Abstract
The purpose of this study is to compare and contrast the basic ethical values underpinning national health care policies in the United States and Canada. We use the framework of ethical theory to name and elaborate ethical values and to facilitate moral reflection about health care reform.
Section one describes historical and contemporary social contract theories and clarifies the ethical values associated with them. Sections two and three show that health care debates and health care systems in both countries reflect the values of this tradition; however, each nation interprets the tradition differently. In the U.S., standards of justice for health care are conceived as a voluntary agreement reached by self-interested parties. Canadians, by contrast, interpret the same justice tradition as placing greater emphasis on concern for others and for the community. The final section draws out the implications of these differences for future U.S. and Canadian health care reforms.
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References
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In making this point, we by no means assume that the U.S.A. and Canada share all social, political and ethical traditions. Indeed, Canada's belief in the right of equitable, universal care is in some respects more consistent with the public policy of several Scandinavian countries than with policies in the United States, or even the United Kingdom. However, several common factors unite the United States and Canada, including their geographic proximity, use of the Common Law tradition (except in Quebec), Constitutions that grant a Supreme Court authority to make law, and an extensive bilateral trade relationship. In the area of health care, an open border permits easy access for university students and health professionals trained in one country's medical school or hospital to practice in the other country's. Despite different attitudes and values among U.S. and Canadian health professionals, the Canadian Medical Association's (CMA) inaugural Code of Ethics was itself borrowed almost verbatim from the American Medical Association's Code of Ethics (See Naylor CD. The CMA's first code of ethics: medical morality or borrowed ideology?J Canadian Studies 1982–1983;17:20–32). We believe that these and other factors serve to set out North American countries apart from Europe and the rest of the world.
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Jecker, N.S., Meslin, E.M. United States and Canadian approaches to justice in health care: A comparative analysis of health care systems and values. Theoretical Medicine 15, 181–200 (1994). https://doi.org/10.1007/BF00994024
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DOI: https://doi.org/10.1007/BF00994024