Wednesday, 20 June 2007

Kill or Cure ... thoughts on health care reforms

I just finished reading "Kill or Cure? How Canadians can remake their health care system." In this book, Dr Carolyn Bennett (MP, Toronto riding of St Paul's) and Rick Archbold build on research, professional consultation and most importantly - personal experience within the system in delivering an invaluable account of the state of Canada's publicly financed health care system, the challenges it faces in meeting increasing demand, and clear opportunities for reform that can both improve the quality of patient care while saving taxpayers billions of dollars.

Though published in 2000, the prevailing concepts on fee-for-service payment models, primary health care teams, enhancing communication across professional disciplines, improving accountability and integrating the latest information technology into the system are as relevant today as they were a decade ago. In short, this book is critical reading for all Canadians interested in working to improve their health develivery system in time for the challenges of the coming century.

To quote Monique Begin, former Federal Minister of Health and Welfare:

"This is an indispensible book to help us understand what is at stake when we discuss medicare and to suggest how caring Canadians can make a difference"

Tuesday, 12 June 2007


Have you ever thought about saving a life?

If you’re like most folks and haven’t yet put yourself on the list, there are about 4000 Canadians waiting for people like you to make their day.

Amidst all of the medical advancements that have taken place in the past half century, few have pushed the boundaries of science and imagination, nor been met with as much controversy, as transplantation. For as much potential as there is to help people, progress in this field cannot seem to shake being the ying to the yang of frustration that comes with finding a donor. Those of you who have had loved ones in need of a new organ might agree that few experiences command as much soul searching as does waiting for that *suitable match*. This is not an area of healthcare where professionals don’t know what’s wrong with the patient, nor is it one where they lack the capacity to make them better – this one is all about numbers, and we need more donors to step up to the plate.

I often wondered why there were so few organ and tissue donors out there. It’s not as if there is widespread moral objection to the process. Most of the major religions not just don’t mind organ donation – but encourage it(1). Many give blood with the underlying philosophy that while they give to others, it is hoped that others will return the favour should they ever be in need. Yet the organ donor registry remains sadly unpopular, and people are dying in the process – to the tune of about 400 per year in Canada. And that does nothing to speak of quality of life issues for the 4000 or so on wait lists for organs they apparently *need*. Almost half of these patients are in my home province of Ontario where the wait times for some can seem particularly unreasonable – a 2006 study in the Canadian Medical Association Journal(2), for example, showed that if you are under 40 and require a new kidney, that you should expect to wait an average of 8 years for one! On a quick tangent – the vast majority of people on the kidney list (1156 in Ontario right now) require dialysis, something that is a life altering process for the individual, not to mention something that costs taxpayers at least $60,000/year at the low end of the spectrum. Do the math.

Ok back to donations … My guess is that it’s simply not something that many people have thought about seriously – I hope I’m right, and if I am then there’s much to be done in promoting and educating people better on the issue. So how can we better spread the word? The common points of contact between people and ‘the system’ seem to be the most practical places to start. At the moment, when people get a driver’s license in Ontario a donor membership card arrives with the actual license in the mail which people can choose to fill out or ignore. Without debate or a decent presentation of the issues, however, the likelihood of filling out such a form is probably low. Having someone actually speak with the applicant, while more time consuming, would be much more effective at recruiting donors through a proper explanation of the need, the process, and most importantly simply being able to immediately satisfy any questions the person might have. Now applying for a drivers license is one thing, but discussions like this might be better suited to offices receiving health card applications, or at Local Health Integration Networks (when they’re finally up at full strength).

One of the scarier proposals that’s been debated by governments, medical associations, students and journal editors is something called *presumed consent* - which means that all of us will automatically be considered a donor unless we explicitly declare our wish to be removed from the list. While proponents of it think it should be a civic responsibility – I for one do not believe it is government’s (or any authorities’) place to assume an individual should do something to their body in this manner. Though I do hope more people consider it, the choice to give up a physical part of one’s self should only be up to that person. It is a choice that should be voluntary, and it should be informed.

Until a clear strategy emerges, however, the debate goes on. Medical associations and some journals will continue to make the case for presumed consent, while governments and people like me will try to resist – but the rest of us should be aware that the only reason this debates exists is because not enough of us are signing up to donate in the first place, and it will go away when and if we do. So in the interim, it’s time to keep talking to people, writing notes like this, and spreading the word anyway we can. For detailed information on the entire donation process and how to sign up yourself, I’ll gladly refer you to the Trillium Gift of Life Network at .

If we can all be heroes to somebody – why wouldn’t we?

1 – For more information, visit the Trillium Gift of Life Network at

2 – CMAJ 2006. (147) p478-482