Fundamental issues
Division of Powers.
Impacts how health system is structured. Recent decision in QB CA summarizes federal and provincial responsibilities regarding health care. At issue is whether assisted human reproduction should be federally or provincially regulated. The federal government has traditionally placed this matter under the criminal law head of power. If defeated, they may try to classify it under POGG power. However, that would be a difficult argument as POGG is not used very often, and it would be difficult to argue that this is a matter of national concern.
Federal heads of power: criminal law. POGG, spending power (i.e. collection and distribution of taxes), quarantine and border control, patent, defence, penitentiaries, immigration. As we can see, the federal role is indirect, supervisory.
Provincial heads of power: hospitals (92.7); medical profession and the practice of medicine (92.13 – property and civil rights; 92.16 – matters of a local and private nature); education (s93) – includes professional regulation.
At issue here, reproduction is held to be under provincial regulation. Human reproduction is not an ‘evil’, hence cannot be regulated by federal criminal law power. On the other hand, true prohibitions, such as stem cell research can rightly be under the federal criminal head of power.
Canada Health Act. Central piece of federal legislation for health care. Canada Health Act does not prohibit anything explicitly, but rather relies on conditional funding. If programs meet criteria then they are funded. If programs do not meet the criteria then they are not funded. The act lists five program criteria and conditions that provinces must follow in order to receieve their federal transfer payments: public administration, comprehensiveness, universality, portability, and accessibility. There are two additional conditions which must be met: first, feds are entitled to specific information ; and second, the province must “give recognition” to the federal government in all health documents.
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