Canada has death panels, and that is a good thing.

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**djones520**

http://www.slate.com/articles/news_and_politics/jurisprudence/2013/10/canada_has_death_panels_and_that_s_a_good_thing.html

Last week Canada’s Supreme Court ruled that doctors could not unilaterally ignore a Toronto family’s decision to keep their near-dead husband and father on life support. In the same breath, however, the court also confirmed that, under the laws of Ontario, Canada’s most populous province, a group of government-appointed adjudicators could yet overrule the family’s choice. That tribunal, not the family or the doctors, has the ultimate power to pull the plug.

In other words: Canada has death panels.

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I use that term advisedly. Former Republican vice presidential candidate Sarah Palin made it famous in the summer of 2009, when Congress was fighting over whether to pass Obamacare. As Republicans and Democrats continue to spar over health care, we should pause to wonder why millions of Canadians have come to accept the functional equivalent of an idea that almost sank health care reform even though, in this country, it was imaginary.

Ontario’s Health Care Consent Act has been on the books for nearly two decades. Like similar laws in many Canadian provinces—and American states—it sets out the process for making treatment decisions when a patient cannot provide or withhold her consent—when she is in a coma and on life support, for example. In such cases, power automatically shifts to a “substitute decision maker,” usually a close relative. When these family members disagree with a patient’s doctors, and when the doctors are nonetheless determined to act, the dispute generally goes to court, where it can take months or even years to resolve. That is how it works in other Canadian and American jurisdictions, anyway. In Ontario, by contrast, the provincial legislature decided in 1996 to create a quasijudicial tribunal, the Consent and Capacity Board, to make these life-and-death decisions more quickly. If a patient’s substitute decision maker withholds consent, then doctors may apply to the board—comprised of lawyers, mental health professionals, and community members—for a determination that the proposed treatment is in the patient’s best interest. If so, the board has the power to consent on the patient’s behalf.

More at the link.

**Easy E**

As Frazzled would tell me, "Slate, you can't trust anything they write since they are a Lefty site! Plus, something about Weiner Dogs and Texas!"

**djones520**

Well, they are saying Death Panels are good, so I'll buy it's a lefty site

**Steve steveson**

Death panels seems rather an over the top way of putting it, but then people said the same thing about the NHS not funding some treatments, as if no insurance company has ever refused to treat someone...

I guess, equally, that some health insurance companies would withdraw funding if the doctors advised against continuing life support. I can't see them carrying on funding for years to keep someone on life support when the doctors have advised it be withdrawn, whatever the families wishes.

**Easy E**

True, all Insurance Comapnies have panels that determine what treatments are "medically necessary" and which ones are not. They then use these broad criteria to determine what is and is not covered, therefore every insurance company in the world has a "Death Panel".

Of ocurse their is an appeal process. Where I use to be familiar with the appeal process had 7 review boards before you would have to go to the Commerce Department of the State Government for redress.

By the way, everytime someone says Death Panel an angel loses its wings.

**whembly**

Um... didn't we always knew that Canada ration care?

Seriously... end-of-life care is and will always be a touchy subject matter.

What it boils down to is thus:
A) Do we want to live in a society that those who can afford better end-of-life care (via insurance, wealth, connections). Thus, making the life achievements in the workforce (ie, what you earned, family wealth, etc) determine your care at the end of your life.

or...

B) Do we want to live in a society that everyone has skin in the game, but the government makes the final determination of your end-of-life care, personal wealth/connection notwithstanding?

**azazel the cat**

1. The tribunal is set up to rule only when the patient cannot provide consent, and generally this means in a coma or brain-dead. Since we have a (more or less) socialized healthcare system, when a person is completely and utterly braindead, we do not want hundreds of thousands of our tax dollars going to keep their meatsuit from decomposing when there is no hope of living. (and it is important to note that "hope" and "belief in supernatural intervention" are very different things)

2. The tribunal is not there to prevent treatment; it is there to prevent nutjob snakehandlers, etc. from disallowing treatment of their children. So no more "we denied medical treatment so we could pray the illness away" BS.

**daedalus**

azazel the cat wrote:

So no more "we denied medical treatment so we could pray the illness away" BS.

I like that we allow people to see how well that works out for them.

**SilverMK2**

whembly wrote:
Um... didn't we always knew that Canada ration care?

Seriously... end-of-life care is and will always be a touchy subject matter.

What it boils down to is thus:
A) Do we want to live in a society that those who can afford better end-of-life care (via insurance, wealth, connections). Thus, making the life achievements in the workforce (ie, what you earned, family wealth, etc) determine your care at the end of your life.

or...

B) Do we want to live in a society that everyone has skin in the game, but the government makes the final determination of your end-of-life care, personal wealth/connection notwithstanding?

You realised that in most countries where you have socialised medical care, you can still elect to get private healthcare insurance as well? In the UK we even have entire private hospitals, private care homes, private specialist care/service/etc centres etc for those who have "made life achievements" (or had ancestors who somehow managed to amass enough wealth to make it self sustaining and pass on their empire, but I guess in America that is the same thing

).

**Frazzled**

I'm actually against that. If you have public care, everyone from Da Queen down should have the same system. Else you'll have the good private system and the crappy public system for the worker drones.

...kind of like the US now.

**SilverMK2**

Frazzled wrote:
I'm actually against that. If you have public care, everyone from Da Queen down should have the same system. Else you'll have the good private system and the crappy public system for the worker drones.

I don't quite see how that would be the case... The NHS may struggle sometimes, but it provides pretty damn good care and still pushes the boundaries of modern medicine.

**Frazzled**

SilverMK2 wrote:
Frazzled wrote:
I'm actually against that. If you have public care, everyone from Da Queen down should have the same system. Else you'll have the good private system and the crappy public system for the worker drones.

I don't quite see how that would be the case... The NHS may struggle sometimes, but it provides pretty damn good care and still pushes the boundaries of modern medicine.

You trust too much.
We hear horror stories here about it. What is your experience with MRIs, hip replacements, and cancer treatrments? This is a question not a criticism.

**whembly**

SilverMK2 wrote:
whembly wrote:
Um... didn't we always knew that Canada ration care?

Seriously... end-of-life care is and will always be a touchy subject matter.

What it boils down to is thus:
A) Do we want to live in a society that those who can afford better end-of-life care (via insurance, wealth, connections). Thus, making the life achievements in the workforce (ie, what you earned, family wealth, etc) determine your care at the end of your life.

or...

B) Do we want to live in a society that everyone has skin in the game, but the government makes the final determination of your end-of-life care, personal wealth/connection notwithstanding?

You realised that in most countries where you have socialised medical care, you can still elect to get private healthcare insurance as well? In the UK we even have entire private hospitals, private care homes, private specialist care/service/etc centres etc for those who have "made life achievements" (or had ancestors who somehow managed to amass enough wealth to make it self sustaining and pass on their empire, but I guess in America that is the same thing ).

I was under the impression that in NHS (like Canada) you couldn't legally get private insurance? (Although, that's changing in Canada too).

Good info... thanks.

**SilverMK2**

Frazzled wrote:
You trust too much.

I've worked in NHS hospitals for the last 5 years and I'm currently training to be a clinical scientist (on an NHS training scheme, in NHS hospitals, lectured by and working with NHS scientists, consultants, doctors and technicians)

We hear horror stories here about it. What is your experience with MRIs, hip replacements, and cancer treatrments? This is a question not a criticism.

Cancer treatments are easy - we have a 2 week pathway between diagnosis and treatment - for example I worked in a plastic surgery department for a couple of consultants who did a lot of cancer surgery - skin lesions, mastectomies etc, and we had an absolute limit of (I believe) 31 days to get them in for surgery once they had been diagnosed, with a target of less than 2 weeks. I could not tell you about oncological treatment but from my limited association with the oncologists while working in plastics, they are as rapid on getting people started on treatments, if not more so.

MRI's work on a priority system, from critical-right-this-minute-scans, urgent scans (generally within 2 weeks) and routine scans (generally up to 6-8 weeks).

Hip replacements depend on the centre. I did work in a T&O department for a while but was mostly in spines and neurosurgery so can't give you much of an idea on hip replacements other than to say the guidelines for any treatment within the NHS is for it to be done within 18 weeks of the initial referral (or decision to treat if they have had other treatments and investigations).

http://www.nhs.uk/choiceintheNHS/Rightsandpledges/Waitingtimes/Pages/Guide%20to%20waiting%20times.aspx

**Frazzled**

18 weeks? Thats four months. Thats a good bit of time. Canada was 7 months for an office comrade's mother.

**SilverMK2**

Frazzled wrote:
18 weeks? Thats four months. Thats a good bit of time. Canada was 7 months for an office comrade's mother.

We're talking about the maximum time allowed from you going in to seeing your GP to the start of treatment. This includes waiting for an appointment with a consultant, waiting for any investigations (which generally have a 6 week target), then follow up with the consultant for your results, then scheduling any treatment. Not a huge wait, though certainly it would be great if we could get it down to less... and 18 weeks is the maximum before you start getting into trouble and have to start explaining yourself to the higher powers, not the time scale services always work to.

**whembly**

Frazzled wrote:
18 weeks? Thats four months. Thats a good bit of time. Canada was 7 months for an office comrade's mother.

For comparison... US is less than 2 months. Frequently less than a month.

**SilverMK2**

whembly wrote:
Frazzled wrote:
18 weeks? Thats four months. Thats a good bit of time. Canada was 7 months for an office comrade's mother.

For comparison... US is less than 2 months. Frequently less than a month.

Again, 18 weeks is the maximum permitted before the department starts getting into serious trouble with the higher powers, not the guide time (though some services do sail close to the wind).

**purplefood**

You know in Canada they ration death panels...

**d-usa**

Having a private company trying to maximize profits deciding how to ration our care has served us well for decades!

But seriously, I am amazed at home many people think rationing care is a new or socialist thing. What do people think that package they get from their insurance company every year really is? It's just them telling you how they are going to ration your care that year.

**cadbren**

We should all receive the same health care? Perhaps we should all be paid the same too, live in the same sized houses, eat the same kinds of food.
Not even the communists could pull that one off and Pol Pot was probably the closest that came to achieving that. Look at how that ended.

**motyak**

cadbren wrote:
We should all receive the same health care? Perhaps we should all be paid the same too, live in the same sized houses, eat the same kinds of food.

None of which is being suggested...not even everyone receiving the same health care. There are bronze, silver, etc levels, aren't there?

**cadbren**

motyak wrote:
cadbren wrote:
We should all receive the same health care? Perhaps we should all be paid the same too, live in the same sized houses, eat the same kinds of food.

None of which is being suggested...not even everyone receiving the same health care. There are bronze, silver, etc levels, aren't there?

I should have quoted Frazzled above as he suggested that everyone should have the same health care instead of the "drone" getting some kind of short stick.

**Ouze**

edit: nm

**KamikazeCanuck**

whembly wrote:
Frazzled wrote:
18 weeks? Thats four months. Thats a good bit of time. Canada was 7 months for an office comrade's mother.

For comparison... US is less than 2 months. Frequently less than a month.

Unless you don't have health insurance. Then it's infinity months.

**Ouze**

KamikazeCanuck wrote:
Unless you don't have health insurance. Then it's infinity months.

No, it eventually... works itself out.

**azazel the cat**

daedalus wrote:
azazel the cat wrote:

So no more "we denied medical treatment so we could pray the illness away" BS.

I like that we allow people to see how well that works out for them.

Generally speaking, I also like it. However, I do not like it when those people are allowed to make the decision on behalf of their dependents.

purplefood wrote:You know in Canada they ration death panels...

Yeah, that is sig-worthy.

**AlmightyWalrus**

cadbren wrote:
We should all receive the same health care? Perhaps we should all be paid the same too, live in the same sized houses, eat the same kinds of food.
Not even the communists could pull that one off and Pol Pot was probably the closest that came to achieving that. Look at how that ended.

Do you always make insane slippery slope arguments or only on certain days?

**notprop**

d-usa wrote:
Having a private company trying to maximize profits deciding how to ration our care has served us well for decades!

But seriously, I am amazed at home many people think rationing care is a new or socialist thing. What do people think that package they get from their insurance company every year really is? It's just them telling you how they are going to ration your care that year.

I'm not sure I would agree that we in the UK would have rationed care? All care is free at the point of use and continues until it is no longer needed. True new treatments have to be approved and are assessed for effectiveness, safety and cost but this would be standard in any system and is not rationing.

To Frazz's point that all should have the same treatment - thems socialist words!

I have used the NHS quite happily all my life and my Job also includes a very good private scheme, so I can pick and choose.

I actually found private hospital care to be less pleasant as it is clearly turnover focus rather than patient care, but if you need a procedure done at a time that suits you and work than you then the private option is a good one to have. I had a groin op done on a Friday PM so that I was back in the office for Monday morning, that isn't necessarily an option with the NHS.

The funny thing about US talk of death panels and the implicit suggestion that other countries have terrible problems looks like a very obvious distraction from the way in which Healthcare and Pharmaceutical companies are rinsing the US citizen for huge profits. While large nationwide systems like the NHS are not perfect (far from it) as a basis of care for all they do a very good job and shouldn't engender the sort of fear it does in the US.

**cadbren**

AlmightyWalrus wrote:

Do you always make insane slippery slope arguments or only on certain days?

Guess you missed the post I made after that one.
I'm not surprised, you can be a bit obtuse about issues that don't follow a socialist agenda.