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8 The Evolution of Public Policy on Reprogenetics in Canada
- Johns Hopkins University Press
- Chapter
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The Evolution of Public Policy on Reprogenetics in Canada C H A P T E R E I G H T The cultural attitudes and values broadly espoused by a society influence how a country’s public policy evolves to deal with the choices posed by new technologies. It is useful to remember that, despite sharing a language and a 3,000-mile-long border, Canada and the United States have quite different histories . As a result, the cultures and values of the two countries differ more than is immediately apparent. These differences, which are deeply embedded in what might be called the national worldview, have led to a distinctive shaping of public policy regarding new reproductive technologies in Canada. The formative nature of some of the culture differences has been described well in Seymour Martin Lipset’s classic book, Continental Divide (1990), which teases out some of the most fundamental differences in the relationship of government to the governed in Canada and the United States. Lipset notes that Canadians’ attitude in general is that government is there to act in the public interest, whereas U.S. citizens have, in general, a greater mistrust of government—government is something to have as little of as possible. As Lipset writes, “One society leans toward communitarianism—the public mobilization of resources to fulfill group objectives—the other sees individualism —private endeavour—as the way an ‘unseen hand’ produces optimum, socially beneficial results.” Most commentators converge in the view that Canadians tend to be less highly individualistic in their worldview, with the relationship of the individual to the collectivity therefore being construed differently from the more PAT R I C I A A . B A I R D individualistic stance in the United States. In Canada, there appears to be a common understanding that individuals are embedded in networks of relationships and are not isolated entities, concerned to protect their own interests against the encroachment of others. People are connected in families and communities and through many different social bonds, and they recognize they cannot enjoy rights and interests in isolation. A principle evidently of much more importance to Canadians than to U.S. citizens is solidarity. Solidarity is the core concept on which the health care system rests, and why health care is universally available. Solidarity is not the same as justice. Solidarity emerges from an emotional bond and fellowfeeling , a sense of “we’re all in it together” (d’Oronzio 2001). This is something many Europeans identify with, but it is less well received in the United States, where individual autonomy and individual freedom are emphasized. Neveretheless, it is the collective emotional togetherness that I call solidarity that has allowed the Canadian publicly supported health care system to evolve the way it did. The health care system reflects the fact that most Canadians think individuals should be treated equally in the face of illness and disease; the provision of universal health care is a tangible way for a society to express mutual support and caring for its members. The difference in how the individual relates to the collective means there is not as strong a place for the market in some facets of Canadian lives, and there is a prevailing view that medical care should be provided on the basis of need, not on the basis of ability to pay. This attitudinal difference is also behind the fact that Canada has a much narrower range of income distribution. In fact, it has chosen tax and social policies that have a redistributive effect. Over the past decade Canada has ranked in the top half-dozen countries in the world for high life expectancy and low infant mortality. The United States, on the other hand, exhibits the largest income gap between rich and poor among wealthy nations, and its health indicator ranking on life expectancy and infant mortality is much lower than Canada’s—far lower than one would expect for its wealth (Marmor and Sullivan 2000; Wilkinson 1996). There are also significant differences between the two countries in religious attitudes. Canadians adhere more to hierarchical denominations—the big three are the Anglican, Catholic, and United Churches. Americans are more likely than Canadians to be fundamentalist Christians, to believe in God and the devil, and to enjoin a more literal reading of the Bible. Christian fundamentalism in Canada does not have the same media presence, numbers, or T H E E V O L U T I O N...