"insured services" under the Medical Service Act Regulations, B.C. Reg. 144/68, s. 4.09, as
amended, the legislation does not specify the benefits it provides. Section 4.04 of the Regulations
does expressly state, however, that certain services, such as those provided solely for legal,
industrial or insurance purposes, as well as telephone advice and cosmetic procedures, are not
insured. Sign language interpretation is not included. In the usual course, the determination of
what constitutes a benefit is left to the discretion of the Medical Services Commission, a ninemember panel composed of representatives from the government, the British Columbia Medical
Association and health care consumers. Pursuant to s. 4(1)(j) of the Act, the Commission is
authorized to "determine whether a service is a benefit or whether any matter is related to the
rendering of a benefit". Conversely, s. 4(1)(c) empowers it to determine the services that are "not
benefits under [the] Act". The only limit on the Commission's discretion is set out in s. 4(2), which
cautions that its powers must not be exercised "in a manner that does not satisfy the criteria
described in section 7 of the Canada Health Act".
29 Assuming that the failure to provide sign language interpreters in medical settings violates s.
15(1) of the Charter in some circumstances, I do not see how the Medical and Health Care
Services Act can be interpreted as mandating that result. The legislation simply does not, either
expressly or by necessary implication, prohibit the Medical Services Commission from
determining that sign language interpretation is a "medically required" service and hence a
benefit under the Act. Indeed, the appellants assert in relation to the s. 15(1) issue that sign
language interpretation, where it is necessary for effective communication, is integrally related to
the provision of general medical services. Their theory, about which I will have more to say later,
is that the failure to provide sign language interpreters violates s. 15(1) because it prevents deaf
patients from benefiting equally from the provision of medical services in comparison to hearing
patients. If this is correct, then the Charter demands that free sign language interpretation be
provided as part of any medical service offered to the general public, at least where the service
requires a level of communication that only an interpreter can ensure. Under this approach, the
legislation must be interpreted to include sign language interpretation as a "medically required
service" in these circumstances. It is clear, therefore, that the failure to provide expressly for sign
language interpretation in the Medical and Health Care Services Act does not violate s. 15(1) of
the Charter. The Act does not list those services that are to be considered benefits; instead, it
delegates the power to make that determination to a subordinate authority. It is the decision of
authority that is constitutionally suspect, not the statute itself.
30 I pause to emphasize that not every conferral of statutory discretion may be interpreted
consistently with the Charter. Some grants of discretion will necessarily infringe Charter rights
notwithstanding that they do not expressly authorize that result; see, e.g., Re Ontario Film &
Video Appreciation Society and Ontario Board of Censors (1984), 5 D.L.R. (4th) 766 (Ont. C.A.),
affirming (1983), 147 D.L.R. (3d) 58 (Ont. Div. Ct.). In such cases it will generally be the statute,
and not its application, that attracts Charter scrutiny; see June M. Ross, "Applying the Charter to
Discretionary Authority" (1991), 29 Alta. L. Rev. 382. In the present case, however, the discretion
accorded to the Medical Services Commission to determine whether a service qualifies as a
benefit does not necessarily or typically threaten the equality rights set out in s. 15(1) of the
Charter. It is possible, of course, for the Commission to infringe these rights in the course of