The Paradox of Hospital Lotteries

By Josh Skinner

Whether you consider something a mandate or a mantra, it often serves a guiding principle for whichever institution they are uttered in. For hospitals, this takes the form of the Hippocratic Oath, commonly conflated with the “first do no harm” (although it does not appear in the Oath itself, it does appear in Book 1 of the Hippocratic school).  Hospitals give their patron’s cutting edge medicine, knowledge and tools to fight against a host of maladies. Diseases, just like their hosts, are constantly evolving and seem to grow in step with humanity, and as a result medicinal research needs consistent funding.

The history of gambling practice in Canada offers explanations as to how hospitals got into the gambling business. The first government ran lottery was established in 1969, despite being initially deemed illegal by the Supreme Court of Canada (SCC). Like most SCC decisions, it was influenced by shifting public perception about the matter at hand. However 69 years prior to this, it was ruled that small scale charities would be allowed to run raffles and use gambling as a method of raising funds. As a result of the 1969 SCC decision, state ran hospitals now had a legally viable avenue for ethical gambling.

This avenue became cemented and monopolized by the mid-80s, when provinces secured a monopoly on gambling, and all charities would have to go through the province to secure a license. Since hospitals are primarily funded through the province, it is by no means a stretch of the imagination to see why provinces would encourage hospitals to undertake ethical gambling as a fundraising method to offset provincial budgets.

To be at the forefront of heartbreaking diseases such as cancer, hospitals have had to become much more inventive in how they equip themselves with tools and resources. Since the late 90s, hospitals such as the Princess Margaret Cancer Center (PMCC) and Sick Kids Hospital have increasingly turned to lotteries to generate funds, with the PMCC being the more successful of the two. The Princess Margaret Hospital Foundation (PMHF) raises just over 50 million dollars annually, while Sick Kids brings in a measly pittance of just about 20 million annually.

These are huge numbers that represent a massive portion private donations to each hospital annually. It’s also good to note that these charities are not run by the hospitals, but are rather contracted out to third parties, who handle the prizes and the day-to-day operations of the lotteries themselves. The merit of lotteries as fundraising tools is also debatable as a result of the amount of money that has to go to these prizes and operational costs.

Prizes themselves often manifest in the form of “million dollar houses” or “totally rad cars”. Websites advertise the house as the grand prize out of everything, despite potentially volatile housing markets that could diminish the value of the home. This is because it reflects better to offer out prizes, which is perceived by the public to be more in the same charitable “ma and pa” spirit of bingo halls as opposed to giant piles of money which are seen as synonymous with state ran lotteries.

The success of these lotteries is a non-debatable issue, and part of this has to be attributed to the altruistic cause that they support. An average citizen is much more likely to engage in charitable activities when there is a personal benefit as well. This is why every Weight Watchers advertisement couples the benefits of the weight loss with testimonials about how tasty the food is. This coupling is the root of the appeal behind hospital lotteries or “ethical gambling”. When one buys a hospital lottery ticket, they are not only helping cancer research but are also giving themselves a chance to win a home with a three story waterfall pool that equipped with nano-bots that monitor and capture all traces of urine.

This promotion of hospital lotteries represents a conundrum for hospitals. Ludomania, more commonly known as gambling addiction, is a well-established mental illness. In Ontario, approximately 3.4% of citizens suffer from moderate to severe Ludomania , which, in Canada’s largest province, accounts for close to 400,000 citizens. Clearly this represents a health problem that doctors should be addressing and not exacerbating through the promotion of ethical gambling.

“First do no harm” is one of the major guiding principles behind medicinal practice, which should weigh heavy on the minds of hospitals who wish to engage in ethical gambling as a primary means of raising funds. Cancer is a deadly beast that needs to be fought with all the resources available to medicinal practitioners, to say the least. However, the health of Canadians should not be made into a zero sum game in which the gains against one disease come at the cost of fighting another.

It would be irresponsible to state that the Sick Kids Hospital and the PMHF lotteries are causing parents to spend their child’s lunch money on another ticket. This is not an issue of outcomes but rather an issue of ethics. It also encourages Ontarians to ask whether the relative lack of spotlight put on this issue is a result of mental health not holding the same weight in the public conscious as its’ physical counterpart.