Doctors cannot offer treatments that are unavailable, and consequently cannot be held morally responsible for failing to provide the relevant treatments. If there are treatments that are better than those covered by the provincial plan, a conscientious physician might tell patients about them to give them the option of looking around for a way to obtain these other treatments. However, a physician does not fail in his duty when he does not provide a treatment that is unavailable to him. The third case also raises no ethical problem. Although hospital budgets always have been and always will be limited, neither administrators nor physicians are responsible for this.
Hospital administrators have to work within the budgets they are given.
That one hospital provides a service while another does not is not an indication that the first hospital is acting irresponsibly or unethically. Hospitals serve catchment areas. Different catchment areas have different needs, depending on the demographics and the health profiles of their client populations. A responsible hospital administration will use its limited funds in the most cost-effective way possible to meet the needs of its client population. When resources are limited, only the services that address the major health problems of the client population in the most cost-effective way can be provided.