The Impact of Personal and Social Philosophies on Health Care Policy

Introduction

The introduction of a scientific model of healthcare and “the founding of medical schools in Canada was inspired by various motives, including the desire of doctors (who invariably founded the schools) to teach along lines of which they approved and to ensure a source of income for themselves. They were supported by those who felt that many Canadians who sought education in the United States were being inadequately trained and were being exposed to dangerous democratic principles… in Canada the schools sought affiliation with universities and maintained high standards of entry, in order to discourage charlatans (or quacks) and to improve the public reputation of doctors.” (Roland)

Today, the Canadian Health Act states that “the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.” (Canadian Health Act, 1985)

But have those policy goals been met? The Canadian Foundation for Healthcare Innovation suggests that “Healthcare in Canada, as elsewhere, must adapt in order to alleviate inequalities and address the needs of the chronically ill and an aging population, especially at a time of fiscal constraint. Some commentators argue that for Canadian medicare to become more cost effective and efficient, it will require expansion to include a range of services currently covered by (privately insured) extended benefits.” (P. 4)

“The physician- and hospital-centric model of healthcare in Canada was not designed to prevent disease or help patients manage chronic conditions. On the contrary, it is optimally designed to treat acute illness over brief periods of time… while modern medicine continues to achieve incredible feats (such as mapping the human genome and finding cures for once untreatable diseases), decades of research has shown that our health is primarily influenced by factors that lie outside the traditional realm of healthcare. Especially as the population ages and experiences increasing rates of chronic disease, the advanced medical care available in healthcare systems in Canada and around the world has less and less

impact on overall population health status.” (Verma, P. 10)

As strain on the system increases, so too does the numbers of patients who are marginalized and discriminated against. Particularly vulnerable to marginalization are those considered responsible for their own health struggles. Patients who struggle with substance abuse issues, the obese, smokers, and anyone whose lifestyle choices may have contributed to poor health are blamed. They are triaged behind those who do not have self-imposed risk factors to consider, and socially condemned as well. Is this just and equal treatment? Some factors in deteriorating health, even when self-imposed, may be born of social issues that need to be addressed so that patients can make better autonomous decisions. Shifting the focus of care to include forms of knowing outside of science, to respecting patients as experts in their own lived experience, and to understanding the philosophical position that both patients and practitioners are working from, could be helpful in shifting power imbalances in health care relationships and policy making, reducing the likelihood of epistemic injustice and silencing.

I would argue that health-care policy makers are influenced by factors both internal and

external to the health care system. As such, seeking health policy solutions within the bio-medical model exclusively is likely to be counter-productive. Values based discourse at all levels of health care policy making could help reduce barriers to access, ensuring more universal care for a broader range of Canadians.

Section 1: Known problems with current policy

The principle of comprehensiveness as outlined in the Canadian Health Act, is not a social reality. By striving for universality of care we are actually creating further inequality. Patient care is always about individuals, yet health care itself favors statistical data, and looks for consistency in symptoms, risk factors, and illness progression as a means of both diagnosing and better managing individual cases. Patients who are atypical, falling outside of the average, are more vulnerable to misdiagnosis and mismanagement of treatment.

The scientific model of care creates a power structure that silences discourse that is based on alternative forms of knowing. Healthcare is more prescriptive than interactive. Patient input is valued primarily when it helps inform science. But would it be better if the default was to pay close attention to patient input? Discounting patient presented issues should not be

an option without sound evidence to support that decision. If it is impossible to guarantee an accurate diagnosis or the best treatment, would it not be better to be attentive to a broader range of voices and types of information?

Our health care model is concurrently scientific and economic. The patient/practitioner relationship has become more like that of a service provider and client as visit times have become steadily shorter. Patients approach the system with health issues and are usually provided with practitioner directed healing goals that they work toward. Long-term illness and disability are viewed as deficits rather than differences within most of Western society. Even with federal and provincial coverage and third party insurance coverage, approximately 14% of Canadian health care costs are covered out of pocket by patients and their families. Yet, patients and their families have little say in what options will be available to them. If they prefer massage therapy to pain management medications, or counselling to anti-depressant drugs, they may have to cover those costs themselves. Preventative health measures,

including nutritional support, adequate housing, and connection to community and to social services that already exist, are an overlooked element in most physician treatment plans. Doctors do not have adequate time to manage these factors, leaving them in the domain other public health and social services, which can mean that patients are not made aware of the existing services, and therefore do not access them. Even when initiatives to engage the public are implemented, they are created by the existing health care system, and are single perspective biomedical in nature, engaging those who are on the fence about certain health issues, or those who are already interacting with the health care system, rather than those who are the most marginalized.

The initiatives to develop services and engage the public in using them are decided upon by policy makers, whose decisions are influenced by both internal and external factors. Externally, they must function in a policy environment that is complex, involves multiple policy sectors across levels of government, and is polarized on how to manage spiking statistics of chronic illness, mental illness, drug addiction, and other health crisis items. Our triage system forces policy makers to strike a balance between multiple budget items that are all valuable but are not all affordable at the same time. With all of the influences in healthcare policy making, equality is not a social reality, even though we are striving for universality of care nationwide. In order to help create a more balanced budget to manage a broader range of health care needs, it is imperative that a variety of voices inform policy. Stakeholders in medical policy include physicians, nurses, and all related medical staff, trained exclusively in the allopathic medicine model, and heavily influenced by pharma-drug corporations. The

voices of the educated and politically connected are more resonant than those of the general public, and especially the marginalized minorities. Still, the largest stakeholders group is the general public.

The majority of Canadian’s don’t tend to think critically about medicine and healthcare until something goes wrong with their health, and then they tend to consider only the emergency room, clinic, or doctor’s office as possible access points for treatment, primarily in the form of prescription drug therapies or surgery. While most Canadians are not engaging with personal health or with health care policy items enough to positively impact our public health statistics, pharmaceutical drug companies are engaging medical professionals and the public alike.

How has the corporate model of social engagement become so successful?

Some pharmaceutical-drug related issues are attributed to circumstances that have changed since the Canada Health Care Act was first passed. Prescription drug errors are currently the second most common cause of preventable death in Canadian hospitals. Over-prescription of certain drugs may be a contributing factor to opioid addiction rates. Burgeoning drug overdose crisis, rapidly rising mental illness statistics, and booming chronic illness is taking its toll on healthcare providers and health care facilities. Mental health care has undergone dramatic change in the past decades and it is important that policy develop around current needs. Psychotropic drug therapy has dramatically reduced the number of institutionalized mentally ill persons. But are medication and institutionalization the only options? Non-drug therapies such as talk therapy have shown promise in effectively treating mental illness. Should talk therapy be a funded treatment option for the mentally ill? Should patients be

advised of talk therapy as an option? Who should advise mentally ill patients? Are there biases in treatment options and their availability now? How can mental health treatment options better represent a broader range of patient values?

In her book, Health Care In Canada: A Citizen’s Guide to Policy and Politics, Katherine Fierlbeck states: “In the past, physicians were seen as the front line defense against problematic drugs, but given the huge increase in the number of drugs and the number of people prescribed drugs…it has become unrealistic to expect doctors to maintain an encyclopedic knowledge of all current drugs, including side effects or the thoroughness of clinical trials.” (P. 163) Since this role of protecting patients from drug issues has been transferred to police and the justice system, addiction rates have not decreased and overdose rates have skyrocketed to the highest they have been in history. Naloxone kits may help reduce overdose death statistics, but they do not target addiction rates themselves. In

addition to personal choice, there are social factors that must be considered in health planning related to addiction. While not traditionally the realm of medical doctors, basic human needs are not being consistently met, precluding many patients from effective care. Without access to regular meals, clean water, housing, and adequate clothing, it is impossible to maintain an appropriate level of health care for any individual. Scientific advancement cannot take the place of the necessities for life. What would it look like if health care policy were expanded to include basic human needs in modern medicine?

All of these external factors strain the system and add to the difficulty of health policy development. Additionally, the issues policy makers address and how they address them is further influenced by personal and social philosophies, some of which are commonly unexamined. Patients complain of epistemic injustices in the system and healthcare practitioners are overworked and stressed. From a policy perspective, the focus is on managing the external factors; how to optimize care while minimizing expense. But we must recognize that we bring our past with us in discourse and it underpins our reasoning and decision making. In the struggle to appropriately triage, manage risk, and utilize

allopathic diagnostics and treatment of illness, the patient voice has been lost.

Epistemic injustices are rampant because neither patient, practitioner, nor policy maker internal influences are adequately considered in health care decision making at a personal or social level. Miranda Fricker defines two types of epistemic injustice; testimonial injustice and hermeneutical injustice. The first refers to undermining an individual’s authority as a speaker and the second refers to undermining an individual’s credibility as a knower. It is clear from doctor’s complaints that patient discourse usually does not inform diagnosis or treatment, that they are not seeing the patient as a knower and are reluctant to spend precious clinic minutes on allowing the patient a speaker role. It is not surprising then that patients are not feeling heard. It is vital that we understand our pre-existing philosophical position and those of our health care providers and policy makers in order to have dialogue that is respectful of

individual values and to avoid this type of epistemic injustices.

Decisions made regarding preventative health, disease diagnosis and treatment, and critical care are all strongly influenced by personal values. Similarly, decisions regarding health care as a social system are influenced by the philosophical beliefs of the decision makers, sometimes without their awareness. By prioritizing values and relationships in health care, a different kind of dialogue is made possible; dialogue that is more negotiative than prescriptive. Dialogue that is inclusive of individuals and their needs.

How can we make health care policy more sensitive to the epistemic concerns and values of all the participants?

Section 2: Identifying the role of values in health care choices

Some factors that contribute to the lack of philosophical introspection in our current health care system include history of biomedical primacy in funding and government support, media influence, social influence, and pharmaceutical corporation influence. This includes the predominant philosophy driving all public decisions: the utilitarian principle to do the greatest good for the greatest number, governed in turn by the economic principle that this must be done at the least cost. Applying these principles to data and scientific evidence based medicine has marginalized all other forms of knowing. Regardless, it is impossible to deny that other forms of knowing can help inform heath care decision making.

Consider intuitive knowing as in a case study of a maternity nurse in the role of a patient delivering her first child. At a certain point in her labor, the woman became highly agitated and insistent that something was wrong with her baby. Her colleagues who were attending her attempted to soothe her, assuring her that experiencing birth is very different from attending birth and what she was feeling was entirely normal. Because she knew the hospital staff well, the mother got up from her hospital bed and called the obstetrician working on the ward herself. Once he examined her he was able to confirm that something was indeed wrong. The baby was in distress, his heartbeat almost undetectable, and an emergency caesarian was the only way to save him. The mothers intuitive knowing ultimately saved her

sons life. Would her colleagues have viewed her as a knower and allowed her the role of speaker had she been on staff rather than a patient? As it stands, in her role of patient, the mother was silenced and the outcome was very near fatal.

Medical professionals are trained to focus primarily on physical symptoms and progression of disease. They are trained to maintain professional distance from their patients which may preclude them from connecting with their patients in a way that allows them to really hear what the patient is saying, both to inform diagnosis and in assessment of the supports that their patients need. Dr. Rana Awdish describes physician disconnectedness in her book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” She believes that medical training enforces a disconnect that increases suffering for both patients and physicians and that is dangerous in that the patient is a valuable source of information and should never be discounted. She believes that contrary to the commonly accepted emotional distance in patient/practitioner relationships, “It is entirely possible to feel someone’s pain,

acknowledge their suffering, hold it in our hands and support them with our presence without depleting ourselves, without clouding our judgement. But only if we are honest about our own feelings…When chaos and uncertainty swirl around us, and the darkness envelopes us, having someone by our side who has seen the darkness before, who can map our path toward the light, who can be our eyes as we fumble in the dark, that person is a gift.” From both patient and practitioner perspective, there is room for better connection and communication, and deeper respect for individuals and their values.

By ignoring values, we continue to perpetuate cultural wrongs. The mistreatment of Indigenous

Canadians that continues up to the present provides strong evidence that values based discourse must be inclusive of more than a single perspective or single set of values. If Canada is sincere in its efforts to correct the harm that has been done in past, a broader range of values must take the focus moving forward. In health care, epistemic silencing proliferates when practitioners don’t see their patients as knowers and are not open to the concept of forms of knowing outside of science having clinical value. While the physician may regard scientific knowledge exclusively, the patient remains the expert in their

phenomenological experience and certainly has much to offer in perspective. Our current focus on reconciliation with Canada’s Indigenous populations, equality for LGBTQ individuals, rights surrounding abortion and dying, and other health related social justice issues, all require values based discourse that is informed by a broad spectrum of perspectives.

Imbalance in power dynamics between patient and practitioner is significant. The most crucial concern is that the values of the patients are not heard or incorporated in policy the way that practitioners’ voices are heard. Policy has so far assumed that practitioners of science-based medicine hold shared values and those values are the right basis for policy. The failures of Canada’s health policy as described in the previous section show that this assumption of a single right value system cannot be maintained. Kidd and Carel identify two forms of epistemic complaints in healthcare practice that should be considered when assessing why patients are excluded from some forms of health care discourse: Patient complaints and physician complaints. Patient complaints “…typically take the form of reports that healthcare professionals do not listen to their concerns, or that their reportage about their medical

conditions is ignored or marginalized, or that they encounter substantive difficulties in their efforts to make themselves understood to their diagnosis and treatment.” Conversely, physicians “…often complain that patients provide medically irrelevant information, make odd statements and superfluous remarks about their condition, or otherwise fail to contribute epistemically to the collection of medical data. Taken together, a difficult epistemic situation emerges in which neither group can engage in effective testimonial and hermeneutical relations with the other.” (Kidd, Carel, P.172-173) This type of silencing does not work in the interest of informing either the patient or the practitioner. More balanced discourse is required for practitioners to better understand the needs of their patients and how they could best advocate for them at the policy level.

What is essential to realize is that the values aligned with allopathic medicine and a biomedical model of illness cannot accommodate several key aspects of Canada’s multicultural population. “Cultural and professional models of illness influence decisions on individual patients and delivery of health care. The biomedical model of illness, which has dominated health care for the past century, cannot fully explain many forms of illness. This failure stems partly from three assumptions: all illness has a single underlying cause, disease (pathology) is always the single cause, and removal or attenuation of the disease will

result in a return to health. Evidence exists that all three assumptions are wrong.” (Wade/Halligan) “By embracing reductionism, however, biomedical models of illness combine several closely related sets of beliefs. These can be summarized as follows:

•  All illness and all symptoms and signs arise from an underlying abnormality within the body (usually in the functioning or structure of specific organs), referred to as a disease

•  All diseases give rise to symptoms, eventually if not initially, and although other factors may influence the consequences of the disease, they are not related to its development or

  manifestations

•  Health is the absence of disease

• Mental phenomena, such as emotional disturbance or delusions, are separate from and

  unrelated to other disturbances of bodily function

• The patient is a victim of circumstance with little or no responsibility for the presence or cause of the illness.

• The patient is a passive recipient of treatment, although cooperation with treatment is

  expected.” (Wade/Halligan, P. )

Section 3: Linking diversity of values to health care policy

Prioritizing values does not only mean hearing the patient’s voice within the existing system, but also considering the elements of health care that are important to them outside of the current system. There are a number of examples of where diverse values should give patients different options for action within the system. Cultural traditions and religious beliefs already shape direction care in some cases, and personal philosophies and preferences are emerging as important elements of care that is respectful of patient values.

We lose a certain amount of our autonomy when we engage with health care. How much are patients willing to give up? How can the health care system better meet more patients where they are at? How much voice should patients have in their own health care planning? Improved patient engagement and rights recognition is particularly important now, as the health care system is strained and dependent on patient self-management of illness. Patients who have a voice are more likely to research their options and advocate for health care that is aligned with their personal needs and values, increasing the likelihood of long-term patient engagement with prevention and management of illness.

Transparency matters to patients. Dialogue can improve transparency, boosting patient confidence in care. There is a tendency to view damaged trust in the medical system as an indigenous or marginalized minority group issue, however, limited access to information, misinformation, misdiagnosis, prescription drug errors, and medical/surgical errors all damage the trust of Canadians, and lack of transparency regarding these issues only compounds mistrust. According to a 2022 Statistics Canada report, “Most studies of medication error have been based on data gathered from clinical records, which are well known to yield incomplete information. Partly because of fear of reprisal, very few incidents—probably only the 5% or so that are considered potentially life-threatening—are noted in patients charts. Therefore, from a review of clinical records, it is not possible to assess the true

frequency of medication error, nor to identify the circumstances that contribute to such error.”

Medical error remains the third leading cause of preventable death in Canada, and although virtually undiscussed, certainly impacts confidence in the system. Considering the focus on reducing preventable deaths caused by smoking and suicide, two of the other leading causes, it appears as though the perception of risk associated with our medical system and its errors may be intentionally minimized. As Dr. Robson, a physician in the Winnipeg Health Authority puts it, “You have to tell people that patients are getting hurt. As long as the public doesn’t realize that one in 13 people coming into the hospital will experience some kind of adverse event — and that’s the conservative estimate — then there isn’t any pressure to say, ‘Listen, fix these damn things.’ ” Research suggests that these errors are the result of combinations of factors, rather than individual mistakes, and could be dramatically reduced if the current health care system was not so strained for resources. External factors including understaffing at

hospitals, excessive time constraints, inadequate health care structures, and budget constraints have all contributed to significant increases in negative health outcomes for patients.

While patient advocates play a valuable role in helping ensure that patient voices are heard in personal healthcare decision making, patient voices are also important when it comes to stakeholders influence on the direction of health care. The pre-existing biomedical system maintains positional authority in stakeholder influence currently. This limits the potential for exploration of alternative forms of health care and health care decision making. Policy decisions impact all Canadians and it is reasonable that as many Canadians as possible should have their needs represented. Greater equality at a policy level must be borne of a better understanding of the values of broader range of citizens. Additionally, social

determinates of health and well-being may prove invaluable in improving overall health statistics. Better education, reduced unemployment and homelessness, and relevant social supports may not be considered part of healthcare, but these factors have a profound impact on public health.

In some health care sectors, alternative and supportive therapies are already successfully offering patients access to vital care. For example, midwifery practice in Northern Canada has reduced risk and harm statistics associated with pregnancy and childbirth in remote areas, equalizing them with those of Canadian woman with access to medical doctor and hospital care. Similarly, physiotherapy has greatly improved long-term healing outcomes for trauma victims across the country. Both of these alternative forms of medicine reduce treatment costs and have helped ease pressure on the overburdened existing medical system.

Canadians already do embrace a variety of alternative therapies and usually with very

positive feedback: Traditional Chinese medicine, acupuncture, reflexology, massage therapy, light therapies, aromatherapy, Indigenous Traditional Healing, chiropractic, and a lengthy list of others. Further, almost three quarters of Canadians regularly consume natural supplements in the form of vitamins, minerals, herbs, and oils. This begs the question: Should these therapies be acknowledged as important parts of patient health and healing because they have proven important to individuals? Should alternative health practitioners have a more resonant voice in the patients’ health care team? If these therapies provide real benefit, should patients be made aware of them and provided with access to these supportive and alternative therapies as part of Canadian public health care? From legalization of medical marijuana, to midwife attended childbirth, to massage therapy, the existing medical system is opening up to alternative therapies. By engaging in philosophical discourse surrounding what feels most

comfortable to the individual, a model of care that provides for a more diverse range of patient needs is made possible. It is important to bring a broader scope of Canadian voices to the table. A more inclusive system is not only inclusive of all people, but inclusive of the elements of healing that they value.

In examining areas of health care that boast greater inclusivity of alternative methods of care, we can see that the evidence is clearly supportive. Under the midwifery model of care, inclusion of a broader spectrum of social, emotional, spiritual, and intellectual needs in patient health plans has succeeded in significantly reducing harm, improving patient engagement with health care, and improving satisfaction with the overall care experience. “The Canadian Association of Midwives (CAM) is an organization that is rooted in the feminist movement and has a history of commitment to human rights and social justice.

It is [their] goal to pursue visionary leadership in [their] work on these issues within the Canadian and global healthcare context. [They] are committed to including transgender, queer, intersex and marginalized communities in [their] central dialogue and ensuring that CAM is inclusive in its statements, actions and in all aspects of its work. These priorities are not established by the needs of the majority but by the importance of the inclusion of all people.” Midwifery inclusivity also maintains a focus on inclusion of Aboriginal communities, those in remote locations, and all marginalized people. They have been tremendously successful in improving health care statistics for women and infants across the country. Although midwives have existed since women have given birth, they were deeply maligned following the late 1800’s/early 1900’s and women were strongly pressured to birth in

hospitals, attended by almost exclusively male doctors. Midwives lobbied against this marginalization, fighting tirelessly for women’s rights, until midwifery was finally legalized in Canada in the 1990’s. Today there are about 250 midwives practicing in British Columbia, with ever growing demand for increase to that number. Amazingly, these women delivered over half of BC babies each year since 2010, a testament to how deeply important inclusion and freedom of choice are to birthing women, their partners, and families. Further, “Midwifery provides vital services in areas where there is a healthcare vacuum, such as in remote northern communities… There are communities that don’t have maternity services. Midwives can fill that void.” Although midwifery was marginalized by the medical

community until relatively recently on basis of risk associated with home birth or birth without a

physician present, studies consistently indicate that even in remote rural areas, home births attended by midwives are no more risky to mothers or infants than hospital or clinical births attended by physicians. Given the tremendous success of midwifery as a “case study” of integrative and inclusive health care in Canada, it is quite feasible that the policies midwifery is built on could be expanded to help overcome marginalization in other areas of health and medicine.

Another Canadian example of the success of a more integrative, values based approach to health care, in the context of a specific hospital and health care jurisdiction, is Toronto’s Mt. Sinai Hospital and Bridgeport Health. These organizations were each founded to provide care to marginalized patient populations. The legacy continues today with Sinai Health System’s commitment to health equity and to providing exceptional care that is accessible to all members of the local community. "We will work with communities and community organizations to promote healthcare services and research aimed at eliminating the health risks associated with discrimination, marginalization, and social inequity.” Extensive research conducted through Mt. Sinai health care jurisdiction has found that empowered patients realize better health outcomes overall. So how do they empower patients? With education,

respect for their decisions, and supportive health care teams that are inclusive of a broader range of professionals and patient-selected members.

Global statistical evidence also supports improved focus on patient values and individual needs and a more integrative health care system. Chinese patients tend to be far more involved and proactive in their health care decisions, as they are responsible for choosing between multiple, equally funded, options for preventative health and treatment of illness. Traditional Chinese Medicine (TCM) is realizing a continually growing scientific evidence base, largely due to China’s support and financial backing of the ongoing study of TCM alongside biomedical medicine, rather than secondary to it. This suggests that the

same scientific advancement and evidence base in other alternative therapies may be possible if existing policies are adapted to allow for greater equality in allopathic and alternative research and development funding.

In Canada, there are existing areas of health care that do allow for an integrative medicine approach. Besides maternity and infant care, mental health therapies, physiotherapy, and Indigenous people’s medicine tend to integrate allopathic and alternative medical practices. Patient outcomes have been very promising in the health care sectors utilizing integrative medicine. Midwifery boasts reductions in medical intervention in child birth of approximately 85%, drastically improved maternal and infant emotional health outcomes, and both short and long term health benefits. Those who receive non-pharmaceutical therapies for illnesses, either in combination with pharmaceutical therapies or exclusively, show better long-term health outcomes with reduced side-effects. This is true of both mental and physical illnesses.

Socially, however, we remain sceptical of alternatives and continue to use

biomedicine primarily. It is important to understand the factors that we are basing our perceptions on before we make decisions that impact both personal and public health. Within the equation we must recognize the power of pharma-drug corporations to influence professional and public perceptions regarding health and health care. They fund approximately 75% of mainstream media through their advertising dollars, pay for curriculum development and student scholarships within medical schools, fund their own private testing of their products, pay for peer-reviews in medical journals, and hold enormous power within international politics. Pharmaceutical companies are for-profit, and their primary incentive is financial. This has a direct effect on all other aspects of health care as they are so central to our model of care. There is almost no injury or disease that is not treated primarily with drug

therapy. This approach is crippling not only our medical system, but also the health of both Canadians and Americans, who consume over 75% of the drugs produced globally. Our health statistics are not improving with our heavy dependence on drugs. With one third of Canadian adults considered dependent on medication for survival, and every medication coming with long term usage warnings, we are in the midst of a health crisis, and most of us are not aware of it.

Evidence does not support the sustainability of the current direction of health care policy. Nine of the top ten pharmaceutical drug corporations today spend more money on advertising than they do on research, with most of their marketing directed at physicians themselves, and their campaigns are working. If constructive social change is to occur, open discourse is an essential first step. Policy makers and medical personnel must be involved, but so too the public. Patients must be aware of and engaged with their rights and preferences in order to exercise them effectively. Human rights perspective education regarding health and our health care system could help reduce the instances of epistemic injustice by broadening

philosophical social views and potentially improving social acceptance of the marginalized. Our social philosophy toward health care is not rational simply because it is espoused by the majority. We must dig deeper into the sources of the beliefs and attitudes that underpin and inform personal health decisions and health policy to provide a more inclusive structure for all Canadians.

There is a growing stakeholder voice that suggests amendments to prescription drug policies are necessary, and could play a role in reducing the ongoing opioid addiction issues in our society. Could tighter regulation of all opioids, including those prescribed for medical use, improve the rates of opioid addiction we are seeing currently? The goal in this case would be to ensure safer, less addictive medicine options for patients to offset prescription drug addictions. It is not entirely uncommon for opioid addiction to begin with prescription use, forcing patients to manage opioid withdrawals when their doctor decides that they no longer require their medications, or to seek those substances from an alternative source. Perhaps we need to rethink the role of medicines in our society from a policy perspective. We have become dependent on medication to fix the effects of increased stress, less wholesome diet, and hyper speed lifestyle. Using drug therapies increasingly liberally to treat an ever growing array of disorders, including those that could quite likely be resolved with lifestyle adjustments,

has had an impact on overall health in our society. Pharmaceutical drug policy and its relationship with public health remains an area where more evidence would be benefit policy decision making.

Conclusion

In the midst of our current health crisis, all stakeholders have a common general goal; to improve overall health and access to health care for all Canadians. Sadly, the variances in their reasons and proposed methods for achieving the common goal are the very thing that is stalling much of the policy change that could have a positive impact. Healthcare policy makers must continually strive to balance proactive and reactive policy. How do we balance the needs of spiking numbers of current patients and their families with prevention of future health crisis among the vulnerable?

Public opinion and lack of policy support often work against policy change. The perceptions of the public are not always borne of thorough research but that does not render them powerless. Social education regarding the dynamics of health, illness, and the healthcare system could be a useful tool in helping prevent the spread of misinformation and unfounded judgements. Improved understanding of the philosophical dynamics of healthcare across policy sectors could help inform both the public and the policy makers in a meaningful manner.

This article suggests that we need to ask a wider range of questions, and answer those questions with more explicit discussion of the values Canadians hold. What voices are currently engaging within healthcare? Where is additional research-based evidence needed? What types of knowing could help better inform policy? Our current medical system is in a continuous state of evolution, learning from past experiences and continually striving for improvement in health care policy and practice. Do all humans automatically have the right to the best treatment? At what point is it possible to exclude individuals from care? Policy change could impact equality through hearing a broader range of voices, exploring a broader range of value systems and philosophical positions, and recognizing more forms of knowledge than the strictly scientific.

Although the public does hold power, most of the pushback against policy changes in healthcare that would allow for a more diverse and inclusive healthcare system comes directly from physicians and other biomedical employees and from pharmaceutical drug corporations. This makes sense considering that they are the stakeholders who could be negatively economically impacted by such a policy shift. But it is unlikely that their pushback will remain weighty enough to balance the rising demand for more options in healthcare if more individuals engage with their personal health, identifying and asking for a more meaningful, individualized approach to health.