Link to full text and citations: https://docs.google.com/document/d/1ckdHFuoL1QjmSrxCkqK0whtfngcfGD10uMnz8ToObSI/edit?usp=sharing
Context
On June 8th, 2004, the case of Chaoulli v. Quebec (Attorney General) was brought to the Supreme Court of Canada, in which the appellants advocated for the ability to use private insurance to access health services without being subjected to long wait times imposed by the public healthcare system. This appeal was made after Dr. Jacques Chaoulli was unable to obtain a license to provide private healthcare services, and George Zeliotis experienced long waiting times to receive medical treatment for his health issues through the public system. The main legal issue brought forth by Dr. Chaoulli and Zeliotis attempts to resolve the question of whether Quebec legislation - s. 11 of the Hospital Insurance Act (HOIA) and s. 15 of the Health Insurance Act (HEIA) - infringed upon constitutional rights, as they prevented Quebec citizens from using private insurance to access public healthcare services. This motion addressed the rights outlined in s. 7 of the Canadian Charter of Rights and Freedoms (rights to life, liberty and security of the person) and s. 1 of the Quebec Charter of Human Rights and Freedoms (right to life, and to personal security, inviolability and freedom).
When this case was initially brought to trial, the Superior Court of Quebec ruled against Chaoulli and Zeliotis, stating that the violation of the right to life, liberty and security of the person under s. 7 of the Charter was justified. The Court of Appeal also supported this decision. Due to these outcomes, the case was appealed to the Supreme Court of Canada.
Ruling and Reasoning
The court arrived at its holding through two avenues: the decision made by Deschamps J. was solely based on the infringement of s. 1 of the Quebec Charter, whereas McLachlin C.J., Major J., and Bastarache J. concurred with this verdict while also making their decision based on the infringement of s. 7 of the Canadian Charter.
Deschamps J. found that s. 11 HOIA and s. 15 HEIA were an unjustifiable infringement of the right to life and to personal inviolability under s. 1 of the Quebec Charter, since waiting times in the public healthcare system can put patients’ physical well-being at a higher risk and also reduces their quality of life. Although its aim to protect the public healthcare system was recognized as pressing and substantial, it was ruled that the current measure was too extreme, thus failing the test of minimal impairment to the protected rights. McLachlin C.J., Major J., and Bastarache J. agreed with this point but argued that the legislation unjustifiably infringed s. 7 of the Canadian Charter as well. R. v. Morgentaler was a key legal precedent used in making this decision. This case addressed the right to receive an abortion, and during its trial at the Supreme Court, it was ruled that a delay in receiving an abortion increases one’s risk of complications and death, thus violating the security of the person. Consequently, McLachlin C.J., Major J., and Bastarache J. declared that the physical and psychological suffering caused by public healthcare delays was a violation of the security of the person, and the risk of death also violated the right to life. Like Deschamps J., they ruled that these measures did not minimally impair s. 7 because the benefits to the public system did not reasonably justify the negative consequences faced by Quebec citizens.
After a vote by Supreme Court justices (4:3), it was held that s. 11 of the Hospital Insurance Act and s. 15 of the Health Insurance Act violated s. 1 of the Quebec Charter, rendering it unconstitutional.
Dissents
Justices Binnie, LeBel, and Fish JJ. disagreed with the majority’s decision. Although they agreed that the legislation infringed on s. 7 of the Canadian Charter and s. 1 of the Quebec Charter, they found that it was justifiable. They argued that the Quebec legislation was not arbitrary - the prohibition of access to private health insurance demonstrates a rational means of protecting the public healthcare system, along with clear policy connections to the Canada Health Act. The minority also concluded that the infringement of the Quebec Charter was justified under s. 9.1, which outlines that rights must be upheld according to “democratic values, public order and the general well‑being of the citizens of Québec.” Justices Binnie, LeBel, and Fish JJ. argued that allowing a two-tiered healthcare system (public and private) would not support these principles, since it would undermine the current public health plan and diminish equal healthcare access among Quebec citizens.
Implications
Based on this decision, the Supreme Court reversed the rulings made by the lower courts, allowing the use of private health insurance for public services. It is important to note that because the Supreme Court ruling is based on the grounds that banning private health insurance violates the Quebec Charter, it does not directly impact the rest of Canada (the issue of whether the law violated the Canadian Charter was split evenly between six justices).
Bibliography
Borden Ladner Gervais LLP. “Canada: The Impact of the Supreme Court of Canada´s Decision in Chaoulli v. Quebec (Attorney General).” Last modified September 27, 2005. https://www.mondaq.com/canada/consumer-protection/34952/the-impact-of-the-supreme-court-of-canada%C2%B4s-decision-in-chaoulli-v-quebec-attorney-general.
Chaoulli v. Quebec (Attorney General), 2005 SCC 35 (CanLII), [2005] 1 SCR 791.
R. v. Morgentaler, 1988 CanLII 90 (SCC), [1988] 1 SCR 30.
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