## Facts

- Three deaf patients relied primarily on sign language and alleged that lack of interpreter services in publicly funded health care impaired communication with providers, increasing risks of misdiagnosis and ineffective treatment.
- British Columbia funded hospital services under provincial hospital insurance legislation and funded physician services through a medical services plan.
- Neither program covered sign-language interpreter services for deaf patients, including after a non-profit interpreter provider experienced financial difficulties and was denied provincial funding.
- The patients sought a declaration that the omission violated equality rights under s. 15(1) of the Canadian Charter of Rights and Freedoms and an order requiring interpreter funding.
- Lower courts dismissed the claim; the Supreme Court of Canada heard the appeal.

## Issues

1. Whether the Charter applied to the omission, given that hospitals and the Medical Services Commission (rather than the legislature directly) delivered insured medical services.
2. Whether failure to provide medically necessary sign-language interpretation denied deaf patients the equal benefit of the health care scheme contrary to Charter s. 15(1).
3. Whether any s. 15(1) breach was justified under Charter s. 1 based on cost and resource-allocation concerns.
4. What remedy was appropriate if a violation was found.

## Decision

- The Supreme Court of Canada allowed the appeal unanimously.
- The Charter applied because hospitals and the Medical Services Commission were implementing a specific government program under statutory authority; the province could not avoid Charter duties by delegation.
- The failure to provide interpreter services where needed for effective communication violated s. 15(1) as discrimination on the basis of disability by denying deaf persons equal benefit of the publicly funded health scheme.
- The government did not justify the violation under s. 1; evidence did not show costs or administrative burdens sufficient to warrant the exclusion.
- The Court issued a declaration of unconstitutionality, suspended for six months to allow the province to design and implement an appropriate response.

## Legal Principles

- Constitutional rights constraints apply not only to legislation but also to discretionary conduct of entities implementing government programs under statutory authority.
- Equality protection requires substantive equality; a formally neutral benefit scheme can be discriminatory if it has adverse effects on a disadvantaged group.
- Once the state provides a benefit by law, it must provide it in a non-discriminatory manner; equal benefit may require accommodation.
- Equality rights may require positive measures, including funding additional services, when necessary to ensure effective access to a public program.
- Cost and resource considerations may be raised under the justification analysis, but the state bears the burden and cannot rely on modest compliance costs to excuse rights violations.

## Conclusion

The Court held that delegated delivery of insured health services remained subject to constitutional equality requirements and that excluding necessary sign-language interpretation denied deaf patients equal benefit of public health care; the violation was not justified by cost, and the Court granted a suspended declaration to permit the government to implement a compliant scheme.


Eldridge v. British Columbia (Att’y Gen.), [1997] 3 S.C.R. 624 (Can. 1997)