Towards a Post-Social Right to Life,Liberty and Security of the Person Through Markets? Conceptions of Citizenship and the Implications for Health Law as Governance
Restricted accessResearch articleFirst published online October, 2020
Towards a Post-Social Right to Life,Liberty and Security of the Person Through Markets? Conceptions of Citizenship and the Implications for Health Law as Governance
In the context of increased expectations of healthcare services and fiscal pressures, rights claims constitute a force pushing for privatization and thus threaten Canada’s single-tier public system. This article introduces the concept of a ‘post-social right’ to understand the current legal effort to enforce a right to healthcare derivative of section 7 of the Canadian Charter of Rights and Freedoms. Commonly considered as a ‘negative’ right, I suggest that the right also has positive capacity. Rather than simply protecting against unjust state intervention, section 7 claims valorize a particular mode of sustaining life, liberty and security of the person according to neo-liberal principles. A right to markets in healthcare aligns health law with the logic of prudentialism as a technology of governance. As the enforceability of the right expands and strengthens, health law as governance operates to normalize market solutions to health matters. It follows that a form of two-tier citizenship arises, dividing ‘activated’ citizens from the ‘inactive’.
Auton (Guardian Ad Litem of) v British Columbia (Attorney General) [2004] SCC 78.
3.
Cambie Surgeries Corp v British Columbia (Medical Services Commission) [2010] BCCA 396.
4.
Chaoulli v Quebec (Attorney General) [2005] SCC 35.
5.
Gosselin v Quebec (Attorney General) [2002] SCC 84.
6.
Lochner v New York [1905] 198 US 45.
7.
Murray v Alberta (Calgary Health Region) [2007] ABQB 231.
8.
R v Morgentaler [1988] 1 SCR 30, 44 DLR (4th) 385.
9.
ArmstrongPArmstrongH (2010) Wasting Away: The Undermining of Canadian Health Care, 2nd ed. Don Mills: Oxford University Press.
10.
BhatiaV (2010) Social rights, civil rights, and health reform in Canada. Governance23(1): 37–58.
11.
BrodieJ (2007) Reforming social justice in neoliberal times. Studies in Social Justice1(2): 93–107.
12.
BrownW (2015) Undoing the Demos: Neoliberalism’s Stealth Revolution. New York: Zone Books.
13.
Canada Health Act, RSC1985, c C-6.
14.
Canadian Charter of Rights and Freedoms, Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11.
15.
Charter of Human Rights and Freedoms, RSQ c C-12, s 1.
16.
ChoudryS (2005) Worse than Lochner? In: FloodCMRoachKSossinL (eds) Access to Care, Access to Justice: The Legal Debate Over Private Health Insurance in Canada. Toronto: University of Toronto Press, pp. 75–100.
17.
Constitutional Law Group (2017) Canadian Constitutional Law, 5th ed. Toronto: Emond.
18.
CruikshankB (1993) The will to empower: Technologies of citizenship and the war on poverty. Socialist Review23(4): 29–55.
19.
DracheDSullivanT (1999) Health reform and market talk. In: DracheDSullivanT (eds) Health Reform: Public Success, Private Failure. New York: Routledge, pp. 1–21.
20.
EleveldAVan HoorenF (2018) The governmentalization of the trade union and the potential of union-based resistance. The case of undocumented migrant domestic workers in the Netherlands making rights claims. Social & Legal Studies27(5): 596–615.
21.
EricsonRBarryDDoyleA (2000) The moral hazards of neo-liberalism: Lessons from the private insurance industry. Economy & Society29(4): 532–558.
22.
FilipponJGiovanellaLKonderM, et al. (2016) “Liberalizing” the English National Health Service: Background and risks to healthcare entitlement. Cadernos de Saude Publica32(8): 1–14.
23.
FloodCM (2006) Chaoulli’s legacy for the future of Canadian health care policy. Osgoode Hall Law Journal44(2): 273–310.
24.
FloodCM (2014) Litigating health rights in Canada: A white knight for equity? In: FloodCMGrossA (eds) The Right to Health at the Public/Private Divide: A Global Comparative Study. Cambridge: Cambridge University Press, pp. 79–106.
25.
FloodCMHauganA (2010) Is Canada odd? A comparison of European and Canadian approaches to choice and regulation of the public/private divide in health care. Health Economics, Policy and Law5: 319–341.
26.
FloodCMThomasB (2016) Modernizing the Canada Health Act. Dalhousie Law Journal39: 397–411.
27.
FloodCMLaheyWThomasB (2017) Federalism and health care in Canada: A troubled romance? In: OliverPMacklemPDes RosiersN (eds) The Oxford Handbook of the Canadian Constitution. New York: Oxford University Press, pp. 449–473.
28.
FloodCMStabileMKonticS (2005) Finding health policy ‘arbitrary’: The evidence on waiting, dying, and two-tier systems. In: FloodCMRoachKSossinL (eds) Access to Care, Access to Justice: The Legal Debate Over Private Health Insurance in Canada. Toronto: University of Toronto Press, pp. 296–320.
29.
FrauleyJ (2012) Post-social politics, employability, and the security effects of higher education. Journal of Pedagogy3(2): 219–241.
30.
FrauleyJ (2014) Caveat emptor under prudentialism: The case of the Canadian home inspection industry. Social & Legal Studies23(2): 195–213.
31.
GarlandD (2014) The welfare state: A fundamental dimension of modern government. European Journal of Sociology55(3): 327–364.
32.
GarlandD (2015) On the concept of ‘social rights’. Social & Legal Studies24(4): 622–628.
33.
GarlandD (2016) The Welfare State: A Very Short Introduction. Oxford: Oxford University Press, 2016.
34.
GraefeP (2018) State rescaling, institutionalized state-citizen relationships, and Canadian health policy. Studies in Political Economy99(2): 175–193.
35.
HuntA (2002) Legal governance and social relations: Empowering agents and the limits of law. In: Mac NeilMSargentNSwanP (eds) Law, Regulation, and Governance. Don Mills: Oxford University Press, pp. 54–77.
36.
HuntAWickhamG (1994) Foucault and Law: Towards a Sociology of Law as Governance. Boulder: Pluto Press.
37.
JackmanM (2000) What’s wrong with social and economic rights?National Journal of Constitutional Law11: 235–246.
38.
KotkasT (2010) Governing health and social security in the twenty-first century: Active citizenship through the right to participate. Law and Critique21: 163–182.
39.
LindrothM (2014) Indigenous rights as tactics of neoliberal governance: Practices of expertise in the United Nations. Social & Legal Studies23(3): 341–360.
40.
MaarseH (2006) The privatization of health care in Europe: An eight-country analysis. Journal of Health Politics, Policy and Law31(5): 981–1014.
41.
MaioniA (2010) Citizenship and health care in Canada. International Journal of Canadian Studies42: 225–242.
42.
MarchildonGPSchrijversK (2011) Physician resistance and the forging of public healthcare: A comparative analysis of the doctors’ strikes in Canada and Belgium in the 1960s. Medical History55(2): 203–222.
43.
MarmorT (1999) The rage of reform: sense and nonsense in health policy. In: DracheDSullivanT (eds) Health Reform: Public Success, Private Failure. New York: Routledge, pp. 260–272.
44.
O’MalleyP (1996a) Post-social criminologies: Some implications of current political trends for criminological theory and practice. Current Issues in Criminal Justice8(1): 26–38.
45.
O’MalleyP (1996b) Risk and responsibility. In: BarryAOsborneTRoseN (eds) Foucault and Political Reason. Abingdon: Routledge, pp. 189–207.
46.
PeckJ (2010a) Constructions of Neoliberal Reason. Oxford: Oxford University Press.
47.
PeckJ (2010b) Zombie neoliberalism and the ambidextrous state. Theoretical Criminology14(1): 104–110.
48.
PetersMA (2005) The new prudentialism in education: Actuarial rationality and the entrepreneurial self. Educational Theory55(2): 123–137.
49.
PetterA (2007) The wrong kind of rights: The Charter threat to medicare. In: CampbellBMarchildonG (eds) Medicare: Facts, Myths, Problems & Promise. Toronto: James Lorimer & Co, pp. 371–376.
50.
PollockAM (2004) NHS plc: The Privatisation of Our Health Care. London: Verso.
51.
PollockAMPriceDRoderickP, et al. (2012) How the Health and Social Care Bill 2011 would end entitlement to comprehensive health care in England. Lancet379: 387–389.
52.
PrémontM-C (2007) Wait-time guarantees for health services: An analysis of Quebec’s reaction to the Chaoulli Supreme Court decision. Health Law Journal15: 43–86.
53.
PrémontM-C (2008) Clearing the path for private health markets in post-Chaoulli Quebec. Health Law Journal (Special Issue): 237–263.
54.
PurvisTHuntA (1999) Identity versus citizenship: Transformations in the discourses and practices of citizenship. Social & Legal Studies8(4): 457–482.
55.
RiceJJPrinceMJ (2013) Changing Politics of Canadian Social Policy, 2nd ed. Toronto: University of Toronto Press.
56.
RoseN (1992) Governing the enterprising self. In: HeelasPMorrisP (eds) The Values of the Enterprise Culture: The Moral Debate. New York: Routledge, pp. 141–164.
57.
RoseN (1996) The death of the social? Re-figuring the territory of government. Economy & Society25(3): 327–356.
58.
RoseN (1999) Powers of Freedom: Reframing Political Thought. Cambridge: Cambridge University Press.
59.
RoseN (2007) The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. Princeton: Princeton University Press.
60.
RoseNValverdeM (1998) Governed by law?Social & Legal Studies7(4): 541–551.
61.
RuggieM (1996) Realignments in the Welfare State: Health Policy in the United States, Britain, and Canada. New York: Columbia University Press.
62.
SearsA (1999) The ‘lean’ state and capitalist restructuring: Towards a theoretical account. Studies in Political Economy59(1): 91–114.
63.
Sokhi-BulleyB (2011) Governing (through) rights: Statistics as technologies of governmentality. Social & Legal Studies20(2): 139–155.
64.
SonnenCMcCrackenM (1999) Downsizing, passive privatization and fiscal arrangements. In: DracheDSullivanT (eds) Health Reform: Public Success, Private Failure. New York: Routledge, pp. 229–250.
65.
SossinL (2005) Towards a two-tier constitution? The poverty of health rights. In: FloodCMRoachKSossinL (eds) Access to Care, Access to Justice: The Legal Debate Over Private Health Insurance in Canada. Toronto: University of Toronto Press, pp. 161–183.
66.
StabileMIsabelleM (2018) Rising inequality and the implications for the future of private insurance in Canada. Health Economics, Policy and Law13: 406–432.
67.
WaltersW (1997) The ‘active society’: New designs for social policy. Policy & Politics25(3): 221–234.
68.
WehlingP (2011) Biology, citizenship and the government of biomedicine: Exploring the concept of biological citizenship. In: BrocklingUKrasmannSLemkeT (eds) Governmentality: Current issues and Future Challenges. New York: Routledge, pp. 225–246.
69.
WhitesideH (2009) Canada’s health care ‘crisis’: Accumulation by dispossession and the neoliberal fix. Studies in Political Economy84: 79–100.
70.
WhitesideH (2015) Purchase for Profit: Public-Private Partnerships and Canada’s Public Health-Care System. Toronto: University of Toronto Press.
71.
YalnizyanA (2007) Growing inequality, basic needs and health. In: CampbellBMarchildonG (eds) Medicare: Facts, Myths, Problems & Promise. Toronto: James Lorimer & Co, pp. 331–336.
72.
YoungD (2015) Individual rights and the negotiation of governmental power: The risk of HIV transmission and Canadian criminal law. Social & Legal Studies24(1): 113–134.
