It is as simple as this: One Sunday in September, Tracy Dort-Kyne flipped over the handlebars of her bike, and woke up a quadriplegic. She was 41, between jobs in the finance industry, and a single mom with three young boys. Once she is out of rehab, she will need a home renovated for a wheelchair, a handicapped-accessible van and round-the-clock care, likely for the rest of her life, to make sure, among other risks, that she doesn't choke to death while no one is watching. Over the course of her life, that could cost as much as $10-million.
Through the health-care system, though, she may not receive much more than a daily bath. She was job hunting when she had the accident, so she had no insurance through work. She's divorced, so she has no spousal benefits. She had life insurance, but hadn't thought of private disability coverage. Yet, in a few months, she'll be wheeled to the door of the Lyndhurst rehab centre, placed in her family's care and left, essentially, to find her own way.
Not long ago, Ms. Dort-Kyne may well have died before she reached the hospital. But medical advances have significantly improved the outcomes for people who suffer catastrophic injuries such as spinal-cord or brain damage and for those left paralyzed by diseases such as cancer.
We know public health care is creaking under the weight of our aging bodies, with home-care needs growing exponentially for grandma. But if the system chooses to save a life – whether it's a premature baby or a 40-year-old single mom – what does it then owe to that life? The problem highlights the inefficiencies in the system, and how little insurance most Canadians have for an unexpected catastrophic injury.
Bill Adair, executive director at the Canadian Paraplegic Association Ontario, says many people are stunned to find out the health-care system largely stops at the hospital door. “We have achieved a state of excellence in acute care, and then we completely let people down, and we set them up for failure.”
How well we care for the sickest comes down not just to public will, but to the public purse. “A lot of people don't want to talk about costs in an ethics conversation,” says Anita Ho, an assistant professor in applied ethics at the University of British Columbia. “But we have to put it on the table. And we have to decide what's a reasonable level of care.”
In other words, having saved Ms. Dort-Kyne, how much will we spend now to maintain her quality of life? What's more, when she had the accident, she was doing exactly what Health Canada would urge, living a healthy, active lifestyle. But what responsibility must individuals take, especially if we choose to rock-climb or snowboard off-trail?
“There are fiscal realities,” concedes Steven Fletcher, Canada's Minister of State for Transport – and the country's first quadriplegic MP. However, he adds: “If we, as a society, choose to save the lives of people with very dramatic injuries, we, as a society, must do everything to help those in the people in the long term. To not provide them with the resources to live dignified and meaningful lives is almost cruel.”
Every year, about 1,500 Canadians suffer a spinal-cord injury. In the past, the majority were young men in car accidents, but today, paralysis is increasingly caused by diseases such as cancer or by elderly falls – both markers of our aging population. The risk also has risen with the growth of bicycle culture and the increasing popularity of extreme sports.
Rene Faucher was doing his best to stay fit and serve as a role model for his three young children when he took to the ice for a recreational hockey game in January, 2010. While playing he tripped and smashed head-first into the boards. He was left paralyzed from the chest down.
Today, Mr. Faucher, 42, has the use of his arms, and after months of rehab he can lift himself into bed. How much more he can improve is a guessing game.
He was once named one of the top 40 businessmen under 40 in Ottawa, but not long before the accident he had offloaded his software start-up under less-than-ideal financial circumstances; his disability coverage had lapsed in November. He was waiting for word on a job, and didn't have any private insurance.