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Future of patient-centred ethics in Ontario.
Correspondence and reprint requests: Blake Woodside, Associate Professor, Department of Psychiatry, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.
Dr. Kotalik's thought-provoking paper in this issue raises numerous important issues related to Bill 26, the omnibus health legislation introduced by the Ontario government in an attempt to crush physician morale. Dr. Kotalik correctly points out that many of the provisions of the bill would force physicians into an untenable situation--one in which, under many situations, they would be forced to second guess the intentions of the manager of OHIP before providing health-care services. He believes that this situation is likely to undermine the basic nature of the physician-patient relationship. He also suggests that implementing the bill's provisions might produce a scenario similar to that in the United States, where many managed care arrangements deny patients access to needed services.
In my opinion, the omnibus bill does not reflect a wish on the part of the Ontario government to impair the physician-patient relationship. Rather, it illustrates the Tory government's inability to understand the nature of its own responsibility to the population as a whole. In other words, the bill redefines the government's contract with the general public around the provisions of health-care services.
The nature of this redefinition is clear: the government indicates without reservation that it will impair the system's ability to deliver health services to the public by imposing impossible conditions on health-care providers. To then claim that the resulting interruptions in access to care are the responsibility of the providers is ludicrous beyond belief. However, I think even this government is not entirely sure that they could get away with such a grand deception. Witness its decision not to implement the provisions of the bill.
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