When is Police Use of Force Justified?

July 19, 2016 11:16 am
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I am a seventh generation Black Canadian. I was also a police officer for 36 years. I have worked in a city, rural, and federal environment.

The growth of the Black Lives Matter movement has come out of the lack of information, accountability, and racist behavior by some individual police officers. This is nothing new. Canada fails to teach the long conflict between black communities and the police. I have lectured, presented, and facilitated, on the subject of Police/Race Relations since 1970.

The use of force by police officers is mandated in part by a Use of Force curriculum. In fact, if you Google “Use of Force Model Ontario” it will be described. The use of force model is a guide not a firm policy. And so it should be. However, it is used to explain the police officers’ use of force to the courts and their police organization. The citizen rarely hears of the model. Why not? All police use-of-force disputes among, politicians, police, citizens, police boards, including Black Lives Matter members, should know how the model applies.

The Head of the Police Union in Toronto (and all police union heads) should be asked the following questions: Please define Racism/Racist behavior. Does racist behavior take place in his organization by some individual members? Should it take place? What proactive steps have you taken as head of the police union to eliminate racist behavior? If not, why not?

I can tell you that racist behavior takes place inside and outside of police organizations. (Google Calvin Lawrence Racism RCMP) (Space between words). There are some police officers that will put their personal belief system before their oath. In this case, racist behavior. This includes all police organizations. All individual police officers do not practice racist behavior.

If you want to minimize the conflict, the police, SIU, and Police Services Board, must do a timely, accurate, open as possible, investigation and then tell the truth no matter who it helps or who it hurts. Once that is done, exonerate or hold the police officer accountable by the courts and/or the police organization. Then implement policies and/or changes to existing policies if need be.

Parliamentary Wrap-Up Session With Rona Ambrose

July 14, 2016 3:03 pm
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Attention: Rona Ambrose is not running for the Conservative leadership. However, after a stellar performance in the last Parliamentary session many wish she would. We sat down with the interim Leader of the Official Opposition to discuss the last Parliamentary session.

OTTAWA LIFE MAGAZINE: What are your observations of the new Liberal government over the last Parliamentary session?

HON. RONA AMBROSE: They have done a lot of consulting, and they still seem to be trying to find their way. Things seem a bit unorganized. I understand that it takes time to settle in. Prime Minister Trudeau didn’t come into office with much training. He was vaulted from leader of the third party to prime minister. Usually you spend time as leader of the opposition and then win an election and go into government. It’s the same for his ministers.

You have experience as a minister in government. Is there anyone who has impressed you so far or who stands out?

Minister of Health, Jane Philpott. During Question Period, she gives real answers and straightforward information. When I worked as the minister of health, opposition MPs would often come up to me and thank me for giving straight answers in Question Period or committee, and I always thought that was odd. But now being in the opposition, I see what they meant and how valuable that is. Philpott is constructive, forthright and respectful of the process.

What are your thoughts on Bill C-14? The assisted dying bill is a contentious issue, especially now that the Senate has weighed in on widening the parameters of who should be eligible.

The bill reflects a good balance. When it was brought to the House, there was, at times, emotional and passionate debate. I thought the bill was good and agreed with most of it, but I didn’t vote for it because it was an open vote and I still have some concerns. I think we need to add safeguards and provisions that address concerns raised by many in the disabled community and also for the mentally ill. It’s a very complex matter and there are so many ethical issues at stake. As for the Senate, it certainly has the authority to propose amendments but it becomes problematic when they entirely reject a bill sent to them by elected members of the House.

 The government is indicating it does not wish to be part of the F-35 consortium. Prime Minister Trudeau says the F-35 fighter jets don’t work. Comment?

The Prime Minister’s remarks about the F-35 are simply not true: they do work. Decisions on fighter jets should not be made by politicians, but by the air force. The F-35s are better for interoperability; not having them would put us out of step with our allies. The previous Conservative government supported their purchase for Canada. However, the procurement was delayed over audit, budget and oversight issues. The Hornet that the Liberals are now talking about is a good fighter jet but sole-sourcing is not the answer. The Liberals should have an open competition to see which planes to buy, but they won’t because they know if they did, the F-35 would win.

What about the debate on pipelines?

It’s interesting that Alberta’s NDP premier Rachel Notley campaigned against pipelines, and now she’s recognized they’re required and they’re safe. Now we have a Conservative premier from Saskatchewan, NDP premier from Alberta and Liberal premiers from Ontario and New Brunswick all supporting the Energy East pipeline.

There is similar debate around liquid natural gas (LNG) plants, most specifically the one proposed in B.C.’s Skeena Watershed. One hundred and thirty scientists wrote to the Prime Minister contesting the National Energy Board’s (NEB) approval of the project.

We have to trust the NEB’s process. They have made recommendations, and it will be problematic for the Liberals if they’re not going to listen to the science and evidence given to them by the appointed governmental body just because they don’t like the answer. They said decisions will be based on evidence. How can they not agree with the NEB on these issues? They are the body that decides what can happen based on all the input and the evidence.

The Conservative Party recently amended its opposition to same-sex marriage. What does that mean for the Party?

It was an important step. A large part of the Party is libertarian and they believe government should stay out of people’s lives. Then other Conservatives believe strongly in freedom and economic prosperity, and not to have their government interfere in their lives. There are also representatives from the LGBT community in the Party, so I’m very pleased and proud that the change was made.

Can you comment on the previous Conservative government’s handling of Aboriginal Affairs in Canada?

I think we did much more than we are credited for. Stephen Harper officially apologized for residential schools and initiated the Truth and Reconciliation Commission. The Conservative government settled many comprehensive land claims and was also very focused on Aboriginal economic development programs that were starting to show signs of success. A significant push was made for improving the conditions and funding in education for Aboriginal children via new federal legislation. Unfortunately, that legislation, which would have injected $2-billion new dollars into education for Aboriginal children across Canada, was halted because of an internal rift within the Assembly of First Nations. This caused AFN Chief Shawn Atleo to leave. The legislation had widespread support across the country so it is sad that it did not proceed. I think it is fair to say that we (the former Conservative government) did not communicate very well in regards to the many things we did on the Aboriginal file.

You were affected personally by the Fort McMurray Fires. Are you confident the government is doing everything properly to assist the residents as they go back and rebuild?

There was a lot of support from the Alberta government and the private sector and NGOs. The federal government has also been assisting – as they should – but I will take a “wait and see” attitude as people come home from the fires and work at getting back on their feet.

Finally, many in the Conservative Party and many media pundits have suggested that you are making the Tory Leadership race tough because of your impressive performance to date as Interim Leader. Many are saying you should be allowed to run so you can stay on.

I took the job as interim leader and I am not running. I’m going to start wearing a t-shirt that says, “I’m not running.” The Conservative Party has so many great potential leaders from within politics and even some outside of politics. I’m sure we will pick a good one and then I’ll lend them as much support as I can.

Solving Canada’s Opioid Epidemic Must Include Tackling What Got Us into the Predicament in the First Place

July 7, 2016 10:51 am
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By all accounts we are in the midst of a deadly drug epidemic so severe and widespread few people in North America will remain untouched by it.  In case you think I’m exaggerating, right now we have probably the highest rates of narcotic abuse and deaths in modern history.

Critics have begun pointing the finger at the medical system and its prescribers – well-meaning doctors and specialists who’ve been giving too many patients excessively powerful opioid medications to deal with modest pain.  But we can dig deeper and look at the relationship between medical education and pharmaceutical company influence as a significant contributing factor.

Typically the suggestion of an epidemic is hyperbolic, but it doesn’t seem so in this case.  Last week, Dr. Perry Kendall, the provincial Health Officer in British Columbia said that BC has a bona fide “public health emergency” on its hands, mostly due to the alarming number of overdose deaths linked to prescription opioids.

Opioids include prescription narcotics like Oxycontin, hydromorph Contin and fentanyl (which some say is 100 times stronger than morphine).  Dr. Kendall said that there were more than 200 opioid-related overdoses so far this year in BC, and if those numbers continue, there’ll be 800 by the end of the year.

What’s happening in BC is just a small microcosm of what is happening across Canada, where we have some of the highest rates of prescription opioid consumption in the world.  From 2006 to 2011, use of opioids in Canada rose by 32 percent and that rise has continued unabated, despite efforts to slow it down.

The United States is also in full-on damage control mode, trying to stem the incredible numbers of deaths due to opioids.  In 2012, there were 259 million prescriptions written for opioids — enough to give every American adult their own bottle of pills.  Since 2000, the overdose death rate in the U.S. has risen by 200 percent and there were nearly 19,000 opioid-related overdose deaths in 2014.  Two weeks ago, I sat in a room while Dr. Vivek Murthy, the new Surgeon General of the United States, told the assembled crowd that he was driven to make the opioid epidemic a top priority in his administration due to the devastation he’s seen in communities all across the country.

He told us the U.S. experiences an overdose death every 24 minutes and the life expectancy of white, male, middle class Americans is dropping.

The problems, as well as potential solutions, are incredibly complicated but I agree with Dr. Murthy when he says that curbing society’s exposure to opioids — particularly those that come from a prescription pad in a doctor’s office — is absolutely vital.  As he said:  “Physicians need to be retrained to think twice — or three or four times — before writing that first opioid prescription.”

It’s important to recognize that liberal prescribing of opioids is a very recent problem and, since the mid-1990s, can be linked to the message-crafting activities of the pharmaceutical industry which helped shape both patient perceptions of pain and influence how doctors thought about the safety of these drugs.  Doctors were increasingly encouraged — sometimes through industry-funded educational activities or by using textbooks on pain management paid for by the makers of opioids — to prescribe the drugs for a much wider population of patients experiencing pain.

If revising the messaging around opioids was a business-oriented strategy of the opioid makers, we cannot place the blame solely upon them. Some of that blame has to do with the co-dependent relationship between physician education and the drug industry, which funds a substantial portion of physician education in Canada.

Is this epidemic not dire enough to finally build the absolute firewall we need between physicians education and the pharmaceutical industry?

We need unbiased, safety-oriented messages around the appropriate use of opioids and knowledge of their wicked addiction potential.  We also need to remind ourselves, both patients and prescribers, that any incredibly powerful and effective drug can also be incredibly dangerous and destructive.

The focus to tackle the addiction problem has to be serious, multifaceted source control.  We need greater access to addiction treatment facilities, and methods to rescue people from the depths of addiction, certainly.  But we also need to curb society’s underlying dependence upon drug company money for doctor training.

Cassells_Alan_new high res-apr2012 5x7Alan Cassels is an expert advisor with EvidenceNetwork.ca and the author of the just-published, The Cochrane Collaboration: Medicine’s Best Kept Secret.

The Good, the Bad and the Unintended Consequences of an Expanded CPP

July 4, 2016 11:17 am
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By Robert L. Brown

Amazingly, eight of ten provincial finance ministers and the federal government have agreed to a modest increase in the Canada Pension Plan (CPP).  The two provinces who have not signed on are Manitoba, where the government is only four weeks old, and Quebec, which has chosen to allow itself the option of adopting a differing strategy.  Since there is already a separate Quebec Pension Plan (QPP), this should have a minimal impact — although it will complicate administrative records for employers with multi-provincial employee groups.

While the new, second tier CPP is modest, it will have some important impacts.  Some will be good, some will be bad, and many may be unexpected consequences.

The new CPP will be fully funded which means everyone pays for their own benefits in full with no debt passed to the next generation.  That’s good since it minimizes intergenerational transfers of wealth.  It also implies enhanced security to plan participants because future generations of participants are not relied upon.  Finally, full funding is consistent with the existing CPP legislation (from 1996).

But, it is also bad.  It means that full new benefits will not be available until at least 39 years after 2025 when the initial implementation of the CPP expansion is completed.  The larger fund (versus the base CPP) also means more volatility than if the plan were financed on a pay-as-you-go basis since investment returns, upon which fully funded plans are dependent, are more volatile year to year than demographic variables like fertility, mortality and migration upon which pay-as-you-go plans depend.

The new CPP will be pan Canadian except for Quebec.  This is good as it will be a large enough plan to invest in alternative assets such as infrastructure and private equity.  It should result in low management expenses.  And the plan can collectively carry the longevity risk and pay out lifetime benefits which is a huge advantage.

But it is also bad.  A plan this large will accrue around $1 trillion in assets.  Where can one invest $1 trillion today in a prudent fashion that will still earn high returns?

But it is also bad.  A plan this large will accrue around $1 trillion in assets.  Where can one invest $1 trillion today in a prudent fashion that will still earn high returns?

But it could be bad.  Will participants understand that the new tier does not bring guaranteed benefits?  What will happen when you have to freeze or even reduce benefits or increase contributions?  Is this politically feasible?

The new CPP may also bring some surprising consequences.  Some will be good.  Obviously for a worker with no pension or a very weak pension, that person now gets a new tier of (modest) benefits.  Smaller plans may be well advised to close and effectively move their workers into the more effective and efficient new CPP.

But there are remaining concerns.  How many small plans will respond by just closing?  Many of these plans are well administered and we should not create incentives for them to terminate.  Many workers will now be forced to pay a second tier of contributions, but when benefits are paid, will lose a significant portion of their Guaranteed Income Supplement and other welfare benefits.

Even with a new Working Income Tax Benefit, is that fair?  Have we targeted the correct audience with this reform?  The new plan could discourage private savings — not the hoped-for result.  And it could stifle private sector innovation.  Again, an unintended consequence with negative impacts.

Is this “one size fits all” solution the best we can do?  Unfortunately, we may not really know the answer for decades to come.  Obviously, there is room for more discussion and debate. This story is not over as yet.

Robert L. Brown is an expert advisor with EvidenceNetwork.ca and a Fellow with the Canadian Institute of Actuaries. He was Professor of Actuarial Science at the University of Waterloo for 39 years and a past president of the Canadian Institute of Actuaries. 

Ontario Offers Free Legal Advice for Survivors of Sexual Assault

June 30, 2016 3:44 pm
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One in three women and one in six men experience some form of sexual assault in their lives. Knowing that this is a struggle many Canadians endure, the Ontario government has come up with a way to help survivors take their first steps forward in the aftermath of assault. Ontario is piloting a new program that will give survivors access to free legal advice, regardless of how much time has passed since the incident.

Starting June 28, sexual assault survivors living in Ottawa, Toronto and Thunder Bay will be able to receive up to four hours of free confidential advice from a lawyer, which can be provided over the phone or in person.

Tracy MacCharles, the Minister responsible for Women’s Issues, says that the government understands that navigating the justice system can sometimes be difficult for those who have been involved in a sexual assault, especially at the beginning.

“Providing free legal advice helps them know their rights and provides critical support in their pursuit of justice,” said MacCharles.

All survivors can access the program by filling out and submitting a voucher request form. Women living in Toronto also have the option to access the program directly through the Barbra Schlifer Commemorative Clinic.

Helping ensure survivors of sexual assault are informed and supported is part of It’s Never Okay – Ontario’s Action Plan to Stop Sexual Violence and Harassment. The plan is meant to help change attitudes, improve supports for survivors and make workplaces and campuses safer and more responsive to complaints about sexual violence and harassment.

“Sexual assault survivors need to know they have choices and they have power,” said Yasir Naqvi, Ontario’s Attorney General. “Providing them with information on support services that are available is only one piece. Offering them free legal advice is key to helping them make decisions about what is best for them as they move forward,”

The pilot is expected to run until March 2018. During that time, the province will assess the effectiveness of the program and determine its next steps.

These legal services are available to both women and men 16 and up whose assault occurred in Ontario. These survivors will have a choice within a roster of lawyers who can provide them with legal council, but not further represent them in court, although they can refer them to another lawyer who can represent them in court.


Any survivors of sexual assault in any of the pilot sites can get information about the program in multiple languages through the toll-free, 24/7 phone line: 1-855-226-3904.

 

Ombudsman Calls For Less Force in Police Training

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Paul Dubé, Ontario’s ombudsman, opened his press conference yesterday by stating that the way police are trained to handle the mentally ill and people in crisis should no longer be a matter of academic debate; rather it is quite literally a matter of life and death.

A Matter of Life and Death is the title of the Ombudsman’s latest report, which was sparked three years ago by the fatal police shooting of Sammy Yatim.

Yatim, 18, was on a streetcar late at night in Toronto holding a knife, brandishing it erratically, apparently mentally unstable. While confronting the lone Yatim on the streetcar with several other officers, Toronto Police Const. James Forcillo shot Yatim nine times after telling him to drop his weapon. Forcillo was eventually charged with second-degree murder and attempted murder, and convicted of the latter.

Public outcry was loud and fierce, especially since the incident was caught on videotape. This event, and similar fatal police shootings of mentally ill people have lead to an overall investigation of Ontario’s police training policies. According to the report, these policies need an outright overhaul. 

“When facing a person armed with a knife, they are taught to pull their guns and loudly command the person to drop it. Although that tactic might prove effective with rational people, a person waving a weapon at armed police is irrational by definition. Too often, the command only escalates the situation. It can exacerbate the mental state of a person who is already irrational and in a state of crisis. And once police have drawn their guns, using them is often the only tactic they have left.”

That’s an excerpt from the Dubé’s report. It goes on to discuss that Ontario police training is heavily weighted towards use of force, which in turn means gun use, instead of relying on de-escalation techniques. The Ombudsman suggests that in the right circumstances, de-escalation could save the lives of the people the police are trying to detain.

According to the report, there have been more than 40 fatal police shootings involving people with mental illness since 2000. They blame this on poor and imbalanced training, saying that Ontario police get just 12 weeks of basic training, which is less than any other province in the country. Within this training, the officers only go through five 90-minute sessions of de-escalation training.

They then have a pass/fail test that is mostly about using force rather than their de-escalation techniques. Police must also undergo annual requalification in firearm and baton training, but that there is no such refresher on de-escalation. That means that throughout a police officer’s career, which could last decades, the Ministry of Community Safety and Correctional Services only delivers seven and a half hours of training in de-escalation.

The report also mentions police culture as a major fault in this issue, stating that in some circles, the idea of fatally shooting those with a mental illness is inevitable. The ombudsman stressed that it was not police they were critiquing, but the government’s training of police.

The report lays out 22 recommendations for how to improve police training; here are a few examples:

  • The Ministry of Community Safety and Correctional Services should institute a new use of force model that is easy to understand and clearly identifies de-escalation options, rather than just use of force options.
  • The Ministry of Community Safety and Correctional Services should offer more guidance for recruits and in-service officers on the use of the police challenge, including when the police challenge has not been successful in de-escalating a situation and when, so long as safety and tactical considerations permit, to use de-escalation techniques. This guidance should be incorporated into a de-escalation regulation.
  • The Ministry of Community Safety and Correctional Services should use the expanded Ontario Police College curriculum to offer more training on mental illness, and strategies to de-escalate situations involving persons in crisis.

Not only does the report offer recommendations, it emphasizes the human toll of the type of police training that values force over de-escalation and management of the situation. The report has in depth accounts of the deaths of each of the following: Lester Donaldson – Toronto, 1988; Edmond Yu – Toronto, 1997; Otto Vass – Toronto, 2000; O’Brien Christopher-Reid – Toronto, 2004; Byron Richard Debassige – Toronto, 2008; Douglas Minty and Levi Schaeffer – OPP, 2009; Aron Firman – OPP, 2010; Evan Jones – Brantford, 2010; Steven Mesic – Hamilton, 2013; Michael Eligon, Jr. – Toronto, 2012.

Each one of these victims was either noticeably mentally ill or at a time in crisis. None were wielding a gun, and they all died due to police shooting.

The new minister of community and safety David Orazietti told the press that he was absolutely committed to having de-escalation written into the reevaluation of the Police Services Act, the legislation that manages police in Ontario.

“I recognize that things need to change,” Orazietti said.

But as the ombudsman report states, there has been a lot of talk, a lot of study, and not enough action, maybe this will be the year that that begins to change.

People Need Less Money to Live As They Get Older? If Only.

June 29, 2016 10:15 am
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Pension plans for teachers, hospital workers and public servants target of study hype

By Michael Wolfson

Last week the C.D. Howe Institute released a short study just in time for the finance ministers’ meeting – rolling out the tired, old argument that as people age, they do not need as much money to live as when they were younger.  If only retirement were so easy.

The study focuses on public servants’ pension plans in particular – including those of teachers and hospital workers — arguing that indexing them to inflation is too generous.  But at the same time the study acknowledges that the broad public system – including the Guaranteed Income Supplement, the Old Age Security pension, and the Canada (and Quebec) Pension Plans —   appropriately provide benefits which are fully indexed for inflation because they offer incomes to fund basic necessities.

So why the double standard on indexing for public system pensions but not public servants’ pensions — and all workplace pensions for that matter?

First let’s look at the old chestnut that as we age, we don’t need as much money. The study gives an image of Canadians’ inexorable decline into frailty, especially after we reach age 75.  They stress that we need to do our vacation travel while we still have our health, because after age 75, we’ll be too disabled to travel or even to go to the movies or dine out.  As a result, the study concludes, public sector workers can safely cut their pension contributions significantly by scaling back their plans’ inflation protection.

This image is wrong from both a health and social perspective, and in terms of its economic analysis.

Of course, as we age, we’re more likely to have a disabling condition.  But the simple fact is that  more than half  of Canadians age 65, 75, and even 85, are not so disabled that they do not need a decent income.  As we hear increasingly, “60 is the new 50,” and so on up the age scale.

Also, expectations for individuals to pay for health and social care are increasing.  Hospitals, doctors and drugs in most of Canada are covered by public health programs.  But a substantial portion of health and social care costs are not covered, and depending on how much provincial governments cover the growing needs for home care and assisted living, these costs may increase significantly over coming decades.

There is broad agreement that most Canadians, given the choice, would rather live at home and not in an institution as they age – that costs money.  Many would be able to age in place if they could have assistance with housekeeping and shopping, for example.  But such assistance can be a substantial draw on post-retirement incomes.

Disappointingly, the study makes little or no reference to these realities.  And the only Canadian data it shows are copied from a highly criticized McKinsey study (which fails the basic scientific canons of openness and replicability), in turn drawing on old (and sadly discontinued) Statistics Canada data up to only 2008.

So what did the C.D. Howe study conclude from these Canadian data?

They show the average levels of inflation-adjusted consumption from age 54 to 77 for those with “middle” incomes declining by almost 50 percent. Seems pretty clear, right?

Except the figures fail to take account of household size.  That’s quite an oversight.

Consumption at age 54 is typically for households with two or three or more members, while at age 77, these are households with only one or two members – a major difference.  If the study had shown consumption per capita (as noted in a footnote), there would be no such dramatic decline.

If we look at these same C.D. Howe/McKinsey results, but this time comparing inflation-adjusted consumption levels of 65 (not 54) year olds to 77 year olds, the decline is only about 10 percent – not the kind of dramatic drop that would support a frontal attack on inflation indexing of public servants’ pension plans.

Furthermore, the decline in real consumption from age 54 to age 65 is driven not only by declines in household size, but also by people withdrawing from paid work, and the general inadequacy of Canada’s retirement income system to replace their incomes from work with decent pensions.

What we really need – instead of such worn out arguments against  inflation protection based on poor evidence – is a reasoned and evidence-based public discussion of the consumption needs of Canadian seniors, both now and projected for coming decades.

Before we can sensibly discuss a wide range of pension policy questions, we’d better have facts based on sound analysis.  Unfortunately, the C.D. Howe study misses the mark.

unnamedAbout the author:

Michael Wolfson is an expert advisor with EvidenceNetwork.ca and Professor, Ottawa Centre for Health Law, Policy and Ethics.  He holds a Canada Research Chair in population health modeling/populomics at the University of Ottawa. He is a former assistant chief statistician at Statistics Canada, and has a PhD in economics from Cambridge.

BREXIT – The Economics

June 27, 2016 2:48 pm
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“Britain’s exit from the European Union is of less significance than the economists have contemplated” at least to the UK.

The economic pundits, always in sync with the status quo have hopped on a new bandwagon!  They shout “The evil English have separated from the EU and they will be punished.”  Punished for what and by whom?  Though the driving force propelling Brexit sadly seems to have been racial migration, perhaps the underlying economic need for exit makes Brexit an essential, if not communal action.  Putting it simply, the EU, its banking, its sovereign capabilities, and its sustainability is in serious trouble.  Yes, most of the world’s banking and reasonable governance is at risk, but none so great as the EU, and none are so dangerous to the rest of the world.  England cannot continue to afford being one of the pegs in the crutch of the Eurozone kicking the can down the road until the fall into oblivion.  (See “China? Oil Prices? Saudi Arabia? Iran? Why Volatility? The Grand Surprise Part Two” January 12, 2016 European section).  It is clear that the longer the can gets kicked down the road the greater the disaster for the Eurozone and its influence on the world’s economy.  It mostly cleaned up its act to be a supportive party to EU foolishness.  Should, in the hope that the EU remain intact, as unlikely as that appears, will the UK suffer in its economic future?  Yes — but that damage will be a small dollop compared to its suffering had it voted “REMAIN.”

A few details (speculative) of the future UK – EU relationship

Lets start with Banking.  As almost every banking institution in mainland Europe is technically insolvent, it is unlikely there will be a massive pull out of banking from the largest infrastructured banking community in the world, London.  It would also accelerate the EU banking death spiral to exclude the British based banks from doing business in Europe.  Would a major banking organization move from London to Paris?  Unimaginable to me.

Switzerland?  After the drubbing the Swiss banks received and continue to receive from governments around the world the hospitality towards American and British institutions would be limited at most, and more likely non-existent.

Frankfurt, Germany.  It is not a great likelihood the US and UK banking establishment will put its future in the hands of the Germans – not to mention English speakers lack enthusiasm in both their lives and businesses to speak other languages.  There are no other even remote possibilities for banking to move.  Banking will stay.  Whether it will flourish is another matter but not one to do with Brexit.

Trading with the EU

It is unlikely the EU will inhibit its trading with the UK as the UK buys €77 billion more goods from the EU than it sells; the EU has trade surplus.  From Germany alone the UK buys €89 billion of goods while selling only €38 billion.  The importance of UK/EU trade to the EU cannot be over emphasized and will not be inhibited.

Borders and employment rules will not be severely impaired.  The UK employs more than 2.0 million non-UK EU nationals.  The likelihood that the EU would spitefully cut off free movement of labor between the two zones is analogous to “cutting of its nose to spite its face.”

The list goes on and on but, simply put, the UK will continuously benefit from being out of the yoke of a failing EU while losing little ground in the relationships should it so choose.  My fear is only the acceleration and exacerbation of the EU’s demise, certainly an issue arising out of Brexit.

SOS Children’s Villages’ Response to the Refugee Crisis

June 21, 2016 11:56 am
Photo Curtesy of Mr. Joris Lugtigheid. A Child refugee trying to keep up with his parents at the border line between Macedonia and Serbia.

Submitted by Boyd McBride, President and CEO, SOS Children’s Villages Canada.

Today, we mark World Refugee Day. United, we stand to support refugees – those who must flee their home because of violence, war and natural disasters. There are over 60 million refugees in the world, over half of them are children, and this number unfortunately continues to rise. Child and youth refugees, especially those that have been separated from their families, need special protection, and have been a priority for SOS Children’s Villages in our key response efforts.

Below are just a few of the efforts SOS Children’s Villages undertakes to support refugees and their children:

Transitory Care and Emergency Response

SOS Children’s Villages has provided on-the-ground aid to refugees, internally displaced families and unaccompanied children in at least 14 countries since 2015. Four SOS mobile emergency response teams have helped thousands of refugees on the move, and SOS Children’s Villages has cared for over 1,100 unaccompanied or separated children in SOS Children’s Villages Interim Care Centres and SOS Children’s Villages. It is no easy feat, but our relationship with local partners enables us to act quickly and in coordination with others to help displaced families on their journey.

SOS Child Friendly Spaces (CFS)

SOS Children’s Villages has offered a safe and protected environment to thousands of displaced children at 13 SOS Child Friendly Spaces. These spaces provide children with structured activities that are carried out in a safe, child friendly, inclusive and stimulating environment, designed to provide a sense of security for the children, and help them cope with what they have experienced during the crisis. Children are provided with informal education, psychological care as well as recreational activities such as storytelling and art workshops. This care is immensely valuable and allows children a safe haven from an often very turbulent reality.

Helping Refugees Reconnect

At six SOS ICT Corners, SOS Children’s Villages has helped hundreds of thousands of refugees and aid workers connect through internet services, phone charging opportunities, and other information and communication services.  Often, the ability to connect with family either at home or their final destination can be a needed and empowering motivator for refugees on their journey.

Partnerships for Social Innovation

Through corporate partnership, SOS Children’s Villages has contributed to innovative solutions to improve humanitarian emergency response.

SOS Children’s Villages International and the University of Salzburg are collaborating on a project that uses satellite imagery and geo-technology to enhance aid organisations’ abilities to respond to emergencies, by providing key information such as the locations of roads and water sources.

SOS Children’s Villages has also contributed to the development of a crowd-sourced emergency response application, called ‘Eden’, from Erste Group, that will enable refugees, NGOs and volunteers to share up-to-date and local information to respond to human needs.

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Photo curtesy of Ms. Katerina Ilievska. Two children trying to keep warm at the refugee transit centre Tabanovce, Macedonia

Tackling Longer-Term Needs of Refugees

Despite the overwhelming number of people currently displaced, SOS Children’s Villages has seen a decline in the number of refugees arriving at transit facilities. The growing need is to provide longer-term services at camps along the Balkan route from Greece to Central Europe, where many refugees currently remain. In response, SOS Children’s Villages Macedonia is expanding its Child Friendly Space (CFS) to help refugees living at the Tabanovce transit centre, where hundreds of people have taken shelter since national borders were closed to new migrants earlier this year.

Throughout the world, SOS Children’s Villages has pledged to protect the rights of children; to provide practical support for vulnerable families displaced from their homes; to form partnerships lending our expertise in child care to government agencies and other non-governmental organisations; and, when required, to deliver alternative care for unaccompanied and separated children.

SOS Children’s Villages is there to speak up on behalf of children, provide a platform for young people to express their opinions, and call on authorities to redouble efforts to find long-term solutions to ensure that families can stay together and that refugee and migrant children are not deprived of their childhood.

Call to Action

To learn more about what SOS Children’s Villages is doing to respond to the refugee crisis, and to contribute to our efforts, click here.

About SOS Children’s Villages Canada

SOS Children’s Villages works in more than 130 countries to support families and help children at risk grow up in a loving home. In a world filled with poverty, violence, and injustice, the greatest victims are often children. For more than 65 years, we have worked with partners in each community to either help families care for their children or to provide an alternative, for instance an SOS family, in which the love of a carer is essential. Everything we do is based on the best interests of the child, and each has an individual development plan. We focus on the care, health, education and general development of each individual.

Personalized Medicine for Child Health is a Distraction

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Genetics will save the day – at least that’s the message you see pretty much everywhere in the media, and sometimes even in the academic literature.  Newspaper articles herald “breakthroughs” in finding genetic biomarkers for autism. Magazine headlines trumpet finding a biomarker for Attention Deficit/Hyperactivity Disorder (ADHD). We read in the grocery line that a gene linked to depression has also been found!

These are serious conditions, so of course parents and public health officials alike are enthusiastic about the potential of finding genetic causes. The same articles that hype the discoveries also calmly assure us that once genetic biomarkers are identified, gene therapies will solve all our problems.  Genetic discovery will lead to personalized medicine and we will all be winners.

Unfortunately, the reality is much more complex. While understanding how genes influence behaviour and development is important, evidence now suggests that genetic influence in many developmental disorders is not as significant as first imagined.

We are a long way off from identifying definitive biomarkers and personalized gene therapies are likely generations away. The hype is big, but our hope is misplaced.

Autism is an excellent example. It’s true that when one identical twin has autism, the chances of the second twin also having autism are increased (though not a certainty), showing a genetic connection. However, geneticists have not been able to identify a “smoking gun” single gene for autism, but rather have found many genes, each exerting its own small effect in a complex polygenetic interplay.

The truth is, even when specific genes are implicated, personalized gene-therapies addressing multiple genes are not very likely.  So why is this focus on genetics problematic?

The focus on biomarkers and the potential of gene therapies may have distracted us from using and expanding services and supports that show promise or already work for many children.

Numerous studies show that children with autism improve with intensive social-focused treatments such as speech, behavioural and occupational therapies. For decades evidence has been accumulating about how supporting parents and providing interventions to enrich children’s educational environments can dramatically help improve developmental outcomes.

Similarly there is solid and growing evidence for psychological and social interventions, along with family supports for addressing ADHD, with solid outcomes.

We do not mean to imply that there is no genetic component to the developmental hurdles children with autism or ADHD face.  But waiting until we understand the genetic underpinnings – or funneling essential funds into genetic discovery — distracts us from investing in ordinary community strategies that can help these children and their families be successful today.

Let’s take depression as another example.  We know that people who carry certain genes related to depression (short alleles of the serotonin transporter gene) are more likely to be depressed as teenagers and adults when they were also raised in difficult conditions, such as experiencing neglect or abuse as children.

On the other hand, others with those same genotypes thrive as teenagers and adults when they had optimal early environments. This speaks to the important role of positive social conditions for these specific gene variants. On the surface, genotype seems to matter, but only under poor early environmental conditions.

So, rather than assessing children for their genotype in order to identify children at risk for this specific cause of depression, we could benefit all children, including those at risk by ensuring that all young families and communities are adequately supported to provide their children with the best start in life.

In this example, the evidence is clear.  Many family and community supports such as early intervention, income support, group prenatal and parenting programs, perinatal home visiting and high quality educational child care could protect children and youth from potential serious behavioral and emotional problems, regardless of their genotype.

Related: Putting Children’s Health and Resiliency on the National Agenda.

So in a range of issues such as autism, ADHD and depression – all with long track records of distinct evidence-based social and community interventions – genetic discoveries are interesting, certainly, and worth pursuing, of course, but do not provide the help that is needed today.

Let’s save the hype for what helps families now.  Let’s invest in evidence-based therapies and social and community supports so that families get the help they need now.

Children facing developmental challenges and hurdles can’t wait for a sensationalized personalized genetic future.  They need early childhood education and classroom supports, one-on-one therapy, parenting supports and income supports to keep the family out of poverty.  In other words, tried and true social and community-based treatments that don’t need to be discovered because the research is already there – and they work.

Nicole Letourneau is an expert advisor with EvidenceNetwork.ca, and the author of Scientific Parenting.

Suzanne Tough is an Alberta Innovates Health Scholar.  Both are professors at the University of Calgary’s Owerko Centre focused on children’s neurodevelopment.

Reforming Healthcare Funding to Address the Needs of Our Aging Population

June 20, 2016 10:39 am
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Why we need a publicly funded insurance program for home care and long-term care

By Réjean Hébert

Funding home care and long-term care is fast becoming the main challenge of our outdated medicare system – a system developed in the mid-twentieth century for a young population that mostly required acute care from hospitals and physicians.  But that need is changing rapidly with our aging population.

The Canada Health Act states that all “medically necessary” services should be covered by public funding.  The chronic diseases of today’s aging population render the existing definition of medicare coverage obsolete.  Our health system routinely fails to address the complex needs of seniors.

Let’s face it: Canadian baby boomers are getting older and many will soon require home care and long-term care.  We need important reforms now to fund the health care system that they will need in the all too near future.

The perverse effects of our current system of health funding result in the use of costly resources from hospitals and other institutions to respond to disabilities and chronic conditions instead of using more cost-effective home care services.  In the current funding paradigm, which prioritizes hospital and acute care, it is unrealistic to expect that home care will be prioritized.

It is equally unrealistic to believe the elderly will have the fundamental freedom to choose their living environment or care providers without basic reforms in how the health system is financed.

As it stands now, many older Canadians in most provinces have to endure the tyranny of public institutions which decide the level of home care services provided, the limits of any home care provided and even the time a senior should leave their home for long-term care and where they should move to. This is unacceptable.

After a long career of research in health services for older people, I became Minister of Health and Social Services in 2012 in the minority government of Pauline Marois. In a recently published article in HealthCarePapers, I outline how one of my top priorities was to implement an Autonomy Insurance (AI) plan. It was an attempt to introduce publically-funded long-term care insurance, which includes home care coverage, in the healthcare system.

Similar funding systems have been introduced with success in many European and Asian countries, such as Germany, France, Japan and South Korea.  The design of the AI plan was based on the assessed needs of the elderly and those with disabilities, using a disability scale. Under the proposed plan, the benefit would fund public institutions or purchase services from private providers. Case managers, already in place in Québec as part of the integrated service delivery system, would be responsible for performing assessments and helping users and their families plan services and decide how to best use the AI benefit.

The funding of the AI plan was based on general tax revenues without any capitalized funding (“pay-as-you-go”), under a separate protected budget program. Cost projections were made; although requiring additional budget increase, the AI would be affordable and less expensive than the status quo.  All the legal, administrative, funding, training and contractual issues were dealt with, in anticipation of the plan’s implementation in April 2015.

Bill 67, creating the AI plan, was introduced in the National Assembly of Québec in December 2013. Unfortunately, the minority government of the day was defeated in April 2014 and the Bill died on the legislative agenda.

Bill 67 demonstrated that a long-term care insurance plan is feasible within our universal tax-funded healthcare system. While Bill 67 was stillborn due to political circumstances, its underlying concept still has merit today.

Clearly, our hospital and physician centered healthcare funding model is not appropriate for our aging population. A different approach must be taken to ensure that home care and long-term care is funded appropriately.

An insurance plan like the one conceived by Québec should be implemented by the provinces.

Should it be a federal program?

It is technically feasible for the Government of Canada to put forward a long-term care program and partially fund it, as was done in the 1960s for the health insurance system at that time. This would be a major step to improving healthcare in this country and a judicious use of federal health transfer payments in the coming years.

Politically, however, is the federal government ready to negotiate with the provinces on an issue that has historically been a political minefield?  To improve an antiquated healthcare system, ensure its long-term sustainability and responsiveness to the needs of older Canadians, it is worth trying to get a consensus around this issue.

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Réjean Hébert is a geriatrician and gerontologist and advisor with EvidenceNetwork.ca.  He is also Professor at the School of Public Health, Université de Montréal; former Scientific Director of the Institute of Aging and former Minister of Health and Social Services in Quebec 2012-14.

The State of the World Economy

June 14, 2016 10:35 am
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We are facing a rerun of 2007-2008 with more dire consequences and a longer duration than we experienced then.
The first blows will surface as a result of the collapse of the European Banking System. Last September, I wrote Where Now-Why Volatility. The Grand Surprise.

 

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 “The U.S? The end of Quantitative Easing. In fact, Quantitative Easing has accomplished little more than inflating stock and bond markets. It has been devastating to pensioners, destructive to U.S. city and state budgets, and non productive to employment levels.”
In January of 2016, China? Oil Prices? Saudi Arabia? Iran? Why Volatility? The Grand Surprise Part Two  is the follow-up. Most of what we discussed is quickly coming to pass, though marked by the foolishness of the Eurozone quantitative easing – read Quantitative Obfuscation.
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 “In conclusion, 2007-2008 is likely to be repeated in the foreseeable future. This time there are no engines of restoration on the horizon. The catalyst will not be the usual blah blah we read in the financial press. It will be the collapse of the financial structure of Europe, both Sovereign and private. World liquidity, which is strained today, will find its home at “zero”. The recovery will be long and painful.
Our series on Greece began in April of 2010, Myths of Today:
“30 Billion Euro commitment will solve the problems of the Euro currency zone. As was the case with the American banks, the number 30 billion was put forth as the salvation of the system. At the top the U.S. government (taxpayer) exposure was about $12 trillion. In April of 2008 we put forth that the number would be at least $3 trillion. We were wrong by $8 trillion. The Greek needs are yet to be determined but they are not 30 billion Euro!”
These are the catalysts to the near term disturbance of the world economy. No proper protections have been built to the financial system to either prevent or deal with this next round. It is unlikely that any will be constructed soon enough to be of help. In the United States, neither Trump nor HillBill as president will take effective steps to prevent or limit serious economic consequences to the U. S. as the solutions are not in the realm of monetary policy and neither will accept or act with the assertive fiscal policy necessary to stem the tide.
About the Author:

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Asher Edelman is an art collector, financier.  He is the founder and CEO of ArtAssure Ltd. and the founder of Edelman Arts, Inc. and Artemus.

Edelman began studying and collecting art in the 1950s. From 1962 to 1988, he enjoyed a successful career on Wall Street, during which time he also taught a controversial course at Columbia University School of Business entitled “Corporate Raiding: The Art of War.”

In 1990 he moved to Lausanne, Switzerland where he founded the Musée d’Art Contemporain. While in Lausanne he curated retrospective exhibitions of artists including Pablo Picasso, Robert Mapplethorpe, Jean-Michel Basquiat and Roy Lichtenstein.

Upon his return to New York in 1995 Edelman began dealing in art and in 2009 founded ArtAssure Ltd., an art finance company. He has served and serves on numerous Boards of dance, educational, music and visual arts institutions.

The Last Chapter

June 8, 2016 10:00 am
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A Supreme Court judgment now permits some Canadians to approach death on their own terms. Who should those Canadians be?

An essay by Catherine Frazee


 

For some of us, the book of life will close abruptly. A sudden pop or crunch or snap, and we’ll be gone. Perhaps some body part or system will betray us, utterly and fatally, in an otherwise banal moment of the day or night. Or perhaps some force of nature or violent strike will pluck us out of existence. There’s no telling. Either way, the outcome will be immediate and uncontrolled. We’ll be dead, and we won’t have planned for it. With any luck, our affairs will be in order and our relationships in good array. And that will be that.

But for many of us, there will be fair warning. Death will announce its approach. Either by diagnosis or by actuarial calculation, or more likely both, we will see the handwriting on the wall.

Then we will have to choose how to write our final chapter.

Canadians who know they are entering the last act of life now have the opportunity to meet death on their own terms. If we match the criteria detailed in the Supreme Court’s decision in the Carter case, we’ll be entitled, if we wish, to choose where, when, and in whose company, we shall die. For many, this will be a source of great comfort, permitting them to cross the stage of life one final time, and when the moment is right, to turn, bow and exit.

Edward Hung called this “an orderly exit plan”. The “accompanied” suicide that he arranged for himself in 2014 involved a trip to Switzerland, but prior to that, a curtain call performance of My Way, posted on YouTube for loved ones – and posterity.

In an open letter published after his death, Hung acknowledged his “good fortune” to have the support and resources that made it possible for him “to approach death in the way I wanted”. An accomplished criminal lawyer with a keen sense of justice, he pleaded the case for law reform months before the Supreme Court would hear arguments in the landmark Carter appeal. “As a Canadian, I had no choice but to resort to Switzerland. … This is just not fair. Our Parliament should allow Canadians to have easy access to assistance for their demise and I hope it would come soon.”

Indeed it would come, in just over two years. As of June 6, access to that assistance is now available on home soil.

“The Legal Vacuum”

In the Supreme Court’s decision striking down the ban on euthanasia and assisted suicide, federal and provincial governments were given one year in which to develop an appropriate legislative and regulatory response. When a new federal government was sworn in last November, a four-month extension was granted by the Court, taking us to June 6. Expert panels and parliamentary committees at the federal level worked toward the development of the “complex regulatory regime” that the Court had indicated would be “better created by Parliament than by the courts”. In a dead heat finish, the June 6 deadline saw Bill C-14, the federal government’s proposed Criminal Code amendments to permit medically assisted death, caught in stalemate with passage in the House of Commons and Senators poised to defeat it altogether.

In what many have called a “legislative vacuum”, Canada has no statutory law with respect to euthanasia or assisted suicide, but both are permitted under the terms of the Court’s decision. This means that doctors are now exempt from prosecution when they take active steps to end the life of a consenting adult who meets the criteria specified by the Court. Specifically, those criteria are: being a competent adult, giving clear consent, having a “grievous and irremediable” medical condition and experiencing enduring and intolerable suffering as a result of that condition.

What exactly is a “grievous and irremediable condition”? The Court gave no guidance about this, except to make it clear that “irremediable” does not require a person to undergo treatments that are unacceptable to them. Otherwise, it will be up to our doctors to decide who is eligible, and up to our provincial or territorial colleges of physicians and surgeons to oversee those decisions.

For better or for worse, this means there will be no consistent approach across the country, no requirement for reporting on assisted deaths, and no legal safeguards to protect vulnerable people from harm.

For example, there will be no legal requirement to have a second physician involved, no need to have requests made formally in writing, and no necessity for any time delay between making a request and receiving an assisted death. Physicians will be permitted to end the lives not only of adult Canadians, but of “suicide tourists” who travel to Canada as Edward Hung traveled to Switzerland.

As constitutional lawyer Dianne Pothier has observed, “Although cautious, risk-averse doctors may be hesitant to act, determined doctors could proceed, confident of the absence of criminal liability.”

Most controversially, willing physicians will be legally permitted to prescribe and administer lethal medication not only to persons who are approaching death, but also to persons who would otherwise have many years of life ahead, including persons with non-life-threatening psychiatric illnesses such as post-traumatic stress and depression.

As with other self-regulating professions, doctors will have professional standards and guidelines to adhere to, but the fact remains that criminal sanctions for misconduct or abuse are unlikely, except in the most egregious of circumstances.

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In many ways, assisted dying legislation in Canada is moving through unexplored ground.

Bill C-14 and the merits of prudence

This does not appear to be what the Court intended. Decidedly, it is not what the federal government intended. Indeed, Bill C-14, Canada’s proposed new law to permit medical aid in dying, now on life support itself, would establish a nationally consistent, regulated approach to this new practice. The Bill includes a number of generally uncontroversial safeguards and regulatory features consistent with the “complex regulatory scheme” that the Court alluded to.

A fulsome articulation of the purpose of the legislation is detailed in the Bill’s preamble, highlighting the weighty policy goals that must be balanced in such a law. Individual autonomy must be respected, at the same time as vulnerable persons are protected from inducement to end their lives. The “inherent equal value of every person’s life” must in no way be compromised, and “negative perceptions of the quality of life of persons who are elderly, ill or disabled” must be discouraged. Suicide must be recognized as a “significant public health issue”. The fundamental principles of the Canada Health Act – public administration, comprehensiveness, universality, portability and accessibility – must be upheld. Non-legislative measures that support “a full range of options for end-of-life care” must be pursued. Perhaps most significantly, the preamble makes clear that “robust safeguards, reflecting the irrevocable nature of ending a life, are essential to prevent errors and abuse in the provision of medical assistance in dying”.

With these grand commitments as its backdrop, Bill C-14 would introduce a more restrictive definition of what constitutes a “grievous and irremediable condition” and by extension, determine who is and who is not eligible to receive an assisted death. The Bill’s definition specifies: having “a serious and incurable illness, disease or disability”; being “in an advanced state of irreversible decline in capability”; having enduring and intolerable suffering which is either physical or psychological; and being on a trajectory towards a “reasonably foreseeable” natural death.

These restrictions have been hotly contested in debates that still rage as Bill C-14 advances haltingly through the lawmaking process. It is safe to assume that court challenges to “push the envelope” and legal strategies to “hold the line” will be forthcoming whatever law, if any, is ultimately fashioned for Canada.

As our law now permits the taking of certain lives in certain circumstances, how shall we know that we are taking the “right” lives, in the “proper” manner? When the dust of parliamentary debate settles, who should be offered the choice of an assisted death, and who should not?

A New Choice, but for Whom?

About some persons, and some circumstances, there remains little debate. Dr. Donald Low, the highly respected Canadian microbiologist who died in September 2013 shortly after recording a heartfelt plea for changes in Canadian law, would now have qualified for an assisted death under Canada’s proposed law. His terminal brain tumor was “serious and incurable”; he was in an obvious state of advanced and irreversibly weakening capacity; and his death, which would come eight days after recording his video, was more than reasonably foreseeable. While he suffered no physical pain, he described a deep personal anguish about the losses that lay ahead as his condition progressed:

“I’m worried about how it’s going to end… What worries me is how I’m going to die. Am I going to end up being paralyzed, will I have to be carried from the bathroom to the bed? Am I going to have trouble swallowing? I won’t be able to take in food. Things like that, that’s what’s bothering me the most.”

The fact that Dr. Low’s articulation of intolerable suffering corresponds with uncanny precision to my own conditions of daily living as a disabled Canadian, while jarring, cannot undermine his claim to a medically assisted death. Suffering is subjective, even when its hold on us can be traced directly to social forces of stigma and prejudice. This has been one of the more difficult conundrums as Canadian disability rights champions grappled with the implications of the Court’s decision in Carter – how to accommodate a right of access for persons like Dr. Low without further entrenching the discriminatory habits of heart that devalue the lives of disabled citizens.

To accept that Dr. Low’s explicit recoiling from disability would constitute a reason to die was a difficult pill for disability rights communities in Canada to swallow. But contextualizing this criterion within the four-part definition of “grievous and irremediable” that Bill C-14 would establish, goes a considerable distance toward easing that discomfort. Coming to terms with disability, learning its ways and routes and rewards, takes imagination, support and most of all, time. But compassion demands that we accept and honour those who are dying for who they are, and when it is possible to do so without undue harm to others, that we permit them to write their last chapter themselves.

As Canadian physicians grapple with the meaning of “grievous and irremediable” in the months ahead, not every case will be as clear-cut as that of Dr. Low.

People like Ms. Taylor

Our deliberations in this regard must begin with the life and circumstances of a Canadian woman named Gloria Taylor. Ms. Taylor was the central figure in the Court’s factual framing and analysis in the Carter decision . Indeed, the Court’s final declaration is expressed directly in relation to the constitutional rights of “people like Ms. Taylor”.

Ms. Taylor had been diagnosed with ALS in 2009, and by the time of the trial in late 2011 her condition had deteriorated significantly. Her death, which came about in 2012 as a result of a severe infection, was reasonably foreseeable; her condition was indisputably serious and incurable and her irreversible decline in capability was fully apparent. Ms. Taylor’s suffering, to some extent like Dr. Low’s, was anticipatory:

“I live in apprehension that my death will be slow, difficult, unpleasant, painful, undignified and inconsistent with the values and principles I have tried to live by. … What I fear is a death that negates, as opposed to concludes, my life. I do not want to die slowly, piece by piece. I do not want to waste away unconscious in a hospital bed. I do not want to die wracked with pain.”

Ms. Taylor went to court seeking assurance that she would be permitted to receive a physician-assisted death when her suffering escalated to her personal “enough is enough” moment. The Court obliged, granting her a constitutional exemption. She was jubilant, and satisfied. She lived for four more months until dying of natural causes in October 2012.

Were she alive today, Gloria Taylor would be entitled to choose an assisted death. This was a difficult ruling for Canada’s disability rights communities to embrace. Ms. Taylor, after all, had drawn liberally from the rhetoric of devaluation and stigma in advancing her claim – equating severe disability with being “stripped of dignity and independence”. But the life that she lived as a disabled person modeled impressive levels of civic and community engagement. While she may have invoked all-too-familiar narratives of shame and misery, perhaps strategically to bolster her arguments, she did not move in the world with shame. Perhaps for this reason, there is little controversy, even now from disability sectors, for according the option of an assisted death to “people like Ms. Taylor”.

But who else should have the option of assisted death?

Kay Carter was an 89-year-old resident of a North Vancouver nursing home who pursued an assisted death in Switzerland. Ms. Carter had spinal stenosis, a progressive condition that caused debilitating compression of her spinal cord. Ms. Carter’s death occurred in 2010, nearly 2 years prior to the trial court hearing that bears her daughter’s name.

Because Kay Carter was not a plaintiff in the case as Gloria Taylor was, the Court made no finding about whether she was indeed one of the “people like Ms. Taylor” who should have access to assisted death. Ms. Carter’s condition had deteriorated to the point of “extremely limited mobility and… chronic pain.” Accordingly, it would certainly appear that Ms. Carter had a serious medical condition, coupled with an advanced state of decline. But would she have met Bill C-14’s criterion of a reasonably foreseeable natural death?

Those who oppose the new Bill’s four-point definition of grievous and irremediable condition, including Ms. Carter’s daughter and son, insist that she would not, and therefore the Bill must be amended to expand the criteria to allow access for persons whose natural death is more remote.

Those who support the current drafting of these eligibility requirements, including Canada’s Ministers of Justice and Health, assert that Ms. Carter would have qualified. They explain that the framing of  ‘a reasonably foreseeable natural death’ takes into account the whole person’s medical status in ways that jurisdictions like Oregon and other US states – where the law requires that persons have a “terminal disease” – do not.

Without medical evidence, Ms. Carter’s eligibility for assisted death cannot be known. But the intensity of these debates underscores the question of whether too many people whose suffering would be brought to an end by an assisted death would be excluded by Bill C-14.

Those who support the Bill, including Canada’s disability rights and palliative care communities, say that it is a necessary restriction that recognizes the public health goals of effective suicide prevention. Assisted death cannot be the remedy for all human suffering. If its eligibility were to extend to persons who would otherwise live for many years, how do we ensure that the youth of Attawapiskat, for example, or traumatized Canadian veterans returning from war, are protected? No doubt the more than 4000 suicides each year in Canada ended the life of someone with enduring and intolerable suffering.  But not all were “people like Ms. Taylor” whose death was foreseeable.  Maintaining the criteria of ‘a reasonably foreseeable natural death’ preserves the coherence of suicide prevention.

Canada’s proposed law would serve the needs of persons who are desperately ill and on a clear trajectory toward death. As the Minister of Justice acknowledged on May 13 when she rose in the House of Commons to speak to Bill C-14,

“At the same time that Bill C-14 permits access to the majority of those who would want it, it would not allow any and all Canadians to access it. It limits access in accordance with the legislative objectives that are stated in the preamble of the Bill.”

For Canada, there will be difficult cases ahead. Indeed, in Québec, where euthanasia for persons suffering intolerably at the end of their lives has been available for several months, there have already been hard cases at the eligibility margins..

Consider, for example, Louise LaPlante’s last chapter. According to the testimony of her daughter, Léa Simard, before the Senate Standing Committee on Legal and Constitutional Affairs, Mme. LaPlante deliberately starved herself to death after being refused medical assistance to die because, although she had multiple sclerosis, she did not meet the “end-of-life” requirement for this assistance under Québec law. Her case is not unique; other Québec citizens like Jean Brault pursued starvation until reaching a point of no return, whereupon physicians relented, because “natural” death had become imminent.

When her daughter was invited to elaborate on Mme. LaPlante’s experience, important details emerged. We learned that Mme. LaPlante was a fiercely independent woman, strong and solitary. After a serious decline resulting from injuries sustained in a fall, her home care arrangements became inadequate.

“The situation was getting worse and worse. … “So much so, that she felt very insecure at night.… She would be 12 hours without care and her situation had become impossible. We met with a social worker to try to get an intermediate resource, but that didn’t work”.

Admission into a long-term care facility was arranged. According to her daughter, this was the “turning point” for Mme. LaPlante.

“For her, that would have been hell. At 66 years, to be with people who were on average 85 years old, completely “gone”, if you will – atrocious conditions for someone who was solitary and independent.… She was a vegetarian and… there were menus that would have completely not met her needs… [There were also] very brusque ways of offering care… Essentially, it was hell, and that’s exactly what pushed her to make that decision… What other solutions did she have… Her only option was to let herself die of hunger.”

In 2003, Harriet McBride Johnson, one of modern America’s great writers from the culture of disability, coined the phrase “The Disability Gulag” to conjure the fortress of despair that felled Mme. LaPlante. It is the “destination” from which many final chapters have been and continue to be written, whenever frailty and social circumstance combine as they did for her.

As long as her home support arrangements were adequate, it appears that Mme. LaPlante had coped with the difficult progressions of her illness, holding fast to her identity as a strong and independent woman. But being uprooted from her home and delivered into a strange and alienating environment seems to have robbed her of all resilience, and may have rendered her highly vulnerable to any inducement toward assisted death.

Those who have experienced the “Disability Gulag” are quick to recognize how despair takes hold in such places. Rhonda Wiebe, speaking on behalf of the Council of Canadians with Disabilities, describes the “very subtle ways in which that chiseling away of the essence of who you are occurs”.

Should Mme. LaPlante’s final chapter have been written differently? Should she have been offered choices other than starvation? To these questions, we would all would surely answer yes.

But should those choices have included an assisted death? In the answers to this question, we confront the divide between those who advocate for unrestricted access to assisted death – whose response is plain and simply, yes – and those who support our new law, whose response is far more equivocal. For in circumstances such as those described for Mme. LaPlante, we can appreciate the devastating impact of being forced into institutional care and enduring overwhelming losses to one’s sense of place in the world. At such times of crisis, when grief and despair can easily take hold, disability groups and other supporters of the proposed law argue that the very offer of an assisted death is in and of itself, an inducement toward suicide.

In establishing that “persons like Ms. Taylor” should have access to a doctor’s assistance to end their life, the Supreme Court stated clearly that persons who are vulnerable to “being induced to commit suicide at a time of weakness” must be protected from such inducement. On the face of it, the question that Mme. LaPlante’s final chapter leaves us with is perhaps not whether she was a person “like Ms. Taylor”, but whether she was a vulnerable person caught at a time of weakness in a web of inducement.

The dynamics of inducement are at the heart of disability rights groups’ urgent calls for a cautious approach to medically assisted death. As disabled American author, Ben Mattlin observes,

“I know how thin and porous the border between coercion and free choice is, how easy it is for someone to inadvertently influence you to feel devalued and hopeless — to pressure you ever so slightly but decidedly into being “reasonable,” to unburdening others, to “letting go.”

Was Mme. LaPlante induced by the catastrophic failure of her home support arrangements to commit suicide at a time of weakness? Some will say it was possible, and others will say probable. We cannot know for certain of course, working back from a few passages of a mother’s life, filtered through her daughter’s memory.

But Bill C-14 would relieve us of the burden of making such determinations, drawing the line where natural death is reasonably foreseeable, and asserting that where it is not, we need to look elsewhere for measures that would alleviate a person’s enduring and intolerable suffering. If Mme. LaPlante’s natural death was not reasonably foreseeable, she would not qualify for assisted death. Her refusal of food and water would summon from us a host of other interventions from a host of other disciplines – social work, suicide prevention, rehabilitation science, psychology, spiritual care, and most importantly palliative care – that little-understood branch of medicine that specializes not in death, but in human suffering.

Human suffering is not like a toothache – specific, identifiable, extractable. Human suffering is a shape-shifter, a formidable ghost that enters our lives not always from the most “obvious” direction. Experts in palliative medicine understand this truth, and work in multidisciplinary teams to explore what Dr. Harvey Chochinov calls “the roots of suffering behind a request to hasten death”. It is work that takes great skill, and work that requires resources proportionate to the importance of lives like Mme. LaPlante’s that may hang in the balance.

Where natural death is not reasonably foreseeable, Bill C-14 asserts that the likelihood of inducement is too high, the risks of social harm too great. Our current legal framework expresses no such hesitation. Our elected parliamentarians chose the more cautious – some would say balanced – route, passing Bill C-14 on third reading. Time will tell whether our chamber of sober second thought, the Canadian Senate, will reach a similar conclusion.

IMG_4461Catherine Frazee, OC, D.Litt., LLD. (Hon.).  Former member of the Federal External Panel on Options for a Legislative Response to Carter v. Canada.  Professor Emerita, Ryerson University, School of Disability Studies.

From Helpless to Hopeful: Korean Dog Meat Farms

June 7, 2016 11:51 am
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Adria in Korea as HSI’s Animal Rescue Team shuts down a dog meat farm in S. Korea. Photo credit: Michael Bernard/HSI.

A couple weeks ago we featured a very special girl as our Pet of the Week. Adria (whose article can be found here), was rescued from a dog meat farm in South Korea and survived a pretty horrific experience before being rescued and making it over to Canada. Understanding the horrors of the dog meat trade can be difficult, as well as heart-breaking to those who have never been exposed to it. 

Photo credit: Michael Bernard/HSI

Photo credit: Michael Bernard/HSI

Understanding the Dog Meat Trade and Those Involved in Stopping It.

Dog meat has been consumed around the world on various occasions and for various reasons. While Western cultures see the act of consuming dog meat as taboo, it is a commonplace food in countries such as South Korea, Vietnam, and China, as well as in rural parts of Switzerland. In many Asian countries such as South Korea, the consumption of dog meat is often done as a part of many cultural dishes and beliefs. However, due to the lack of regulation in the dog meat industry, there are no laws in place which control how the dogs are raised and slaughtered. As a result, many dogs are often burned or boiled alive or electrocuted as a part of an unproven belief that the adrenaline running though the dog as it’s killed will improve the tenderness of the meat.

Many of the dogs that end up in dog meat farms are either born there, or were once family pets that were surrendered to the farm owner or stolen from their homes. Dogs in these farms are often held in small cages with no protection from the elements and are often found emaciated. They are not given water, but instead get nutrients and hydration through a stew-like slop.

In addition to the unethical factory conditions, dog meat consumption has been linked to the spread of cholera and rabies throughout southern Asia. The World Health Organization has found that the consumption of dog meat increases the risk of contracting Cholera twenty-fold. Rabies has been a particular threat as the conditions that dogs are held, transported, and slaughtered in allows for the rapid spread of the disease.

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Photo credit: Frank Loftus/HSI.

To combat this horrific trade, the Humane Society International has been working with dog meat farmers in South Korea to help them transition to a more ethical and humane method of farming. Since 2015, the HSI has successfully shut down 5 dog meat factories and rescued hundreds of dogs from slaughter. They recently completed their largest rescue operation yet and rescued 171 dogs from slaughter. The rescued dogs have been flown all over North America to find forever homes, with nine of them, including Adria, brought over to Ottawa’s own Freedom Dog Rescue.

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Photo credit: Meredith Lee/HSI.

In Ottawa, these dogs were placed in foster homes that were trained to work with dogs that are scared of humans, have little to no training and can suffer from health problems due to malnutrition. All nine dogs with Freedom Dog Rescue have already begun to bounce back and thrive in loving homes and are beginning to adjust to gentle human touch—something they had never experienced before.

The HSI is part of the Asia Canine Protection Alliance, an international alliance of organizations dedicated to ending the horrific dog meat trade in Asia. ACPA is made up of four groups including Soi Dog Foundation, Animal’s Asia Foundation, and Change for Animals Foundation. To help end the dog meat trade, you can volunteer with or donate to either of these groups.

Ending Homelessness Through Housing First Initiatives

June 3, 2016 2:59 pm
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Up to 15 per cent of the homeless population in Canada is struggling with mental illness. Could giving them a permanent home be a way off the streets and into a healthier life?

In this interview, Evidence Network’s podcast editor Mélanie Meloche-Holubowski speaks with Dr. Jino Distasio, Director of the Institute of Urban Studies at the University of Winnipeg and Vicky Stergiopoulos, Psychiatrist-in-chief at St. Michael’s Hospital. Together they discuss the link between poor housing and health outcomes. Throw on your headphones and enjoy!

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Dr. Jino Distasio

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Vicky Stergiopoulos

 

 

 

 

 

 

 

Dr. Jino Distasio, Director of the Institute of Urban Studies at the University of Winnipeg and Vicky Stergiopoulos, Psychiatrist-in-chief at St. Michael’s Hospital and investigator for the At home/Chez soi program explain how Housing First initiatives could reduce the number of homeless in Canada.

Interview by Mélanie Meloche-Holubowski, Podcast Editor at EvidenceNetwork.ca, and journalist with Radio-Canada.

Health Reform in Ontario Must Include Oral Health

May 26, 2016 1:34 pm
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A healthy mouth is part of a healthy life.

The Ontario government’s proposed reform of the provincial health care system is going forward with a glaring omission: primary mouth care. To make this reform truly “Patients First,” Dr. Eric Hoskins, Minister of Health and Long Term Care, must include primary care for the mouth.

Dentists are not part of the primary health care system and physicians are not trained to deal with mouth diseases, such as those that affect teeth and gums. Primary mouth care is not covered under OHIP, and hospitals are not equipped to deliver dental care. Ontario only has public dental programs for low income children under 18, and a patchwork of basic services for people receiving social assistance.

If you develop extreme pain in your abdomen and think it could be appendicitis, you can get emergency care at the local hospital. If you develop extreme pain in your mouth and cannot afford to see a dentist, no such luck. Usually the emergency room physician will give you a prescription for painkillers, maybe antibiotics, and advise you to see a dentist.

How does that help? Well it doesn’t. The reason many go to the emergency room for mouth pain in the first place is because they can’t afford to see a dentist. Left untreated, mouth diseases progress and can lead to the need for more costly interventions such as hospitalization.

This is a common scenario in Ontario.

In 2014, there were almost 61,000 hospital emergency room visits for dental problems. The most common complaints were abscesses and dental pain.

It is estimated that every nine minutes a person shows up in a hospital emergency room with a dental problem. The minimum cost of each hospital visit is $513. As a result, taxpayers spend approximately $31 million annually to have physicians acknowledge that patients have dental disease that they cannot treat.

When Medicare was first introduced, primary mouth care was left out. At that time the links between poor oral health and chronic diseases such as diabetes, cardio-vascular and respiratory diseases, and the delivery of pre-term, low birth-weight babies were not established. Now we know that you cannot be truly healthy if you have diseases in your mouth.

The insufficient understanding of the importance of good oral health and the lack of advocacy for inclusion in Medicare meant the delivery of dental services remained in the private sector. Over fifty years later the disturbing reality is that too many people in Ontario do not have access to basic dental care services.

The College of Dental Hygienists of Ontario estimates that two to three million Ontarians have not seen a dentist in the past year. The main reason is the cost.

Neither the private dental system nor the patchwork of public oral health programs are meeting the needs of the most vulnerable people in our communities: low-income families and workers without dental insurance; low-income seniors and the elderly in institutions; indigenous people; immigrants and refugees; people with disabilities and people living in rural and remote areas.

We have an opportunity in Ontario in 2016 to begin to change this dismal picture.

The Health Minister is proposing the “Patients First” plan to reduce gaps in the health care system with the objective of improving health equity to ensure all Ontarians receive timely, consistent and appropriate high quality care, no matter how much they earn, where they live or what their ethnicity. Legislation is expected to be tabled in the Ontario legislature this spring, but the plan is inadequate without the inclusion of primary oral health care.

Our teeth and gums are part of our body, and poor oral health affects our overall health and well-being. The proposed plans must ensure equitable access to oral health services so that vulnerable people in our communities can get the care they need and be healthy.

How can this be done? We urge the provincial government to require Ontario’s fourteen Local Health Integration Networks (LHINs) to be responsible for ensuring access to oral health services for vulnerable populations as part of their new primary care planning roles.

Ensuring low-income people can get preventive oral care and treatment will reduce visits to hospital emergency rooms, improve health outcomes and reduce acute care health costs.

To achieve these goals in a cost efficient way, we urge the Ontario government to act faster on its 2014 promise to extend public dental programs to include low-income adults. Services should be delivered through publicly funded dental clinics in public health units, Community Health Centres and Aboriginal Health Access Centres. These institutions already serve many vulnerable people in their communities.

It’s time to bring the planning and delivery of oral health care services into the mainstream of policy discussions on Ontario’s health care system if we are to achieve better health outcomes for all Ontarians.


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Jacquie Maund is the Policy and Government Relations Lead for the Association of Ontario Health Centres and an advisor with EvidenceNetwork.ca.

 

 

 

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Dr. Hazel Stewart is the Director of Oral Health Programs, Toronto Public Health.

Ottawa Police Services Crisis: The Cart Pulling the Horse

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Ottawa Life Magazine has been writing about the problems with the Ottawa Police for the past five years. In 2011, we said that Councillor and Ottawa Police Services (OPS) Board Chair Eli El-Chantiry should resign over his all too cozy relationship with then Police Chief Vern White. El-Chantiry saw no reason why he or anyone should be concerned about him socializing with the Police Chief he was supposed to be overseeing. When current Chief Charles Bordeleau was accused of allegedly interfering in a court case involving a careless driving charge against his father-in-law, El-Chantiry did nothing. His chummy, wink wink, nod nod relationship with the police management team and complete misunderstanding of his role as OPS Chair has now crossed into gross incompetence.

The OPS Board was later forced to send the case to the Office of the Independent Police Review Director (OIPRD) after the accusations were reported by Postmedia. When referring it for investigation, El-Chantiry said that the board was not passing judgment on what the Chief did but, acting in the interest of “openness and transparency.” He does not even seem to comprehend that the entire point of oversight is to monitor and pass judgment on a regular basis to ensure that the police are operating at the highest possible standard. Chief Bordeleau vehemently denies the accusations and El-Chantiry has further damaged the Chief’s reputation. El-Chantiry should have sent the original accusations to OIPRD and let them do their job. By not doing so, Bordeleau’s reputation has been damaged in the public eye. Bordeleau has been trying to bring change to OPS. He has a small mutinous crew of undisciplined officers on his force and continues to deal with an unacceptably high number of incidents of police misconduct by Ottawa constables, including cases of spousal abuse, driving under the influence and police improperly accessing personal data on police computers. There are also investigations underway involving 11 Ottawa police constables allegedly involved in fraudulent reporting activity. Under the current Police Services Act, Chief Bordeleau cannot terminate any of these constables. If the accusations are true, they should all be fired.

Related: Why Police Fear Evidence-Based Research.  

Ottawa Centre MPP and Minister of Community Safety and Correctional Services Yasir Naqvi will soon introduce changes to reform the Police Services Act, but until then, Bordeleau must work with the current Act which is outdated and does not have the provisions to allow Police Chiefs to fire officers for criminal or inappropriate activity. The Ottawa Police Association, like most others, circle the wagons and protect their own, even when criminal behaviour is involved. This harms the good police officers and creates an environment where some police think they can commit crimes and are untouchable. In Ottawa, there have been five violent murders since January. All of them are gang and drug related. Otherwise, overall crime across the city is down. After the fifth murder, Chief Bordeleau issued an open letter asking the public to help the police. A day later, one of “Ottawa’s Finest,” Constable Paul Heffler, sent out a cowardly email to the entire force criticizing Chief Bordeleau. It was a breathtaking and insolent act of insubordination that should have resulted in his immediate termination with cause. Heffler, who has almost 30 years in policing, sent it knowing full well there was little at risk for him as he will soon retire on a fully indexed, taxpayer-subsidized fat cat pension. He actually wrote in his email that “there are few services and businesses that pay their employees $100,000 salaries and treat them like they are dime store security guards.” He raises an important point. Why are we paying police constables like him and others such high salaries, amongst the highest salaries of any public servants in Ontario, when private sector companies are available to cover these duties at one-third of the cost? If we did that, then the Ottawa Police would have the money to pay for intelligence gathering, equipment and extra resources they require to combat the serious and growing issue of gang violence in Ottawa. Instead, we have a head of Police oversight who is dumber than a bag of hammers and police constables who have become so arrogant and entitled that they now think they don’t even need to listen to the Chief of Police.

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