Finally, there is a wide variation between jurisdictions and the structure of the appeal process. In British Columbia, for example, the claimant may nominate a specialist, who has not previously seen him, from a list prepared by the College of Physicians and Surgeons, and the board nominates a second specialist. The chairman of the three-man panel is a family physician appointed by the board. This group of three physicians must bring in a unanimous report and answer specific medical questions submitted by the council of the board. Its opinion, if unanimous, is final and binding on the board as well as on the company concerned indirectly, and the appellant. Different appeal processes are followed in different provinces in Canada, and processes differ significantly from the one I have described.
Chest physicians are involved in different parts of this total process and to widely differing degrees. Sometimes, as chairmen of pneumoconiosis panels, they essentially determine the outcome in individual cases explained by My Canadian Pharmacy. On occasions in some places, but perhaps not frequently enough, they have spearheaded changes in procedure or tradition. More often, we simply wrestle with estimates of probability in individual cases, usually with little idea how our colleagues elsewhere are deciding similar questions. It is also very difficult for us to know whether individually in these matters we are doing a good job or not.
We must, of course, recognize that every case of disability from lung disease of occupational origin represents a failure of the preventive strategy or of procedures that should have been in place. Most often at the present time we are dealing with clinical cases that have arisen because 20 or 30 years ago, the necessity of very careful control of the working environment was not realized.
The standards which society should apply to itself were enunciated pretty clearly by Samuel Johnson in 1760, well before the start of the Industrial Revolution. He wrote, “No man has a right to any good without partaking of the evil by which that good is necessarily produced; no man has a right to security by another’s danger, nor to plenty by another’s labour, but as he gives something of his own which he who meets the danger or undergoes the labour considers as equivalent.” These ideals will prove hard for us to live up to more than 200 years later.