## Facts

- Quebec maintained a universal public health-care plan and prohibited private insurance for services covered by that plan.
- Section 15 of the Health Insurance Act and section 11 of the Hospital Insurance Act barred private insurance for publicly insured services, effectively preventing insured patients from purchasing coverage for private treatment of those services.
- George Zeliotis experienced long delays for medically necessary treatment in the public system and sought private insurance to obtain timely care.
- Dr. Jacques Chaoulli sought to provide services through an independent private hospital model but was impeded by the statutory scheme restricting private insurance for publicly covered services.
- The challengers alleged that lengthy wait times for necessary care, combined with a blanket insurance prohibition, exposed patients to risks of serious physical and psychological harm, including death.

## Issues

1. Whether Quebec’s prohibitions on private insurance for publicly covered services violate the rights to life and personal inviolability under the Quebec Charter, and if so, whether the limits are justified.
2. Whether the same prohibitions violate section 7 of the Canadian Charter (life, liberty, and security of the person), and if so, whether any infringement is justified under section 1.

## Decision

- The Supreme Court of Canada allowed the appeal in part by a 4–3 vote.
- A majority held the impugned provisions invalid under the Quebec Charter because they infringed protected interests in life and personal inviolability and were not justified.
- The declaration of invalidity was suspended for 12 months to allow legislative action.
- On the Canadian Charter section 7 issue, three judges found a violation and three judges found no violation; a seventh judge declined to decide the issue, leaving no binding section 7 holding.

## Legal Principles

- When a government establishes and regulates a public health-care scheme, the scheme must operate consistently with protected rights and may not, without justification, expose individuals to serious risks to life or bodily integrity.
- Excessive delays in access to medically necessary treatment can engage rights related to life and personal inviolability/security of the person where the evidence shows a real risk of serious harm.
- A categorical ban on private insurance for publicly covered services may fail proportionality review if it impairs protected interests more than necessary to achieve objectives such as preserving the public system.
- Comparative and contextual evidence (including other jurisdictions’ arrangements) may be relevant to evaluating whether an absolute restriction is necessary to protect the public system.

## Conclusion

The Court held that Quebec’s blanket prohibition on private insurance for services covered by the public plan was unconstitutional under the Quebec Charter in the context of harmful treatment delays and was not justified, while the Court produced no binding national ruling under section 7 of the Canadian Charter due to an even split.


Chaoulli v. Quebec (Att’y Gen.), [2005] 1 S.C.R. 791 (Can.)