That a message be sent to the Senate to acquaint it that this House agrees with the amendments made by the Senate to Bill C-275, an act establishing the Canadian Association of Former Parliamentarians.(Motion agreed to.)
That, in the opinion of this House, the government should enact legislation which would require that a binding, national referendum be held at the time of the next election to ask Canadians whether or not they are in favour of federal government funding for abortions on demand.He said: Mr. Speaker, Motion No. 91 is not just about abortion. It is about democracy. It is about giving voters a real say in how they want their scarce health care dollars spent. It is about voters deciding which health care procedures they consider essential. It is about voters making these tough decisions for themselves, not having politicians and bureaucrats make these decisions for them.
We are debating whether voters have the right to direct federal government health care funding to medical procedures they think are most essential and of the highest priority. We are debating whether Parliament should decide for the people or whether the people have the right to decide for themselves.
Throughout my speech today I will pose key questions that need to be answered in relation to this debate. Then I will proceed to answer each one.
First, where do the people stand on tax funded abortions? In the 1991 provincial election in Saskatchewan two-thirds of the voters in a plebiscite voted to deinsure funding for abortions. A January 1995 poll conducted in Alberta produced similar results, with 73 per cent of women and 69 per cent of men opting for defunding of abortions. In November 1995 an Environics Focus Ontario survey found that 57 per cent of respondents do not think the Ontario health insurance plan should pay for abortions.
As of this morning in the short time available since my motion was presented to the House, I have received 109 petitions with 2,790 signatures supporting my Motion No. 91. I will start tabling these petitions in the House later today. Many other MPs have also received petitions from people objecting to their money being spent on medically unnecessary abortions.
Next, how much do abortions cost Canadian taxpayers? A 1995 Library of Parliament research paper found that approximately 100,000 therapeutic abortions are performed each year in Canada. About 70,000 abortions are performed in hospitals at a cost of about $500 each, a total cost of $35 million per year. Another 30,000 abortions are performed in free standing clinics at a cost of about $250 each, totalling about $7.5 million a year. Physician fees were calculated in the 1992-93 fiscal year to be $9.1 million. The cost is quite substantial.
Next, is abortion only a provincial issue? I disagree with those who say this is a matter for the provinces to decide. As long as the federal government is paying part of the provinces' medicare bills, federal politicians have a responsibility to ensure that scarce taxpayer dollars are being spent on medical procedures that voters think are the highest priority.
In April 1994 Terese Ferri, barrister and solicitor and a member of the Ontario Bar, wrote a paper titled ``Legal Issues Concerning the Public Funding of Abortions in Alberta and Canada''. Ms. Ferri wrote:
It is well established that, while the federal government has jurisdiction to make federal funds for health care contingent upon adherence to national standards, legislation on matters concerning the provision of health care is entirely within the domain of the provinces.
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From my review of legal briefs on this issue, I conclude that the federal government has the power to set national standards and provide federal funding in accordance with these standards. It is clearly within the power of the federal government to say which medical procedures it will fund and which it will not.
Performing abortions is a provincial jurisdiction. Paying for abortions is a decision for both federal and provincial governments to make independent of one another because they each pay a portion of the costs.
The Reform Party is on record saying we want to define core services which are covered by medicare. Is this a decision best left to politicians and bureaucrats or to the people? I say it is the people who should decide, which is what would happen if Motion No. 91 were passed by Parliament today.
Next, what does the Canada Health Act say? In the legal analysis mentioned previously lawyer Terese Ferri wrote:
Under the Canada Health Act, federal funds are available to provincial health care plans which, among other things, are comprehensive, universally available and accessible. The plan must insure all insured health services provided by hospitals and medical practitioners, section 7. Hospital services are defined as ``services preventing disease or diagnosing or treating an injury, illness or disability''. Physician services are defined as ``medically required services rendered by medical practitioners'', section 2.
Section 3 of the Canada Health Act states that the primary objective of a Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada.Unfortunately the Canada Health Act does not include a list of medical procedures or services which the federal government thinks are services preventing disease or diagnosing, treating an injury, illness or disability, or a list of medically required services.
I think it is about time the federal government start defining which hospital services and physician services are medically necessary.
Reformers have referred to this list of medically necessary services as core services which should be supported by federal tax dollars.
If it can be proven that a medical procedure or service does not protect, promote and restore physical and mental well-being, that the service does not prevent disease, is not an illness and is not medically required, then this should be sufficient reason to deny federal tax funding for such a procedure. Is that not right?
Further, if it can be proven that abortions actually jeopardize the health and well-being of the patient, the federal government has a duty to withdraw tax funding for this procedure because it violates the purpose of the Canada Health Act as stated in section 3. Terese Ferri's legal analysis concluded that it would be legitimate for the federal government to disqualify from funding those provinces which do insure such services.
That logically leads to the next question. Is abortion medically necessary? Induced abortion as interpreted by the Canadian Medical Association is the active termination of a pregnancy before fetal viability. Viability is considered to be the ability of the fetus to survive independently outside the womb. A fetus is considered viable in Canada after 20 weeks of gestation and/or the fetus weighs 500 grams at birth.
A non-therapeutic abortion is an interruption of a pregnancy for non-medical reasons by any means. A therapeutic abortion is an interruption of pregnancy for legally acceptable medically approved indications. Therapeutic is defined as curative, dealing with healing and, especially, remedies for diseases. I find it hard to believe that anyone can consider most abortions to be the curing or healing of an illness or that a normal pregnancy is considered a disease.
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Dr. R.M. Ferri, in a 1994 psychiatric brief, reported a 1983 study of abortion practices in a typical Ontario hospital which revealed that 98.5 per cent of the 704 abortions performed that year were for mental health reasons. To show that this 1983 study is false let me report on another study.
The family planning division of Health and Welfare Canada conducted a study of 554 women who received abortions in Canadian hospitals. Here are the responses to the question: ``What is your main reason for your decision to have an abortion?'' Two hundred and eleven of the 554 women, or 38 per cent, did not want children at this time, did not want children at all or said their family size was complete. One hundred and one of them, or 18 per cent, said they could not afford a child or that they did not have the money to move to larger accommodations. Ninety-seven, or 17 per cent, said they were too old or too young to have a child, that they were afraid the child would be abnormal or they feared the pregnancy would pose a risk to their health. Sixty-nine, or 12 per cent, said they were not married, did not want their friends to find out about the pregnancy, that the child was not their partner's, that the partner did not want a child or believed the pregnancy threatened their mental health. Seventy-six, or 14 per cent, said they were alone, did not want to raise a child, would have to quit school or a job, or that it would interfere with their career plans.
These responses demonstrate that most women seeking abortions do so for reasons other than treatment for medical or mental health problems.
Dr. Ferri concluded from his literature review that, first, abortion is not a verifiable remedy which significantly improves the health of a patient; second, the safety, efficacy and validity of abortion for mental health reasons has not been proven; third, abortions
performed for psychiatric reasons worsen a woman's mental health; fourth, abortion is not therapeutic and is actually harmful to women's mental health; and fifth, funding by the government under a health care plan cannot be justified.
In 1989 The Psychiatric Journal of the University of Ottawa, Volume 14, No. 4, published a major Canadian survey of studies on abortion for mental and emotional health reasons. The study survey was conducted by Dr. Philip Ney, the psychiatric director of the adolescent unit of the Queen Alexandria Hospital in Victoria, B.C. The study concluded that, first, there is no satisfactory evidence that abortion improves the psychological state. Second, mental ill health has been shown to be worsened by abortion. Third, recent studies are turning up an alarming rate of post-abortion complications. Fourth, the emotional impact of these complications needs to be studied. These are important considerations which we cannot ignore.
The committee to end tax funded abortions concluded in its January 1995 report that abortion is a procedure that disrupts the normal physiologic process and carries a physical risk to the woman undergoing the procedure. In spite of the fact that over 23 million abortions have been performed in North America in the last 25 years there are no good medical studies demonstrating the therapeutic benefit to women on physical, psychiatric or psychological grounds. The procedure, therefore, has no proven medical benefit and cannot be justified as medically necessary in any context other than political. My own review of available research leads me to the same conclusion.
I do not have time today to touch on some of the other health related concerns which abortion raises, for example, the evidence that is mounting that abortion raises a woman's risk for getting breast cancer, a study that needs to be done more thoroughly.
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Would ending tax funded abortions violate the charter of rights and freedoms? In preparing for this debate I reviewed three independent legal opinions on the question. Would non-payment of abortion procedures violate the rights guaranteed by sections 7 and 15 of the charter of rights and freedoms?
First, in his November 1994 analysis Frank de Walle of the firm de Walle and McDonald concluded that refusal to fund abortions did not restrict access, did not discriminate and did not place any government obstacle in the path of a woman choosing to terminate her pregnancy.
He added that the government is not obliged to finance rights and used this analogy to prove his point. A right to freedom of expression does not entitle one to demand the government pay for press coverage. Just because you have freedom of speech does not demand that you have the right to demand others pay for the expression of that.
In May 1994 Darren Richards of the law firm Snyder & Company arrived at similar conclusions. He said that the de-insuring of abortion procedures may not be found to violate section 15(1) of the charter. His legal analysis concluded if the courts found such an action to be discriminatory that the de-insuring of medically unnecessary abortion procedures could qualify as a reasonable limitation of rights pursuant to section 1 of the charter.
Mr. Richards also reviewed section 7 of the charter which protects everyone's right to life, liberty and security of the person. He concluded that the non-funding of abortion does not place any government obstacle in the path of a woman choosing to terminate her pregnancy and therefore her to life, liberty and security of the person is not violated.
The third study I would quote is from Terese Ferri, barrister and solicitor in the province of Ontario who concluded that de-insurance of abortion would not infringe on the rights guaranteed under the Canadian Charter of Rights and Freedoms.
What does the Criminal Code of Canada say about abortion? Section 287 of the Criminal Code made abortions illegal except when completed by a qualified medical practitioner in an accredited or approved hospital. It was struck down in 1988 by the Supreme Court because it violated section 7 of the charter of rights. It is still a criminal offence under section 290 to supply a drug or instruments to be used to cause a miscarriage.
Section 223 of the Criminal Code establishes the point at which a child becomes a human being for the purpose of determining if a homicide has been committed. This section defines that a child is a human being if it has completely proceeded from its mother in a living state and provides that a homicide is committed if a child dies after meeting the definition of a human being.
Therefore any abortion completed before the baby has completely proceeded from its mother's womb is not murder. While late term abortions are not common, I find it unconscionable that the Criminal Code does not prohibit them, but this is a matter for another private member's bill.
I was at a meeting last year at which the speaker was a woman in her late teens. She related some of her objections to abortion. She had survived the abortion procedure. This in itself may not sound too remarkable unless I go on to explain that she was the unborn child that was aborted. We need to change our Criminal Code definition of murder.
In conclusion, Motion M-91 raises several fundamental questions. First, do the people of Canada have the right to a direct say in how the government spends their money? This is a question of democracy and the right of people to have input. Second, abortion is not a medically necessary procedure in most instances and scarce
health dollars should not be spent on it. Third, approval of my motion does not contravene the rights of anyone.
It is wrong for a government to avoid talking about sensitive issues. The essence of what we do in the House of Commons should be to fully debate all issues of concern to the Canadian people. The job of government is to carry out the will of the people. If we cannot decide the issue here it should be referred to the people of Canada and not simply avoided. I therefore make this request. I seek the unanimous consent of the House to have my motion declared votable.
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The Deputy Speaker: Is there unanimous consent to permit this to be a votable item?
Some hon. members: No.
Ms. Shaughnessy Cohen (Windsor-St. Clair, Lib.): Mr. Speaker, I am rising to speak on Motion No. 91 concerning federal funding support for abortion services on demand. I want to address the role of the federal government vis-à-vis the Canada Health Act with respect to determining insured health services.
As one of our greatest national projects, Canada's health care system is a defining element of Canadian society. Medicare has contributed to a quality of life that is recognized to be one of the best in the world. It also gives us a comparative advantage in the global marketplace.
I am happy to say, as I usually do, that the riding of Windsor-St. Clair and my community of Windsor had a great deal to do with that, starting with early insurance plans like Windsor medical and with the great vision of the Right Hon. Paul Martin, Sr.
The health care system represents the best of the Canadian spirit, reminding us of the good that we can achieve together. Medicare was introduced and developed by a succession of Liberal governments, providing a tangible example of the commitment of the Liberals to compassionate public policy.
The Liberal Party and the government remain firmly committed to the five fundamental principles of medicare as set out in the Canada Health Act: public administration, comprehensiveness, universality, portability, accessibility.
The one principle which I particularly want to focus on is comprehensiveness. At its most basic, comprehensiveness requires that provincial health care insurance plans cover all medically necessary services performed by doctors or in hospitals. The term medical necessity is a key concept. It is an integral part of the understanding and operation of the act. The term medically necessary is used in the Canada Health Act in conjunction with other conditions to assure Canadians that once a decision has been made that a service is medically necessary, then access becomes universal and on uniform terms and conditions.
In my view this debate is not just about abortion. This motion has much broader consequences than that. It is about which government is going to decide that any medical procedures are necessary. It is about whether our aging parents will have access to oxygen when their respiratory systems fail. It is about whether children and adults with disabilities will get the specialized support they need. It is about whether our constituents will have universal access to any medically necessary procedure.
Since the beginning of federal support for health care in 1957 through the hospital insurance and diagnostic services act, decisions regarding what is medically necessary have been left to the provinces to determine. This is consistent with the provisions of the Constitution. It makes sense because after all the provinces manage the health care system. The government does not do that and the man or the woman on the street does not do that.
The provinces work with the appropriate medical experts. They are delivering the service, they are closer to the patients. This means that decisions regarding medically necessary insured health services are up to the provinces and their medical associations or those whom they consult to decide.
I might add that there is a remarkable degree of congruence and consistency among all provinces and territories on this front. On the matter of health insurance coverage for services all provinces and territories, particularly for abortion services, have regarded them as medically necessary services and insure them on this basis. I emphasize that there is almost no service that is not medically necessary in some cases. These determinations have been made based on the context of the service being provided.
The government firmly believes that it is not for Ottawa to say that this procedure or that procedure must be covered. This responsibility is better left to the provinces and physicians who deliver services on a daily basis and who are aware of the circumstances under which they are delivered.
This approach stands in sharp contrast to what is happening in the United States where insurance companies are telling more and more physicians what they will cover, what they can or cannot do for their patients and even how to do it.
The Canada Health Act permits the determination of medical necessity at the point of delivery of the service. This approach is superior to developing a list of insured health services. Lists are simplistic and rigid. They result in some services being insured and others not being insured in all circumstances. They also invite a steady move to privatization especially if more and more services
are covered by private insurance because the government is out of them because it is not on the list.
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Determining medical necessity at point of service is one of the greatest strengths of the Canada Health Act. This approach allows circumstances to vary from service to service. It is an approach that recognizes the medical condition of the patient. It is an approach that ensures Canadians receive services on the basis of need, not on the basis of ability to pay.
Since the beginning of medicare, medically necessary services have been made available without point of service charges. I cannot deny that fiscal realities have forced us to make some tough decisions regarding our health care system. There is still room to make our health care system more efficient.
Putting our universal and comprehensive health care system in place took commitment. Facing the challenges and finding solutions to problems which arose over the years took commitment. That commitment is still here today. It is a commitment that Canadians want and one that this government takes seriously.
We will ensure that Canadians continue to receive medically necessary services on the basis of need and not on the basis of their ability to pay. Access to services is based solely on the medical needs of the patient. Medical necessity, not how much money one has, should dictate access to medical services. Canadians expect that they will have medically necessary services available without point of service charges.
The federal government has an important role to play in ensuring that Canadians receive the care they need. What we can and will continue to do is to interpret the Canada Health Act as requiring coverage of all medically necessary services.
Our national health insurance system is close to the hearts of Canadians. It is something too precious to tamper with on a piecemeal basis. This is why the federal government cannot support this private member's motion. Supporting this motion could jeopardize the principles of the Canada Health Act. It could jeopardize the constitutional authority of the federal government and the provincial governments. More important, it could jeopardize the health of Canadians.
[Translation]
Mrs. Pauline Picard (Drummond, BQ): Mr. Speaker, I am pleased to participate in today's debate on Motion M-91 put forward by my colleague from Yorkton-Melville.
Abortion has long been a matter of concern to the people of Quebec and Canada. It is a very sensitive issue that brings into play profound and very different convictions on individual rights, social responsibility and moral standards. It also raises questions on the place of women in our society. For all these reasons, abortion could easily become a divisive issue.
This, however, does not mean that the issue of abortion must be ignored. Unfortunately, too many governments, lacking the courage or the political will to take their responsibilities in sensitive matters, go for the easy way out and bury their heads in the sand.
At that level, the motion put forward by my colleague from Yorkton-Melville at least has the merit of trying to move the issue forward. The motion reads as follows: That, in the opinion of this House, the government should enact legislation which would require that a binding, national referendum be held at the time of the next election to ask Canadians whether or not they are in favour of federal government funding for abortions on demand.
The idea of asking Canadians to settle the matter is quite democratic and may seem interesting at first sight. It would be nice to see the Liberal government be as democratic toward the men and women of Quebec who want to make Quebec a sovereign country. These people will undoubtedly remind them of this in the next election.
To get back to Motion M-91, one must go beyond mere appearances and wonder whether a referendum is really the best way to settle this matter. After thinking about this and reading the documentation available, I can only conclude that a referendum is not the way to go, for several reasons.
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First of all, there is a vast consensus within the public in favour of free choice; that is a well known fact. An Environics poll dated June 29, 1992, indicated that 79 per cent of Canadians agreed that the decision to abort is one that should be made by each woman, in consultation with her doctor. In Quebec, 80 per cent of respondents also agreed with this statement. Considering that, every year, more and more people support freedom of choice, we have every reason to believe that these numbers are at least as high, if not higher, today.
I therefore think that holding a referendum on this issue is unnecessary. It is up to us, as elected members, to act accordingly.
The public is not the only one in favour of free choice. Year after year, decision after decision, the courts reaffirm the legality of abortion. An often used argument concerns the rights of the mother to be. On August 8, 1989, the Supreme Court ruled that no presumed rights of the foetus or the father existed or should take precedence over a woman's right to decide what happens to her own body.
This kind of thinking on the part of the courts is observed worldwide. In the United States, in England or wherever, it is
becoming increasingly obvious that the only arguments against abortion that may hold up are moral in nature.
The motion before us today also raises a totally different issue, concerning jurisdiction over matters of abortion. Under section 92(7) of the Constitution Act, 1867, the establishment, maintenance and managements of health care institutions come under exclusive provincial jurisdiction. We can never stress this point enough. In addition, the courts have vested in provincial legislatures extensive jurisdiction over public health matters of a merely local or private nature, in accordance with section 92(16).
Regulatory control of all professions, and health care professions in particular, also fall under the provinces' jurisdiction over property and civil rights, in accordance with section 92(13) of the aforementioned act.
For these reasons, which leave no doubt as to the fact that Quebec and the other provinces have jurisdiction over health, the federal court of appeal ruled, in 1983, that the general issue of abortion comes under the exclusive jurisdiction of provincial authorities.
Therefore, we wonder why it should be necessary to ask Canadians whether or not they are in favour of federal government funding for abortions, as proposed in the motion moved by the hon. member for Yorkton-Melville.
Let us be clear: health comes under provincial jurisdiction. It is only because it acted in a roundabout way that the federal government managed to get involved in this sector, thanks to its spending power. Of course, eligibility for federal funding depended on certain conditions being met. We all know the story very well.
Upon reading the motion moved by the hon. member for Yorkton-Melville, one also wonders about the appropriateness of holding a referendum at the same time as a general election. The themes, the stakes and the whole dynamic surrounding an election are many and varied, and are not necessarily given the same weight.
Imagine for a moment that the motion is passed, that the government enacts a law, and that a referendum is held in Canada and in Quebec on federal funding for abortions. What do we do with the results? How do we interpret them?
For example, if a majority is in favour of federal funding for abortions, which conditions should apply? Who can perform these abortions? Where? When? How? For what reasons can a woman get an abortion? Who ultimately makes the decision? All these questions remain unanswered because the current wording of Motion M-91 only deals with the financial issue.
By contrast, if a majority opposes federal funding, does it mean these people are opposed to abortion? Not necessarily. People may be in favour of abortion, but opposed to its funding.
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In conclusion, the motion before us raises more questions than it answers. Given the costs of a referendum, we seriously wonder about the appropriateness of the wording of Motion M-91, not to mention that we would first have to ask the Prime Minister to tell us which percentage, in his opinion, would be required, since he seems to be in the process of redefining democracy.
The issue of abortion is much too important for women and for society in general to be treated as a mere funding issue, particularly through a referendum to be held at the same time as a federal election. For all these reasons, and for other ones, I cannot support Motion M-91.
[English]
Mr. Leon E. Benoit (Vegreville, Ref.): Mr. Speaker, I am pleased to take part in the debate on the motion presented by the hon. member for Yorkton-Melville which reads:
That, in the opinion of this House, the government should enact legislation which would require that a binding, national referendum be held at the time of the next election to ask Canadians whether or not they are in favour of federal government funding for abortions on demand.I will generally debate the basis of what services our public health care system should be required to pay for. I will also speak on the issue of allowing Canadians to decide how their tax dollars should be spent.
This is a federal and provincial issue. The federal government has the power to set national standards for health care and provide federal funding in accordance with these standards. It is clearly within the power of the federal government to say which medical procedures it will or will not fund. Performing abortions is a provincial jurisdiction. Paying for abortions is a decision that provincial and federal governments make independent of one another because they each pay a portion of the costs.
As an aside I will talk about the federal government portion relative to that of the provincial government. When the Canada Health Act was set up, funding for health care was 50:50. Now approximately 22 per cent is paid by the federal government and the rest by the provincial government. By the time the recent budget of the finance minister is implemented, the federal portion of funding will be reduced to approximately 17 per cent. It is an ever decreasing amount.
Getting back to the motion, it really does not matter which government is involved, in the end the same taxpayers are paying. One would think that federal and provincial governments would target spending of taxpayers' money based on the good it will do or the need for the service. In this case where health care spending is involved the main consideration should be the impact of making people healthier or preventing disease or injury.
How are decisions regarding health care set out in the Canada Health Act? The Canada Health Act requires the provinces to provide and pay for medically necessary procedures. In most cases abortion is not medically necessary. It is a service which does not make people healthier or prevent injury or disease. In fact, it does the opposite. It disrupts a normal physiological process and poses a risk to the woman undergoing the procedure.
Surveys demonstrate that the vast majority of women seeking abortions do so for reasons other than the treatment of a medical or mental health problem. The member who proposed the motion has already mentioned a study by Health Canada which I believe is well worth repeating.
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It was a study of 554 women who received abortions in Canadian hospitals. Here are the responses given to the question ``what is your main reason for the decision to have an abortion''. Thirty-eight per cent said they did not want children at this time, did not want children at all or that their family size was complete. Eighteen per cent said they could not afford a child or that they did not have money to move to larger accommodations.
Eighteen per cent said they were too old or too young to have a child, that they were afraid the child would be abnormal or they feared that pregnancy would pose a risk to their health. Twelve per cent said they were not married, did not want their friends to find out about the pregnancy, that the child was not their partner's, that the partner did not want a child, or that they believed the pregnancy threatened their mental health. Fourteen per cent said they were alone and did not want to raise a child, would have to quit school or a job, or that it would interfere with their career plans.
Even abortion providers admit abortions are generally not medically necessary. For example, Henry Morgentaler told a Vancouver radio audience in 1988 that fewer than one-tenth of one per cent of abortions are necessary to save the woman's life.
Irvin Cushner of Planned Parenthood Federation of America testified before a Senate hearing that more than 98 per cent of abortions are done for non-medical reasons.
Notice that none of these studies was done by pro life groups or was even commissioned by pro life groups. It is exactly the opposite.
Through two decades of widespread abortion experience, doctors have increasingly described it as a surgery that carries risks to the woman's fertility, risks of chronic pelvic pain, breast cancer and in subsequent pregnancies premature labour or miscarriage. Studies show that even abortions performed for psychiatric reasons worsen women's mental health.
Motion No. 91 is not just about the funding of abortion. It is also about democracy. Politics has clearly become increasingly further removed from the people. This clearly shows a need to give voters a real say in how they want their scarce health care dollars spent.
Decisions regarding important social issues should be made by voters, not politicians and bureaucrats. The Reform Party is clear in its policy. It was presented during the last election campaign and it will be presented in the next election campaign. The Reform Party clearly says the role of a politician is first to tell their constituents during an election campaign what their view is on an issue such as this, providing public funding for abortion, of which I am not in favour.
We should hold a national referendum. That is exactly what this motion requests. It would give the public a direct say rather than leaving the issue in the hands of politicians and, in many cases, in the hands of bureaucrats. This will give people a direct say.
Barring a referendum, the opportunity for people to vote directly, Reform MPs are committed to ensuring public debate takes place across the country. Reform MPs will ensure the media is involved in these discussions. The media plays a very important role in the debate. Through some formal mechanism such as a public poll or a householder survey we will determine the will of the majority of constituents. In all cases Reform MPs will vote with the majority view in their constituencies.
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Old style politics and the style of politics being done in the House by the governing party are anything but democratic. What the government feels is a free vote is really, rather than MPs voting the will of their constituents, voting their own consciences in most cases.
I seek the unanimous consent of the House to have this motion referred to the Standing Committee on Health.
The Deputy Speaker: Is there unanimous consent to have the motion referred to the standing committee?
An hon. member: No.
Mr. Gordon Kirkby (Parliamentary Secretary to Minister of Justice and Attorney General of Canada, Lib.): Mr. Speaker, this motion shows a misunderstanding of the process by which medical services are determined for funding. It assumes the federal government plays an active role in this determination. This assumption runs contrary to the spirit and the letter of the Canada Health Act.
This act respects the role of the provinces in the delivery of health services and recognizes that provincial health care systems must address the unique needs and circumstances of each province.
This allows each province and territory latitude to make necessary decisions. This also gives provinces and territories latitude in the application of the five Canada Health Act principles and the ability to make decisions consistent with their own priorities and capacities.
In January 1988 the Supreme Court of Canada, interpreting the charter of rights and freedoms, struck down the Criminal Code provisions involving therapeutic abortion committees. This removed all administrative apparatus associated with this procedure.
This decision invalidated the entire legislative scheme for limiting women's access to abortion, leaving the matter of abortion to be decided by women in consultation with their doctors.
The Canada Health Act requires that medically necessary hospital and physician services are insured. The operation of provincial health insurance plans and the delivery of health services to residents are within the purview and decision making power of the provinces and territories. In short, the provinces and their doctors will decide whether services are medically necessary. Provinces are then responsible for insuring and delivering these services to residents.
As a statement of federal policy, the Canada Health Act respects that the provinces must have flexibility in deciding how to best organize, finance and deliver health services. The federal criteria provide the framework, but it is the provinces and the territories that are responsible for these basic decisions.
This division of relative roles and responsibilities has given us the excellent health care system we have today. It is certainly one of the reasons the Canada Health Act received unanimous approval in the House of Commons in 1984.
The federal government's role in health financing has been instrumental in shaping our health care system while providing the provinces with the scope necessary for determining how best to allocate federal transfers to address the health needs of their populations.
It is important to consider what provincial flexibility really means in terms of the Canada Health Act. The provinces are responsible for deciding in partnership with their health professionals which services are medically necessary and which should appear on the list of insured services.
Each province receives its advice from licensing bodies as well as medical associations on a scientific and professional basis for these decisions. Each province has its own consultative mechanism. On the basis of such considerations, the various services have been determined to be medically necessary and therefore are insured in every province and territory in Canada.
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The challenge that continues to face us is the prevention of unwanted pregnancies. We know the reasons women seek abortion include lack of information about or access to birth control measures or sex education. These can be addressed through research, education, counselling and other forms of assistance through organizations which provide information and support.
One of our goals must be to secure for Canadians the widest possible range of choices about whether and when to have children. Unintended pregnancy is a particularly troubling and frustrating issue since it is largely avoidable. Despite recent advances in education and accessibility of contraception, unintended pregnancy still occurs.
The heaviest burden of unintended pregnancy rests on those who are the most disadvantaged, the young, the poor and those without the support of a caring family. Youth are particularly vulnerable. We must make it a matter of high priority to educate our young people to be responsible. We must promote responsible behaviour. The importance of education and birth planning as well as policies and programs that inform Canadian families and reduce the need for abortions cannot be underestimated.
Health Canada will continue to make resources available where our limited funds permit for activities related to sexual and reproductive health issues. These include community based projects funded through the health promotion contribution program and grants provided to national heath organizations. It is important that government and voluntary organizations work together to respond effectively to health information needs, especially of high risk or hard to reach populations.
We recognize the federal government has the legal authority to conduct national referenda and that the federal government contributes to the funding of provincial and territorial health insurance plans.
However, we also recognize it is not within the constitutional authority of the federal government to dictate the specifics of the operation of provincial health plans. The federal government does not fund specific health care services or types of services on a national scale in the manner this motion suggests. Both as a matter of law and as a matter of policy the federal government would not intervene in the operation of provincial and territorial health insurance plans so long as the principles of the Canada Health Act are respected.
The government does not have any choice but to oppose this motion within the context of the Canada Health Act. The determination of what services to insure is a matter of provincial and territorial jurisdiction.
Mr. Stan Dromisky (Thunder Bay-Atikokan, Lib.): Mr. Speaker, responsibility for determining insured health services has
always been with the provinces. We must stress that time and time again because apparently our colleagues from the third party are not in harmony with this concept.
The responsibility is determined in conjunction with the respective medical associations. The Canada Health Act principle of comprehensiveness requires that all provincial and territorial health insurance plans provide coverage for medically necessary services.
Let us be clear. The responsibility for determining which services are medically necessary is a provincial one. Even though the decisions regarding medical necessity are the responsibility of the provinces and territories which manage their own health care systems, we find that insured medical and hospital services are more than evident between and among provinces and territories.
The federal government's role in part is to assume responsibility for setting national criteria to ensure Canadians receive the care they need. This is exactly what the Canada Health Act does. It ensures residents of Canada have reasonable access to necessary health care services on a prepaid basis.
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Provinces administer their own health insurance plans. They manage their own systems. They are in the best position to make decisions regarding insured health services. This is particularly important given that there is almost no service that is not medically necessary in some situations. Why should we fix something that is not broken?
The federal government has a responsibility to promote and preserve the health of all Canadians. However, it cannot make the kind of decision this private member's motion is asking for. To try and use the spending power of the federal government in this way would be contrary to how this federation functions.
What we should do and will continue to do is to use our spending power to ensure that the five principles of the Canada Health Act are maintained. There is in this country a longstanding partnership between the federal, provincial and territorial governments with regard to health care. It is a partnership that we continue to develop and promote. Supporting this private member's motion would disrupt this historical distinction and balance.
Mr. Myron Thompson (Wild Rose, Ref.): Mr. Speaker, I realize there is not much time left so I will take as little time as possible. I will raise a couple of points that the member for Yorkton-Melville wanted to say before he ran out of time.
The hon. member points out to members of the House of Commons and to the nation that a number of individuals in Canada prefer not to support some things financially and they feel they should have a voice. He is trying to give them that voice through a referendum. If it is not possible to do it through a referendum, the hon. member would have liked to have done it through a vote by the members in the House of Commons.
The Bloc member said we do not need a referendum and that in the House of Commons we should represent the people. I find it very difficult to represent the people when we are denied a vote in the House of Commons by the voice of one individual. I find that totally unacceptable.
I also find it rather strange to hear the government members rigorously talking about the provinces' responsibility to decide whether or not they want to fund abortions or the provinces' responsibility in making a number of decisions when not too long ago I heard the Liberal members say point blank that the provinces would do as they tell them or their funding would be stopped. How hypocritical can they get? One day they are saying it is up to the provinces to decide how they want to run their system and the next day the federal government is going to take away all their funding if they do not do what they are told.
It boils down to when important issues come before the people of Canada, the one thing most Canadians do not realize is that they are being denied democracy by this Liberal government. They have been denied democracy for the past 10, 15, 20 or 30 years. Canadians want it to stop and I agree with them. It is time that democracy started ruling this House instead of the dictatorial attitude of certain individuals who sit on that side of the platform. The sooner that happens, the better off we will be.
[Translation]
The Deputy Speaker: The time provided for the consideration of Private Members' Business has now expired and the matter is dropped from the order paper.