Search

Access to Care, Access to Justice: The Legal Debate Over Private Health Insurance in Canada Edited by COLLEEN FLOOD, KENT ROACH and LORNE SOSSIN. Toronto: University of Toronto Press. 2005. [...]

The year 2012 marks the fifth anniversary of the Environmental Goals and Sustainable Prosperity Act (EGSPA). The Act is an experiment in improving government performance in promoting sustainable prosperity through the process of setting legislative goals and enhancing accountability. This article provides an overview of the Act and an assessment of its performance over these first five years. As such, it supplies the context for the other contributions to the collection of essays on EGSPA in this issue of the Journal. The authors conclude that the Act has had a positive impact on government action on sustainable prosperity and that there is room for improvement, particularly with respect to the overall goal of integrating environmental protection with economic prosperity. The article concludes by offering some recommendations to strengthen the Act. [ABSTRACT FROM AUTHOR]

The article discusses the significance of economic charges for ocean dumping. It provides an overview of the ocean dumping problems which includes analysis of the failures of the current direct regulatory regime. It explores the economy theory of a charge approach to environmental problems. It discusses legal issues of ocean dumping charge.

An interview with William Lahey, director, Dalhousie Health Law Institute is presented. When asked about the significance of self-regulation in nursing, he asserts that nurses establish and enforce the profession's values, and standards for education and practice. He discusses the consequences of failure to deliver self-regulation, citing the case regarding the General Medical Council (GMC) in the U.K. It is suggested that nursing regulators should focus on benefiting nursing self-regulation. INSET: 10 ways to participate in self-regulation.

As Canada's population ages, frailty - with its increased risk of functional decline, deterioration in health status, and death - will become increasingly common. The physiology of frailty reflects its multisystem, multi-organ origins. About a quarter of Canadians over age 65 are frail, increasing to over half in those older than 85. Our health care system is organized around single-organ systems, impairing our ability to effectively treat people having multiple disorders and functional limitations. To address frailty, we must recognize when it occurs, increase awareness of its significance, develop holistic models of care, and generate better evidence for its treatment. Recognizing how frailty impacts lifespan will allow for integration of care goals into treatment options. Different settings in the Canadian health care system will require different strategies and tools to assess frailty. Given the magnitude of challenges frailty poses for the health care system as currently organized, policy changes will be essential.

Consideration of ethical and legal themes relating to frailty must engage with the concern that frailty is a pejorative concept that validates and reinforces the disadvantage and vulnerability of aging adults. In this chapter, we consider whether a greater focus on frailty may indeed be part of the solution to the disadvantages that aging adults face in achieving equality and maintaining their autonomy within systems that have used their frailty to deny them equality and autonomy. First, by examining equality both as an ethical norm and as a requirement for protections against discrimination, we raise questions about the grounds on which health providers and health systems can be required to give equal concern and respect to the needs of frail older persons. Second, we explore autonomy and identify the tension between meaningful self-determination and prevailing ethical and legal norms associated with informed choice. Third, we argue that a proper understanding of frailty is essential within both of these themes; it respects equality by enabling health providers and systems to identify and address the distinct care needs of aging adults and helps to align informed choice theory with appropriate processes for decision-making about those needs., (2015 S. Karger AG, Basel.)