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.

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.

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.

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.

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


Education Governance Health Transparency

DataLibre: Health Canada library holdings latest to be repurposed as kindling


Health Canada library changes leave scientists scrambling
Main Health Canada research library closed, access outsourced to retrieval company
Laura Payton and Max Paris, CBC News January 20, 2014

Fresh on the heels of the Department of Fisheries and Oceans (DFO) library bonfire comes news that the Health Canada library holdings are scheduled to be repurposed as kindling (or cat litter, or pretty much anything, so long as it doesn’t involve reading). While the DFO tried to defend its decision on the basis of an obviously flawed internal analysis, Health Canada hired an external consultant to provide a recommendation. If there were any lingering doubts as to whether these decisions are being ideologically-driven, the CBC did a good job addressing the question

The draft report from a consultant hired by the department warned it not to close its library, but the report was rejected as flawed and the advice went unheeded.

To highlight the emerging MO, just recently used in the DFO library closure decision

If you want to justify closing a library, you make access difficult and then you say it is hardly used.
– Dr. Rudi Mueller, retired Health Canada pathologist

And to emphasise his point

Scientifically, we are going to be a third-rate country.
– Dr. Rudi Mueller, retired Health Canada pathologist

It’s unclear whether the good doctor meant to imply Canada’s reputation for scientific research was already that of a ‘second-rate’ country, or whether he was implying Canada’s skipping steps down the ladder with such ill-conceived policies. It’s quite sad either way.


Fraser Institute report on Canadian health care affordability: Selectively (mis)representing OECD health data


The Price of Public Health Care Insurance: 2012 Edition
Nadeem Esmail and Milagros Palacios, The Fraser Institute September 20, 2012

OECD Health Data 2012 – Frequently Requested Data

The intent of the Fraser Institute report is fairly transparent.  It promotes privatisation of Canadian health care insurance by presenting the current publicly-funded system as unaffordable, its rising costs unsustainable.  That costs are rising is a fact, although the rate of increase declined in recent years (exception 2008-2010).   The real issue is what the alternative is to the current Canadian health insurance system.  If the Fraser Institute is prescribing a privatised health insurance system like that of the United States, well, it doesn’t take too much digging into the OECD report to see that prescription would be harmful to Canadians’ health.

The Fraser Institute points to the fact Canadian health care expenditure accounted for 11.4% of GDP in 2009 and 2010, that it is among the highest in the OECD.  What it doesn’t say is that health care expenditures in 12 of the 34 countries included in the report exceed 10% of their respective GDPs.  The highest?  The United States, where its private health care system accounts for a staggering 17.6% of GDP.  The countries that had total health care expenditures well below 10% of GDP?  Mexico, Estonia, Poland, Czech Republic, Turkey and Korea.  No comment.

Health care expenditure per capita?  Canada: $4,445  United States: $8,233.  The per capita expenditure figures in the OECD report are based on USD purchasing power parity (US$ PPP).  Given Canada’s volume of trade with and size relative to the US economy rendering it the price-taker, such a disparity in relative health care cost is all the more notable.

The Fraser Institute focuses on the growth rate of Canadian health care expenditure over the previous decade. The OECD report shows it was largely due to two periods of exceptional growth, 2000-2001 and 2008-2010. For the remainder of the 2000′s, the annual growth rate of total expenditure on health varied between 2.9% and 4.3%.

Other interesting facts about Canada’s health care expenditure found in the OECD stats: Out-of-pocket payments (OPP) as a percentage of total health expenditure were lower over the last decade than throughout the 1990′s. Public expenditure as a percentage of total health expenditure remained fairly stable (~70%) since the mid-90′s. Pharmaceutical expenses per capita rose slightly since the mid-90′s then started to decline in recent years. These costs are projected to decline further as widely-prescribed drugs’ patents (e.g. Lipitor, Plavix, Crestor, Advair, Symbicort) expire and others are set to expire in the near future.

The referenced mid-90’s spike and subsequent decline in out-of-pocket payments and pharmaceutical expenses coincided with the introduction / expansion of provincial prescription drug programs, like Quebec’s Prescription Drug Insurance Plan. As the OECD historical data suggests, such programs have helped control costs in the long-run.

While the Fraser Institute purports to alert Canadians to trouble ahead if they insist on maintaining their publicly-funded health insurance system, this appears to be a false alarm.

 The abstract for this report by the Fraser Institute notes

The 10 percent of Canadian families with the lowest incomes will pay an average of about $487 for public health care insurance in 2012. The 10 percent of Canadian families who earn an average income of $55,271 will pay an average of $5,285 for public health care insurance, and the families among the top 10 percent of income earners in Canada will pay $32,628.

It seems The Fraser Institute takes issue not only with Canada’s publicly-funded health insurance system, but with its progressive income tax system as well.

Children Employment Financial security Food security Governance Health Homelessness Housing Poverty

Austerity budgets target those already living in austere conditions: the disabled, the poor and their children

Ontario’s budget will include welfare freeze: McGuinty
The Canadian Press Mar. 25, 2012

According to the Oxford English dictionary:


ADJECTIVE (austerer, austerest)
(Of living conditions or a way of life) having no comforts or luxuries.

Middle English: via Old French from Latin austerus, from Greek austēros ‘severe’.

One could argue few have less comforts or luxuries than those dependent on already well-below-subsistence-level government income supplements such as Ontario Works, Disability Support and Child Benefit programs.

Welfare incomes by household type (Ontario), 1989-2010

These programs have not been indexed to reflect the cost of living over the years.  In constant dollars, social assistance supplements for all recipients are less today than they were two decades ago.  If that’s the case, then how have social assistance payments become such a budgetary burden in recent years?

Ontario Works and ODSP beneficiaries, Oct 2008 - Jan 2012

Answer: Volume.  From October 2008 thru January this year, the number of Ontario Works beneficiaries increased by one third,  and Ontario Disability Support beneficiaries by one fifth.  Both figures are well beyond Ontario population growth over the same period (3.78% from Q3 2008 to Q4 2011, CANSIM Table 051-0005).  It’s not the ageing population either, as the elderly cannot collect federal Old Age Security / Guaranteed Income Supplement and provincial income supplements at the same time.

A significant part of the explanation for the ballooning Ontario Works numbers stems from the Great Recession. Job losses began to mount in October 2008, Ontario’s Manufacturing sector particularly hard hit.  That recession and the current jobless (non)recovery have now spanned more than three years.  However, federal Employment Insurance (EI) benefits, for the increasingly few who qualify for them, only extend for a few months in Ontario’s major (urban) population centres.  As EI benefits lapsed… well, the numbers speak for themselves.