Category: ESPC Publications: Research Updates

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Note: this is excerpted from the March 2021 edition of our “Research Update” publication. The Edmonton Social Planning Council, in collaboration with our volunteers, strives to provide stakeholders and community members with up-to-date reviews, prepared by our volunteers, on recently published social research reports and publications.

A review by Shawna Ladouceur

In 2011, the Royal Society of Canada (RSC) published End-of-Life Decision Making. This timely report framed the findings and recommendations of an expert panel convened by the RSC in response to questions of public policy around the legalization of medical assistance in dying (MAiD). A decade on, the RSC assembled a Policy Briefing Committee to assess the impact of the 2011 report to track policy and statutory progress and to identify ongoing challenges. Summarized here, the policy brief lauds success, but also looks ahead to next steps and work still to be done.

Recognizing the impossibility of addressing MAiD in isolation, in preparing the 2011 report the RSC conducted an extensive review of literature exploring the full continuum of end-of-life care, which includes:

• withholding and withdrawal of potentially life-sustaining treatment,
• advance directives,
• palliative care,
• potentially life-shortening symptom relief,
• terminal sedation, and
• assisted suicide and voluntary euthanasia (i.e., MAiD).

This in-depth examination of social attitudes, ethical issues, and legal statutes led the RSC to conclude that Canada should move forward with provisions for MAiD—for which they provided 30 recommendations to guide the process.

Proving fortuitous, the 2011 report coincided with arguments heard in the groundbreaking case, Carter v. Canada (2015). Heard by the British Columbia Supreme Court, the case challenged Criminal Code statutes forbidding euthanasia and physician assisted suicide. Admitted into evidence on the grounds of providing expert opinion on the matter, the report was quoted and later echoed in the judge’s decision to declare the statutes in violation of the Charter of Rights and Freedoms (the Charter). Insisting that inherent risks of legalization “could be very substantially mitigated through a carefully-designed system imposing stringent limits that are scrupulously monitored and enforced,” the Supreme Court of Canada affirmed findings in this case (p. 11). Given 12 months to amend the Criminal Code, the judgement required Parliament to move forward with legislation allowing legal access to MAiD in Canada. The resulting Bill C-14, however, departed from both the report and from recommendations of Parliament’s own commissioned experts on some key provisions.

This divergence left work to be done at all six points along the continuum of end-of-life care and the door open to ongoing policy and statutory challenges. Although the policy brief shows there has been good progress in facilitating advanced care planning and moderate progress in expanding access to palliative care, the remaining areas have yet to be addressed—that is, clarifying legal status of withholding and withdrawal of potentially life-sustaining treatment, terminal sedation, and potentially life-shortening symptom relief. The policy brief outlines 31 remedial recommendations to address these deficiencies as well as those of current MAiD legislation. Ongoing challenges also hold promise in remedying several enduring expert concerns with current MAiD legislation. These concerns include the exclusion of persons not at the end of life or whose natural death is not reasonably foreseeable; lack of provision for advance requests; exclusion of mature minors; and a 10-day waiting period.

One challenge resulted in the important 2019 Truchon and Gladu v. Canada and Québec decision, in which the Québec Superior Court found MAiD eligibility criterion, including the requirement for death to be reasonably foreseeable, too restrictive and thus in violation the Charter. This provision therefore ceased to have any effect in Québec as of March 2020. The federal government chose not to appeal the decision. Québec has, however, “indicated its intention to address the issue of eligibility for MAiD where mental disorder is the sole underlying medical condition” (p. 29).

Currently before the House of Commons, the federal government’s own Bill C-7 would mitigate other outstanding expert concerns. This Bill would allow advanced requests for MAiD in cases of reasonably foreseeable death and would eliminate the associated waiting period. Bill C-7 also appears to concede some ground to Truchon and Gladu (2019), adding language regarding natural death that has not become reasonably foreseeable. The federal government has also agreed to further study the issues of advance requests and mature minors during the five-year review required by the 2016 MAiD law.

The retrospective provided by the policy brief indicates the 2011 report has been cited many times since its publication—most significantly in the landmark case heralding the advent of MAiD, but also in scholarly literature, policy documents, and the media—certainly exerting an effect on public opinion and events in intervening years. However, despite progress, concerns remain. The brief provides recommendations to redress deficiencies along the continuum of end-of-life care—including prevailing concerns with existing MAiD legislation—and leading options to address the issues that most certainly lie ahead.

Publication Source:

Sumner, L. W., Downie, J., Gupta, M., & Wales, J. (2020). End-of-life decision making: Policy and statutory progress (2011-2020). Royal Society of Canada https://rsc-src.ca/sites/default/files/EOL%20PB_EN.pdf 

Get to know our volunteer:

Shawna Ladouceur is a Registered Nurse who sees the impacts of the social determinants of health in ways that demand action. She has extensive experience working directly with vulnerable populations in the inner city. Her personal interests include skiing, hiking, biking, running, reading, and travelling.

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Note: this is excerpted from the December 2020 edition of our “Research Update” publication. The Edmonton Social Planning Council, in collaboration with our volunteers, strives to provide stakeholders and community members with up-to-date reviews, prepared by our volunteers, on recently published social research reports and publications.

Reviewed by Hanna Nash

Canada’s universal health care is a keystone marker of what many Canadians would identify as, in part, what makes us proud to be Canadian; a nation of those who aid and support one another in all health matters, regardless of outcome. Though our country has continued to expand services under universal health care since 1966, one area remains unincorporated. In the Advisory Council on the Implementation of National Pharmacare’s report, A Prescription for Canada – Achieving Pharmacare for All, the authors discuss how nationally implemented pharmaceutical access would benefit all Canadians and our country’s health care expenditures.

Formed in 2018, this federally appointed advisory council made significant findings and key recommendations to the federal government after studying global pharmaceutical policies and interviewing diverse groups of Canadians in all provinces and territories such as: politicians, Indigenous leaders, patients, health care providers, business owners, and academics. What is perhaps most striking among their findings is an imminent need for universal pharmaceutical accessibility in Canada—its financial impact would not only benefit individuals, but would save Canadian taxpayers significant amounts of money each year, within its first year of operation even (p. 47).

A transition phase beginning January 1, 2022 would allow the development of a Canadian drug agency to work with federal, provincial, and territorial governments to create a list of drugs that would be covered, and would continue to add recommended drugs and pharmaceuticals for a fully operational agency by January 1, 2027 (p. 78). When purchasing prescriptions drugs, Canadians would not be expected to spend more than $100.00 annually per household.

Approximately 20% of Canadians either simply cannot afford medication or do not have adequate insurance to cover their required medication (p. 113). This means that many Canadians do not take their essential prescriptions, which can cause further health complications later on, or, as in the case of one million Canadians, they must borrow money to afford the cost of their medications. What is further distressing is that Canadians who are already at a financial disadvantage are also the most impacted, and are more likely to experience ill health due to inaccessibility to medication. The elitism of pharmaceutical accessibility in Canada is felt most disproportionately by women, young people, and low-income wage earners. The end result of this disjointed and unequal approach to pharmaceuticals is that too many Canadians fall into poor health and cost Canada’s health care system billions of dollars in visits to ERs, hospitals, and physicians each year while missing work and/or school—thereby further preventing them from improving finances and health (p. 169).

The difficulty in managing Canada’s pharmaceutical costs is due to its collage of public (100) and private (100,000) drug plans that do not present significant clout when negotiating the cost of medications, as they are not unified. Among countries that offer universal health care, Canada is the only nation that does not have pharmaceuticals included under its health care plan. Additionally, the advisory council discovered that Canada pays some of the highest drug prices in the world compared to other OECD nations. The only countries that pay more for pharmaceuticals are the United States and Switzerland (p. 29).

These findings pose too great a risk for Canada’s health care to continue without putting individuals and the government into further debt. The solution to saving federal money and aiding individuals is for each province and territory to place pharmaceuticals under universal health care. This would ensure that, as a single-payer nation, Canada would have greater bargaining power against pharmaceutical companies and would, in turn, be able to negotiate better prices for all prescription drugs—including new and ground breaking treatments and formulas.

The authors tested their universal health care approach by calculating the costs of covering medications for those with diabetes, cardiovascular disease, and chronic respiratory conditions. By covering individual expenses for those particular health conditions, Canadians could conceivably save up to $1.2 billon each year (p. 47).

With these findings in mind, the authors advocate for a drug agency to push forward and come to fruition. However, one factor that must be considered is the co-operation of all provinces and territories in achieving this final stage of universal health care. If these recommendations can be fully embraced by provincial and territorial governments, the federal government could potentially see huge savings in medical costs, and a healthier, more productive, society.

Publication Source:

Government of Canada. (2019). A prescription for Canada: Achieving pharmacare for all. Health Canada. https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/implementation-national-pharmacare/final-report.html

ABOUT THE RESEARCH REVIEWER:

Hanna Nash enjoys ballet performances and other live theatre, as well as outdoor sports, and travelling to new countries. Hanna is interested in sharing information and knowledge to Edmonton’s diverse communities.

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The Edmonton Social Planning Council, in collaboration with our volunteers, strives to provide stakeholders and community members with up-to-date reviews on recently published social research reports and publications.

In this issue, we have the following reviews:

* Working-Age Singles: The “Forgotten Poor” of Canada — Reviewed by Kara Abdolmaleki
* Indigenous Homelessness in Canada — Reviewed by Shawna Ladouceur
* Youth Homelessness in B.C. — Reviewed by Mohamed Mohamed
* Achieving Pharmacare for All — Reviewed by Hanna Nash
* Housing First as a Form of Intervention — Reviewed by Reem Saraya
* Revisioning Coordinated Access — Reviewed by Asheika Sood
* Basic Income as a COVID-19 Response in B.C. — Reviewed by Elaine Tran
* Decriminalizing Race — Reviewed by Aastha Tripathi
* Colouring Outside the Lines — Reviewed by Jayme Wong

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Note: this is excerpted from the August 2020 edition of our “Research Update” publication. The Edmonton Social Planning Council, in collaboration with our volunteers, strives to provide stakeholders and community members with up-to-date reviews, prepared by our volunteers, on recently published social research reports and publications.

Reviewed by Hanna Nash

In Alberta’s Failed Oil and Gas Bailout, authors Jim Storrie, Duncan Kinney, and Regan Boychuk discuss their dissatisfaction with the Government of Alberta’s investments in the oil and gas industry. These authors come from non-profit watch groups established to keep a continuous look on government decisions and protect the interest of Albertans.

Storrie, Kinney, and Boychuk examine the actions of Crown investment manager Alberta Investment Management Corporation (AIMCo), responsible for over $100 billion of provincial assets. According to the authors, this management company has allocated $1.1 billion from Alberta’s pension funds and the Alberta Heritage Saving Trust Fund to junior and intermediate provincial oil and gas producers and oil field service companies at the direction of the prior and current Alberta governments. The main focus of the report is the contention the authors have with AIMCo’s likely loss of millions of the public dollars it invested. Part of this loss is due to falling shares that each of the publicly traded companies it invested in have already experienced, in addition to the bankruptcies of companies that have received millions of dollars in AIMCo investments, the fallout from COVID-19 concerns, Russia and Saudi Arabia’s oil price war, and the expected cost of Alberta’s oil well environmental clean-up initiative.

The report is a well researched and thorough review of AIMCo’s problematic relationship with Alberta’s current government, the United Conservative Party (UCP), and the lack of checks and balances in place that have allowed a mismanagement of funds to occur. The authors demonstrate how the UCP used their political influence to push the interests of oil and gas companies into AIMCo’s investment profile—largely due to the political donations that the UCP and their third-party advertisers received from oil and gas companies. The authors discuss the conflicts of interest these relationships present as they create an environment of investment focused solely in the oil and gas sector, without any attention given to alternate investment areas. Additionally, the passing of Bill 22, in the fall of 2019, now permits AIMCo to oversee investment management for many essential pension funds in Alberta such as the Alberta Teachers’ Retirement Fund (ATRF). This directive from the province has angered many Albertans as such pension funds and investments are now solely controlled by AIMCo. Despite ATRF’s dissatisfaction with AIMCo’s performance, they are not permitted to dissolve their relationship as Bill 22 does not provide any alternative methods or options of investment management. These investment protocols coupled with a lack of transparency from AIMCo have given many Albertans rise to feel distrustful where AIMCo is concerned.

Storrie, Kinney, and Boychuk’s in-depth review of AIMCo’s investment practices presents troubling and worrying indications of how public funds in Alberta are being spent. The authors portray a very distrustful relationship between the UCP and those whose money is being invested in businesses that are operating at a loss rather than a profit. Notably, the money being used by the current provincial government is largely deferred money that Albertans earned and chose to invest in a retirement fund; they have not given permission for their government to invest through such methods.

This report is very well researched and investigated, however, it is obvious that the authors present a very strong bias against investing public funds in non-renewable energy resources. At times, the report produced a more personal opinion of the current UCP government’s business practices rather than an unbiased presentation of information.

The non-profit groups on behalf of which the authors are writing are undoubtedly interested in the current political climate of Alberta’s government, and how government action will impact future generations of investment and growth. The authors provide insight into the difficulties that Albertans currently face, and promote open and transparent interactions between the provincial government and its Crown corporation for the benefit of Albertans.

PUBLICATION SOURCE:

Storrie, J., Kinney, D., & Boychuk, R. (2020). Alberta’s failed oil and gas bailout. Progress Alberta. https://pressprogress.ca/wp-content/uploads/2020/04/AIMCO-report.pdf

ABOUT THE RESEARCH REVIEWER:

Hanna Nash enjoys ballet performances and other live theatre, as well as outdoor sports, and travelling to new countries. Hanna is interested in sharing information and knowledge to Edmonton’s diverse communities.

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