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.

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

11:55 am
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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. 

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