Mentally ill Canadians deserve the right to die with dignity

Mentally ill Canadians have been excluded from medical assistance in dying (MAID) but that is about to change in a few months.

image: Eastside-online

When that option arrives in March, 2023, Canada will have one of the most liberal MAID laws in the world, joining only a few other countries that allow access for the mentally ill.

As it now stands, only those with a “grievous and irremediable medical condition” can apply for MAID; not just if you are about to die from a fatal or terminal condition but if your life is insufferable.

The distinction between a medical and mental suffering is arbitrary and archaic. There is no mental suffering that isn’t physical. To suggest that we live in a world other than the physical is to perpetuate the ancient notion of a mind/body duality.

To prevent mentally ill Canadians with a “grievous and irremediable” from access to MAID is to further discriminate against the mentally/physically ill. Like the notion of a mind/body duality, made popular by Rene Descartes in the 17th century, mental illness has been characterized in voodoo terms, such as possession by demons.

Mental/physical illness is stubbornly difficult to treat and those afflicted pay a price. The mentally/physically ill are often deemed unemployable and, as a result, are often poor and homeless. Their pain often has physical origins outside the body; victims of trauma, childhood abuse and addiction; symptoms compounded by financial stress and loneliness.

In contrast, those who now access MAID come from a position of privilege.

They tend to be wealthier Canadians. More likely, as an Ontario study found, to fall into the highest income bracket. They have been, in other words, people of relative privilege, wanting the same control in death that they had in life.

The same group of wealthy Canadians who have access to health care also have access to MAID, and the numbers are growing.

In 2021, there were 10,064 assisted deaths in Canada – an increase of 32 per cent over 2020. The average age of Canadians who received MAID last year was 76. Two-thirds have a cancer diagnosis, and nearly one-fifth have a heart condition.

Doctors critical of MAID suggest that assisted dying for the mentally/physically ill will become an easy out for a broken health care system, offering death rather than hope and treatment to society’s most vulnerable and marginalized citizens.

Yeah, right. If you happen to be living an insufferable and irremediable life, just wait for us to fix the broken health care system. Shouldn’t take more than a few decades. Meanwhile, just grin and bear it.

Can doctors, a privileged group of people living in a society that routinely stigmatizes people with disabilities, objectively judge what makes life worth living?

Some worry that there will be a flood of new applicants for MAID but if the Netherlands is any example, the number of mental/physical cases will be a tiny fraction of the total. The Netherlands has had psychiatric illness available for MAID for two decades.

Expanding MAID is about not discriminating between mental and physical health, but seeing patients as whole people capable of making their own decisions.

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Where the heck is Kenosha and why does it matter?

 

Hardly anyone outside of Wisconsin had ever heard of Kenosha before a Black man, Jacob Blake, was shot by a policeman two weeks ago. The policeman, Rusten Sheskey, a seven-year veteran of the Kenosha Police Department, held Blake’s shirt as he shot Blake in the back seven times while Blake’s children waited in the car.

image: politico.com

I had heard of Kenosha only because I had just finished reading a feature-length article in Harper’s magazine about how Kenosha county where, after having supported Democrats in almost every election for almost every office for forty-four straight years, voters had swung to President Trump in 2016.

Kenosha is critical in the upcoming U.S. presidential elections. As Kenosha goes, so does the country. Democrats have to take back Kenosha and nearby Racine to take Wisconsin. And they have to win Wisconsin to beat Trump nationally. No wonder it’s called “the tipping-point state.”

Wisconsin, before voting Trump, would have seemed familiar to Canadians. In his article for Harper’s, James Pogue says: “Wisconsin had a homegrown tradition of political congeniality and soft egalitarianism that traced its origins to the days of Robert La Follette and the Progressives.”

Similar to the Saskatchewan Roughriders, which the continent’s oldest community-owned professional sports franchise outside baseball, Wisconsin’s Green Bay Packers are the only publicly-owned, not-for-profit, major league professional team in the United States.

Why would a state, so seemingly familiar to Canadians, vote for someone that Canadians generally despise?

The answer is multi-faceted: dwindling union solidarity led to less involvement in the community and a diminished sense of pulling together; betrayal on the part of the Democratic Party; and a fading vision of the American Dream that promised opportunity.

Wisconsinites became disillusioned when both major parties agreed that what was good for the boardroom was good for America. The union jobs of Wisconsin, with the highest wages in America and therefore in the world, went south to states with right-to-work laws and weak unions.

In 1993, President Bill Clinton ratified the North American Free Trade Agreement over the desperate opposition of labour groups and Midwestern Democrats. House majority leader Dick Gephardt called the treaty “a threat to our wages and our standard of living.”

President Obama, who had won industrial counties in Wisconsin by margins that Democrats hadn’t achieved in a generation, promised to expand labour’s organizing power with the Employee Free Choice Act. It was never passed.

Disillusioned, Wisconsinites looked for anyone outside the mainstream. Congressman Mark Pocan told James Pogue: “People thought at first, ‘Oh he’s going to fight China, this’ll help.’  Folks are realizing that no matter how much they thought that Trump was going to support them, it hasn’t turned out better.”

Now Kenosha is the focus of racial tension. Parts of the state are harshly segregated. According to one analysis of recent census data, the quality of life for black residents in Milwaukee and Racine is among the worst in the country.

Supporters of Black Lives Matter and armed young men descended on Kenosha on August 25 in what Kenosha County Sheriff David Beth described a “chaotic, high-stress scene, with lots of radio traffic and people screaming, chanting and running.”

In the mayhem, a Trump supporter, a white 17-year-old with an assault rifle from Illinois, killed two protesters and wounded a third.

President Trump defended the young killer on Monday, illogically claiming that he was acting in self-defense when unarmed protesters confronted the shooter.

Kenosha, a small city the size of Kamloops, will loom large in the upcoming presidential elections on November 3.

 

Low income Canadians could benefit from automatic tax filing

Many low income Canadians are missing out on benefits because they don’t file tax returns.

image: Victoria News

While most Canadians such as me think of what they owe at tax time, low income Canadians should be thinking about what they could receive. They pay virtually nothing in taxes and receive the greatest household income in terms of benefits from the Canada Revenue Agency.

So, why wouldn’t low income Canadians file returns? The reasons vary but when you don’t have much money, you can’t afford to pay for someone to prepare your taxes or to pay for a program like TurboTax that helps navigate the tortuous forms.

And this year could mean even fewer low income Kamloopsians file returns because the volunteers who usually help out with taxes are physically isolating themselves. That’s certainly the case for the society I belong to, CSI Kamloops. In normal times, we help thousands of people prepare returns at our North Hills Mall location. This year, we might be able to help at our Brock Activity Centre dependent on whether we can open.

For low income Canadians, the CRA is more like a social service than a tax collection agency. Since returns are used to determine eligibility for a abundance of other benefits, low income Canadians could be missing out on them as well. Professor Jennifer Robson of Carleton University explains:

“For many Canadians, the tax system can be more like a social service system. It delivers cash benefits such as the GST credit and Canada Workers’ Benefit, for example. Through a notice of assessment from CRA, the system also helps people prove their annual income so they can qualify for means-tested programs including housing and daycare subsidies, home heating rebates, and many others (Canadian Centre for Policy Alternatives Monitor November/December 2019).”

Working-age Canadians in the bottom 20 per cent of other income get the vast majority of their income from government transfers, “income that could be put at some risk if they can’t or don’t file a return,” adds Robson.

One way to ensure that low-income Canadians receive the benefits of filing a tax return is to have their returns automatically filed for them.

Almost everything is now in place for that to happen. You no longer have to apply for the Canada Workers’ Benefit because the CRA automatically assesses returns for eligibility for the tax credit. The same is true for the Guaranteed Income Supplement. Automatic enrolment is in place for the GIS so that seniors no longer have to apply for this benefit.

When I filled out my tax return using TurboTax, my forms were automatically filled out by accessing my CRA account. Except for political and charitable donations, CRA already had all my information.

Automatic tax filing doesn’t mean that the returns can’t be reviewed and corrected. In my case, I had the option of changing the CRA generated forms or not. Automatic tax filing probably wouldn’t work for those with complex returns such as business owners who could opt out the automatic return.

Not everyone thinks it’s a good idea. The tax preparation industry including Intuit, maker TurboTax, has spent $6.6 million in the U.S. lobbying against government tax filing. If taxes could be filed automatically, it would eat into their profits.

Norway, Denmark and Sweden already offer automatic tax filing. Other jurisdictions such Chile, Spain and California are coming on board. It’s all but done in Canada.

New doctors need to give up sense of entitlement

There are more doctors than ever before; yet two million Canadians can’t find one.

  image: davegranlund.com

An estimated 30,000 Kamloopsians don’t have a family doctor, although only about one-half of them are looking if national averages apply.

Something doesn’t add up. Why can’t Canadians find a doctor if there is a surplus? It’s complicated.

First, recent graduates of medical schools can’t find the residency they want. Without a residency, they will never become doctors.

This year, 2,980 will graduate from Canada’s 17 medical schools. They will compete for 3,308 residency spots. That would seem like every graduate should get a spot. However, 917 of those spots are in Quebec which means that there is a shortage for English-speaking graduates.

Then there is the arcane process of matching graduates to residencies which leaves some out. Health reporter André Picard says:

“But matching a graduate to a residency spot is a complex process, overseen by the Canadian Resident Matching Service (CaRMS). Medical students apply to CaRMS in one or more specialties; committees select who they wish to interview and rank them; graduates rank the programs and, finally, an algorithm spits out a match, and the student is legally bound to take that residency spot (Globe and Mail, May 1, 2018).”

Graduates have become pickier. They get assigned in residency specialties where they don’t want to work. As a result of preferences and the complexities of CaRMS, 115 graduates are unmatched this year. Jobs are waiting for them -there are 78 unfilled positions, 65 of them in family medicine.

The unmatched graduates have invested a lot. They have accumulated an average debt of $100,000 during four years of training. Taxpayers have invested a lot. We are on the hook for their subsidized education. The cost of training a medical student is $250,000.

Also, some graduates want a regular job where they work only 40 hours a week as in a hospital in a so-called “hospitalist” position. At $150 an hour, a hospitalist makes $300,000 a year with no overhead. Compare that with a doctor in his own private practice. After paying staff and rent, a doctor would have to earn $400,000 a year to take home that much -and they’d work longer hours with less medical equipment and fewer support staff such as nurses. But there are only so many hospitalist positions.

One-half of Canada’s physicians focus on sports medicine or palliative care says Dr. Danielle Martin on CBC’s the Current:

“. . .they’re not practicing what we would think of as full scope full service cradle-to-grave primary care family medicine, and that is what those people who are lining up at Dr. Pengilly’s clinic and asking [for a primary caregiver].”

Doctors need to abandon their sense of entitlement says Picard. We need more general practitioners, especially in small cities and rural Canada. Enrolling in medical school doesn’t entitle graduates to jobs wherever they want, in the speciality of their choice.

“Becoming a doctor is hard,” says Picard, “It’s also a privilege. We need a system that ensures the right doctors are working in the right places, not on where personal desires can trump societal needs.”

Facebook is a Canadian utility

So many Canadians use Facebook that it should be regulated like any other Canadian utility. No broadcaster or telephone company would operate in Canada without government oversight. We should make it comply with our regulations as with other communications utilities.

      image: Tod Maffin

It’s the most-used Canadian social media. Ninety-four percent of Canadians aged 18 to 44 have a Facebook account. Overall, 84 per cent of us have an account and 80 per cent check the site daily according to The State of Social Media in Canada, 2017.

Now, Facebook is about to become more integrated into our lives with an announcement May 1, 2108, of a dating service. CEO Mark Zuckerberg said: “And if we are committed to building meaningful relationships, then this is perhaps the most meaningful of all.”

Facebook’s phenomenal rise has made it a monopoly. Canadian professors Andrew Clement and David Lyon say:

“In light of Facebook’s overwhelming grip on the social networking industry, the commissioner of competition should investigate the company for its monopolistic behaviour (Globe and Mail, April 23, 2018).”

Facebook’s ascent has left governments behind. Other communications industries have taken decades to mature and regulations have kept pace. Regulators have had time to insure that TV, radio and telephone companies meet Canadian standards of privacy, identity and sovereignty.

“The Canadian Radio-television and Telecommunications Commission (CRTC) should learn to treat social-media enterprises as utilities,” says Clement and Lyon.

There’s a lot of misunderstanding about the nature of Facebook’s grip. It seems so personal that there’s a conspiracy theory claiming Facebook is eavesdropping on people’s conversations through their smartphones and using that insight to serve ads. Tech expert Avery Swartz finds this ironic:

“People find it hard to believe that computers could know so much about them, even though they are voluntarily feeding their information into the machine. For private citizens, Facebook’s targeted advertising is creepy. For advertisers, it’s captivating (Globe and Mail, April 23, 2018).”

Facebook doesn’t sell users’ data to advertisers. It sells access to data, so advertisers can target their ads to specific audiences. No wonder that advertisers like Facebook. They can place an ad for as little as one dollar a day and ad campaigns can be created for $100.

Targeted advertising is hardly unique to Facebook. It’s been around much longer than the internet. Big businesses target consumers by placing ads on certain TV stations at specific times. They distribute flyers to targeted neighbourhoods.

However, the issue is not targeted advertising. It’s the way that Facebook treats Canadians and whether its practices align with the values and practices imposed on other communications utilities.

There’s been a campaign to #DeleteFacebook but given how integrated the social medium is in the lives of Canadians, it’s not likely to succeed. An Angus Reid survey revealed that only four per cent plan to delete their accounts.

“Given its business model,” add Clement and Lyon, “Facebook on its own cannot meet the objectives of Canadian media regulations – advancing Canada’s identity and sovereignty, its social and economic fabric, universal accessibility, neutrality, affordability, openness, public accountability and rights protection.”

Canadians like Facebook. Now’s the time help Facebook like Canadians by making it truly ours.

Canadians look beyond America

For the first time in decades, Canadians are more likely to hold a negative view of the U.S. than positive. According to a survey by the Environics Institute, it’s the lowest ever with only 44 per cent saying that they hold a positive view of the U.S.

     image: openeurope.org.uk

It happened overnight says Doug Saunders:

“It is not a subtle drift – Canadians were overwhelmingly positive about the United States as recently as 2016, until Donald Trump’s inauguration put a majority into the anti-American column. The proportion of Canadians who see the United States as “a negative force in today’s world” is now almost 6 in 10, a 12-per-cent rise over 2008, making America by far the most negative country in the eyes of Canadians (Globe and Mail, April 16).”

Canadians see the U.S. even more negatively than even North Korea which is second at 46 per cent.

The U.S. and Britain used to be viewed as “standing out as a positive force in today’s world.” Now Germany is number one, Britain has fallen to second place, and Sweden has risen to third.

While we don’t share languages, we do see similar values in Germany and Sweden.  Those two countries took in two-thirds of Europe’s refugees during the crisis of 2016 at a time when President Trump was denouncing them. And they have avoided far-right governments, which make them look more like Canada.

Canadians look globally in terms of trade. Almost three-quarters of Canadians have a “very favourable” view on international trade. Even NAFTA is more popular than ever. Two-thirds of us say that it “helped rather than hurt” Canada -the highest level since the agreement took effect in 1994.

It may seem as though whatever Trump is against we favour, but it’s not just anti-Trumpism.

Peace defines Canada as much as war. Much has been made of the battle of Vimy Ridge as a defining moment for our country. However, peace played a significant role in shaping Canadian values. Pollster for Environics Institute, Michael Adams, says:

“In recent decades, Canadians have consistently named peacekeeping as their country’s most notable contribution to world affairs since Pearson’s Nobel Prize. This sentiment has held through both Canada’s World surveys that the Environics Institute has carried out, first in 2008 and in 2018 (Globe and Mail, April 16).”

Canadians are more connected than Americans. Anatoliy Gruzd, one of the authors of a recent report The State of Social Media in Canada, told CBC Radio’s Spark:

“Canada is one of the most connected countries in the world. There are twice as many Twitter users than the U.S. per capita. We are very outside-looking. We want to know world events (Mar. 11, 2018)”

Facebook is the most popular social medium with 84 per cent of Canadians having an account. YouTube is second at 59 per cent.

Canada is a nation of immigrants and, unlike the current U.S. president, we value them as an asset not a liability. Canadians look to the world, not only because trade is vital to our economy and to keep in touch with families in home countries, but because we see ourselves as part of a global community.

 

Indigenous labour is an untapped resource

Canadians opened their hearts and homes to Syrian refugees last year. It was a warm humanitarian gesture as well as an economic imperative: Canada relies on immigrants to sustain our work force.

    image: Government of Canada

Treatment of our Indigenous people is puzzling in both regards. Refugees from Indian Reserves do not receive a warm welcome. Communities don’t sponsor Indigenous families and put them up in homes. They are not being bombed but they are fleeing abominable conditions: mouldy housing, undrinkable water, poor education, appalling health care and little hope for employment. Instead of being helped, First Nations refugees often end up on city streets with few options for integration into society.

Not only are Indigenous Canadians uninvited in cities but the labour resource they represent is wasted.

The Centre for the Study of Living Standards released a report earlier this month entitled “The Contribution of Aboriginal People to Future Labour Force Growth in Canada.” The 36 page report outlines the wasted labour resource of Indigenous Canadians.

Indigenous citizens are the youngest, fastest growing demographic in Canada.

To start with, all Indigenous people are underemployed. More critically, participation of the 15-24 age group is 12 per cent lower than average. Only one-half of Indigenous youth are employed. That untapped resource could contribute to future labour force growth. It’s worse in the North where participation in the labour force is one-fifth the average.

If Canada’s Indigenous work force were developed, they would contribute to one-fifth of the future national labour growth. That contribution could be in the North, where they are most needed. As the global climate change warms and the climate of the North warms disproportionately, opportunities will open for jobs in resource extraction, infrastructure, housing and tourism. The expansion of the Indigenous work force In the North could comprise 83 per cent of total northern growth.

What would it take? The report states rather dryly:

“Indigenous people also face deficiencies in hours worked, employment, income by level of education and health among others. Progress must be based on Indigenous autonomy and this in turn will require strengthening administrative and managerial capacities, most likely under new institutional arrangements.”

In more vital words, it will take a reversal of our colonial past which was designed to dominate and assimilate Indigenous peoples. The Trudeau government made a good start when it divided the Indigenous portfolio in two with Jane Philpott becoming minister of Indigenous services and Carolyn Bennett becoming minister of Crown-Indigenous relations and Northern Affairs.

Some criticise the move as increased bureaucracy but the split was recommended in 1996 by the Royal Commission on Aboriginal Peoples. Both ministers are capable I can only hope they will succeed in ending the anachronistic Indian Act.

National Chief Perry Bellegarde of the Assembly of First Nations is optimistic:

“First Nations are working to move beyond the Indian Act and re-asserting our jurisdiction and sovereignty over our own lands, title and rights.”

Let’s bring our Indigenous brothers and sisters in from the cold. And if compassion doesn’t motivate Canadians, maybe a bleak economic future without them will.

Continental divide with U.S. widens

We used to think we were becoming more like our American cousins. In 2002 58 per cent of Canadians thought we were; now it’s only 27 per cent.

    “Weirdo” image: CBC

There’s more to the shift than the election of President Trump. We are maturing and are more confident. And it has to do with the realization that we are fundamentally different.

Those differences are revealed in response to a relatively simple statement: “The father of the family must be master in his own house.”

Because values are clustered together, response to that statement reveals other values says pollster Michael Adams: “Patriarchy is only one of more than 50 values we track, but it is clearly among the most meaningful. It is also a value that is highly correlated with other values such as religiosity, parochialism and xenophobia, and views on issues such as abortion, guns and the death penalty.”

American response to the statement cycles up and down. When asked in 1992, 42 per cent agreed. Support for patriarchy went up during the Bush presidencies and back down to 1992 levels during the Obama years. The election of President Trump has restored patriarchy to record highs.

Canadian response has been relatively constant for decades -in the low twenties.

It’s a versatile analysis. It also reveals the degree that immigrants adopt Canadian values. Thirty-five per cent of Canadian immigrants agreed with statement; not surprising when most immigrants come from male-dominated countries. In the U.S., substantially more immigrants agree with patriarchy at 56 per cent, even though they are from the same countries as in Canada.

I’m impressed with the way that Adams has of cutting through the clutter of public opinion. I wrote about his research in 2004 in my column for the Kamloops Daily News . Back then he was examining the connection between patriarchy and religiosity. “Canadians have more confidence in their ability to make moral decisions without deferring to religious authority,” said Adams.  As a percentage, twice as many Americans go to church weekly as Canadians, twice as many believe the Bible is literally true, and twice as many say religion is important to them.

In the same column, I argued that the continental divide is marked by something other than just the U.S./Canada border. Progressives on both sides of the border share the same “country.” I find that when I talk to people in the U.S. states of the Pacific Rim, they sound remarkably Canadian. Adams recent research confirms that progressive/populist divide in the U.S. Support for patriarchy is less strong in the coastal states than the Deep South.

Swings in U.S. support for patriarchy reveal a national insecurity. Psychoanalyst Robert Young has studied the psychology of populist movements. “When people feel under threat,” says Young, “they simplify; in a reduced state people cannot bear uncertainty.”

This siege mentality that currently grips the U.S. under Trump indicates just how insecure some Americans feel. Before 9/11, fundamentalist saw modernity and pop culture as a threat to core values. After September 11, the threat became global with the loss of jobs overseas.

The reasons why Canadians don’t want to become more like Americans is becoming ever clearer, as are the reasons why some Americans appreciate Canadian values.