In Canada, with our single-payer health care system, Rasouli’s situation has a very public bottom line: Should taxpayers foot the bill for his family’s indefinite goodbye?
But American critics of Canadian health care will declare that merely asking this question is unacceptable, unethical, even unthinkable—and that it proves that the Canadian system gives doctors a dangerous incentive to kill off their patients as quickly as possible. They are wrong. The Hippocratic Oath’s promise to do no harm still applies. But they are also only wrong in part. When taxpayers provide only a finite number of acute care beds in public hospitals, a patient whose life has all but ended, but whose family insists on keeping her on life support, is occupying precious space that might otherwise house a patient whose best years are still ahead.
The incentives in the American health care system point in the opposite direction. In the United States, keeping an all-but-dead patient alive on life support in a hospital bed generates income for the hospital, for as long as its bills get paid.
Ontario’s Consent and Capacity Board provides an objective process for resolving these difficult, end-of-life dilemmas.