In fact, it is hard to imagine a facet of health care reform that does not have some type of legal ramification. In an ideal society, there would be congruence between the legal framework within which health care is delivered and the ethical parameters and principles that ought to govern the delivery of health care itself. The Canadian society is no more and no less ideal than any other. Consequently, there are occasions where the fit between the legal frameworks within which health care operates, and the ethical requirements inherent in the mandate of health care itself, is problematic. This absence of congruence can take two forms. In one case, the law or at least part of it, is in direct conflict with itself or is at variance with what the society considers ethically appropriate. In the other case, there is no law at all and the very absence of a law leads to ethical dilemmas. Canadians believe that competent persons have the right to execute advance directives detailing their treatment once they are no longer competent to make such decisions in their own person. However, in most provinces statute law and its accompanying regulations have not caught up with this change in ethical perspective. Consequently, health care delivery protocols tend to require emergency response personnel to initiate resuscitative treatment even when there is an advance directive to the contrary. This sets up an ethical dilemma for emergency response personnel, which, under the circumstances, are not conducive to the delivery of good and efficient health care. Another area of ethical concern pertains to children. Canadian society has come to accept that discrimination based on age is ethically unacceptable. Children may act as decision makers in their own right, as long as the children are deemed competent and the attending health care professional agrees that the choices they make are in their own best interest. Nevertheless, for some health care providers it has led to tension between the ethics of autonomy, which has become a cornerstone of Canadian medical practice, and the tradition of paternalism towards children.

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