11.3

great proportion of the emergency surgical work, with the
exception of the most severe and catastrophic conditions,
is generally dealt with by the registrars. In the best
hospitals it is customary for close telephone contact to be
maintained between the registrars and their chiefs for the
discussion of emergencies. It is traditional too for the
consultant to accept continued responsibility for all patients
under his care. Thus, in the event of post-operative
complications, any problems will usually be discussed with
the consultant concerned rather than with a "duty doctor"
who is unknown to the patient. This acceptance of continued
responsibility is essentially a traditional ethical
commitment of the consultant, rather than a strictly legal
contractual responsibility under the N.H.S.- a point worth
stressing since, in recent confrontation with the department
of Health, it has been established that consultants were
within their legal rights in working strictly to their
contractual hours.

Patients admitted for surgery under the N.H.S. are
required to sign a consent form which explicitly states "I
understand an assurance has not been given that the operation
will be performed by a particular surgeon". The only way
r
of securing the guarantee that a named surgeon will imdetake
an operation is by becoming a private patient. It will
therefore be seen that, if the present Government carries
out its threat to fully separate the N.H.S. and private
sectors, it would be impossible for a patient in a N.H.S.
hospital to ensure that he or she received the services of a

12.1

12.2

surgeon of their choice. This is but one of many ways

in which confrontation between the Goverment and the medical profession can damage the quality of medical care offer ed

to the patient.

A FINAL WORD ON PERSONAL RESPONSIBILITY.

It has been truly said that "Liberty is the luxury of self-discipline". But it is equally true that, without

a reasonable amount of personal liberty, it is difficult
for folk to recognise the virtues of self-discipline and
personal responsibility. When, as in the more extreme
examples of State Welfare, people are relieved of most
decision-making and consumer choice it becomes more and more
difficult for them to make decisions on their own behalf.

People in general are prepared to strive harder for
themselves and their families, rather than for some more
nebulous notion of the "general good". A major task of
public policy is to harness this self-interest to the
public good: in other words, to promote the spread of truly
enlightened self-interest. It takes a Nation, such as

In a

Britain, formerly bred in independence, to survive the
arrival of a system which offers almost complete dependence
on the State for so many of the essentials of life.
country with little or no tradition of individual responsib-
-ility towards the State a health service such as ours
would much more rapidly become a major disaster.
despite what has been said about British traditions, it
would seem that only now, after more than a quarter of a
century of massive State Welfare, is the system showing

But,

12.3

12.4

12.5

12.6

signs of serious breakdown,

It is not simply the recipients of health care, the
patients, who are damaged by a surfeit of State Welfare, but
also the doctors, nurses and ancillary staff. The old local
lbyalties to the district hospital, and to the great teaching
centre, are fast diminishing in Britain. They are
diminishing for the very simple reason that local team spirit
and loyalty to an institution are threatened, and often
ultimately destroyed, by any system which also tries to
impose allegiance to a centralised, bureaucratic and
politically orientated administration.

It is my belief that a sensible mixture of independent
and State-financed Medicine is essential to the health of

each. We are unrepentant supporters of a mixed medical
economy and utterly reject the concept of State monopoly
or near-monopoly in Medicine.

In your own country you already have a remarkably
variegated set-up so far as your hospitals and specialist
service are concerned. Thus, Americans may be treated in
municipal, veterans and service hospitals, as well as in

university or private hospitals, or in one of your internationally
famous private clinics such as the Mayo, the Cleveland or the
Lahey.

It would be impertinent for a mere Briton, and even for one who had a naturalised American father and an American stepmother, to tell your own great country how to arrange its medical affairs. But perhaps one could be so bold as to suggest that you should seek every possible means of promoting

20.

Murley.

the greatest measure of personal responsibility, and of

preserving a substantial element of variety and choice

for both patient and doctor.

STATEMENT OF DR. BETTE STEPHENSON BEFORE THE

SUBCOMMITTEE ON HEALTH

COMMITTEE ON WAYS AND MEANS

September 12, 1975

First, may I thank you for the honor and privilege of appearing before you today. I hope that in some small way

I may add to your knowledge of the medical

care insurance

program of Canada, and thus make a contribution to your

deliberations.

I do not envy the Members of this Committee

the awesome responsibility you have been assigned, but would wish you every success.

I think it is important that my testimony be placed in proper context. While I am currently in the midst of an election campaign, seeking a seat in the government of the Province of Ontario, the counterpart of your State legislature, I do not appear before you as a novice politician. My comments are offered from the perspective of a practicing family physician--a physician who has been actively involved in her professional association at the local, provincial, and

national levels.

To prevent an acute shock reaction to some of my comments, for those of you who are not aware of the differences, I would point out that there is a vast difference

between the policies,

58-442 O 75 - 4