Some ethical reflections on accountability

Wait times have come to dominate the health reform agenda and have captured the public imagination. Waiting for any service--from fast food to e-mail--is difficult for contemporary Canadians; this is especially true for healthcare. Addressing wait times is part of a much larger initiative essential for the health system and dependent on a culture shift from the "blame game" to a sustained, meaningful accountability. Achieving this goal in such a value-laden endeavour as healthcare will be no small task. Accountability for the fair provision of access to and quality of services in healthcare is complex and demanding, in large part because of the nature of health need and the social meaning of healthcare. Failure of progress on this issue is related to a lack of clarity about the locus, meaning and scope of accountability. Without such clarity the term runs the risk of becoming useless or dangerous. Ethically, the key lies in understanding the profoundly value-laden nature of both healthcare and public policy.