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Governance Health Human rights Justice Population

Now that assisted suicide and euthanasia is legal, what Canadians can expect: Literature review

The arbitrary second deadline set by the Supreme Court of Canada for the coming into force of its arbitrary and senseless decision to invalidate Criminal Code protections against assisted suicide and euthanasia has arrived. Unless further extended, as of today Canadians wishing to commit suicide but too squeamish to do so themselves can take a shot at finding a doctor to kill them.

While the government will likely make the case for pushing through its proposed legislation, Bill C-14 a.k.a. the Medical Assistance in Dying Bill, it will have little practical effect. While presented as taking a conservative approach by only allowing individuals whose “death is reasonably foreseeable” to consent to being killed, Bill C-14 contemplates extending such consent to “mature minors” and those with mental illness within less than 180 days after it’s passed.

So what can Canadians expect to flow from this ill-considered decision to legalise consent to being killed? Unfortunately, a review of the literature in jurisdictions that legalised assisted suicide and euthanasia prior to Canada isn’t encouraging.

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Governance Health Human rights Justice Population

Bill C-14, an assisted suicide and euthanasia law by any other name

Canadian Members of Parliament are set to vote on Bill C-14, also known as the Medical Assistance in Dying Bill. The bill will repeal numerous legal protections against assisted suicide and euthanasia in the Criminal Code, in line with 2012 Supreme Court of Britisch Columbia and  2015  Supreme Court of Canada decisions that found such protections unconstitutional. Notably, both Parliament and the courts have reversed course on previous decisions that upheld the constitutionality of those same legal protections under nearly identical circumstances.

Bill C-14 has been promoted by the federal government as taking a conservative approach, only allowing assistance in cases where “death is reasonably foreseeable” and implementing “safeguards” against abuse. However, as written it clearly contemplates broadly legalising assisted suicide and euthanasia, even for “mature minors” and those with mental illness.

Conspicuously absent from the debate has been any discussion about the experience with similar legislation in the United States and European Union, where both legal and medical reviews have been decidedly critical, second-guessing the wisdom of even having such legislation. That’s likely because the rationale for such laws, the topic to be covered here, is questionable at best.

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Health Media

As WHO affirms link between meat consumption and cancer risk, Canada frets over bacon

Figure 3. Non-linear dose-response meta-analysis of red and processed meats consumption and the risk of colorectal cancer

Source(s): Chan DS, Lau R, Aune D, et al. Red and processed meat and colorectal cancer incidence: meta-analysis of prospective studies. PLoS One 2011; 6: e20456.

This week, the International Agency for Research on Cancer (IARC), the cancer agency of the World Health Organization (WHO), released a long-overdue monograph1 affirming the link between meat consumption and cancer risk.  After reviewing more than 800 studies, the IARC decided to classify processed meat as a known carcinogen (Group 1), and red meat in general as a probable carcinogen (Group 2A). The agency urged public health officials to re-examine their dietary recommendations. Those anticipating the Canadian media to objectively inform the public of the news and start a rational dialogue may have been disappointed.

A news segment by Canada’s national broadcaster interviewed a cattleman who viewed the report as “an attack“ on his industry. The reporter referred to it as an “added hit” to declining beef and pork sales before queuing up a spokesman for the Canadian Cattlemen’s Association. He urged Canadians to ignore the findings and follow Canada’s Food Guide recommendations, as did the family physician who closed the segment.

Canada’s ‘national newspaper’ fared no better. It published an editorial that was criticised by readers for insulting their intelligence, and a column by its public health reporter that urged readers to ignore the supposedly misleading report – even as it misrepresented its content.

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Environment Health

Earth Day 2015: On 45th anniversary, little cause for celebration

If American television is anything to go by in the lead up to the 45th Earth Day anniversary (on April 22, 2015), there should be some concern about how many more remain to be celebrated. Given the increasingly unnecessary to downright unhealthy reasons for the continued exploitation of our limited natural resources, there seems little sense to the ever-expanding environmental destruction.

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Governance Health Justice Transparency

In debate over drug legalisation, it’s worth revisiting Prohibition (which actually worked)

Canada’s pot policy needs to sober up
Andre Picard, The Globe and Mail August 21, 2014

Sometimes, you catch news items a bit late. Today, that item is Globe public health reporter Andre Picard’s recent write-up on Canada’s marijuana legalisation discourse (which closely mirrors that taking place in the US).

As succinctly stated, a more sombre reflection on the possible / likely ramifications of legalisation than what’s so far passed as ‘debate’ is needed. Mr. Picard seems to pull back a bit in his August 2014 column, grouping pot as a, “recreational drug, such as tobacco and alcohol”. In an earlier (April 2014) column, the ‘recreational drug’ reference was to opioids, such as abused prescription OxyContin and heroine.

While cannabinoid and opioid are distinct, they “share several pharmacologic properties”. The science is far from settled on whether in therapeutic use the combination of the two is more beneficial or harmful. The science is far clearer on the combination’s recreational / mis-use: It’s quite harmful, and can be fatal. Since it targets similar (but not the same receptors) as opioids, cannabis can likewise be addictive (the distinction between ‘habit-formation’ and ‘addiction’ is more art than science).

Decriminalisation, or legalisation?

Cannabis use can be quite socially harmful, to individual users’ health (cognitive development, mental health), and to the greater public (motor vehicle, workplace accidents). There’s also economic harm, to individuals (criminal record implications), and to the state (enforcement, rehabilitation). The interesting debate, it would seem, is whether to simply decriminalise possession or legalise commercial trade (production, distribution, sale).

The interesting line in, and jump-off point from, Mr. Picard’s column:

But there are a lot more alcoholics than there are stoners.

Yes, there are. Now. When one can purchase alcohol at just about every convenience and grocery store. Along with a pack of smokes. For less than ten bucks. Will that still be the case when a pack of marijuana cigarettes is sold alongside the Players and duMaurier for a similar price?

One of the most disingenuous arguments put forward for marijuana legalisation is that government regulation will keep it out of children’s hands – like alcohol and tobacco. It’s a transparently absurd argument to anyone who’s attended Canadian high school any time in the past half century. Because Canadian high school kids don’t have access to alcohol and tobacco.

Similarities to Prohibition debate

Did Prohibition Really Work? Alcohol Prohibition as a Public Health Innovation
Jack S. Blocker, Jr, American Journal of Public Health February 2006

Actually, Prohibition Was a Success
Mark H. Moore, New York Times October 16, 1989