Friday, October 18, 2002 – Page A18

Universality is at the heart of Canada's publicly funded health-care system. No one is denied the care he or she needs because of inability to pay. Regrettably, in the case of autistic children in British Columbia, what should have been a political matter became a legal one. The B.C. Court of Appeal insisted unanimously this week that the province pay for a specialized treatment for these children.

But the fault rests with the government. It failed to grasp the situation of children whose autism is characterized by profound withdrawal. Without the treatment, they are condemned to a life of isolation. With it, they have a chance to live meaningfully among their peers. What could be more necessary than that?

As a general principle, the courts should leave funding issues to elected officials. Those officials are accountable to the electorate; the judges are not. Legislators also have a greater ability to hold public consultations before making their decisions. In particular, given the need for fiscal responsibility, the court was unwise in this case to order the government to pay $20,000 in symbolic damages.

The funding for the autism treatment is not cheap. The intensive program ordered by the court -- the only treatment known to be effective -- involves 40 hours a week of one-on-one behavioural therapy, and costs $45,000 to $60,000 a year for each child, for two to three years. Since roughly one child in 1,000 suffers from autism, that could mean about 200 B.C. preschoolers at a time could benefit -- a total cost of as much as $12-million.

On the other hand, more than 90 per cent of untreated children are placed in group homes or other institutions, at a cost that may exceed $100,000 a year. Only one in 64 children will improve without treatment.

The savings in denying treatment are therefore illusory. Of the four children whose parents brought the B.C. legal challenge, after struggling to pay for the treatment themselves, three were able to enter mainstream school classrooms.

There is a strong argument to be made that, when the courts step in to order services, they open the floodgates. Today it may be autistic children. Tomorrow it might be, say, fertility treatments for individuals or couples who are unable to conceive on their own.

But British Columbia raised the floodgates argument in 1997, when, in a precedent-setting case, the Supreme Court of Canada ordered hospitals to provide sign-language interpreters for deaf patients. B.C. argued that virtually everyone with an unmet medical need would be seeking a court order for the treatment. It didn't happen.

In the end, the B.C. court case shows how difficult it will be to control health-care costs by trying to limit insured services at the margins (or to the marginalized). To deny one group of children a necessary treatment in a universal system is to deny their worth as human beings. That is what makes it a constitutional matter. Universality does not mean everything -- but it does mean everyone.