Advisory Council Member, ISSP, uOttawa
Guest Scholar, Centre de recherche en droit public, Université de Montréal
Former Deputy Minister of Health for Canada from 1993 to 1998
I would like to offer some reflections agreed upon on my experience as a former Deputy Minister of Health for Canada from 1993 to 1998. During this period, I experienced the Krever survey on contaminated blood, the redesign of the Canadian tobacco law, the aftermath of the Baird report on new reproductive technologies, the impact on Canada of a plague outbreak in India and Ebola in Nigeria. The management of all these events prompted social, economic and legal reflection of course, but also ethical.
Globally, we are going through a crisis of unprecedented magnitude caused by the spread of a virus that has spread with unprecedented speed that leads us to rethink our ways of thinking and acting. In our rich country we are faced with a situation which brings us and will lead us to make choices which will have to be based not only on quantitative data but also on qualitative data.
These choices should clearly identify the values on which they will be based. To this end, we often mention the common good, the public interest, the general interest, living together, without precisely defining what we are talking about. These are all concepts which, according to the definitions we give them, have a variable understanding and extension. I will focus here on the common good.
A conceptual framework for the common good
The common good as such is almost never defined. For the purposes of my doctoral thesis, based on the experience acquired in the management of several files, I did a literature review on this subject which led me to specify its conception from works of Aristotle and Plato through Thomas Aquinas, Hobbes, Mill, Rawls, Kant, Habermas, Smith, Keynes, Locke, Bentham, Hayek, Friedman, etc. From all these writings two currents emerge: an economic / liberal current (or neo-liberal) and a humanist and social current. The definition that I retained is largely related to the humanist and social current.
This reflection led me to build the following conceptual framework:
The values or principles represented in this model must interact with each other.
Application to the current pandemic
How can such a framework help us in the difficult decisions that we have to make during the pandemic and that we will have to make in the months and years to come? For example, decisions related to containment and deconfinement, the choice of structures intended for the most vulnerable people, the research to be undertaken, the allocation of health resources, the drugs to be developed?
We have been very focused on "cure" in health management and we have often forgotten about "care" and therefore public health. This approach led us to an important hospital-centrism.
Knowing that in 2031, a quarter of the Canadian population will be 65 and over, we must make difficult choices in the development of our public policies - all the more so as the consequences of the economic measures taken during the pandemic will not give us the ability to do whatever we want to do. So like many vulnerable countries, whether we like it or not, we will have to decide on the basis of principles and values not only economic but also social and legal.
Politicians will likely be able to present texts to us that will mention some of the values presented in the model above, but will the implementation be designed to reflect these values? This is the challenge ahead.
For this implementation to be done in a fair, responsible manner and taking into account justice, solidarity and autonomy, it will be necessary, among other things:
- Specify clearly and in accessible language the objectives of the desired laws, measures and standards;
- Establish public consultation processes to properly identify the level of social acceptability;
- Develop continuous partnerships with all strata of the population including the elderly;
- Respect the dignity and privacy of all;
- Evaluate the implementation on an ongoing basis;
- Adequately finance research on diseases but also interdisciplinary public health;
- Agree to contribute to humanitarian aid and the achievement of sustainable development goals.
Such a conception of the common good is not easy to implement because it leads to complex choices that can never satisfy everyone. It is in the level of acceptance of these choices by the population which will frequently have to move from an individualist approach to a collective approach that we will see if the objectives pursued by the common good can be achieved.