Other News

Advanced Directives for Assisted-Dying a Dangerous Step

April 7, 2016 10:55 am
Advanced Directives for Assisted-Dying a Dangerous Step

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

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

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

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

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

That is a risky proposition.

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

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

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

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

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

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

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

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

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

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

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

Prok and Roll!

April 6, 2016 11:50 am
Prok and Roll!

All photos by Andre Gagne.

It’s been an interesting journey from The Police to Prokofiev for Stewart Copeland. The energetic drummer’s career includes six Grammys for the famed proto-punk band he helped found with Sting, a slew of eclectic film, TV and video game soundtracks fused with his distinctive reggae-influenced sound and, more recently, Rolling Stone ranked him the 10th greatest drummer of all time.

His current project finds him collaborating with Canadian pianist Jon Kimura Parker for Off the Score, a group that rests frenetically on the border of classical music and rock. To Parker, it’s just Prok and Roll, blending the more classical pieces of composers likes Sergei Prokofiev with the powerhouse drumming of Copeland’s earlier career and a lot of unexpected stops in between.  Whatever you do, just don’t call it chamber music.

The duo, along with band-mates Marlon Martinez on double bass, Judd Miller on the curiously named electronic valve instrument and Yoon Kwon on violin, were in town last night for a performance at Dominion-Chalmers United Church hosted by the Ottawa International Chamber Music Festival. It was a set list that included everything from Stanley Clarke to Stravinsky, extended compositions that merged French impressionism, big band jazz and electronic dance music, and, of course, cacophonies of beautiful noise supplied by Copeland. The audience realized from the first thundering crash of the drums that this wasn’t your average classical performance, and if they needed more proof, the ushers were handing out earplugs.


Stewart Copeland explodes on the drums.

“Stewart and I met briefly at the La Jolla Summerfest a few years ago,” explains Parker.  “What really got the ball rolling was Stewart looking for a small group in which to experiment — he specifically wanted a classical pianist who was willing to do unconventional things.”

Parker explains how he found himself inside of Copeland’s legendary recording studio Sacred Grove and stood surrounded by a staggering selection of instruments. Sitting down at the piano, he suggested they play a movement by Prokofiev, and Copeland could simply just jam to it. The sound quickly found itself.

“Amongst all that fancy classical music are riffs with primal energy that even drummers understand,” says Copeland. “We also looked for material that still retains its character even after our abuse upon it.”


Tear up, mash and abuse they did until, afterwards, what was familiar is now slightly marred but still recognizable and you only want more of it. You can hear it as Off the Score performed “Rite of Spring”. Copeland’s hands were a blur as they exploded on his drum kit like a demolition crew leveling a condemned building, Parker blazed through various tempo shifts and Kwon, who had just thrown her sheet music across the stage, played like lighting holding a violin.

“Every piece has a different approach to being “off the score,” says Parker on how the group approaches a composition to change it up in a unique, sometimes jarring way.

“We have the music of Ravel and Bach whose only transgression is the instrumentation. We have works of Stewart’s where my most terrifying measures are not the ones filled with 32nd notes, but the measures that say ‘free improv.’ Can you imagine what it’s like for me to play the finale of the Prokofiev 7th Piano Sonata and have the world’s greatest rock drummer jamming to it? It’s unbelievable and different every night. Rite of Spring pays tribute to Stravinsky but quickly spirals into power chords and mayhem!”

The music wasn’t the only thing that produced a little pandemonium. Come show’s end when Copeland’s sticks were tossed to the crowd, in a scene usually found at a rock show, two fans attempted to jump over a church pew, feet flailing in an attempt to catch them.

“Every show has had a few die-hard Police fans,” Parker says, explaining the thrill is equal for him on stage. “What they get is a chance to hear the awesome drumming of Stewart Copeland in a much more intimate setting. It’s exhilarating to watch him play, listen to his fills, and bask in his energy.”

For Copeland, he’s fine with trading in some old Police hits for even older Prokofiev hits.

Presenting a simple rock song to players of classical calibre did inspire a more ambitious approach to the arrangement,” he says.  “These guys can play anything so let’s see how far out this can go.”

Why Aren’t Governments and Medical Associations Doing More About Superbugs and Over-Prescribing?

April 5, 2016 2:09 pm
Why Aren’t Governments and Medical Associations Doing More About Superbugs and Over-Prescribing?

In 1928, a petri dish in Alexander Fleming’s lab was accidentally contaminated by a mold spore, leading to the discovery of penicillin and, in time, a revolution in medicine. Deadly infectious diseases like pneumonia, meningitis and tuberculosis could now be reliably treated.  Everything from childbirth, to transplant surgery, to chemotherapy was made safer through the use of antimicrobials to prevent infection.

The trouble is that bacteria and other pathogens are constantly evolving into ‘superbugs,’ capable of resisting our current cache of antimicrobials, which include antibiotics like penicillin as well as antifungals, antiparasitics and antivirals.  The WHO warns that “a post-antibiotic era – in which common infections and minor injuries can kill – is a very real possibility for the 21st century.”

Recent studies predict that by 2050, antimicrobial resistance will claim more lives annually than cancer and drag down the global economy by as much as 3.5 per cent of GDP.  There are considerable costs in the here and now, as 18,000 patients are infected with superbugs every year, contributing $1 billion in added health care costs.

In the arms race between germs and medicine, the global community has two complementary strategies at its disposal:  First, we can develop new antimicrobials, and secondly, we can slow the emergence of resistant strains through judicious use of current antimicrobials.

As the WHO’s warning suggests, neither strategy is being executed effectively at the moment.  Very few antimicrobials have been brought to market over the past 30 years – they are unprofitable for drug companies – and we continue to squander the available cache through overuse and misuse in healthcare and animal agriculture.

The bulk of antimicrobial prescribing is done by general practitioners, for outpatient treatment of things like coughs and sore throats.  Though there is an element of guesswork in treating these generic symptoms, there appears to be a great deal of overprescribing.  In moments of candor, GPs admit to prescribing antibiotics to placate pushy patients – two-thirds of whom wrongly believe that antibiotics are effective in treating colds and flu.  That physicians bow to patients in this way is understandable because there is little regulatory pressure pushing them to be careful stewards.

Other countries have national strategies in the works that appear more rigorous and accountable.  Last year, President Obama announced a system of monitoring and incentives, aimed at reducing inappropriate use of antibiotics in outpatient settings by 50 per cent by 2020.  In England, the NHS has likewise set targets for reduced outpatient prescribing of antimicrobials, backed by financial incentives.  Senior officials with the country’s National Institute for Health and Clinical Excellence (NICE) have mused that doctors who overprescribe antibiotics may face disciplinary action.

Where is Canada on this issue?

There is consensus that the federal government must play a leadership role on antimicrobial stewardship, coordinating efforts by provinces and health professionals.  Yet according to a 2015 report by the Auditor General of Canada, nearly two decades of study and consultation have yielded little by way of actual targets and deadlines.

Instead, what we see is a heavy emphasis on information gathering and awareness-raising.  For example, the Public Health Agency of Canada’s Framework for Action on antimicrobial resistance, released in 2014, acknowledges the problem of over-prescribing, but the only concrete proposal mentioned is an annual Antibiotic Awareness Week.  A bewildering array of initiatives by the provinces and non-governmental agencies is also engaged in surveying and raising awareness about antimicrobial resistance.

Unlike the U.S. and England, there appear to be no firm targets for reduced antimicrobial prescribing, let alone clear lines of accountability for their achievement.

A key challenge here is that responsibility for health is shared between the federal government and the provinces, with the further wrinkle that physicians are self-regulated by the Colleges of Physicians and Surgeons.  Unsurprisingly, our search of the Ontario College of Physicians and Surgeons’ database turned up zero cases of doctors investigated for poor antimicrobial stewardship.

Given the national and international implications of this issue, the federal government needs to take the lead and ensure that the provinces and in turn physicians make tangible progress.

In our view, the most straightforward path through this jurisdictional morass would be for the federal government to use its spending power to lead by carrot-and-stick – offering the provinces financial incentives for targeted reductions in antibiotic use.

Flood_ColleenColleen M. Flood is a Professor in the University of Ottawa and a University Research Chair in Health Law & Policy. She is inaugural director of the Ottawa Centre for Health Law, Policy and Ethics.





Thomas_BryanBryan Thomas is a Research Associate with the Centre for Health Law, Policy and Ethics, University of Ottawa

Originals Spring Craft Sale Celebrates 30 Years

9:59 am
Originals Spring Craft Sale Celebrates 30 Years

All photos by Alexandra Gunn. 

After 30 years of spring success, the annual Originals Spring Craft Sale came to our Nation’s Capital for another season of live demonstrations and unique offerings. The artisan marketplace held at the EY Centre featured the works of over 180 artists, artisans and designers from across Canada.

Notable artist Andrea Kolpaska of ‘Originals by Andrea’ featured bold and beautiful jewellery designs. Woodworking masters of ‘Behind the Woods’ displayed carefully crafted silhouette art and ‘Reiner’s’ featured their beautifully handcrafted quality leather ottomans in various animal designs.

For many first-timers, the Originals Craft Sale was an experience in the handmade. With an array of quality Canadian handcrafted products, including fashion, home décor, natural body care, fine art, stunning jewelry and specialty foods, it was a truly unforgettable show.

John Ladouceur, founder and president of Signatures Shows Ltd, said that the 30th edition of Originals is “dedicated to the brilliant artisans and loyal visitors who have helped define our Canadian handmade community.”

Each exhibitor at the show designs and creates their own work, and their items are 100 per cent handmade in Canada.

“We strongly emphasize the tangible elements of our shows and always look for new ways to offer them to our visitors,” said Ladouceur. “By showcasing the incredible talents of our Originals artisans in a live setting, we are not only bolstering the quality of our show experience, but also offering visitors a new glimpse into the unique world of Canadian handmade.”

Annemarie Glebe, of Reiner’s Original Quality Leather Ottomans, sought out the opportunity to appear at the show because “the Signatures Show is a high-end one that profiles Canadian artists and crafters goods. People know the show for its quality and the original product that is offered year after year.”

For Canadian artisans, the show is an opportunity to reach a broader market and to reconnect with former clients.

“By attending this event, the public is able to become familiar with our product for its quality and originality. The opportunity of receiving clients’ favorable feedback first hand is very rewarding. We have been well received by individuals who are home to Ottawa and the neighboring communities and we are always excited for new opportunities to expand our presence,” said Glebe.

Signatures Show Ltd. is Canada’s largest producer of fine craft shows, with over 36 years of experience and over 300 shows produced. Each year, Signatures welcomes over 400,000 visitors to its 16 shows in 12 cities across Canada. Based in Ottawa, it is a 100 per cent Canadian-owned and operated business.

For more information, visit originalsshow.ca and signatures.ca.

Recent Posts