L’impact de l’indemnisation des accidents du travail sur le système de santé canadien (1ère partie)

Posted By William Stephenson – Mar. 25, 2013

Au Canada on parle souvent du système de santé public administré par les provinces comme s’il était l’unique système de santé au pays. Il y a cependant plusieurs autres systèmes de soin pour les personnes qui ne sont pas couverts par la Loi canadienne sur la santé.

LE SYSTÈME DE SOIN DES COMMISSIONS DES ACCIDENT DU TRAVAIL (CAT)

L’un des plus importants systèmes hors du système de santé public est celui des Commissions des accidents du travail. Ces commissions sont des organes provinciaux, semi-indépendants du gouvernement qui indemnisent les employés blessés pour des accidents survenus au travail. En 2008, les CAT ont dépensé en somme près de 1,8 milliard de dollars sur les soins de santé et la réhabilitation vocationnelle.

Dans les dernières années, les CAT ont commencé à parfois faire soigner les employés dans des centres privés et permettent, dans certains cas, aux employés d’être soignés avant les gens qui attendent des soins dans le système de santé public.

Ceci soulève donc des questions pratiques et morales, que nous aborderons dans la deuxième partie, quant à la place d’un tel système dans un pays qui cherche à garantir l’égalité de l’accès aux soins de santé en empêchant les individus de payer pour un soin plus rapide, mais qui permet aux CAT de faire soigner les employés blessés avant les individus couverts par le système public.

 

FONCTIONNEMENT ET OBJECTIF

Les fonds d’indemnisation des accidents du travail sont financés par des cotisations prélevées auprès des employeurs qui font partie de certaines industries. La plupart des industries contribuent aux fonds d’indemnisation : en 2007, 89.6 % des employés au Canada étaient couverts par ces fonds d’indemnisation.

À chaque année les CAT calculent les taux de cotisation selon l’industrie et selon le nombre d’incidents survenus chez l’employeur. Ces taux sont appliqués à la masse salariale de l’employeur pour calculer sa contribution annuelle. Les CAT sont donc essentiellement des assureurs établis par les provinces.

Cependant, en payant leur part aux fonds d’indemnisation, les employeurs sont absous de la responsabilité civile pour les accidents et les maladies de leurs employés survenus au cours et à cause de l’emploi. De leur côté, les employés bénéficient d’une indemnisation plus sûre et rapide que celle qu’ils auraient eue en passant par le système judiciaire.

HISTORIQUE

  • 1884 – L’indemnisation des accidents du travail commence en Allemagne : Bismarck met en place un régime obligatoire d’indemnisation.
  • 1913 – Publication du Rapport Meredith en Ontario: le juge Meredith propose un régime d’indemnisation collectif, sans égard à la faute, avec une administration indépendante à l’abri de l’influence politique.
  • 1915 – L’Ontario devient la première province à mettre en place un régimed’indemnisation des accidents du travail.
  • 1931 – Entrée en vigueur de la Commission des accidents du travail au Québec.
  • 1946 – La Saskatchewan devient la première province à adopter un système de santé public.
  • 1984 – Adoption de la Loi canadienne sur la santé : elle établit les critères selon lesquels les provinces peuvent obtenir des fonds fédéraux pour financer leur système de santé. Cependant, la loi ne couvre pas certains groupes de personnes, y inclus : les étrangers, le personnel des Forces Canadiennes et de la Gendarmerie Royale du Canada, les prisonniers fédéraux, et les employés couverts par l’indemnisation des accidents du travail.

Dans la deuxième partie, nous examinerons de plus près l’impact qu’ont les CAT sur les systèmes de soins provinciaux, l’effet de la privatisation et ses conséquences humaines.

Sources :

http://www.awcbc.org/fr/canadianworkerscompensation101.asp

http://www.awcbc.org/fr/historyofworkerscompensation.asp

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645160/

http://www.actuaries.org/CTTEES_SOCSEC/Documents/Canada_Workers_Comp.pdf

http://www.cpsa-acsp.ca/papers-2007/Healy.pdf

http://www.awcbc.org/fr/statistics.asp

Notes from the McGill Research Group on Health and Law’s Annual Lecture

Posted By Jessica Walsh – Mar. 17, 2013

On 30 January 2013, disability rights scholar Anna Lawson delivered the Annual Lecture of the McGill Research Group on Health and Law. Lawson is Deputy Director of the Interdisciplinary Centre for Disability Studies at the University of Leeds (UK).

The lecture highlighted how making progress in disability rights depends on both the achievement of the rights to health and equality. In other words, we need both equality in health (i.e. equality in accessing care, refusing unwanted treatment) and health in equality (i.e. preventing disability status from being a determinative factor in where people live and work). Lawson also stressed the importance of implementing the Convention on the Rights of Persons with Disabilities (CRPD) as well as an integrated approach to disability issues that reaches across disciplines.

Below is an overview of the lecture.

 

Background Facts

  • 15% of the world’s population is disabled
  • 1/5 of the world’s poorest are disabled
  • There is a bilateral link between poverty and disability: if you are poor, you are more likely to become disabled; if you are disabled, you are more likely to be poor.
  • 35% of all children not in school are disabled
  • only 2% of disabled children are enrolled in school
  • disabled people experience disproportionately high levels of unemployment

 

Equality in Health

Disabled people experience significant inequality across the globe. Realizing equality in health means achieving equality in the following areas:

 

EQUALITY IN REFUSING UNWANTED TREATMENT

Most people have the right to refuse treatment with informed consent. Disabled people, in particular girls and women, have been victim to the imposition of treatment such as mental health therapies and sterilisation. The CRPD says imposition of treatment without informed consent is torture and that there are ways for states to support disabled people in exercising their legal capacity in such situations.

EQUALITY IN ACCESSING GENERAL HEALTH CARE

Where health care is available, disabled people should have access like everyone else. However, there are institutional obstacles that currently prevent disabled people from accessing care in the same way as others. These obstacles include lack of accessible transport, inaccessible buildings and medical equipment, lack of sign language interpreters, and lack of awareness and understanding of disability issues by care workers.

 

EQUALITY IN ACCESSING DISABILITY-SPECIFIC TREATMENT

Disabled people may require specialized services related to their particular disabilities. These services place added demands on governments in caring for their citizens.

 

EQUALITY IN ACCESSING UNDERLYING DETERMINANTS OF HEALTH

There should be non-discriminatory access to an adequate standard of living, food, clothing, water, public housing, social protection and poverty reduction programs and disability-related expenses. Stigma can often cause disabled people to be refused these basic services. Therefore, states must challenge the stigmatization of disabled people in order to create access to water and sanitation.

 

Health in Equality

Health plays an important role in trying to realize equality.

 

DISABILITY STATUS RESTRICTS EQUALITY

Diagnoses of disability affect where people live, where they are educated, where they work, and the type of welfare benefits they receive (for instance, if one chooses to receive disability benefits instead of working full time).

 

HEALTH LIMITS THE ABILITY OF DISABLED PEOPLE TO BRING DISCRIMINATION CLAIMS

Disabled people must show they meet a certain definition of disability before bringing a claim for discrimination. This is especially difficult for people with fluctuating health conditions or progressive conditions that fall outside the accepted definition.

 

The Promise of the CRPD

The CRPD was celebrated upon its adoption by the disability movement as the beginning of a new era for disability rights. There are innovative provisions within the convention. For example, Art. 4(3) states that disabled people should be actively involved and consulted by governments in policies affecting them. However, the CRPD does not provide guidance on how actively involve disabled people in these decisions. It is hopeful that these details will come through individual and group complaints to the UN Committee on the Rights of Persons with Disabilities, which has already heard its first case (see HM v Sweden).

 

Conclusion

Going forward, we need to ensure that health does not inhibit equality. Implementing the CRPD will contribute to this goal, but there also need to be inclusive development practices that integrate disability into development frameworks like the Millennium Development Goals.

Take away message: until equality is tackled, disability will be a big problem. We must reach beyond our professional and disciplinary boundaries to begin addressing inequalities around us.

Is Legalizing Physician-Assisted Suicide a Good Idea? – A Debate between Professors Daniel Weinstock and Margaret Somerville

Posted By Silvia Neagu – Mar. 6, 2013

This is Part 2 of the MJLH Online’s recap of the 2013 colloquium on physician-assisted suicide. To see Part 1, on the morning panel presentations, go here.

During the afternoon of the McGill Journal of Law and Health’s 2013 Colloquium, Margaret Somerville and Daniel Weinstock, two professors at McGill Faculty of Law, debated the ethical considerations surrounding physician-assisted suicide. Professor Winstock is a member of the Royal Society of Canada Expert Panel on End of Life Care and Professor Somerville is the author of Death Talk: The Case Against Euthanasia and Physician-Assisted Suicide.

Framing the Issue

According to Professor Somerville, the issue requires us to consider “how we die and whether some ways of dying are ethically and legally acceptable and others are not.” For Somerville,  the inevitable conclusion to this question is that euthanasia is not ethically acceptable. She warns that the euphemistic language conceals the deeper moral issues.

On the other side of the debate, Professor Weinstock advocated that, with proper safeguards,  physician assisted suicide can be part a part of end of life care.  Weinstock emphasized that currently physician-assisted suicide is already occurring tacitly through a “hush-hush wink-wink” approach. He underlined that considering the costs and benefits associated with a change also entails considering the costs associated with maintaining the status-quo. He argued that the current situation is not costless in terms of patient pain and physicians going under the radar.

Individual Rights and Societal Implications

Weinstock emphasized that the issue involves recognition that “individuals have a prima facie interest in making decisions about how their lives are going to proceed, in all facets of their lives.”

On the other hand, Somerville pointed out that the issue should not simply be considered from the individual’s perspective, because it has significant implications at the institutional level, particularly for medicine and law, which are the two “value carrying” institutions in a secular society.

Further, she stated that the debate surrounding euthanasia involves a values conflict between respect for life and autonomy.

In response, Weinstock said that his position is not in conflict with “respect for life.” He emphasized the need to distinguish between biological life  and personhood.

Answering the “What If’s”

Weinstock stated the Commission’s recommendations would, in reality, offer greater protection than the current situation since physicians would not be able to suggest assisted dying. He stated that the change in Canada will likely come in the form prosecutorial guidelines, instructing prosecutors not charge doctors in cases which meet the requirements for physician-assisted suicide.

According to Weinstock, the argument that there will be rampant abuses and that there are currently no abuses makes a presupposition about the morality and psychology of physicians which simply does not make sense.

The “slippery slope” has already occurred in Netherlands and Belgium, according to Somerville. Further, she stated that the comparison with Quebec’s approach to abortion, which  also involved the province declining to prosecute and abortion becoming legal by default,  is not a positive example for the pro-Euthanasia side.  For Somerville, the fact that many pregnancies currently ends in abortion, indicates that legalizing euthanasia is not desirable.

Finding common ground

Despite their different perspectives, both professors emphasized the importance of strengthening palliative care and its availability.


For the first time, the online team recorded the symposium on social media by live-tweeting the event. A collection of all the tweets from the day can be found on Storify. Visit the Journal’s Facebook page to see photos from the event.