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.

Safe, Secure and Affordable Housing is a Health Issue: Why Canada Needs a National Housing Strategy Now

May 11, 2016 11:55 am
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“Social factors, like housing, income and wealth, educational background and race are more powerful determinants of health outcomes than our behaviours, genes or even the healthcare system.”

When you’re feeling unwell, whether from a minor cold or a devastating terminal illness, the feeling of home, the desire for a safe and comfortable place to rest and recuperate, is a universal one. But what if your home itself is a source of stress and illness? Worse yet, what if you don’t have a home at all? As family doctors, we see and know just how powerful the effect of proper housing can be on the health of our patients.

On the front lines of healthcare, family doctors have that rare opportunity to stand back and see a person as a whole, in the context of their lives and their social situations. As practitioners of evidence-based medicine, we also seek out the most effective interventions to improve the conditions of our patients; and the evidence is clear. Social factors, like housing, income and wealth, educational background and race are more powerful determinants of health outcomes than our behaviours, genes or even the healthcare system.

And yet, experts in health are often trained to focus on the provision of health care services, often sending patients back into the social and economic conditions that made them sick. Nowhere is this more evident than in the case of individuals experiencing homelessness or living in unsafe, precarious housing.

We treat chronic back pain and send people back to sleep on concrete streets. We treat insomnia and send people back to chaotic shelters where they cannot sleep. We treat asthma and send people back into moldy homes where they labour to breathe. We send patients back to the very places that create their disease.
As healthcare providers, we know the actual prescription needed is safe, secure and affordable housing. We are not alone.

Canada’s former chief public health officer, Dr. David Butler Jones, agrees that inadequate housing can have several negative repercussions on health ranging from “respiratory disease and asthma due to molds and poor ventilation, to mental health impacts associated with overcrowding.

Unfortunately, this issue is not a small one. An overwhelming 1.5 million households in Canada are living in precarious housing that is inadequate, unsuitable and unaffordable. In other words, 1.5 million families live in housing that requires major repairs, does not have enough bedrooms for their needs and pay more than 30 percent of their household income for this unfit housing.

This is not a sustainable situation and it endangers the health of our communities. The 1.5 million in precarious housing does not even count the over 235,000 people a year experiencing homelessness in Canada – those living in shelters, sleeping outside or surfing friends’ couches.

The recent Federal Budget offered $2.3 billion for affordable housing – a step in the right direction. We know some of the funds will be allocated to deal with homelessness, First Nations housing and seniors. While these are positive steps forward, there is yet to be a timeline announced for promised consultations on the allocation of these funds. The federal government’s solution to our housing crisis cannot be about writing cheques and walking away.

When consultations are eventually launched, as health providers who see the impact of these policy decisions on the ground, we have our own suggestions. First and foremost, housing must be viewed as a health and social justice issue. Safe, secure and affordable housing is crucial to maintaining and improving health and well-being.

Secondly, these conversations must include not just the health sector, community partners and think tanks, but most importantly, those with lived experience of homelessness and precarious housing.

Finally, our approach to the housing crisis cannot be one-off policy changes but should be part of a coordinated national housing strategy. This is the very approach recommended by the United Nations Economic and Social Council just this past March. They raised red flags over our insufficient funding for housing, our shortage of social housing units and increased evictions related to rental arrears.

Tackling these problems in a coordinated national housing strategy — not just with short-term spending promises, but with meaningful long-term partnerships — isn’t just good social policy, it’s good health policy too.

It’s time to move from crisis to action, from precarity to security and towards improving housing and health for everyone in Canada.

Article written by Danyaal Raza and Ritika Goel.

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Danyaal Raza is an advisor with EvidenceNetwork.ca and Upstream, a family physician at St. Michael’s Hospital and Assistant Professor at the University of Toronto.

 

 

 

 

 

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Ritika Goel is a family physician with the Inner City Health Associates working with people experiencing homelessness, as well as a Lecturer at the University of Toronto. 

 

Letter to the Editor: Paul Champagne on the Attawapiskat Crisis

April 26, 2016 10:46 am
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This letter to the editor from Baynes Lake resident Paul Champagne outlines a strategy for improving conditions in Attawapiskat, a Northern Ontario First Nation suffering under a recent suicide crisis that has put it in the national media spotlight. You can read the full letter, sent on April 23, below:

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It’s Not Just the Law That’s an Ass Mr. Dickens

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Charles Dickens at his writing desk. 

The 19th century novelist and author Charles Dickens, who is famous for such great books as David Copperfield, Oliver Twist, A Christmas Carol and Great Expectations, once wrote that the ‘Law is an Ass’.  Dickens had a valid reason for saying this because in the 19th century there were no patent laws in the United States to protect established authors from having cheaper versions of their books pirated and sold to the public.  Not a single penny in royalties went to the authors.  During one of his famous visits to the United States Dickens gave a number of speeches denouncing the absence of patent laws. In his novel American Notes he expressed his condemnation and outrage at America for failing to protect its most creative authors and writers.

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An early copy of Dickens’ A Christmas Carol.

If Dickens were living today he could easily have included the Canada Border Services Agency (CBSA) for the manner in which they operate.  Here is a Department that appears to be accountable to no one.  It doesn’t matter what they do or how incompetently they carry it out, no one is held responsible.  It’s shocking that there is no independent and impartial oversight body that the public can complain to when they have received shoddy treatment from the CBSA.  This department is a law onto itself and it’s high time the government of Canada changed this situation.  The Correctional Service of Canada comes under scrutiny by the Correctional Investigator and even our national police service, the RCMP, is subject to oversight by the Civilian Redress and Complaints Commission.  So why isn’t there an oversight body in place to hold the people who work for the CBSA accountable for outrageous behaviour?

Since I do not travel outside of the country I fortunately have not had the pleasure of being greeted by some power hungry CBSA officers upon my return to Canada.  However, I have been told some horror stories by a number of people that should make any Canadian sit up and take notice.  Even sitting at home minding your own business, you are not safe from their antics.  About four weeks ago, I ordered a book from a Bookstore in England.  The book featured the work of Charles Dickens.  The book had been advertised as a large folio sized publication consisting of six divisions or sections.  Each of the numbered divisions or sections contained three plates by the famous 19th century artist Frederick Barnard.

Normally a book sent from the United Kingdom to Ottawa arrives in four or five days but with a courier like FedEx it’s usually three days at most.  I received notification via voicemail from FedEx that my book had arrived and that there was $18.30 owing in GST and other charges.  I informed FedEx that I would pay for the book upon delivery.  You can imagine my shock when FedEx called the following day and informed me that the book could not be released because it had been seized by the CBSA.  I was totally shocked as I didn’t realize that Charles Dickens was on a watch list and that he had been classified as a terrorist or subversive agent by the CBSA.  FedEx informed me that in order to have my book delivered that I would have to fill out various forms and provide them proof of purchase and payment for the book.  I did this immediately and sent it off to FedEx.  Thinking everything was in hand I patiently waited for delivery of my book.

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Many Canadians run into trouble at the border, but as Davies experienced, sometimes you don’t even need to leave your living room.

The next day FedEx called and informed me that CBSA still refused to release my book.   When I inquired why, she told me that the CBSA officer refused to clear it because there were ‘six’ books in the package.  She told me that before they would release my book that I would have to go the CBSA office at the airport and fill out the same forms I sent her and account for the prices of each book.

I couldn’t believe what she was telling me. The book which I bought is listed on the internet and sold through a variety of bookstores. They describe the book as having six divisions or sections.  For a customs officer who obviously knows nothing about books to hold back delivery of my book on Charles Dickens is nothing less than mind-boggling.  A person might be forgiven for thinking that it doesn’t get any crazier than this…but unfortunately it does.

Exasperated, I contacted the President’s Office for The Canada Border Services Agency looking for an explanation.  My case, or should I say the case of CBSA versus Charles Dickens, was referred to a liaison person.  I thought great, somebody in charge will recognize the lunacy of this situation.  However that was not to be the case.  Instead, after waiting four hours and hearing nothing, I called the CBSA representative back a second time.  The only thing he did was refer me to a supervisor for CBSA at the Airport.

The supervisor claimed he was there to help get the matter resolved.  However once he got into the issue that there are ‘six books’ in the box and not one I confess I reached my tolerance limit and hung up the phone on him.  As for the person I was dealing with in the President’s Office, that conversation was a real eye opener.   What he told me is that customs officers are accountable to no one.  He went so far as to say that no one can tell a customs officer how to do their job.  This should be enough for every person in this country to demand that the federal government set up an oversight body to hold CBSA staff accountable.  If the President of the Canada Border Services Agency cannot manage her staff and hold them accountable when they make idiotic decisions, then we have a very serious problem in this country.

RelatedNew Government Should Start by Making the RCMP More Accountable

Like most Canadians I am aware that the CBSA has a statutory responsibility under the law to examine parcels to ensure that people are not importing illegal goods such as guns, drugs, bomb-making paraphernalia and unauthorized goods into the country.  However, once a Canadian citizen provides sufficient proof to justify the importation of those goods into Canada that should be the end of the story. The fact my book is not being delivered because some CBSA officer doesn’t have the mental capacity to figure out that there is only one book with six separate sections is scary.  Charles Dickens was right when he said the law is an ass, and if he were living today I have no doubt he would also have included the Canada Border Services Agency.

By the time you read this I still won’t have my book, and Charles Dickens will still remain under watch and in custody at the Ottawa International Airport.

Written by Darryl T Davies. Davies is an Instructor in criminology and criminal justice with the Department of Sociology and Anthropology at Carleton University. 

OLM Argued the Case Against Mike Duffy was Groundless Back in May

April 21, 2016 3:31 pm
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Update: Today all 31 charges were dismissed against Sen. Mike Duffy. Below you can find an article Ottawa Life Magazine publisher Dan Donovan wrote last May, arguing that Duffy was being unfairly targeted by the media. Today, the judge confirmed this suspicion.

21st Century Lynching and Shakespearean Tragedy Take Centre Stage

The Mike Duffy trial is a public showcase for all the secrets and lies that are the realpolitik of the capital. Duffy has already been tried and convicted in the public eye. For theatre, he was first drawn and quartered by Canada’s national media in what can only be described as a 21st century lynching. I worked for many years on Parliament Hill as a speechwriter, legislative assistant and political staffer. The place has its own rules and more importantly, its own governing conventions. The Parliamentary press can be a self-involved and pretty sanctimonious bunch. Duffy’s trial at the Ottawa Courthouse is having the dual effect of bringing out the real story about his expenses while exposing the shallowness and callousness of the Parliamentary press and the elitism of the “pundit class” at Canada’s major broadcasters.

The national media narrative is that Senator Duffy pilfered taxpayers dollars and broke spending rules and got caught with his hand in the cookie jar. In fact, it goes further and suggests that he took the whole cookie jar…whatever that is. Even though these journalists work in the parliamentary precinct and have access to the players and procedures or conventions that govern the Senate, few, if any of them took the time to investigate or explain the conventions of the Senate related to spending. The trial is exposing much of this and shedding some new light on Senator Duffy. He, like all senators seems to have run his affairs as a senator using the vagary of Senate rules and conventions. The issue about his residency and related expenses is key. He has been consistent that he expensed these within the rules. Ironically, the Senate still refuses to release to the public several audits which show how other senators dealt with housing expenses.

The release of this information could greatly help bring clarity to the Duffy affair. If the convention was that it was ok to claim part of housing expenses in various ways and all senators did this, than Duffy has done nothing to break the rules. Duffy’s problem was that he was both popular and ambitious, which can be a deadly combo in Ottawa. He is a former award-winning and respected journalist who, for years, was one of the most popular political broadcasters in Canada. MPs from all parties and their staff would seek him out and share information or give him stories that they wouldn’t give to others. He had a great reputation, was always gracious and never betrayed anyone’s trust. People genuinely liked and trusted “Mike.” He loved Parliament and he knew “the game.”

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The evidence to date seems to indicate his Senate expense claims were not for personal enrichment but were used to pay people for tasks he was involved with as a senator. The duplicity of the press regarding their outrage and the amount of time they have spent over the expense receipts for his makeup is laughable. This, coming from the very same people that use makeup in their jobs on a daily basis, understanding that makeup is as important to a broadcast journalist as a stick is to a hockey player. It would have been far more responsible for at least one journalist covering the Duffy case to get the RCMP to explain why he was charged with bribery. Bribery requires a “bribee” and a “briber.” According to the RCMP investigator, Duffy is apparently the person accepting a bribe…yet no one was charged with giving him one.

Duffy maintains he never accepted any bribe and it appears his lawyer is making that case for him. Proportionality and fairness in broadcasting must be put back into play regarding Senator Duffy. Regardless of what you think of Mike Duffy, his rise to prominence and fall from grace are like a Shakespearian tragedy. The Shakespearian comedy in this is watching broadcasters, especially those at the CBC (who are paid with taxpayers’ money), sanctimoniously rail away at Duffy for betraying the public trust when they themselves have accepted large personal payments from private corporations to give speeches and attend conferences. Talk about a hand in the cookie jar.

The Puzzle of Physician-Hastened Death

April 19, 2016 9:43 am
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Physician-hastened death is a puzzle, and one that, despite its complexity, we as a society have been tasked to assemble. Some of its pieces are so different from one another, and it is hard to imagine how they might fit into a cohesive whole. And yet, by June 6th – the deadline set by the Supreme Court of Canada – time will have run out, and whatever the state of assembly may be, it will depict our response to suffering and end-of-life decision making for generations to come.

As drafters of legislation slog their way through the mind-numbing variety of pieces and possible configurations, here are a few strategies that puzzle mavens have long counted on.

First, get a sense of what the puzzle might look like. With respect to physician-hastened death, one option looks like the Benelux countries, which allow euthanasia or assisted suicide in response to suffering, independent of life expectancy and in some jurisdictions, independent of age.

Another option resembles Quebec or Oregon, where eligibility is confined to end-of-life circumstances for competent adults only. This uniquely Canadian option depicts a balance between carefully regulated physician-hastened death, and our constitutional obligations to protect vulnerable persons from harm.

Next, locate the frame within which the rest of the puzzle is assembled. Regarding physician-hastened death, a critical framing question is: ‘Do we consider this a part of medicine?’ The response to this query fundamentally determines the placement of many subsequent pieces.

If physician-hastened death is part of the continuum of medicine, then we must treat it as such. Like any other new treatment or clinical innovation, it demands careful evaluation and methodological rigor, including fixed eligibility criteria, detailed data collection, objective monitoring of outcomes and tracking of adverse effects; the ability to analyze cumulative data, with incremental ramping up entirely based on preceding trial outcomes.

We would insist on no less stringency for a new cold remedy or wart ointment, let alone physician-hastened death.

Others insist that physician-hastened death is not part of medicine. While chairing the External Panel for the Federal Government on Legislative Options for Carter v. Canada, I heard many clinicians, including those involved in these practices, describe it as ‘a social intervention.’ One American physician referred to his role in assisted suicide as ‘an act of love.’

If not a medical act per se, then drafters of legislation must embed it within a broad legal and social policy framework, while being mindful of equity, justice, transparency and the social determinants of health. Within this context, eligible patients who wish to have their lives ended could continue to avail themselves of whatever social supports and medicine have to offer, while at the same time pursuing a regulated Criminal Code exemption to permit a hastened death.

Finally, puzzle connoisseurs will arrange similar pieces, based on color, texture or other distinguishing features. Regarding physician-hastened death, the pieces divide into three thematically distinctive groups. The first group I would label ‘evaluating and responding to suffering.’ These pieces are very familiar to healthcare professionals across multiple disciplines, and ones they are entirely comfortable dealing with: determining the source and nature of a patient’s suffering, coming up with treatment options and attempting therapeutic measures to mitigate the patient’s distress.

The next group of pieces I would label ‘decision making.’ These are perhaps the trickiest ones to place. If physician-hastened death is framed as a medical act, then decision-making pieces must comply with standards governing all clinical innovations, particularly pre-approval, to be sure that protocol requirements have been fulfilled before administering a hastened-death.

If physician-hastened death is not framed as a medical act, then decision making pieces of the puzzle will have legal markings, giving shape to a process that determines eligibility, screens for undue influence and verifies informed consent.

Related: Advanced Directives for Assisted-Dying a Dangerous Step

The final group of pieces I would label as ‘carrying out the hastened death.’ While the court will have made this legal, it does not de facto make it medical. The External Panel was told there are no doctors on the premises when organizations such as Dignitas or Exit help patients die and that non-medical personnel are very proficient in carrying out this task.

While physicians may choose to include hastened death within their scope of practice, it is not a forgone conclusion that this will or necessarily should remain within their exclusive domain.

In the days ahead, Parliamentarians will be debating legislation governing the practice of physician-hastened death. Putting this puzzle together will take wisdom and courage. Here is hoping the picture that emerges is coherent and just, as each piece falls into place.

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Dr. Harvey Max Chochinov is a distinguished professor of psychiatry at the University of Manitoba. He was chairman of the federal government’s external panel for options to Carter v. Canada and is an adviser to the Vulnerable Persons Standard.

Letter to the Editor from the Philippine Ambassador to Canada

April 14, 2016 1:00 pm
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This letter to the editor from the Philippine Ambassador Petronila P. Garcia is a response to the article “Correcting Misconceptions & Upholding Justice in the South China Sea” from our February/March 2016 print issue. You can find that article here. The letter is included below in full.

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It’s Time for the Federal Government to Enforce the Canada Health Act

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Extra-billing, user fees for health services on the rise across the country.

Extra-billing in Ontario, private MRIs in Saskatchewan and user fees in Quebec: violations of the Canada Health Act are on the rise across the country. Canadian doctors are concerned about the impact of this trend not only on their patients, but on our public health care system as well.

Health Canada is required to publish a report every year in order to detail how provincial and territorial health care insurance plans have (or have not) satisfied the conditions for payment under the Canada Health Act. Provinces that are not in compliance are to be penalized with a reduced Canada Health Transfer (CHT) payment.

This year’s report showed that in 2014-15, the only province that received such a penalty was British Columbia. Their CHT payment was docked $241,637, about half of the amount in extra billing a 2012 audit found to have been committed by Dr. Brian Day’s Cambie clinic in just one month. It’s notable that British Columbia, the only province docked funds, is also the only province currently seeking to enforce the act by cracking down on Cambie’s activities.

Physicians and clinics have quietly been charging extra fees for health services for many years, yet calls for the federal government to enforce the Act have been ignored. Coming down hard on extra-billing may not sound as exciting as announcing new funding for specialized medical services, but it is the job of the provincial and federal health ministers to protect the Canada Health Act and guarantee equitable access to Canadian health care.

In Ontario alone, the frequency of such charges has grown at an alarming rate and escaped the notice of provincial and federal auditors and health ministers. The Ontario Health Coalition published a report in 2014 listing dozens of instances where independent health facilities (e.g. eye surgery, colonoscopy, diagnostic and executive health clinics) charged extra fees for medical consultations, examinations, diagnostic testing and other manners of “upgraded services.” These fees are for services that are covered by the health system. This is otherwise known as extra-billing, a practice that is against federal and provincial law.

Despite these contraventions, previous Canada Health Act reports show that Ontario has never been penalized.

This year’s report has the potential to be more than a quiet committee discussion with no subsequent action. It can be the springboard for Health Minister Philpott to assert her government’s commitment to defending medicare, Canada’s most treasured social program.

Where better to start than reminding Saskatchewan and Quebec’s premiers that their recent actions violate the Canada Health Act?

In November 2015, the Saskatchewan government voted to introduce pay-per-use MRI services, allowing those who are able to pay to jump the queue and receive priority treatment. Premier Brad Wall argued that implementing a parallel diagnostic system would alleviate wait times, ignoring the evidence to the contrary from Alberta’s foray into private MRIs a decade ago. As Wall himself noted in 2009, these clinics violate the principle of accessibility in the Act. By speaking out, Minister Philpott can help to stem the tide of privatization in Saskatchewan’s health care system.

That same month, the Quebec National Assembly approved Bill 20. This omnibus bill enables physicians to charge extra fees to their patients for services already insured under public medicare, with no clearly established limits. The fact is many physicians in the province had been charging extra fees to patients for a long time. The government included provisions for extra billing as an amendment in response to pressure from the Quebec College of Physicians. Instead of coming down against extra-billing as was hoped, Minister Barrette worked to normalize the practice instead.

Related: What Should be Covered by our Publicly Funded Healthcare System?

Breaches of the Act have never been addressed in Quebec, despite the admission of physicians instituting user fees and extra billing and calls to stop this practice from Quebec organizations such as Médecins Québécois pour le Régime Public and Fédération des Médecins Omnipraticiens du Québec.

User fees, access charges, extra billing all come down to the same thing – inequitable access to Canadian health care.

Charging patients at the point of care for medically necessary services strikes at the heart of the principle that access to health care should be based on need rather than ability to pay. It undermines equity, increases system costs and reduces public commitment to universal coverage.

The Trudeau government promised real change. As an acclaimed physician and Canada’s Minister of Health, Minister Philpott has an opportunity to take a new approach to defending Canadian health care by sending a strong statement to the provinces that they must adhere to the Canada Health Act.

It is time for Minister Philpott to show there is a doctor in the House and take action to ensure medicare will be there for all Canadians in their time of need.

Meili_Ryan_high resRyan Meili is a Family Physician in Saskatchewan and Vice-Chair, Canadian Doctors for Medicare and a policy expert for the Evidence Network.

Opinion: Canada Needs Business, Not Busybodies

April 8, 2016 10:49 am
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If you are a federal politician looking for an escape hatch from Bombardier’s controversial request for a billion dollar federal bail-out, one of the company’s vice-presidents recently provided it. Rob Dewar said federal help would be “…an extra bonus that would be helpful but is very clearly not required.”  No helped needed, so case closed, right? Wrong. Prime Minister Trudeau still wants to help.

Why? With the company reportedly pushing to move jobs from Toronto to Mexico, the federal budget deficit more than twice what was promised and thousands of unemployed energy sector workers getting no bailout, what does the Prime Minister gain from giving a billion dollars to a company that doesn’t need it?

To find the answer, visit the wood shop.

Last month, a popular lumber retailer in Manotick, Ontario, called The Wood Source, opened a new show room and warehouse, but only after filling out 1500 pages of government forms over six years and paying $600,000 in fees and other administrative costs—enough money to employ 10 people for a year. The company had to hire an arborist to write a separate report on each little poplar tree that would be cleared, including its size and species—this on few acres of otherwise useless brush. The government charged the business a fee for the loss of parkland—even though the land had never been a park.

You would think it was a pulp mill, not a lumber mill, as fully half the cost of the building was paperwork.

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Forty years earlier, The Wood Source built a similar workshop and the government required a one-page drawing stamped by an engineer and a one-page application. Done. Approved. Ready for construction. The building is still in use today over four decades later.

Now, not only is the company besieged with government paperwork, its electricity bill has tripled to over $100,000 a year, mostly to pay for government subsidies for wind turbines and solar panels, which produce only a minute fraction of Ontario’s energy.

The company’s part-owner, Tim Priddle, complained of these costs to a local provincial Liberal minister, who said, “I will put you in touch with some people in my office who can help you with various grant programs that may be available.” Why not just cut the red tape and energy costs and let the company keep its own money?

The same can be asked in the case of Bombardier. In November the federal government blocked the expansion of the Toronto Island Airport, which would have enabled Bombardier’s C-Series planes to land there. That effectively killed $2 billion worth of the company’s sales to Porter Airlines, at the same time as the Quebec and federal governments consider $2 billion in Bombardier bailouts. That is not just wrong. It is strange. The Liberals claim the reason they have plunged us into deficit is to fund infrastructure. This project IS infrastructure, which a City of Toronto Report says would boost economic growth by $124 million and it would allow more business people to fly in and out of the business district, relieving car traffic between Pearson Airport and downtown.

Moreover, Liberal governments are raising taxes because they need revenue, yet the airport expansion would generate $55 million in revenue without a tax increase, according to a report by Urban Strategies prepared for the City of Toronto.

Similarly, the government has added new steps to the approval of pipeline projects that will delay the Energy East project by additional months. The pipeline will carry western crude to eastern Canada, and help end the insanity of New Brunswick refineries buying oil from Saudi Arabia at a premium, while Albertans sell it to the Americans at a discount. Each day the pipeline is delayed costs the Canadian economy $38 million, according to former Encana CEO, Gwyn Morgan. He added that a single week of those losses cancels out the entire $250 million that Prime Minister Trudeau offered in stabilization money to help Alberta’s struggling economy. Here again is the irony: the government harms the Alberta economy with pipeline delays and then offers a subsidy to make up for it.

Elsewhere, they cut Tax Free Savings Account limits from $10,000 to $5500, and then announce they will force people to pay more to the government-controlled Canada Pension Plan.

They block growth and then subsidize growth. They raise taxes on savings and force people to save more. They weigh down a small business and then offer the same business a subsidy.

President Reagan used to say that when Liberals see an object that moves, they tax it. If it keeps moving, they regulate it. When it finally stops moving, they subsidize it. But why doesn’t the Liberal politician just stay out of the way in the first place? Because that would make him so much less important. He would have no role. It would be like airbrushing him out of the selfie.

The Liberal politician is the ultimate economic busybody—always turning up uninvited, always trying to be the centre of attention, always in the way and always causing more problems than he solves.

Our economy needs business – not busybodies – for Canadians to achieve their full potential.

Article By Pierre Poilievre.

Ottawa Life Magazine accepts opinion editorials from all federal political parties. 

Uber and the Accessibility Question

April 7, 2016 2:11 pm
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A user organizing a ride through UberAssist. Photo by Eric Murphy.  

Ottawa’s plan to legalize Uber has locals who use accessible taxis concerned that the service they’ve fought for and relied on for years may be drawn-back, or even cease to exist.

“In Ottawa I can call West-Way taxi, or Capital Taxi or Blueline, say ‘I need a wheelchair accessible vehicle to pick me up at my house,’ and I get it,” says Peter McGrath, a lawyer for the federal government who uses a power wheelchair.

This service is essential for anyone like McGrath who needs to stay seated in their wheelchair while travelling. They cannot use Uber’s new Assist service because it does not require vehicles to have ramps, and Para Transpo is a poor alternative because riders have to schedule their trips well in advance.

If poor business forces the taxis to scale back, McGrath is afraid he’ll be left without a ride.

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Peter McGrath is a lawyer for the federal government and a longtime advocate for people with disabilities.

“What will the city do to ensure that accessible vehicles are available 24 hours a day?” he asks.

Coun. Diane Deans, who led the planning committee that oversaw the proposed taxi regulation changes, says that Ottawa’s accessible taxis aren’t going anywhere.

“I can’t imagine the taxi business ever going out of business,” says Deans. “They have $9 million in accessibility service alone. They have all of the phone-call arranged taxi service in the city.”

Furthermore, Deans’ committee has recommended that if Uber is legalized, the ride-hailing company should have to either dedicate at least 15 per cent of its driving time in Ottawa to accessible vehicles, or pay 30 cents from every Uber ride into a fund for accessible services. Technically, the city currently isn’t able to force Uber to pay that 30 cent surcharge, but Deans says that they are pursuing the provincial authority that will let them do just that.

“That money would go into a pool and we would work with the Accessibility Advisory Committee to determine how best to use those funds,” Deans says.

Peter McGrath doesn’t share Deans’ confidence in Ottawa’s taxi service or the new fund.

“If Uber crowds out all the cab service, and why wouldn’t they, how are the cabs going to compete?” he asks.

McGrath doesn’t believe the cab companies can survive off of the $9 million accessibility service or the business that would come from phone calls and people who pay in cash. He is also concerned that the 30 cent surcharge on Uber rides would be largely directed to Para Transpo. McGrath argues that because you have to book it in advance, Para Transpo is woefully inadequate. He’s not alone in that thinking.

“I use Para Transpo…but it’s kind of my last resort,” says 21-year-old Sarah Mercer, who uses a manual wheelchair. “If something comes up, I can’t just call Para Transpo and have them pick me up.”

Mercer’s experience with accessible cabs hasn’t been perfect either. She’s called them and been left waiting for half an hour or a full hour, and sometimes they never arrive. One night, after waiting for roughly two hours for an accessible taxi, she used Uber instead.

“I’ve never really had a problem with [Uber] showing up on time,” Mercer says.

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Some fear that the taxi companies may be edged out of the market, leaving a gap in accessible service. Photo by Eric Murphy.

Since Mercer uses a manual wheelchair, she can have an Uber driver help fold up her chair and store it in the car. However, people who must stay seated in an electric wheelchair, like McGrath, don’t have that option. Neither traditional Uber drivers nor those in the UberAssist service that launched in Ottawa on March 23 have the ramps or space that he needs.

Uber does have a power chair accessible service called UberWAV that’s available in a number of cities, including Toronto, but even if it were to come to Ottawa, McGrath is skeptical about the reliability of UBER’s model.

“The problem is that Uber is just an app…they don’t own their own fleet of vehicles,” he says. “I can request a wheelchair accessible van. What they can’t guarantee is that a wheelchair accessible van will be available.”

Users in other cities have faced that problem. In a 2015 article from Wired, a group of protesters weren’t able to summon an UberWAV vehicle while standing right in front of the company’s Manhattan headquarters.

“I’m not sitting here trying to cause a problem,” McGrath says. “If UberWAV can guarantee that they will provide more accessible trips than what’s currently available in the city of Ottawa now, sure, I’m happy to have it.”

Advanced Directives for Assisted-Dying a Dangerous Step

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The moment we are born, our lives take flight; and the longer we are airborne, the greater the chance of encountering turbulence along the way. While every flight is destined to land, some landings are harder to contemplate than others.

The parliamentary committee tasked with advising the federal government on how to roll out physician-hastened death must have struggled with the prospect of dying with dementia. Their advice to lawmakers was anyone with a condition likely to cause a loss of competence should be able to complete an advance directive any time after their diagnosis, directing that they should be euthanized.

This recommendation goes well beyond anything the Supreme Court of Canada intended.

The court stipulated physician-hastened death must only be considered for competent adults, in the circumstances of their current condition. The idea that Canada would make it lawful for people to consider a future version of themselves unacceptable and sign off on an order to have their lives ended was not something the court contemplated.

After all, in any assisted-dying regime, a competent patient is free to change their mind or express their ambivalence by withdrawing a request or postponing an assisted death. To permit an assisted death to proceed on the basis of an advance directive effectively denies this protection to persons who are no longer capable of making or expressing health-care decisions.

That is a risky proposition.

Research shows people are not very good at predicting what they would want and what they might need and feel in circumstances they have not yet confronted. The farther removed those circumstances are from today’s reality, the more difficult it is to imagine the response.

So why did the Canadian committee go as far as it did?

Fear is seldom a reliable guide to good social policy. But like most of us, parliamentary committee members must have found the prospect of turning into an altered version of their former selves terrifying. They likely did not appreciate that dementia is a progressive terminal illness; the seventh-leading cause of death in Canada. They probably did not appreciate the suffering they imagined was due to lack of adequate or appropriate end-of-life care these patients receive — despite ample evidence that the symptom burden can be comparable to cancer.

Patients with dementia are less likely to be referred for palliative care, have family caregiver involvement in decision-making or receive palliative medication, including pain medication.

Dutch legislators included a euthanasia advance-directive provision for patients anticipating a cognitive decline. While their rationale likely mirrored the Canadian parliamentary committee, the idea has turned out to be completely untenable. Despite requests occasionally being made, they are rarely adhered to.

Related: We Must Speak for Those who Can’t.

Related: Assisted Suicide for Those with a Mental Illness is a Risky Proposition.

In the vast majority of instances, physicians find it “inconceivable” to comply with the requests, given the patient with dementia has become a psychologically different person than the one who made the original request. Physicians are no longer able to determine the patient’s current wishes, feel the patient is not suffering or believe that they no longer want to die. While family members were supportive of not including life-prolonging treatment, they asked that the euthanasia advance directive not be followed because of uncertainty about the person’s current wishes, not being ready for the person to die or not sensing that the person is suffering.

As for planning a good death with dementia, end-of-life discussions need to start sooner rather than later. Patients must have the opportunity to express their wishes and preferences for care. Their pain and symptoms need to be well-managed. Advanced-care planning can ensure unwanted treatments, which may prolong the length of life without sustaining or improving the quality of life, are not imposed. Such planning can also reduce the likelihood of unnecessary hospitalizations and increase the chances of dying where people choose.

There is good data to demonstrate that compassion, a gentle touch, respect, and patience can benefit even those patients with moderate to severe dementia. Granted, this approach is not the quick and efficient landing the parliamentary committee members may have had in mind. But for now, it is the very best we can do.

Chochinov_Harvey_high resDr. Harvey Max Chochinov is a distinguished professor of psychiatry at the University of Manitoba and an expert advisor with EvidenceNetwork.ca. He holds the only Canada research chair in palliative care. He led an external panel, appointed by the federal government, looking at legislative options to Carter v. Canada. He is an adviser to the Vulnerable Persons Standard (vps-npv.ca).

Feds Kill Idea to Erect Cape Breton’s Never Forgotten National Memorial, Sloppily

April 1, 2016 9:15 am
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It was April 2009 and he was on a pilgrimage close to his birth place in Italy. Because he left for Canada when he was only four, he really didn’t remember very much about the area at all. Perhaps the cemetery off to the right was there back in 1950 when his parents left to settle in Canada, but he didn’t recognize it now, some 60 years later. Its layout was so immaculate that he decided to pay a short visit. Approaching the gate entrance, the sign announced it was a Commonwealth War Graves Cemetery. On entry, he respectfully approached the first headstone which read, “Pte Ted Truskoski, 17, Canada.”

Seventeen! He thought perhaps such a young age for a soldier was highly unusual – until he walked along row after row of Canadians killed in the Battle of Ortona, which was fought over the Christmas period in 1943. He realized that many soldiers, too many, including a 16-year-old from PEI, were high school age. It was only a year later that he was told that Ted had actually lied about his age and that he too was only 16 when killed.

Tony Trigiani realized that many of the Canadians who had travelled over 7,000 kilometres from their homes to purge a brutal enemy had been incredibly young. He made a silent pledge that he would find a way to honour their sacrifice and the sacrifice of all Canadians who crossed the oceans to help others recapture their freedom.

His research revealed that over 114,000 Canadians are buried in 2,500 Commonwealth Cemeteries around the world. This figure does not include the thousands lost or buried at sea. They will rest there forever, but perhaps, he thought, we could welcome their souls home and provide a quiet place in Canada where relatives and friends could remember, away from the hustle and bustle of urban areas where so many cenotaphs are located.

Later in 2009 he discussed the idea with a number of veterans he had supported financially during the fundraising campaign for the Juno Beach Centre in Normandy. Unbeknownst to him, one of the well known D-Day veterans, Bruce Melanson contacted Veteran’s Affairs in Charlottetown, alerting them to Tony’s idea for the monument. In April 2010 they contacted Tony and a senior official with Parks Canada joined the discussions, expressing interest and support for the concept.

A subsequent feasibility study, funded by Tony, concluded that there would be country-wide support for such a memorial. I was contacted for my opinion and was so impressed with the concept that I came on board as an ambassador for the project and was pleased that retired Colonel Alain Pellerin, a good friend for many years, agreed to join Tony’s team as a fellow ambassador.

The next step was to find a site. Considering the great majority of our fallen were buried in Europe it was decided that Canada’s East Coast would be the closest and best location, particularly Nova Scotia where the majority of troops dispatched to two World Wars embarked. Parks Canada suggested a number of sites in Cape Breton and Tony visited each one of them, including his eventual favourite, Lakie’s Head in Cape Breton Highlands National Park.

At a 2011 meeting with Parks Canada in Halifax, Tony expressed his desire to erect the memorial at Lakie’s Head. Parks Canada felt the site would be too small and recommended he return to Cape Breton and visit Green Cove, also in the National Park. Admiring its beauty from the tiny adjacent parking lot, in Tony’s words the site “spoke to me,” and he imagined a statue with open arms facing the sea, line of sight to the Vimy Memorial in France, welcoming lost Canadian soldiers home.

A month later Tony made a more detailed presentation at Veteran’s Affairs headquarters in Charlottetown, which was attended by an even more senior representative from Parks Canada who flew in from Ottawa strictly for the meeting. The presentation included a design for the monument based on Canada Bereft, the mourning figure on the magnificent Vimy Memorial in France. The family of Walter Seymour Allward, the original statue’s sculptor, gave their permission and plans were made to merely elevate the figure’s head and raise her arms, signifying a welcoming home gesture.

In February of 2012, Tony met with the Minister of Veteran’s Affairs in Ottawa. The Minister of the Environment joined the discussions as a keen supporter.

In July of 2013 we were advised by the Minister of the Environment that Parks Canada was authorized to negotiate with the Never Forgotten National Memorial Foundation regarding building the memorial in the Cape Breton Highlands National Park.

All costs for the construction and maintenance of the Memorial would be private funds.  Parks Canada granted the Foundation $100,000 to partially pay for a business plan including tourism forecasts and a website.

We naively assumed we were on a roll. A recent Vice Chairman of the Commonwealth War Graves Commission, Sir Alistair Irwin, graciously joined our Foundation as Co-Chair. He would subsequently hand a copy of our foundation booklet to Prince Charles.

During the following months a large number of well-known and respected Canadians joined the project as patrons. Margaret McCain, Brian Burke, Rex Murphy, Jean Charest, Frank McKenna, Paul Manson, Mila Mulroney, Roy McMurtry, Hugh Segal, Ian Tyson, Peter Stoffer and numerous other Canadians offered their support.

Dr. Donald Julien, the Executive Director of the Confederacy of Mainland Mi’kmaq, joined us as a patron ensuring the interests of the Confederacy would be an important part of the planning process.

During this process, a highly respected former Minister of the Environment told me to prepare for glacial project progress as Parks Canada was the most byzantine organization he had ever encountered. We discovered the hard way that he grossly understated his warning.

In order to proceed with the project, Parks Canada required a Basic Impact Analysis be conducted at the site to address any environmental issues. Consultation with the local community was also a prerequisite and something the foundation continued to push Parks Canada to arrange.  The foundation’s requests for public meetings started early in 2013, yet these were delayed by Parks Canada until October 7, 2014.  These requirements were completed with encouraging results. Although there were outspoken critics at the Town Hall deliberations, they were a distinct minority and were sometimes even drowned out by the “yea” side’s standing-ovations.

In July of 2014 we were shocked when Parks Canada advised us to pay for and undertake a Detailed Impact Analysis, a much more comprehensive undertaking with a price tag well over $200,000.

During the entire time between 2013 and 2016 we weren’t able to start fundraising without a completed DIA. It would have been inappropriate to solicit and accept private funds when we didn’t have a Licence of Occupation (“Building Permit”) which could only be issued on completion of the DIA process. Meanwhile our critics, in a well coordinated campaign to halt the project, started gaining momentum. To our dismay, even editorials from influential news organizations joined the band wagon, repeating false-truths and giving them inappropriate and unearned credibility.

We were accused of planning construction within the Park’s Restricted Zone when we were clearly outside that zone. We were allegedly covering a unique (definition: “being the only one of its kind”) rock formation when in fact the monument only partially covered 0.4 of a hectare, a miniscule portion of a 26,000 hectare suite. The creation of a parking lot for 300 cars was routinely quoted when the plans called for a mere 60. A “towering monstrosity” was a favourite criticism when the actual height, at 20 meters in the current plan, pales in comparison to the Statue of Liberty at 45 meters and Christ the Redeemer in Brazil at 38 meters and is only a bit higher than the fiddle replica greeting the tour boats as they dock at Sydney harbour. Not satisfied with just “towering,” an “ugly” monstrosity entered the debate. This in spite of the fact that the monument’s image was based on the design of Canada Bereft that won a competition with 160 entries in 1920, and is now an essential part of the Vimy Memorial in France. For heaven’s sake, even the government financially supported Vimy Foundation, which I have outspokenly supported along with six other charities assisting soldiers over the years, turned their back on us even though our objectives coincided to honour our fallen. Out of nowhere, because they were aware of our intentions years earlier, trademarking “Mother Canada” got their knickers in a knot and they joined the cue of critics. What a shame, missing an opportunity for some synergy in honouring our fallen.

In the area affectionally referred to as North of Smokey, and where the monument would stand, local resident Lisa MacLeod started a Facebook page in support of the memorial that grew to thousands of followers. This led to petitions totalling over 1,100 signatures which local MP Mark Eyking presented to the House of Commons on January 28, 2016 in a less than inspiring manner.

Perhaps the lowest blow of all was the accusation that Tony, the ‘devious Toronto businessman,’ would be flogging cheap trinkets in a gift shop and placing sponsor’s signage on the monument site itself. Some even claimed he had trademarked Mother Canada’s image in his own self-interest. These vindictive comments never mentioned that the approval to build required that millions of dollars be provided for the monument’s long-term maintenance, and that trademarking would avoid “cheap trinkets” on the market. The plans also clearly directed that there would be absolutely no sponsor’s or anyone else’s signage on the monument site itself.

Four years and thousands of dollars after commencing the process to complete the final DIA to the satisfaction of Parks Canada, it was finally submitted on February 4, 2016.

The following day, Tony was advised on an early morning phone call that Parks Canada was withdrawing its support for the project and the monument would not be permitted to be built in the Park. The follow up e-mail from Parks Canada on behalf of the Minister of the Environment follows:

NEVER FORGOTTEN NATIONAL MEMORIAL
MEDIA STATEMENT

Parks Canada has reviewed the entire Never Forgotten National Memorial initiative as well as the key elements and timelines within the Memorandum of Understanding (MOU) that guides this complex proposal.

Based on that review, Parks Canada has concluded that there are too many key elements that remain outstanding for the project to be achieved by the planned date of July 1, 2017, including the availability of funds to the Foundation, agreement on the structuring of the funding for construction and maintenance, and a definitive final design plan.

After careful consideration, Parks Canada has decided to withdraw from the MOU and the project. Parks Canada will no longer be working towards the realization of the memorial in Cape Breton Highlands National Park. As a result, the project will not be moving forward on Parks Canada land.

Parks Canada appreciates the Never Forgotten National Memorial Foundation’s vision in honouring Canadians who made the ultimate sacrifice for their country and wishes the Foundation success in its on-going pursuits.

Daniel Watson
Chief Executive Officer
Parks Canada Agency

I never imagined how many misleading and inaccurate comments could be crammed into one media release. A number of the issues raised in that release had been well addressed numerous times including a detailed letter sent the previous month including the funding issues and the modified timeline for the completion of the memorial. To elaborate, the following provides some illuminating facts.

1. Parks Canada media release– the Foundation did not have availability of funds.

Fact – Parks Canada had been told numerous times that there were large donors waiting to contribute funds but were waiting on Parks Canada to approve the DIA and issue a license of occupation.  What major donor was going to contribute funds to a project that was still not approved?  Major donors included a large national retailer and well known philanthropists in Canada.  Parks Canada were told on a number of occasions about these “donors in waiting” but continued to play delay games.

2. Parks Canada media release– No agreement on structuring of funding.

Fact – Parks Canada dramatically increased the maintenance endowment funding amounts for the Foundation to raise, without any reasoning, explanation or any details of what they would do for the millions in funding that they were asking the Foundation to hand over to them.  Parks was insisting that they would only keep the Memorial open during the park season and never told the Foundation if they would do anything more than empty out the garbage cans.

3. Parks Canada media release – No Definitive Design Plan

Fact– A definitive design plan can only be produced once Parks Canada makes a determination on the final DIA.  Parks Canada had not made a decision. The Foundation spent thousands of dollars on making numerous changes to the plans every time Parks demanded, including a submission of requested changes to the DIA that were sent the day before the announcement.

All of us, including a large number of Cape Bretoners, are gutted with the termination of the government’s support for the project. We are, however, embarrassed and angry regarding the disrespectful way a unique, yes unique, Canadian patriot was treated in the final days of the Never Forgotten National Memorial. Mr. Tony Trigiani, with the purest of reasons and an unmatched dedication to this country’s soldiers, having sacrificed his health and expended over a million dollars of his own money to underwrite a process made more expensive and time consuming each and every time Parks Canada inflicted another bureaucratic requirement, deserved so very much more than an early morning phone call from a bureaucrat displaying a shocking lack of insight regarding the project and a follow up e-mail perpetuating the myths appearing above.

Once the previous government approved the project in 2013, with the exception of Peter MacKay, we received little or any support from ministers. In truth, they were speed bumps throughout the process. But to their credit they had the decency to grant us an audience or respond to our letters.

At the very least, the current Minister of the Environment should have invited Tony to her office to communicate her decision face to face, thank him for his patriotism and express regrets regarding the glacial decision-making process within her Parks Canada. It is hoped that good manners alone will dictate such an invitation. After all, it is 2016.

Lewis MacKenzie resizedArticle by Major General (Ret’d) Lewis MacKenzie.

Budget Day 2016

March 24, 2016 3:48 pm
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Ever wish you were a journalist working on Parliament Hill? In the slideshow below, celebrated photographer Jean-Marc Carisse captures the excitement of Budget Day 2016.

Assisted Suicide for Those With Mental Illness is a Risky Proposition

March 15, 2016 12:48 pm
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Who but those who have experienced it can appreciate the soul crushing anguish of mental illness? Afflictions of the mind can be paralyzing and fundamentally change the way we perceive ourselves (I am worthless), anticipate the future (my prospects are hopeless), and experience the world (life is unfair and unforgiving). The combination of self-loathing, hopelessness and despair can tragically lead to suicide.

Parliament’s Special Joint Committee on Physician-Assisted Death, nevertheless, urged the federal government not to exclude individuals with psychiatric conditions from being considered eligible. Their reasoning comes down to this: mental suffering is no less profound than physical suffering, so denying individuals with mental illness access to physician hastened death would be discriminatory and a violation of their Charter rights.

People with mental illness are no strangers to discrimination. Two-thirds suffer in silence for fear of rejection and mistreatment. Only one in five children who need mental health services receive them, either because of concerns they will be stigmatized or supports are simply not available. Doors are constantly being closed on the mentally ill, denying them of stable employment, social opportunities, secure food and housing; and sometimes fundamental protections under our criminal justice system. They are marginalized, victimized and vilified.

Mental illness is one of the best predictors, more so than poverty, of inequitable access to healthcare in Canada. People with severe mental illness die about 25 years earlier than adults in the general population.

Making a fairness argument for the availability of physician-hastened death for a group of people treated so unfairly seems a cruel irony. In Oregon, having a psychiatric condition does not preclude eligibility for physician-assisted suicide. However, that condition must not impair the patient’s capacity to give consent and must, as in every other eligible case, occur alongside a medical condition with a prognosis of less than six months. Experts I met involved in Oregon’s Death With Dignity Act, in place 17 years now, could not fathom the idea of providing assisted suicide purely on the basis of non-terminal psychiatric disorders.

In the Netherlands, Belgium and Luxembourg, psychological suffering stemming from either a physical or mental condition is considered a valid legal basis for physician-hastened death. They account for a small but growing minority of death-hastening cases. Last month, a critically important study was published in the journal JAMA Psychiatry by American psychiatrist, Scott Kim.

Kim and his team reviewed 66 case summaries, published online by the Dutch regional euthanasia review committee between 2011-14, of people who had received either euthanasia or assisted suicide for psychiatric reasons. The majority were women, with issues including depression, psychosis, post-traumatic stress disorder, anxiety and substance abuse; some also had various forms of cognitive impairment (e.g. intellectual disability, early dementia) and autism. Most had personality disorders and were described as socially isolated and lonely. In one quarter of instances, despite differences of opinion between physicians, death hastening proceeded. In about one third of cases initially refused, most were carried out by new physicians willing to comply.

The parliamentary committee position seems premised on the recognition that physical suffering and mental suffering can be equally devastating. That does not mean, however, they can be approached the same. The nature of mental illness often leads people to see themselves as worthless, to believe that their situation is hopeless; and to perceive — often reflected through society’s judgemental gaze — that their lives have little value. But this context should help us see that a death hastening response is fraught with hazard; and runs counter to a recovery oriented practice advocated by the Mental Health Commission of Canada.

Like all Canadians, people with mental illness have rights that are protected under the constitution. And like all Canadians, these rights need to be balanced against the interests of a free and just society, wherein vulnerable persons must be protected. The most effective protections healthcare providers offer patients are built on the foundation of a caring and committed therapeutic relationship.

For patients whose illness tends towards self-destruction, and for patients whose suffering is rooted in social conditions like loneliness, a physician-assisted death option will crack that relational foundation. Current evidence shows that vulnerable persons will fall through that crack.

The committee, in its wisdom, expressed confidence that physicians would be able to figure this out. Hopefully, as lawmakers draft legislation in the days ahead, deeper wisdom will prevail.

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Dr. Harvey Max Chochinov is a distinguished professor of psychiatry at the University of Manitoba and an expert advisor with EvidenceNetwork.ca. He holds the only Canada research chair in palliative care. He led an external panel, appointed by the federal government, looking at legislative options to Carter v. Canada.

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