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Deeper Insite Into Harm Reduction Strategies
I’ve mentioned the controversy surrounding the safe injection sites before. But I went in for a closer look recently in Vancouver, when I attended the appeal by the Crown of the decision of Pitfield J. last year in PHS Community Services Society v. Canada, [2008] B.C.J. No. 951; 293 D.L.R. (4th) 392 (B.C. S.C.) that allowed the facility to stay open.
Omar Ha-Redeye with two Vancouver residents supportive of Insite's programs
The Respondents in this case were seeking the extension of an exemption for the Insite facility under the Controlled Drugs and Substance Act (CDSA).
The opposition to the exception by the Federal Crown, appealing the decision made by the B.C. trial court last summer, was based on the rationale that the science on harm reduction was mixed, and the money could be better allocated elsewhere, according to information by the Minister publicly found on the website.
The Appellants themselves characterized their objections slightly differently. The CDSA formed a regulatory scheme to protect the public from many different types of dangerous substances. In this context of protecting the public, they were well within their jurisdiction of Federal powers to target the program for termination.
The Appellants also rebuffed Federalism arguments of this being a health service exclusively in the provincial jurisdiction by stating that there was no legal requirement by the province to provide this type of service. If harm reduction strategies were explicitly mentioned by statute the situation would be very different.
Health Law: What Does It Mean To You?
The Health Law Student Association (HLSA) at the University of Ottawa brings together people who have a common interest in the area of Health Law.
However, when questioned, most members of the HLSA (myself included) will probably struggle for some kind of coherent definition. The more I plunge into the depths of Health Law, the more I realize that a definitive scope of what Health Law entails is just not a reality.
Instead, the ebb and flow of the Health Law stream seems highly dependent on the particular lawyer or health practitioner you ask, on the particular law firm, organization, or hospital you’re involved with, or simply on the whim of the funding allocation decisions of the government of the day.
Law 101 for Health Care Professionals
Fourth post in a series on the First Annual Interprofessional Health Law Conference.
Elyse Sunshine of Gardiner Roberts provided health care professionals the basics of the regulatory scheme governing the health sector in Ontario.
Jason Lamarche on the Insite Program
As a follow-up to the previous post on the Insite program, here is some commentary from Jason Lamarche of the Liberal Minute.
The Harm Reduction Controversy & Injection Sites
Third post in a series on the First Annual Interprofessional Health Law Conference.
The harm reduction panel spoke about strategies for reducing communicable diseases. Most of the discussion focused on the controversy over injection sites.
The first legal injection site in North America was Insite in Vancouver, B.C. The downtown eastside area where the clinic is based was considered by the Canadian Community
Epidemiology Network on Drug Use (CCENDU) as the center of an injection drug epidemic.
The US Office of National Drug Control Policy called it “state-sponsored suicide,” and Harper later said, “We as a government will not use taxpayers’ money to fund drug use.”
The Values and Ethics of Euthanasia
Second post in a series on the First Annual Interprofessional Health Law Conference.
The euthanasia panel started off with Bob Parke, an ethicist with Humber River Regional Hospital. The discussion over euthanasia is often a conflict of different values, including:
- autonomy
- family, community, faith traditions, society
- beneficence
- care provider values
There are often tough questions to ask, like how to deal with internal defibrillators. They are necessary for the patients who use them, but they can also cause a lot of pain at the end of life.
However, the main reason most patients want euthanasia is not because of pain, which can often be managed these days through pharmaceuticals. More often it’s about feelings of being a burden to those around them, especially family. Feelings of loneliness and isolation are also common motivations.
The greater challenge for those in health care is to ask whether we should use all the technology we have simply because we have it. There are also issues of distributive justice, which needs advocates to champion various causes.
Trudo Lemmens, an Assoc. Prof. at UofT in both Medicine and Law, discussed the claim for legalization of assisted suicide and euthanasia. Refusing treatment is often more often accepted internationally than active euthanasia.
The case law on the subject was basically leading in this direction, providing more self-determination and control of the body by the patients.
The arguments against this, which were expressed at the level of the Supreme Court of Canada, was the impact this would have on attitudes and protections in society. It could easily be projected, for example, on to people with disabilities. In an environment with limited health funding, there is enormous potential for abuse.
The Charter does provide a heavy ones on the government to ensure there are no less restrictive means of infringing individual liberty rights. This essentially is a question of evidence, and some countries do have legal euthanasia already.
Lemmens discussed a case of a Jehovah’s Witness who didn’t want a blood transfusion, but was provided one anyways by a physician and sued. The court held that people have a right to make choices, even if they are foolish.
He also discussed another case in the Netherlands, where a woman who was severely depressed, had lost two sons, and could not be treated conventionally. The court there ruled that she had a right to assisted suicide, and that psychological suffering can also be a form of unbearable suffering.
Dianne Williams is a palliative care nurse and nurse practitioner at St. Michael’s Hospital. Her role was to explain what palliative care was, and how palliative care used to be synonymous with hospice care. Hospice is actually community based care, whereas palliative care is a philosophy of care associated with more medical and professional services.
Most of the patients they see in palliative care was cancer patients, but they are now seeing more cardiovascular problems, respiratory cases, HIV/AIDS, and end-stage cardiac or renal disease. There is now more integration of palliative care outside of cancer to other disease trajectories.
Palliative care improves the quality of life through prevention and relief of suffering. They use early identification, assisting in treatment, and deal with physical and pyschosocial problems. Palliative care can start right at the time of diagnosis.
She closed with a quote from Robert Buckman to emphasize the role all of us can play through communication instead of relying exclusively on pharmaceuticals,
Communication skills make an appreciable difference to clinical management. We take for granted our own communication abilities in history taking, but further training can enhance our ability to diagnose and treat conditions, including depression.1 Communication is often a major component of the medical management in chronic and palliative care: sometimes it is all we have to offer. Compared with most medications, communication skills have undoubted palliative efficacy (often reducing symptoms significantly), a wide therapeutic index (overdose is rare), and the commonest problem in practice is suboptimal dosing. At a more mercenary level, poor communication skills have been shown to be a predictor of medicolegal vulnerability and also of burnout.2,3
Finally, Hugh Sher of Scher & De Angelis LLP, spoke against euthanasia. Sher held several executive roles including with the Human Rights Committee of the Council of Canadians with Disabilities and ARCH Disability Law Centre.
He started by asking,
If only choice is to suffer to death or kill yourself, some would say its not a choice at all.
Euthanasia is not about pain, according to Sher, but about fear and desperation. The debate focuses on how we define our choices in society.
A religious basis used to serve as fundamental prohibition vs these discussions, but we don’t live in that same framework. We now live in a secular society based on individual freedoms and rights.
But this argument transforms doctors as healers to doctors as killers, which is a fundamental transformation. Physicians are gatekeepers of services, and also have their own perspectives based on their own ethical, cultural and religious views.
He related the ordeal of one of his clients who had a severe disability. He had wonderful relationships and wished to live, even though there was no likelihood of dying from his condition any time soon.
But the person needed oxygen to survive. And the cost of this service was more than what he got from the government.
Sher raised the example of some Aboriginal communities in the Maritimes who have a high rate of depression and a dependancy on solvents, but nobody would advocate euthanasia, nor should they.
Euthanasia requires consent, but this notion is often ignored. This decision is often made for people in the terminal end of life, not when they are earlier on in their disease. They do not lose their humanity over this continuum of the disease, so why do perspectives of euthanasia then change?
He claimed over 1600 people were killed in the Netherlands without proper protocols being followed. Another report following this finding discovered that another 800 people had been similarly killed.
According to Sher, once you make the decision to rationalize ending people’s lives, it’s much easier to rationalize the failure to follow protocol. It creates a culture permissive of these acts, and we can move the goal posts more and more.
Lemmens did say in response that at least in the Netherlands we know what the situation is. In Canada, we still do not fully know what practices are being observed in end-of-life care.
Dr. Sarita Verma at the Health Law Conference
First post in a series on the First Annual Interprofessional Health Law Conference.
Dr. Sarita Verma, Deputy Dean of Graduate Postgraduate education at UofT Medicine, is a family physician who originally trained as a lawyer at UofO.
She quickly polled the audience and found about half of the attendees were law students, half medical students, with some nursing, public health, and other graduate students.
The Tension Pentagon
Dr. Verma briefly discussed some of the many areas of health law where medicine and law interact. She noted that mental health was one of the growing areas of health law.
She then presented a new model she had developed to evaluate the context of health law issues. This tension pentagon was comprised of 5 different stakeholders, whose interests often conflicted and interacted with each other.
At the center of the pentagon was the public, which is important in creating a publicly-centered health system.
The 5 influencers were:
- ethics
- practitioners
- funders
- industry
- legal system
First Annual Interprofessional Health Law Conference
The First Annual Interprofessional Health Law Conference is being held this morning at UofT law. The session is being broadcasted live to viewers across the world.
Notes from the session can be found below.
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Dr. Sarita Verma at the Health Law Conference
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The Values and Ethics of Euthanasia
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The Harm Reduction Controversy & Injection Sites
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Law 101 for Health Care Professionals
Building Careers in Health Law
Building Careers in Health Law: Inaugural Event of the HLSA at UofO
by Natasha Danson and Darcy Ammerman of UofO Law
Health law is an emerging and exciting field in Canada. The Health Law Student Association at the University of Ottawa (HLSA) grew out of the observation that, unlike other Canadian law schools, Fauteux Hall did not yet have a student organization for those students specifically interested in health law. So far, the student response to the HLSA has been fantastic.
Our first jam-packed HLSA event took place on November 12, 2008 when Mary Jane Dykeman, a Toronto-based lawyer, delivered an informative lecture entitled “Building Careers in Health Law”. Ms. Dykeman is a guru in the health law field; she regularly advises health care clients on a broad range of issues including mental health, consent and capacity, health privacy, governance, and hospital risk management, and she is active in the health law community through her academic posts at Osgoode Hall Law School.
At the event, Ms. Dykeman shared her varied experiences in the health law field and imparted students with valuable career advice. In particular, Ms. Dykeman recommended that students strive to gain recognition and expertise in the health law field by participating in public speaking events and by publishing case comments and papers as soon as is practicable.
Building upon our “Careers in Health Law” theme, we plan to host a panel of Canadian health law experts to share their experiences in the field next semester.
In February, the HLSA will also co-host the “Health & Human Rights Conference”, a day-long conference in collaboration with the UofO chapter of CLAIHR, Canadian Lawyers for International Human Rights. As part of this conference, the HLSA will review paper submissions and invite international and local speakers to speak in Fauteux Hall. We believe that this collaboration will prove invaluable for those students seeking to explore the connections between health, human rights and the law internationally.
In the winter semester, the HLSA Charity Committee will also host an evening event to fundraise money for a local charitable organization addressing health care issues.
If you’d like to get involved in the HLSA or have any questions, please contact us via email.
Natasha Danson is the Co-Chair of the HLSA
Darcy Ammerman is the Fundraising Coordinator of the HLSA
Early Release for Weight
Earlier this year we raised the question of how the justice system will deal with the obesity epidemic.
We just got what might be our first test case.
Michel Lapointe, aka Big Mike, got early release last Tuesday because he couldn’t fit in any of the furniture in his cell. To make things worse, or better in the case of Mike, two other facilities refused to receive him.
Although he received a five-year sentence for conspiracy, drug trafficking and gangsterism, the authorities told him,
You have been detained for more than 25 months and your prison conditions are difficult because of your health.
He will be required to follow some conditions, including finding a job, staying away from bars and checking in with a parole officer.
Should prisoners get early release simply because facilities have failed to consider accommodation of different body types?
Is early release an adequate exemption from their duty to provide an equitable system to rehabilitate criminals?
Confessions of an Obamaniac in Canada
Obamania… Mania.. in the House
With the U.S. presidential elections only days away now, it seems we might just have a president that is more popular abroad than he is at home for the first time in many years.
The French are ecstatic, and have high hopes of reverting back to their name for fried shreds of potato.
Other Europeans offer more succinct explanations. Simon Heffer of the Daily Telegraph says,
Many Britons will feel it would be rather nice to have a vote, too. Well, maybe not a whole vote: I would settle for one worth 50 per cent of those cast by American citizens.
Canada is no exception, with “Obamania” sweeping the country. Some Canadian commentators attribute this to an anti-Bush sentiment – frustration with unilateralism and naked self-interests at the rest of the world’s expense.
But Thomas Walkom offers a word of caution,
Which U.S. presidential candidate talks of expanding the war on terror by attacking more countries? If you answered John McCain, you’re wrong. The correct response, of course, is Barack Obama.
