Solidarity between doctors and nurses in Quebec

Canadian doctors--at least some of them--are different.
The Washington Post has the story.

Hundreds of Canadian doctors demand lower salaries

"In a move that can only be described as utterly Canadian, hundreds of doctors in Quebec are protesting their pay raises, saying they already make too much money.

"As of Wednesday afternoon, more than 700 physicians, residents and medical students from the Canadian province had signed an online petition asking for their pay raises to be canceled. A group named Medecins Quebecois Pour le Regime (MQRP), which represents Quebec doctors and advocates for public health, started the petition Feb. 25.

“We, Quebec doctors who believe in a strong public system, oppose the recent salary increases negotiated by our medical federations,” the petition reads in French.

"The physicians group said it could not in good conscience accept pay raises when working conditions remained difficult for others in their profession — including nurses and clerks — and while patients “live with the lack of access to required services because of drastic cuts in recent years.”

"A nurses union in Quebec has in recent months pushed the government to address a nursing shortage, seeking a law that would cap the number of patients a nurse could see. The union said its members were increasingly being overworked, and nurses across the province have held several sit-ins in recent months to push for better working conditions."

Harm reduction (for opioids) in Canada

Here's a story from the Washington Post:
At the heart of Canada’s fentanyl crisis, extreme efforts that U.S. cities may follow

"the Overdose Prevention Society, took over a vacant building next door, giving users a clean indoor place to inject drugs. There are 29 similar sites in British Columbia, the epicenter of Canada’s drug crisis, and more across the country.

“To save lives, you need a table, chairs and some volunteers,” said Sarah Blyth, the manager here.
...
"As fentanyl rampages across North America, several U.S. cities have announced that they will open the first supervised drug-consumption sites like those in Canada. Their plans illustrate the gulf between the two nations: While Justin Trudeau’s government is doubling down on its “harm reduction” approach, any U.S. organization that tries to follow suit would be violating federal law and risking a confrontation with the Justice Department.
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See also this academic paper
Addressing the Nation’s Opioid Epidemic: Lessons from an Unsanctioned Supervised Injection Site in the U.S.
Alex H. Kral and Peter J. Davidson
American Journal of Preventive Medicine, 53, 6, 2017, 919 - 922

and this January 2017 news story
Awash in overdoses, Seattle creates safe sites for addicts to inject illegal drugs

Blood plasma in Canada: should compensation for donors be banned?

I am one of the signatories of a long letter arguing that Canada (which imports most of it's blood plasma products from the U.S.) should not ban the compensation of Canadian plasma donors.

Here's the letter:
Ethicists and Economists express concerns about banning compensation for plasma donors with regards to ensuring the security of a safe Immune Globulin Product Supply.
Submission to the Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada

Here's the press release:
Ethicists and economists express concerns about banning compensation for plasma donations

Do organ donors have a right to donate?

Here's a case that makes clear that some donors really wish to become donors, in this case deceased donors. The story is from the Canadian Broadcasting Service news:
Organ donation changes dying for those getting medically assisted death
People who have chosen to die with medical assistance are often the best candidates for donation

"When ALS diminished Brian Wadsworth's quality of life, he asked for medical assistance in dying. Organ donation was the natural next choice. And while the decision came with logistical challenges and ethical concerns, his loved ones say he never looked back."

Bleeding (and more) for Canada

Peter Jaworski in USA today discusses Canadian repugnance for paying for blood or sperm.

If it weren’t for America's free-market ways, more Canadians would have trouble getting pregnant.

"Canada used to have a sufficient supply of domestic sperm donors. But in 2004, we passed the Assisted Human Reproduction Act, which made it illegal to compensate donors for their sperm. Shortly thereafter, the number of willing donors plummeted, and sperm donor clinics were shuttered. Now, there is basically just one sperm donor clinic in Canada, and 30-70 Canadian men who donate sperm. Since demand far outstrips supply, we turn to you. We import sperm from for-profit companies in the U.S., where compensating sperm donors is both legal and normal.
...
"Canada has never had enough domestic blood plasma for plasma-protein products, such as immune globulin. Our demand for those products, however, is increasing. Last year, we collected only enough blood plasma from unremunerated donors to manufacture 17% of the immune globulin demanded. The rest we imported from you, in exchange for $623 million, or $512 million U.S.

Reliance on your blood plasma looked like it might change a little bit when, in 2012, a company called Canadian Plasma Resources announced plans to open clinics in Ontario dedicated to collecting blood plasma. The trouble is that its business model included compensating donors. Almost immediately, groups such as the Canadian Union of Public Employees and the Canadian Health Coalition began to lobby the Ontario government to pass a law to stop CPR from opening clinics. Ontario obliged in 2014, passing the Safeguarding Health Care Integrity Act, which among other things made compensation illegal.

When CPR shifted attention to Alberta, so did the groups opposing them. Just this year, the Alberta government introduced the Voluntary Blood Donation Act, which would prohibit compensation.

British Columbia’s government is just now looking at options to ban it as well.

What persuaded these governments? The anti-compensation groups argued that blood plasma from compensated donors was less safe, that people should donate blood plasma for free rather than for money, and that there is something wrong with having a for-profit business model in health care.

The latter two concerns are strangely specific. They don’t seem to apply to you Americans. If they did, the groups would have lobbied to make importation of anything other than products made from unremunerated donors also illegal. But they didn’t.

Instead, they object to a Canadian for-profit company compensating Canadian blood plasma donors in Canada, but American for-profit companies compensating American donors in America does not appear to register on their moral radar. Like the importation of sperm from for-profit U.S. companies that compensate donors, it has all the appearance of moral NIMBYism. It’s fine if it happens in your backyard, and we’ll happily buy the products, but we object to it happening in our backyard."

************

And here, in Canada's National Post:

Peter Jaworski: Canada needs blood plasma. We should pay donors to get it

Canada buys the vast majority of its plasma-protein products from American companies that attract plasma donors by paying them. Yet we ban the same practice here

Harm reduction: decriminalizing drugs to reduce overdoses?

From the Toronto Star:
Should Toronto push to decriminalize all drugs? The city’s medical health officer ready to consider it
The city is convening a committee of health and drug policy experts to explore “a different approach that puts the health of the community first,” Dr. Eileen De Villa said.

"Toronto’s new Medical Officer of Health is calling for a public discussion on the merits of decriminalizing all drugs in the wake of the ongoing overdose epidemic.

“It’s clear that our current approach to drugs in this city and this country doesn’t seem to be having the desired impact,” Dr. Eileen De Villa told reporters Friday at a briefing on how the city is responding to drug users overdosing and, in some cases, dying.
...
"On Friday, following Thursday’s emergency meeting of city partners, De Villa reviewed with reporters the city’s overdose prevention strategies which include asking police to carry the fentanyl antidote and speeding up the opening of three safe injection sites.

De Villa said among the 10 key strategies in Toronto’s Overdose Action plan is a call for a public health approach to drug policy that puts the health of the community first, “rather than looking at this as an issue of criminal behavior and or an area for law enforcement.”

The city is convening a committee of health and drug policy experts to explore “a different approach that puts the health of the community first,” she said.

While acknowledging the city doesn’t have the power to change the Criminal Code, “Toronto has always been a leader … in policy and I don’t see why we wouldn’t continue to be a leader on this front,” said De Villa, who stepped into her high-profile position four months ago."
***************

Not everyone is interested in this kind of harm reduction. Here's a Washington Post story about a different point of view expressed by an Ohio sheriff (I think this is a point of view that also comes up in opposition to e.g. making clean needles available to drug addicts):

Why this Ohio sheriff refuses to let his deputies carry Narcan to reverse overdoses

"No one has come up with a solution to the opioid epidemic that has decimated Rust Belt states, but for people who overdose, Naloxone is about as effective an antidote as there is. The results of the opioid antagonist, which is sprayed up a person's nose and reverses the effect of opioid overdoses, have been likened to resurrecting someone from the dead.

"Paramedics and firefighters routinely carry the easy-to-administer medication in their vehicles. For police officers in the nation's hardest hit areas, like southwest Ohio, the Food and Drug Administration-approved nasal spray, known by the brand name Narcan, can be as common as handcuffs. Even some librarians have learned to use the drug to revive people who overdose in their stacks.

"But Richard K. Jones, the sheriff of Butler County, Ohio, raised eyebrows recently when he said that his deputies will never carry the medication.
...
"Jones said Narcan is the wrong approach for a war on opioids that “we're not winning,” and said he favored stronger prevention efforts to prevent people from first using the drug."

Polygamy convictions in Canada

The CBC has the story:

Winston Blackmore and James Oler found guilty of polygamy by B.C. judge
Former bishops of Bountiful both have numerous wives and children
CBC

"Two former religious leaders in B.C. have been found guilty of polygamy after marrying more than two dozen women over the course of 25 years.

"Winston Blackmore and James Oler were convicted of practising plural or "celestial" marriage in the fundamentalist community of Bountiful, B.C.

"In B.C. Supreme Court on Monday, Justice Sheri Ann Donegan said Blackmore "subscribed to beliefs and practices of the Fundamentalist Church of Jesus Christ of Latter-Day Saints," a Mormon sect that believes in plural marriages.

"James Oler, another former leader from the same community, was accused of having five wives and Blackmore 24 wives.

"Both men are former bishops of the sect in the province's southeast. Neither denied having multiple marriages and Blackmore has fathered more than 145 children from his marriages.
...
"Blackmore's lawyer, Blair Suffredine, previously said he'd launch a constitutional challenge to the validity of the polygamy laws if his client were to be found guilty.
...
"The legal fight began in the early '90s when police first investigated allegations that residents of an isolated religious community were practising multiple marriages.

"A lack of clarity around Canada's polygamy laws initially led to failed attempts at prosecuting Blackmore, followed by several efforts to clarify the legislation, including a reference question to the B.C. Supreme Court.

"The court ruled in 2011 that laws banning polygamy were constitutional and did not violate religious freedoms guaranteed in the Charter of Rights and Freedoms.

"The mainstream Church of Jesus Christ of Latter-Day Saints, based in Utah, officially renounced polygamy in the late 1800s and disputes any connection to the fundamentalist group's form of Mormonism."
********
Prosecution of polygamy in the U.S. has focused not on polygamy itself, but on the fact that some of the brides are underage.  Here's an AP report of the present case via ABC news, which includes the following:
"Oler was chosen to lead the Canadian community just north of the U.S. state of Idaho following Blackmore's excommunication from the sect in 2002 by Warren Jeffs, considered the prophet and leader of the group.

"Authorities have said Jeffs still leads the sect from a Texas prison, where he is serving a life sentence for sexually assaulting underage girls he considered brides."
*********

See my earlier posts on polygamy

Doctors harvesting organs from Canadian patients who underwent medically assisted death

The National Post has the story:
Doctors harvesting organs from Canadian patients who underwent medically assisted death

"Doctors have already harvested organs from dozens of Canadians who underwent medically assisted death, a practice supporters say expands the pool of desperately needed organs, but ethicists worry could make it harder for euthanasia patients to voice a last-minute change of heart.

In Ontario, 26 people who died by lethal injection have donated tissue or organs since the federal law decriminalizing medical assistance in dying, or MAID, came into effect last June, according to information obtained by the Post. A total of 338 have died by medical assistance in the province.

Most of the 26 were tissue donors, which usually involves eyes, skin, heart valves, bones and tendons.

Bioethicists and transplant experts say people who qualify for assisted dying deserve to be offered the chance to donate their organs. The gesture could bring a profound sense of psychological comfort, they say, provided the request for assisted death and the decision to donate are kept entirely separate."

Ontario's new surrogacy law (and other laws regarding who is the parent of a child)

In Canada, Ontario has just (last month) amended some of its laws regarding the definitions of who are the parents of a child, with implications for surrogacy, among other things.
Bill 28 Projet de loi 28
An Act to amend the
Children’s Law Reform Act,
the Vital Statistics Act
and various other Acts
respecting parentage and
related registrations

Here's the part on surrogacy, which seems to imply that surrogacy in Canada will be subject to legal risk about who the parents are until the child is seven days old.

"7. Where a surrogate and one or more intended parents of
a child to be carried by the surrogate enter into a surrogacy
agreement and a child contemplated by the
agreement is born, the intended parents become the
parents of the child and the surrogate ceases to be a
parent of the child if specified conditions are met.
These conditions include that there are no more than
four intended parents under the agreement, that each of
the parties to the agreement received independent legal
advice before signing, and that the child is conceived
through assisted reproduction. The change in parentage
is also contingent on the surrogate giving written consent
relinquishing the surrogate’s entitlement to parentage
of the child, but the consent may not be given
before the child is seven days old. Until that time, after
the child is born the surrogate and the intended parents
share parental rights and responsibilities respecting the
child, unless the surrogacy agreement provides otherwise.
If the surrogate does not or cannot give consent,
an application may be made to the court for a declaration
of parentage respecting the child. Although a surrogacy
agreement may be used as evidence of parental
intent, it is unenforceable in law. (Section 10)"
**********

Here is some commentary on that and other parts of the law, from the blog Above the Law:
Ontario’s New Surrogacy And Sperm Donation Law Is Both Awesome And Terrible

Family consent for deceased organ donation in Canada

The National Post has the story:
One in five willing organ donors in Ontario have their wishes vetoed by family — and doctors don’t argue

"Legislation in most provinces and territories outlines legal authority for organ procurement from someone who has died. Written consent, such as an organ donor card or an online registration form, is legally binding. Family members can’t revoke that consent in most Canadian jurisdictions (the law is less clear in the North West Territories) — their refusal is legally meaningless.

"Despite the legal authority to do so, every provincial donation organization in Canada has a policy that the wishes of families will be followed (except Manitoba, where the wording is vague). Alberta legislation clearly prohibits seeking family consent when donor consent was previously provided and yet an Alberta Health Services directive states “your next of kin will be asked by the donation team to sign a consent form.”

"With more than 4,000 Canadians waiting for a lifesaving transplant, the gap between the law and what actually happens is glaring.

“People who register want donation to be part of their legacy,” says Linda Wright, the former director of bioethics of the University Health Network in Toronto, where more organ transplants are performed than anywhere else in Canada.

“As a living person you want to know your wishes will be respected,” she says, but health-care providers “don’t want to further traumatize families” often shocked and devastated over the sudden loss of a loved one.

"To date, no physician in Canada has ever overridden the wishes of the family in favour of the legally binding consent of the potential donor."

Public appeals for organ donors by patients in Canada

The Ottawa Sun has the story: After Eugene Melnyk, transplant surgeons OK public appeals for living organ donors

"Eighteen months after a donated liver from a stranger saved the life of Ottawa Senators owner Eugene Melnyk, his case has helped prompt Canadian transplant officials to accept that public pleas for living organ donors are ethical, legal and even beneficial, under the right circumstances.

Melnyk was one of two high profile cases in 2015 (the other was the family of twin girls from Eastern Ontario, the Wagners) in which public pleas were made for a liver donor. Hundreds of people answered the call to donate parts of their livers to save Melnyk’s life. His eventual transplant was a success and both Melnyk and his anonymous donor — who was described only as a Senator’s fan — recovered. Little Binh Wagner also recovered from a successful liver transplanted from an anonymous donor (her twin sister received part of their father’s liver).

The cases raised ethical questions about the fairness of public pleas that tend to favour those with more compelling stories over others legitimately waiting for an organ transplant. They also highlighted the fact that there is no national policy on organ solicitation, a gap the Canadian Society of Transplantation, the Canadian National Transplant Research Program and the Canadian Blood Services hope to close with guidelines released this week.

The guidelines acknowledge that ethical questions remain, but note that the gap between supply and demand of organs and the availability of public platforms to easily make such pleas means those questions are going to continue.

Dr. Atul Humar, medical director of transplant at the University Health Networks in Toronto where Melnyk’s and Binh Wagner’s transplants were performed, said public solicitations are increasing, mainly because of easy access to social media and a shortage of organs to transplant. Earlier this year, Gianna-Lynn Favilla, an eight-year-old Russell girl, received a life-saving liver transplant after the family made a desperate public plea on her behalf. The donor was a neighbour and the father of Gianna-Lynn’s best friend.

At the end of 2014, 4,514 patients (3,473 for a kidney and 507 for a liver) were waiting for an organ in Canada. During the same year, 2,356 transplant procedures were performed and 278 patients died while on the waiting list."
...
"The issue has caused some soul searching among transplant officials in Canada and around the world. Some institutions have refused to transplant organs obtained from public solicitation and the practice is banned in Australia. Recently, European transplant officials came to a similar conclusion as the Canadian guidelines: “As long as donor shortage persists, we should not condemn patients, who do not have a live kidney donor, or only have a very slim chance of finding a suitable donor when they decide to publicly solicit for a live donor.”

Foreign students recruited to Canadian Universities

Inside Higher Ed reports on concerns that universities' eagerness for high tuition payments is leading to unqualified students are being recruited:
Corruption in Higher Ed: Canada in the Crosshairs
It is overwhelmingly evident that there is a remarkable and callous disregard for academic ethics and standards in a scramble by Canadian universities to sign up foreign students.

"It is overwhelmingly evident that in the last two decades we have witnessed first-hand a remarkable and callous disregard for academic ethics and standards in a scramble by Canadian universities and colleges to sign up foreign students, who represent tens of millions of dollars to their bottom lines.
We have been in a school auditorium in China and listened to the school owner tell prospective parents that the Grade 12 marks from the Canadian provincial school board program can be manipulated to secure admission for their children into Canadian universities. This, while the Canadian teachers sat oblivious to the presentation in Chinese.
In hundreds of our own interaction with students who completed the Canadian provincial school board’s curriculum in China and who achieved grades of 70% and higher in their English class have been unable to achieve even a basic level of English literacy in the written tests we have administered.   But when the largest country of origin for incoming international students and revenue is China - the Canadian universities admitting these students salivate over the dollars and focus less on due diligence.
We were once asked by a university on Canada’s west coast to review 200 applications from Saudi Arabia, in order to identify the two or three Saudi students who were actually eligible for conditional admission to that university's undergraduate engineering program. But the proposal was scuttled by the university's ESL department that wanted all 200 to enroll in its language courses. It insisted on and managed conditional admissions for all 200. It’s common at Canadian universities for the ESL program “tail” to wag the campus “dog” when it comes to admissions. In fact, recent Canadian government regulations have been proposed to crack down on this practice as it is an affront to academic integrity."

Organ donation rates in Canada

http://www.cbc.ca/news/health/organ-donation-1.3755193

"Despite the progress, Canada lags behind "top-tier" countries such as the U.S. and Spain, where deceased donation rates exceed 30 donors per million population. Canada's rate currently stands at 18.2 donors per million population, up from 14.1 for that measure in 2006.

Spain fostered a culture of donation over three decades and Canada is now embarking on creating one, said Dr. Peter Nickerson, vice-dean of research at the University of Manitoba and a medical adviser to CBS.

About 21 per cent of donations come after cardiac death, said Kimberly Young, director of donation and transplantation at CBS. Before those programs were implemented, most deceased organ donations occurred after catastrophic brain injury. Now organs can be donated after the heart stops.

Young also acknowledged the hundreds of Canadians who've chosen to become living donors, many without ever knowing the recipient.

The living donation rate hasn't increased in the past decade, Young said. One of the reasons it hasn't decreased, as in some countries, is due to the national paired kidney donation program. It pairs compatible donors, including those in different parts of the country. Doctors consider kidney donations the best treatment for end-stage kidney disease.

Lung transplants are in the top tier of comparable wealthy countries, thanks to pioneering research at lung retrieval centres such as Toronto General Hospital, Nickerson said. Likewise, liver donation rates are high. Heart access is relatively equal, he said.

There have also been significant improvements in access to transplants among those who have the hardest time finding a donor match because of a highly sensitive immune system. "

Repugnance watch: US ceases efforts to end global trade of polar bear parts

The Guardian has the story: US ceases efforts to end global trade of polar bear parts

"The US government has quietly dropped its campaign for an international ban in the trade of polar bear parts, which would have given the practice the same outlaw status as the elephant ivory market.

The US Fish and Wildlife Service has spent several years attempting to ban the overseas trade of polar bear skins, teeth, paws and other parts from Canada, which permits the hunting of the Arctic predators.

However, the federal agency has said it won’t pursue the matter further at an international summit of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (Cites), in September. Instead, the US will focus on the threat posed to polar bears from climate change.

...

"The US’s bid to ban the polar bear trade has garnered support from the UK, Germany and Russia but has been opposed by Canada, which insists that hunting is sustainable and an important cultural practice of the native Inuit people. Hunting can also generate income for communities, with tourists paying up to $50,000 for the chance to shoot a polar bear."

The marijuana business in the U.S.: legal in some states, but still illegal under Federal law.

The Guardian suggests that Canada may soon find commercial opportunities in marijuana :
Will Canada become America's cannabis capital?
Plans to legalise recreational marijuana in Canada have those south of the border worried they’ll lose their lead in the emerging pot industry

"He may be the chief executive of Denver’s largest marijuana dispensary, ground zero for America’s fastest growing industry, but Andy Williams struggles with a lot of financial hurdles.

The First Bank of Colorado closed the accounts of everyone in the family business, Medicine Man Technologies, including children who have no part in the industry. Williams can’t take on any investment and needs to fund expansion through personal loans from friends and family.

Customers can only pay in cash; banks refuse to hold his money and everyone from employees to contractors need to accept cash payments. Employees, who can’t prove their income as a result, often struggle to get loans and mortgages.

Furthermore, section 280E of the US tax code prohibits the deduction of expenses related to controlled substances for tax purposes, and Williams predicts that he gives the internal revenue service an additional $600,000 each year as a result of business expenses that can’t be written off.

While recreational marijuana legalisation is well on its way in states like Colorado, it remains illegal at the federal level, stifling the growth and innovation of the industry’s first movers.

Meanwhile, north of the border, Canadian prime minister Justin Trudeau has vowed to legalise recreational marijuana consumption on a federal level, opening the door to investment, less restrictive tax policies and banks that can treat the marijuana industry like any other. While legalisation hasn’t yet taken place in Canada, when it inevitably does American marijuana businesses may suddenly find themselves at a disadvantage. "

Learning opportunities at Canadian universities

Two universities I visited recently in Canada offered the following learning opportunities

Bleeding for Canada: plasma exports from the US to Canada

In the HuffPo:, Peter Jaworski begins his rant about the blood supply with a good line about food:  Commodifying Blood Donation Could Solve Canada's Shortfall

"Many people think blood is special in a way that means it shouldn't be "commodified," or bought and sold on a market. It is a basic human need. It's not like the latest gadget or a pair of shoes; it is to be revered, not remunerated.

"I'm glad we don't think food is special in this way. If we did, imagine how many people would die of starvation, or would suffer from hunger.

This past December, the Ontario legislature preserved the sanctity of the exchange of blood through Bill 21, entitled the "Safeguarding Health Care Integrity Act." Schedule 1 included provisions from Bill 178, the Voluntary Blood Donations Act", which prohibits paying and receiving payment for blood, either directly or indirectly. With this bill, the legislature has made the giving and receiving of blood a sacrament.

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Of course Canadians don't have to pay other Canadians for blood plasma. If you look at the Harmonized Tariff Schedule (HTS) administered by the U.S. International Trade Commission (USITC), you find that HTS number 3002100210 stands for Human Blood Plasma, and in 2013 Canada had imports $29,274,584 worth from the U.S., where of course we compensate plasma donors.

HT: Josh Penrod

Why most kidney exchange chains have patients receive a kidney before their donor donates one

A "how could things go wrong" story from Canada, when a donor donates before her recipient receives a kidney (due to a last minute glitch):
Organ exchange program slow to deliver on promise to man in need of a kidney, family says
Canadian Blood Services says overall, the kidney exchange program has been successful

"A national program that matches living kidney donors with recipients hasn't delivered on a promise after a woman donated a kidney to a stranger so her ailing son-in-law could get a much-needed transplant, the family says.

"Estella Jamieson agreed to donate one of her kidneys, only after being assured her son-in-law would soon get a transplant. She says she decided to contact Go Public because he is still waiting.

"I know I helped somebody and I'm glad that family is going good, but I just feel if I would have waited I could have helped my own family more," a teary Jamieson says. 

"Jamieson and her son-in-law, Jeff Pike, signed up for the Living Kidney Donor Paired Exchange Program a couple of years ago. It's run by Canadian Blood Services along with provincial transplant programs. 

...

"Jamieson gave her kidney to a stranger, so Pike could get one from another donor. 

"We did our half. My mother-in-law has helped improve someone's life but the return of her doing that, is someone would in turn help me at the same time — not some time down the road when the stars align. I can't help but feel like there are options out there that could speed things up," Pike says. 

"The surgeries were scheduled for February, but the day before Pike's procedure, he developed shingles and couldn't go through with the transplant. Jamieson donated a kidney anyway, on the promise her son-in-law would get a kidney when his health improved. Pike was medically cleared less than a month later but is still waiting. 

"I was assured Jeff would be top priority if I went through with the surgery. It's seven months later and he still doesn't have a kidney. Even if he had date ... but there's no date, there's nothing," Jamieson says.

"While Pike waits, he can't work full-time and is physically weak. He also requires dialysis twice a day. 

...

"Despite all that's happened, Estella Jamieson says she would still recommend the program to others, with one caveat. 

"Don't get me wrong. I think it is a very good program and anyone with a loved one that wants to go into it, I'd say yes to go ahead. But make sure your loved one is getting a kidney when you give yours." 

Doctor-assisted dying in Canada

The Globe and Mail has the story:

Supreme Court rules Canadians have right to doctor-assisted suicide

"Canadian adults in grievous, unending pain have a right to end their life with a doctor’s help, the Supreme Court ruled on Friday.

The unanimous ruling, by establishing that the “sanctity of life” also includes the “passage into death,” extends constitutional rights into a new realm. The courts have used the 1982 Charter of Rights to establish gay marriage and to strike down a federal abortion law. The new ruling will change the way some Canadians are permitted to die.

In a brief, powerful opening paragraph, the court explained why it was creating a new constitutional right to autonomy over one’s death in some circumstances: Those who are severely and irremediably suffering, whether physically or psychologically, “may be condemned to a life of severe and intolerable suffering” by the government’s absolute ban on assisted dying. “A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.”

The decision was signed by The Court, which happens occasionally when the justices wish to lend their decisions extra weight. The nine judges, who range in age from mid-50s to 74, dismissed the notion that competent adults cannot consent to their death. “We do not agree that the existential formulation of the right to life requiresan absolute prohibition on assistance in dying, or that individuals cannot ‘waive’ their right to life. This would create a ‘duty to live,’” the ruling says.

The court decision puts Canada in the company of a small group of countries such as Belgium – and U.S. states Washington and Oregon – that permit doctor-assisted death. And it gives the Conservative government difficult choices as it heads toward an election expected in the fall. The court suspended its ruling for 12 months to allow for new rules and laws to be drafted, but Ottawa could choose to do nothing, and allow provinces and medical regulatory bodies to create the ground rules for assisted death. Or it could do what it did when the Supreme Court struck down prostitution laws 14 months ago: study international models and then create a uniquely Canadian version that may or may not respect the principles established by the court."

HT: Nicola Lacetera

Kidney exchange in Canada

Moving to chains in Canada too...


Heartbeat: A chain of faith, a gift of life: Revolutionary organ exchange program can involve a domino chain of up to 10 people across Canada, and it drastically reduces wait times for transplant recipients

 "Nemeth was feeling increasingly ill and didn’t have that long to wait.

"Luckily, she didn’t have to. In early 2012, at her doctor’s urging, she joined the Living Donor Paired Exchange program.

"In the registry, donor-recipient pairs whose organs are incompatible with each other can be matched with others in the same situation and the organs swapped to complete transplants. There are Good Samaritans — non-directed anonymous donors — who simply donate a kidney out of altruism also entered in the registry. Algorithms determine matches to optimize use of rare blood and antibody types: swaps that result can involve up to five-pair chains — up to 10 people in cities across Canada all intricately linked in a complex “domino” transplant.

"The registry was founded as a pilot project in three provinces, including B.C., in 2009. It has since gone national and is overseen by Canadian Blood Services, which conducts three (formerly four) searches or “runs” a year.

"To date, there are about 145 registered pairs.

"More than 140 transplants have been performed, with the first cross-country multi-hospital swap in June 2009. Nemeth’s own chain involved three pairs: done at St. Paul’s and in Winnipeg.

"The program not only shortens waits and saves lives, but it also saves money: dialysis costs $60,000 a year while a kidney transplant is around $25,000 plus $6,000 a year for medication.

"Even before the national registry, provincial hospitals like St. Paul’s were doing ad hoc local swaps for just these reasons.

“We were basically doing these on the back of an envelope,” Dr. Landsberg said, adding St. Paul’s did its first regional domino transplant around 2006.

"But the national registry has been a true game-changer. Because of it, he said, “the number of difficult to match patients who were stacked on that wait-list and who I predicted would be on there forever have been able to get transplants.”

"And despite the tenuous nature of the chains, so far, he said, “We’ve never had a donor back out.”