The Milbank quarterly
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The Milbank quarterly · Jan 1988
Medical politics and Canadian Medicare: professional response to the Canada Health Act.
The Canada Health Act of 1984 served as a lightning rod for profession/government conflict, culminating in a 25-day doctors' strike in Ontario. The act was perceived as threatening medical dominance and professional autonomy in its prohibition of user fees and extra billing. A post-strike survey of 2,397 physicians across the provinces, however, reveals important limits to physicians' ideological support for an unregulated medical market place. Rather, there are divisions within the profession on how to translate commitment to autonomy into appropriate policy objectives and political strategies.
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A person who becomes demented can be considered as he presently is, a demented person, or in light of his entire life, of which dementia is but the final stage. These two perspectives can provide conflicting determinations of the person's interests and preferences, since what is best for a demented person at the time may not make his life better overall and may be directly contrary to preferences expressed while competent. Reflection on the concept of autonomy--what faculties it requires, what its point is--provides a clear understanding of the rights of the demented patient.