Op-ed on Bill 20 written by two members of the CDS working group

Posted on The Montreal Gazette

May 7, 2015

Bill 20 will make it harder for disabled people to get proper care

As researchers representing Concordia University’s Critical Disability Studies working group, we are scholars advocating for the rights of people with disabilities. Members of our interdisciplinary group also work to make visible the systemic ways that society “dis-ables” such individuals. Health Minister Gaétan Barrette’s Bill 20 is a case in point. It harms people with disabilities and undermines their rights and access to care.

Bill 20 proposes to put strict minimum patient quotas on family physicians and to dramatically reduce support services, cutting budgets and staffing in an already overburdened system. It is proposed under a mask of economic reform, however the cuts are not simply a question of dollars and cents, but rather a result of government misspending, lack of procedural transparency and hasty decision-making without prudent consultation, including the vital participation of people with disabilities.

The politics of austerity and rhetoric of economic prudence are hurting those who most need and rely on access to health care. This is wholly irresponsible and unethical, particularly for someone who as a physician is expected to uphold the Hippocratic oath to “first do no harm.”

Bill 20 has been denounced by the Quebec Federation of Family Physicians (Fédération des médecins omnipraticiens du Québec, or FMOQ) for instituting quotas and turnstile medicine over quality patient care. People with disabilities often have more complex care requirements and the family doctor is at the centre of an interdisciplinary team of medical specialists, therapists and support services. Effective care requires time at each visit for a thorough consultation, which can vary considerably, depending on the issue at hand and is not easily reducible to a weighting system, as was recently proposed in response to physician concerns. Barring this, the risk of undiagnosed or misdiagnosed issues increases significantly, which can end up costing significantly more in hospital stays and emergency visits.

Parents of children with a disability already face multi-year-long wait lists for access to services. Research clearly demonstrates the lifelong benefits of early-intervention medical care and therapies for children with a range of disabilities. Effective follow-up from qualified medical professionals is also essential, as children often face a higher risk of life-threatening diseases such as leukemia. Parents of children with disabilities are being increasingly expected to take on medicals roles they are not trained for or forced to seek medical care and therapies through private practitioners, creating a two-tiered system and putting unbearable personal and financial strain on Quebec families. We need an effective, accessible medical system that supports our kids with diverse abilities. Instead, Bill 20 further restricts access to already limited resources.

People with disabilities already face numerous obstacles in the health-care system. In the case of Bill 20, there is nothing to convince us that access to health care will be improved at all.

Disability is more than a diagnosis. Medical practitioners need both time and resources to help disabled patients make informed decisions about their health and well-being. Due to the complexity of their health conditions, it is vital that they be are able to use emergency health care (such as walk-in clinics or the Emergency Room) without feeling that they are punishing family doctors. Such situations promote an ableist environment that is not welcoming to people with disabilities.

As a society, have a moral responsibility to take care of all Quebecers. Barrette’s proposed legislation threatens this, in favour of political manoeuvring under the guise of economic reform. We urge the health minister to reconsider Bill 20 and instead work with the disability community to develop alternatives that will work both for medical practitioners and their patients.

Jacqueline Wallace, PhD and Laurence Parent, PhD candidate, are members of the Critical Disability Studies working group at Concordia University