Martha Jackman

The Future of Health Care Accountability: A Human Rights Approach

Published by Ottawa Law Review

2016 The paper argues that there is an urgent need in Canada for a human rights approach to health care accountability. Taking as its starting point that health care decision-making must respect Canadian Charter and international human rights guarantees, the paper contends that accountability mechanisms, both in relation to the overall performance of the health care system and individual access to care, must be designed to reflect and reinforce these fundamental human rights principles, not only as a matter of domestic and international legal obligation, but in order to be effective. To make this case, the paper first provides a brief overview of the concrete steps governments have taken towards implementing the various accountability reforms that have been put forward in Canada over the past twenty years. It then considers the implications of the absence of a human rights approach to health care accountability, particularly for those whose needs are least well served within the current system. The paper goes on to suggest that what is required, moving forward, is not only the recognition that health care is a fundamental right, but the creation of institutions and mechanisms capable of enforcing that right at both the access to care and system performance levels. The paper points to the Alternative Social Charter as one possible model for achieving effective accountability within the health care system: a critical reform for the future of health and human rights in Canada.

URL: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2746855

Rights Based Strategies to Address Homelessness and Poverty in Canada: The Charter Framework

Published by Advancing Social Rights in Canada

2014 This chapter explores the extent to which a domestic constitutional framework exists for a rights-based approach to housing and anti-poverty strategies in Canada, compatible with, and informed by, international human rights law and jurisprudence. Particular attention is paid to four Canadian constitutional provisions: 1) the commitment to provide public services of reasonable quality to all Canadians, under section 36 of the Constitution Act, 1982; the right to life, liberty, and security of the person, under section 7 of the Canadian Charter of Rights and Freedoms; the right to equal protection and equal benefit of the law, under section 15 of the Charter; and Canadian governments’ obligation, under section 1 of the Charter, to balance and limit rights in a manner that is reasonable and demonstrably justifiable.

URL: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2696250

Section 7 of the Charter and Health-Care Spending

Published by The Fiscal Sustainability of Health Care in Canada

2004 This paper address three questions relating to section 7 of the Canadian Charter in the health care context: whether section 7 guarantees a right to refuse unwanted health care; whether it establishes a right to receive care; and whether it guarantees the right to provide health care services. The implications of the section 7 requirement that deprivations of life, liberty or security of the person must be “in conformity with the principles of fundamental justice” is also considered. In the individual treatment setting, principles of fundamental justice can be met by ensuring that patients participate fully in decisions about their own care. In the policy and regulatory setting, fundamental justice can be met by ensuring that decisions relating to health care services are publicly debated before implementation. To ensure meaningful participation at the individual level, health care providers may need to spend more time with patients. At the institutional level, increased accountability of decision-making may also be more time-consuming and therefore more costly. However, such expenditures are likely to be outweighed by the savings achieved through more effective health care decisions.

URL: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2696232

Constitutional Rhetoric or Social Justice? Reflections on the Justiciability Debate

Published by Social Justice and the Constitution - Perspectives on a Social Union for Canada

1992 The Ontario government’s initial efforts to put a social charter on the Canadian constitutional reform agenda were welcomed by poverty rights advocates across Canada, who lamented the absence of explicit reference to social rights in the 1982 Charter. However, no government seems prepared to support the entrenchment of anything stronger than a declaration of good intentions. The chapter challenges conventional arguments relating to positive versus negative rights; judicial competence and the pursuit of rights as a mechanism for social change, that underlie the prevailing critique of justiciable social rights. It concludes that, by rejecting the justiciablity of social rights, Canada’s First Ministers have lost a precious opportunity to transform the Charter into a more faithful reflection of the social values and aspirations which the vast majority of Canadians share.

URL: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2699628

Charter Equality at Twenty: Reflections of a Card-Carrying Member of the Court Party

Published by National Journal of Constitutional Law

2006 On the twentieth anniversary of the Canadian Charter's equality guarantees, the author reviews the record of Charter litigation as a means to redress inequalities in Canada and concludes that it is mixed at best. Far from undermining Canadian democracy, the Charter provides an important and legitimate avenue for challenging growing social inequities. Yet, low income litigants invoking the Charter have met with limited success due to a series of presumptions, including that social policy is beyond the legitimate purview of the courts, and that the state is neutral in its dealings with the poor. All in all, the author suggests, the relationship between rights and democracy is far more nuanced than the Charter critics argue, and the real question is not whether the Charter and the so-called Court Party are destroying democracy, but rather how the Charter's equality rights can inform and contribute to further strengthening the underlying values of our democratic system.

URL: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2699654