That all men are equal is a proposition which, at ordinary times,
no sane individual has ever given his assent. —Aldous Huxley
For many of our professional associations, health care transformation translates into more government dependency, as they seek ever more resources from taxation. For most physicians, I believe the opposite is true. The emphasis (for example at the last CMA General Council) on seeking equality, or equity, raises the question: what do the terms really mean?
We live in the third most sparsely populated country on earth. Equal care across the land is a practical impossibility. Metropolitan dwellers in need of emergency critical care for catastrophic illnesses will always have better access and outcomes than those living in smaller communities.
There are variable complication and survival rates for treatments in different hospitals. Individual physician expertise and success rates vary. Physicians have insider knowledge of whom we perceive to be the best doctors. Not everyone has that knowledge and, even if they did, might have difficulty making use of it. Equality is a myth, and will remain so, until all diagnosis and treatment is automated and performed by universally available intelligent robots.
Equitable distribution of resources does not, of course, correlate with equal. Equitable availability of health care introduces the concept of fairness and thereby subjectivity. It raises ethical questions relating to lifestyle-induced health problems (for example, smoking, alcohol, drugs, boxing, hockey, and so on). Professional athletes risk injuries in order to earn multi-million-dollar paychecks.
An oncologist recently pondered the issue of new life-prolonging drugs for patients with terminal illnesses. Who will authorize treatment costing $20000 per week for a 3-month life extension? Will those who are not offered the treatment have the option of paying for it? Equality is maintained when either everyone or no one gets the treatment.
Tommy Douglas wanted good basic care for all, but did not set a ceiling on what citizens could access for themselves. When his daughter (actress and medicare supporter Shirley Douglas) received poor nursing care in the public system, he hired private nurses to care for her.
Early in 2014 (after a 5-year wait), these and similar issues will be placed before a judge of the BC Supreme Court. Such arguments will be heard in the context of a constitutional challenge to inappropriate rationing of access and care in Canada. We expect an impartial, evidence- and fact-based decision. It is unfortunate that we as a profession, and our governments, have abrogated our responsibility for leadership in achieving transformation of our health system. We must now depend on our legal system to enforce necessary change.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
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- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org