I discussed above some of the reasons why states may be reluctant to recognize Indigenous health rights, in particular, as legally enforceable. There are also many general reasons why states may be reluctant to recognize enforceable health rights. These include concerns about escalating costs. See, for example,
Jackman, M.,
The Implications of Section 7 of the Charter for Health Care Spending in Canada (
Saskatoon:
Commission on the Future of Health Care in Canada, 2002), at 11–16,
available at <
http://www.srap.ca/publications/jackman_the_implications_of%20section_7.pdf> (last visited January 22,
2013). They may also reflect practical challenges. For example, in Canada health care services have developed in a complex fashion, with roles having been spread out and between multiple entities. These include federal and provincial governments, as well as municipal ones. Health care regulatory bodies, local health authorities, regional health care entities and of course individual health care professionals are all involved. In such a context, baseline accountability has proven to be a political and practical challenge. Commenting on the accountability problem, see
Flood, C. Sinclair, D., and
Erdman, J., “Steering and Rowing in Health Care: The Devolution Option,” Queen's Law Journal
30 (2004):
156–
204, at para. 1: “[W]here does a patient turn when told there is no hospital bed available? To her physician, the hospital, or the provincial government of the day as represented by the Minister of Health? When a nurse is worried about the impact of a part-time rather than full-time employment policy, to whom does she turn for answers? Does she look to the collective agreement, bargaining agent, hospital CEO or board, or to the provincial Minister of Health? Should these protagonists look, in extremis, to the federal Minister of Health? The answers to these inquiries are ambiguous at best; at worst, there are no answers. Who is accountable for health care?”.
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