
58. See especially Commission on the Future of Healthcare in Canada, Building on Values: The Future of Healthcare in Canada: Final Report (Ottawa: The Commission, 2002) at 75-90, 137-157.
59. Above, n.38 at para. 8 (Simon Brown LJ).