Health Care Services Act, S.B.C. 1992, c. 76 (now the Medicare Protection Act, R.S.B.C. 1996, c.
286), ss. 1, 4(1)(c), (j), 6, 8.
Medical care in British Columbia is delivered through two primary mechanisms. Hospital
services are funded under the Hospital Insurance Act by the government which reimburses them
for the medically required services provided to the public. Funding for medically required services
delivered by doctors and other health care practitioners is provided by the province's Medical
Services Plan (established and regulated by the Medical and Health Care Services Act). Neither
program pays for sign language interpretation for the deaf.
Each of the appellants was born deaf and their preferred means of communication is sign
language. They contend that the absence of interpreters impairs their ability to communicate with
their doctors and other health care providers, and thus increases the risk of misdiagnosis and
ineffective treatment.
The appellants unsuccessfully sought a declaration in the Supreme Court of British Columbia
that the failure to provide sign language interpreters as an insured benefit under the Medical
Services Plan violates the s. 15(1) of the Canadian Charter of Rights and Freedoms. A majority of
the Court of Appeal dismissed an appeal from this judgment. The constitutional questions before
this Court queried: (1) whether the definition of "benefits" in s. 1 of the Medicare Protection Act
infringed s. 15(1) of the Charter by failing to include medical interpreter services for the deaf, (2) if
so, whether the impugned provision was saved under s. 1 of the Charter, (3) whether ss. 3, 5 and
9 of the Hospital Insurance Act and the Regulations infringed s. 15(1) by failing to require that
hospitals provide medical interpreter services for the deaf, and (4) if the answer to 3 is yes,
whether the impugned provisions were saved under s. 1. Also at issue were whether, and in what
manner, the Charter applies to the decision not to provide sign language interpreters for the deaf
as part of the publicly funded scheme for the provision of medical care and, if a Charter violation
were found, what the appropriate remedy would be.
Held: The appeal should be allowed. The first and third constitutional questions were
answered in the negative. It was not necessary to answer the second and fourth constitutional
questions.
The Charter applies to provincial legislation in two ways. Firstly, legislation may be found to be
unconstitutional on its face because it violates a Charter right and is not saved by s. 1. Secondly,
the Charter may be infringed, not by the legislation itself, but by the actions of a delegated
decision-maker in applying it. The legislation remains valid but a remedy for the unconstitutional
action may be sought pursuant to s. 24(1) of the Charter.
In the present case the question whether the alleged breach of s. 15(1) arises from the
impugned legislation itself or from the action of entities exercising decision-making authority
pursuant to that legislation must be explored. The failure of the Medical and Health Care Services
Act to provide expressly for sign language interpretation as a medically required service does not
violate s. 15(1) of the Charter. The legislation simply does not, either expressly or by necessary
implication, prohibit the Medical Services Commission from determining that sign language