An interesting article in the Medical Post caught my eye recently. David Hodges posed ten questions to medical ethicist Dr. Margaret Somerville (PhD) in “10 questions with…..Dr. Margaret Somerville on science and society”.

Her response to the question, “With reproductive technology what aspects concern you?” leads to even more questions. She answered that “there is a rule in ethics that says there should be a preference in favour of the most vulnerable people; therefore, usually in a situation where you’ve got adults’ rights competing with children’s rights, I think there should be a preference in favour of the children.” She adds that there should be a new focus on children’s human rights, in particular in respect to their origins.

She may be right that the first quarter of the 21^st century could be the major start of the recognition of children’s human rights, but what happens to cases like the one involving the 11 year old Hamilton boy with leukemia whose parents were required to fight for his right to discontinue chemotherapy which was thought to be lifesaving by the medical team involved?

Having endured previous rounds of chemo, this patient did not want to endure further efforts in this regard and having witnessed his late mother lose her fight against her own cancer he had an insight that others may not have despite his young age and despite the fact that he is reported to have fetal alcohol syndrome.

It is a strange juxtaposition to see court cases which potentially force patients to endure treatment against their will and their families wishes, including children who have significant life experience, compared with cases where young patients are denied government funded treatment such as the many autistic children who are wait-listed for intensive therapy that could provide them with life altering benefits.

As we move forward in the evolution of healthcare, how will it be decided who the vulnerable patients are? If autistic children are not vulnerable then who is? How will it be decided who should receive publicly funded care and how and when they should not?

In an era of cloning and stem-cell research with the potential to ultimately create or regenerate body parts who should decide what finite public resources should be spent to provide care based on these technologies or others? If public resources are restricted in some cases, what alternative will patients and their families have? Is it right to create the expectation that all medical eventualities will be covered by the public purse when it seems more and more that this is not possible?

With awe-inspiring technology at our finger tips now and even more ability to create and sustain lives in the future, we will be challenged to meet the needs of the many forms of “vulnerability” in Canadian society. Improved ability to support the rights of vulnerable patients, both young and old, could be more readily achieved with more honesty about the limitations of our public system.