Steve Szebenyi, an only child, tried for 10 years to sponsor his parents in Hungary so they could live out the rest of their years with him in his Toronto home.
But Canadian immigration officials rejected the application, on the grounds that his mother, Gizella Szebenyi, has Type 2 diabetes. Mrs. Szebenyi, who was 61 when the application process began, was able to compensate through her diet for the fact that her body does not produce enough insulin. Now 73, she still does not use insulin or any other medication, and has never sought medical treatment.
Immigration officers, however, ruled that she could be expected to cause an excessive demand on Canada's health-care system, defined as needing more than $15,000 worth of care over five years. They also turned down Mr. Szebenyi's father, because of his wife's condition.
"My mother has never needed any medical attention. I believe my family has been very badly treated by immigration officials," said Mr. Szebenyi, 50. "We didn't do anything wrong. She has been discriminated against, her rights trampled on. Isn't the Charter supposed to offer equal benefits to all?"
He immigrated to Toronto from Hungary 15 years ago, and launched an application to sponsor his parents in 1993. They came as visitors in 1996, and left eight years later after their bid for permanent residency was rejected.
The Szebenyi case illustrates a contentious area of immigration screening: How do officials decide which diseases are acceptable, and which are kept out?
The answer, according to immigration lawyers, is that it can be subjective. The issue of medical screening is before the Supreme Court of Canada, and its ruling in the case, expected this year, could force Ottawa to change the law.
The Immigration and Refugee Protection Act of 2002 states that foreign nationals are inadmissible on medical grounds if their health condition is likely to be a danger to public health or safety, or might reasonably be expected to cause "excessive demand" on Canada's health or social services.
"The medical officer reviews an applicant's medical condition, considers the severity and prognosis and determines the likely health and social-service requirements for that condition," said Maria Iadinardi, a spokeswoman for Citizenship and Immigration Canada.
"Our rate of refusal on medical grounds is less than 1 per cent," she added.
Ms. Iadinardi said few foreigners with diabetes are rejected as permanent residents. The two most frequent reasons for refusal are kidney damage and vascular complications, such as coronary artery disease.
She said Mrs. Szebenyi was refused because she failed to submit to more tests. "It's up to applicants to meet requirements of the immigration act."
If Mrs. Szebenyi were an HIV-positive refugee, arguably a more serious ailment, Canada would welcome her with open arms.
And if she were the child or spouse of an immigrant, and she had the AIDS virus or any other condition, she would be allowed in. That is because refugees, as well as spouses and children sponsored by family members, are exempt from the "excessive demand" test.
"I feel badly for people with HIV. But it does seem contradictory that most of them are allowed in while a diabetic is not," said Mr. Szebenyi, who supports his wife and two teenage children as a driver for a dental supply company.
Immigration lawyers argue that visa officers who screen prospective immigrants should take into account people's circumstances, as well as their ability and willingness to pay for social services.
"It shouldn't be, 'You have the condition, therefore you are inadmissible,' " said Robin Seligman, a lawyer who has seen two clients with Type 2 diabetes denied entry to Canada. "Immigration officers should have to do a reasonable assessment. The test should be to look at the individual, their past, and family history and say, 'What is the reasonable likelihood they will use the services?' "
Mr. Szebenyi is appealing the case to the Federal Court, but cannot afford legal counsel and knows the odds are slim that the decision will be reversed.
Another prospective immigrant whose file was rejected on medical grounds has taken his battle with CIC to the Supreme Court. David Hilewitz, a South African businessman with $5-million in assets, wanted to come to Canada as an investor immigrant, but in 2000 officials ruled that his then 17-year-old son could cause excessive demand on the medical system. Gavin Hilewitz, who has developmental delay, requires special schooling and has the mental capacity of an eight-year-old.
Mr. Hilewitz, however, argued that he has always paid for his son's private schooling and would continue to do so in Canada. He also told the visa officer he was prepared to buy a video or toy store in Canada so that his son would have a place to work as a young adult. Gavin is healthy, had never had to use any social services or institutional assistance in South Africa, and was described by a psychologist as being a "delightful" person able to shop by himself, use Internet cafés, go bowling and to the zoo, and phone his parents to be picked up.
The visa officer concluded that while Mr. Hilewitz had thus far defrayed the costs of his son's needs, he could not predict his ability to do so in the future.
The Federal Court overturned this decision, noting in its 2002 ruling: "There does seem to be an incongruity between admitting someone as a permanent resident because he has significant financial resources but refusing to take into account those same resources when assessing the admissibility of a dependent."
In 2003, however, the Federal Court of Appeal restored the original decision, ruling that applicants' wealth is not relevant in determining whether they or their dependents could place an excessive demand on Canada's social services. The Supreme Court heard the case in February, and its ruling could change the way immigrants are screened.
Toronto immigration lawyer Sergio Karas believes many diseases fall into a grey area. "Many times it's a judgment call from the doctors of immigration's medical service," he said. "Possibly it errs in favour of some diseases and against others."
Last year, nearly 1,000 prospective immigrants were deemed medically inadmissible, according to CIC, most of whom had infectious diseases or were mentally ill. Eighteen people with diabetes were turned down.