Monique Lanoix opposes Ontario’s legislation allowing transfer patients to long-term care without their consent because the legislation violates human rights, social dignity, and solidarity.
The Ontario Government recently passed Bill 7, “More beds, better care”. This amends the Long-Term Care Act of 2021 and targets “patients who occupy a bed in a public hospital and are designated by an attending clinician as requiring an alternate level of care”. It authorizes the placement of those requiring alternate levels of care to a facility that is not of their choice and without their consent.
In Ontario, individuals considering placement in long-term care can choose up to five homes, in order of preference, where they will be waitlisted. Even if Bill 7 includes a provision for appeal, the threat of having to pay $400/day while waiting in hospital for a decision on the appeal will likely encourage compliance. By taking away the right to choose a home, the government of Ontario has disenfranchised individuals who live with disabilities and require assistance to perform the activities of daily living. Under the latest set of rules, the government allows the designated homes to be located twice as far in the northern part of the province than in the southern part. This translates into an increased burden, especially in the North of the province, for families wishing to visit loved ones and it will likely have a negative impact on the frequency of visits. If access to long-term care is already inequitable across the province, Bill 7 only makes it worse. This legislation is a call to critically reflect on the meaning of equitable access to long-term care and whether society is truly inclusive of those who need this care. Ultimately, Bill 7 is an attack on fairness, equity and solidarity, the values that constitute the basis for our health care system.
Premier Ford’s refusal to seek any consultation for Bill 7 and his paternalistic assurance that it is for patients’ own good, hide a disregard for those who require long-term care. The government has essentially silenced the very voices of those who are most impacted by it. For Trish Auliffe, president of the National Pensioners Federation, “Bill 7 swipes directly at the core of human dignity: an older person’s and their family’s right to the enjoyment of life and respect”. It may appear that a human rights framework is better suited to denounce the injustices imbedded in Bill 7. However, dignity provides a complementary perspective to assess whether Bill 7 upholds the values that undergird the provision of health care services.
In an article on health and dignity, Nora Jacobson suggests that there are two meanings of dignity: human dignity and social dignity. In part, social dignity points to the ways in which “respect and worth are conveyed through individual and collective behaviour”. Legislation can be thought of as a form of collective behaviour. By taking away the ability to choose a home, Bill 7 sanctions treating these vulnerable individuals as expendable. What does this say about access to adequate health care services, regardless of social status, geographical location, or ability?
Canadians have consistently supported their health care system. This was the case when Roy Romanow undertook a countrywide consultation in 2002: Canadians told him they strongly supported “the core values on which our health care system is premised – equity, fairness and solidarity”. Those values remain strong as witnessed during the pandemic when Patty Hajdu stated that the values underpinning the Canada Health Act, equity, fairness and solidarity, would help Canadians come out of the pandemic. Does Bill 7 uphold those values?
Bill 7 allows the violation of the rights of some patients based on their need for long-term care; it discriminates between northern Ontarians and southern ones. It does not uphold the values of equity and fairness. What about solidarity? The knowledge that we will all need care bolsters our commitment to share the costs of a public health care system. This is the value of solidarity and it includes everyone. At present, those who live in long-term care institutions are at risk of marginalization. Bill 7 further harms the fragile bond linking those persons to the rest of society, meaning that the goal of a truly inclusive society becomes more difficult to achieve. Not only does Bill 7 threaten the rights of some, it damages the very fabric of our society.
Monique Lanoix is Associate Professor in the Faculty of Philosophy and in the program in Ethics, Social Justice and Public Service at Saint Paul University in Ottawa.