Prime Minister Stephen Harper peers through a PET (Positron emission tomography) scanner during a campaign stop at the Thunder Bay Regional Health Sciences Centre in Thunder Bay, Ontario on Tuesday April 19, 2011. THE CANADIAN PRESS/Frank Gunn

The time has come for Stephen Harper to get serious about health care.

Since taking office in 2006, Harper has justified his hands-off approach by hiding behind the Health Accord his predecessor negotiated, sticking to what was possible under minority mandates. Those fig leaves are gone and the Harper government stands naked in the face of major structural and ethical questions on which it alone has a mandate and a duty to lead.

To her credit, having been on the job little more than a month, Health Minister Rona Ambrose is expected to signal that she plans to run things differently than her feel-good predecessor Leona Aglukkak, who was more school nurse than CEO of Canada’s biggest enterprise. Ambrose will meet Monday with the general council of the Canadian Medical Association in Calgary and is expected to deliver the message that the prime minister knows that he can no longer be Bert the Turtle when it comes to health care.

Harper recognizes Ottawa can never give the provinces enough money to buy full peace, but his decision to largely ignore the file is based more in an innate belief in decentralism and he has never come to terms with the fact that Canadians aren’t with him on this file. A poll coming out Monday is expected to show that fewer than three-in-10 Canadians think the federal government is doing a good job when it comes to health care. The numbers are considerably better for the provinces and the doctors, meaning that when fingers start being pointed after the current health accord’s expiry, they’ll be aimed squarely at the Peace Tower.

Oddly, though, while money is always part of the three-way tug of war between the federal government, the provinces and health care professionals, Conservatives might be surprised to learn it’s not all that close to the top of the CMA’s list of priorities. Instead, the country’s doctors are calling for something far more precious — leadership.

For almost a decade, virtually everyone in the health industry has called on Ottawa to champion the creation of a human resources plan for health care. Canada needs a central service that ensures the proper number of doctors, nurses, radiologists and other specialists are being trained and deployed where they are needed. But year after year, Health Canada has refused to step up to create an effective human resources system for Canada’s health system.

The result of this laissez-faire approach is that too many of the best doctors gravitate to Canada’s three biggest cities, to the detriment of other regions, which are often forced to import doctors from developing countries to staff their clinics.

The free-market mantra is that people go where the jobs are. Another one is that patients go where the doctors are — even if that means driving six hours to see an oncologist. Operating rooms in big cities are booked months in advance, while perfectly good regional hospitals struggle to find qualified night staff. Obviously, the provinces need to play a big role in countering this HR problem, but they can’t do much if the federal government won’t even talk to them as a group.

“Imagine if the federal government came to that table. What a strong force that could be,” a hopeful Dr. Anna Reid, now out-going president of the CMA, told Maclean’s last year.

Ambrose also should expect to face worried questions about the hodgepodge of laws Canada has surrounding a myriad of end-of-life issues. Which treatments for dying patients are legal and which are not? When does a doctor’s duty to a patient outweigh allegiance to laws written ages ago? No one can say.

Which treatments for dying patients are legal and which are not? When does a doctor’s duty to a patient outweigh allegiance to laws written ages ago? No one can say.

While doctors have always been among the most vocal opponents to easing end-of-life laws, that is changing. Dr. Louis Hugo Francescutti, who takes over from Reid as the CMA’s president this week, says doctors are ready to have this debate among themselves. But such a debate needs to happen with the full participation of the federal government, whose role it is to uphold the laws.

Only the most naïve person believes that many — perhaps most — Canadian doctors wouldn’t, in extreme cases, use their abilities to end someone’s suffering in his or her final hours. End-of-life issues are as old as medicine itself, whether they involve withholding treatment, alleviating the suffering of someone in their death throes, or helping someone take his or her own life. It happens. It just hasn’t been discussed in polite company.

But for a generation now, how one faces death has been a hot-button issue at family dinners, and certainly since the book Final Exit, now in its third edition, was first published 22 years ago. For boomers the issue isn’t theoretical question anymore — and it’s not one that any federal party can simply ignore.

Social conservatives and regional differences in laws have created in Canada — and throughout the world — a black market for ending life. This can’t go on, and for a range of moral and ethical reasons it shouldn’t. Patients shouldn’t have to fly around the world to die away from their loved ones. Canadian doctors shouldn’t have to fear the overzealous application of dated and widely-flouted laws.

This requires leadership, and at very least, Ambrose needs to assure doctors that she and Justice Minister Peter MacKay will take this forward and, if necessary, stare down the social conservatives in their caucus and at the party’s policy convention in early November.

These two questions are just a few in a long list of tough issues facing Canada’s health care system that go way beyond the relatively simple question of funding. But lest Ambrose think that’s not a root issue likely to grab her by the foot, she should probably call a few of her Liberal predecessors.

Harper’s indifference toward the health care system was never benign and the problems go well beyond funding. There will be money fights ahead, but with an election looming in 2015, Harper can not afford to be doing nothing on matters on which he should be leading. Nor can the rest of us.

James Baxter is the founding editor and publisher of iPolitics.