Fédéralisme d’ouverture et pouvoir de dépenser au Canada

In power since January 2006, the leader of the Canadian Conservative party, Stephen Harper, promised to break with the previous governments’ “domineering” style of governance and to put into practice a new type of “open federalism.” Specifically, this approach involved correcting the fiscal imbalance between Ottawa and the provinces, taking measures to recognize Quebec’s specificity, and limiting the federal government’s recourse to an alleged spending power. This article briefly surveys the foundations of Canadian politics and the years when the Liberal party was in power, between 1993 and 2006, to assess the measures adopted by the Harper government, particularly with respect to the spending power. This power is not attributed in the constitution nor is it founded on clear jurisprudence, but Ottawa still claims and invokes it. Despite ther promises, the Conservatives have failed to offer a satisfactory formula for limiting its usage. So, Canada remains driven by the centralising process that has prevailed since the start of the 1980’s.

Caractérisation des unités de soins aigus chirurgicaux au sein des départements de chirurgie générale au Canada

Introduction : The acute care surgery (ACS) units are dedicated to the prompt management of surgical emergencies. It is a systemic way of organizing on-call services to diminish conflict between urgent care and elective obligations. The aim of this study was to define the characteristics of an ACS unit and to find common criteria in units with reported good functioning. Methods : As of July 1st 2014, 22 Canadian hospitals reported having an ACS unit. A survey with questions about the organization of the ACS units, the population it serves, the number of emergencies and trauma cases treated per year, and the satisfaction about the implementation of this ACS unit was sent to those hospitals. Results : The survey’s response rate was 73%. The majority of hospitals were tertiary or quaternary centers, served a population of more than 200 000 and had their ACS unit for more than three years. The median number of surgeons participating in an ACS unit was 8.5 and the majority were doing seven day rotations. The median number of operating room days was 2.5 per week. Most ACS units (85%) had an estimated annual volume of more than 2500 emergency consultations (including both trauma and non-trauma) and 80% operated over 1000 cases per year. Nearly all the respondents (94%) were satisfied with the implementation of the ACS unit in their hospital. Conclusion : Most surgeons felt that the implementation of an ACS unit resulted in positive outcomes. However, there should be a sizeable catchment population and number of surgical emergencies to justify the resulting financial and human resources.

Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

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