Op-Ed by SAMIR SHAHEEN-HUSSAIN, Montreal Gazette. Thursday, December 04, 2008

The story of a newborn baby whose birth documents were initially withheld by an obstetrician (“Marley’s the baby who didn’t exist,” Nov. 27, and “Pediatrician offers to treat baby Marley,” Nov. 28) exposes a lamentable, all-too-frequent reality. It represents the tip of a much more significant problem faced by people who do not have permanent residency status in Canada. Dr. Yvonne Vasilie from the Lakeshore Hospital withheld baby Marley’s birth documents because her parents, Laura Cobian and Wayne Samuels, were not able to fully pay the fees for the obstetric care provided to Cobian.

Vasilie’s actions are contrary to medicine’s mantra of “primum non nocere” (“first, do no harm”): She unnecessarily delayed the process by which baby Marley would receive her medicare card by not submitting the relevant papers as per protocol. Vasilie’s actions might have also played a role in influencing baby Marley’s parents to leave the hospital earlier than necessary, despite the baby’s reportedly being clinically jaundiced.

An obstetrician’s job is not to determine who can and cannot give birth in a hospital, but to deliver care; a physician’s role is not to judge those she is treating. The primary responsibility of health-care providers should be to restore and maintain the health of individuals and populations whom they are serving; financial compensation for services rendered should never compromise this prime directive.

The doctor’s actions imply that some people have a right to be in this country, while others don’t. We categorically reject such a position. We affirm that people have a right to migrate, work and live wherever they wish. In particular, we recognize the fact that people migrate as a result of being displaced for economic, political and social reasons, usually because of exploitative policies by Western countries and corporations.

As long as such iniquitous and exploitative policies persist, and as long as borders exist that allow for the free flow of capital, these same borders must remain open to the free movement of people.

In this situation, the hospital has taken a laudable position critical of what Vasilie did, and Vasilie now says that this was all a “misunderstanding.”

Baby Marley’s parents and family should be applauded for going public with their case. There are far too many similar situations that go unreported. The most extreme cases are those of non-status people (those callously referred to as “illegals”) who cannot risk reporting such undignified treatment for fear that they will be detained or be deported.

Those fears mean people might delay accessing health- care services or be forced to get care in more clandestine ways, often at their own peril. As health- care workers on the island of Montreal, we see these situations frequently and it is clear that such political encumbrances undermine our ability to provide the standard of care these people are entitled to as human beings. Universal and accessible health-care services should be guaranteed for all, regardless of citizenship status or ability to pay.

We live in a political context in which military spending costs billions and money is wasted on other dubious initiatives and bureaucracies at federal, provincial and municipal levels, while politicians continue to be paid exorbitant salaries and enjoy comprehensive health-care benefits. In light of this, it is disingenuous to cite money woes as a justification for draconian health-care policies that have nefarious consequences on everyday people.

Meanwhile, the claim that “foreigners” are supposedly “abusing the system” (“Sick of foreigners abusing the system,” Nov. 28) is a convenient distraction that scapegoats migrants – primarily racialized migrants – while ignoring the excesses that occur within the system and reinforcing the as-yet unsubstantiated claim that more money necessarily translates into better services.

From a public-health perspective, there is a myriad of studies that underscore the heavy burden on individuals and society from a lack of access or incomplete access to health-care services for all. Ensuring that all people in Montreal are able to access health-care services is a simple matter of dignity and justice.

There are campaigns in Toronto for a “Don’t Ask, Don’t Tell” policy to safeguard access to services – including health care – for people with precarious citizenship status, spearheaded by groups like No One Is Illegal – Toronto.

Indeed, the solution in Montreal, Quebec and Canada quite simple: health care for all. Period.

– Samir Shaheen-Hussain is a Montreal pediatrician. His opinion piece was signed by Nazila Bettache, MD; Joey Bonifacio-Cruz, MD; Juan Carlos Chirgwin, MD; Anne-Marie Gallant, a nursing student; Helen Hudson, RN; Annie Janvier, MD; Jad Abou Khalil, a medical student; Tarek Loubani, MD; Gillian Morantz, MD; Chi-Minh Phi, MD; Olivier Sabella, MD; Sophie Schoen, a nursing student; and Brett Schrewe, MD.