2009 Karen Selick
An edited version of this article first appeared in the August 12, 2009 issue of the Ottawa Citizen under the headline "When something's growing in your head...". It also appeared on August 13, 2009 in the Calgary Herald under the headline "A Canadian's journey south".
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the Record Straight on Shona Holmes
You know your doctor is busy so you don’t trouble her for an appointment immediately, hoping you’ll get better. When you finally do go, she’s alarmed by your vision loss and your skyrocketing blood pressure. She orders an MRI scan. Five weeks later you get the report: there’s a lesion on your pituitary gland, just below your brain. The doctors aren’t sure what to call it. It could be a meningioma, a pituitary adenoma, a craniopharyngioma, an epidermoid adenoma, or a Rathke’s cleft cyst, they say.
You ask what these terms mean. Several of them are types of brain tumour, one possibly malignant. Uh-oh.
Your doctor refers you to two specialists. The earliest appointment you can get with a neurologist is more than seven weeks away. The earliest appointment with the endocrinologist is 16 weeks away.
But this thing is growing in your head. Your optometrist’s tests confirm that you are getting progressively closer to blindness. What to do?
Shona Holmes, the woman who has been criticized in some quarters recently for jumping into the U.S. debate on health care reform, faced exactly this situation. She decided to take matters into her own hands. If Canada’s health care system didn’t care enough about her to alleviate the unbearable anxiety that anyone would feel under such circumstances, there were other places in the world that would.
Shona travelled to the world-famous Mayo Clinic in Arizona, where she was seen by three specialists within seven days. She was fortunate: her growth turned out to be non-malignant. But it still had to be removed or she would surely go blind. As well, it seemed to be the source of hormonal problems that had been plaguing her. Left unattended, she was warned, her symptoms could worsen dramatically and over the long run, could be fatal. The U.S. doctors were clear: urgent surgery was needed.
Shona returned to Canada thinking that with such a clear diagnosis and treatment plan, she would have no trouble getting urgent surgery. Wrong again. Faced with more consultations and more waits of indefinite duration, she returned to the U.S. and had immediate surgery that restored her vision completely within ten days.
Would you have done anything different? I wouldn’t. Canadian politicians and celebrities frequently don’t wait either, using private Ottawa clinics or U.S. hospitals for speedier care.
Nor should Canadians have to wait, according to the Supreme Court of Canada. In 2005, the court struck down Quebec’s health insurance monopoly, thereby permitting Quebecers to purchase private health insurance.
“Access to a waiting list is not access to health care,” wrote Chief Justice Beverley McLachlin. The court accepted evidence that Canadians sometimes die on waiting lists for the public health care system. Many others undergo physical and psychological suffering that saps not only their enjoyment of life but also their ability to contribute to society as productive members of the workforce.
Four years have passed since the Supreme Court rendered that decision, but Ontario’s laws have not changed.
That’s why Shona Holmes, supported by the Canadian Constitution Foundation, is bringing a similar constitutional challenge to Ontario’s health insurance monopoly. Canada’s Charter of Rights and Freedoms guarantees citizens’ rights to life, liberty and security of the person. No-one should have to experience the agony Shona went through because of a legal prohibition on spending your own money to buy something essential for your health.
Some fear that ending the health insurance monopoly would also spell the end of Ontario’s public health care system. The experience of other countries has demonstrated that this is not the case. Public and private plans co-exist in many countries, including Austria, Germany, the Netherlands, Australia, the United Kingdom and Sweden, providing care to all citizens, regardless of income, but without long waiting lists. These countries have health care outcomes as good as, or better than, Ontario’s.
Ironically, two of the doctors who treated Shona in Arizona were Canadians who had gone south. Permitting privately funded medicine in Canada could end the brain drain and might even encourage some of the medical talent we have been exporting for decades to return.
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August 19, 2009