Issues of Distributive Justice in the Canadian Health-care System

Joy Kellen, University of Calgary

The Canada Health Act promotes foundational principles of universality and accessibility of health-care for all Canadians. Contrary to popular belief, a systematic analysis of social determinants of health indicates differential access continues to exist. This paper considers the impact of distributive justice on access to health-care in the Canadian health-care system. Distributive justice is about equal respect for persons – being entitled to the same rights and services as all other citizens and services of greatest benefit offered to the least advantaged (Rawls 1993, p. 5-6). Cardiovascular disease is used as an exemplar to consider the impact of distributive justice within the Canadian health-care system. This system traditionally focuses on treatment of diseases such as congestive heart failure at point of failure, with hospitalization for surgical intervention or intensive medical therapy. This concentration of funding and resources on interventions poses ethical problems of availability and accessibility of care for individuals living in low income or poverty situations. Their inherent social exclusion limits their freedom of choice and autonomy, and subsequently their opportunity for referral to specialty clinics for assessment and treatment. Such realities beg the question: Are health professionals truly attempting to provide care for those with the greatest need?

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