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“Baby by Stealth” covers only one side of complex argument

March 23, 2010 6 comments

In her front-page National Post article, “Baby by Stealth”, journalist Kathyrn Blaze Carlson, suggests that a Canadian statute is causing Canadians to break the law. Quoting some professionals whose income is derived at least in part from assisted human reproduction, Carlson writes that the Assisted Human Reproduction Act is “forcing a slew of prospective parents underground”.

The article suggests that Parliament is wrong to treat people who just want to be a mom or a dad like criminals. But the one-sided argument hardly helps advance debate on this complex issue.

Regulating human reproduction in Canada has not been easy, especially for politicians who face re–election by citizens who can disagree fundamentally on reproductive matters.

Not surprisingly, every Canadian effort at regulation has been controversial. The Ontario Law Reform Commission bravely tackled the matter in 1982. But that all-male body recommended that “surrogacy” deals be enforced, even by taking a breast-feeding infant from its mother.

Canadian women reacted by lobbying for the federal Royal Commission on New Reproductive Technologies. It reported in 1993, after spending $28 million hearing from individuals and groups throughout the country and commissioning volumes of original academic research.

Despite the cost and the effort, it would be eleven years before Canada’s Parliament enacted the Assisted Human Reproduction Act.

And then in June 2008, the Quebec Court of Appeal decided that Parliament acted unconstitutionally regarding many statutory provisions because they concerned health – a matter within provincial jurisdiction. The Federal Government appealed to the Supreme Court, whose decision we await.

Meanwhile, the Federal Government has, since January 2009, had a duty to review the existing statute. It is unclear whether Prime Minister Harper’s government has even commenced the statutorily-required task.

This history can perhaps unite all Canadians in agreement on two points: it is difficult to pass legislation in a federation about matters as sensitive as whether people can buy semen, ova and embryos; and some Canadians are bound to feel badly treated by everyone’s best efforts to regulate assisted human reproduction.

So maybe we should not ask, “How can we make everyone happy?” but rather, “Whom should we worry about the most?”  Parliament admirably answered this question in 2004 when it recognized and declared that, “the health and well-being of children born through the application of assisted human reproductive technologies must be given priority in all decisions respecting their use”.

So what are the health and well-being interests of the children? Some reproductive technology providers say, “The children should be grateful to be alive.” In other words, they believe that the children’s interests are in being born and the consequences of the methods are irrelevant.

But many disagree. Some people conceived by third party gametes say that not knowing half of their identity creates a significant loss. Many claim that not only must they grieve this loss; they must defend the legitimacy of their grief – a double blow.

Some donor-conceived people compare themselves to adoptees whose loss is recognized. Adoptees are encouraged to seek their birth parents and are aided by government registries in their search. By contrast, parents who use third party gametes need not tell children the truth about their conceptions. Nor is anyone who knows the identity of the genetic parent required to disclose this fact to the child, even when the child becomes an adult.

Whilst the donor-conceived and adoptees arguably suffer similar losses in being separated from their genetic parents, adoptees can find resolution of the loss in the knowledge that the decision to surrender them for adoption was arrived at with great emotional difficulty, as a last resort. The donor-conceived, however, can find it much harder to find resolution of this deliberate separation of genetic and social parenting.

The donor-conceived can believe that their genetic parents were only interested in money, and gave no real thought to the children they were helping to create. They can be devastated by the full import of what their genetic parents did – that their parents were motivated by the money. A condition of the sale can be the promise of anonymity, but the donor-conceived can be severely affected by their inability to meet their genetic parents or even know their names.

Curiously, the National Post article seems to lament, “We see donors who originally thought they didn’t want to be very involved, but who then want increased involvement after the child is born.” How is parental involvement with his or her child a bad thing, even if it is inconvenient for the rearing parents? Children are usually glad to know and to develop a relationship with their genetic parents.

Parliament’s decision to ban the sale of semen, ova and embryos is bound not to make everyone happy. But insofar as it attempted to protect human reproduction from becoming a commercial enterprise, its motivation is honourable.

In the reproductive technology business, some people claim that adults have a right to have a child no matter what the cost. Parliament and Canadian legislatures have a moral duty to investigate the costs to prospective children and to take steps to reduce them.

When regulating assisted human reproduction, the health and well-being of children and prospective children must be given priority, even if commercial or other adult interests might incidentally be thwarted.

Dr. Juliet Guichon is Senior Associate in the Office of Medical Bioethics and a faculty member of the Department of Community Health Sciences in the University of Calgary Faculty of Medicine.

The coming cancer crunch

By Dr. Peter Craighead
For The Calgary Herald — March 18, 2010

Publicly funded health care is only sustainable by focusing on and providing what is needed by its constituents.

During the boom years, many Albertans and their health-care leaders assumed we could ask for whatever we wanted. The truth is that Alberta’s health-care system now is forced to balance the needs of our public against the wants of its health-care leaders, whether this is in the provision of surgical services for joint replacement, caring for stroke patients or funding expensive cancer treatment.

The Rolling Stones aptly describe this in their song: “You can’t always get what you want, but if you try sometime you just might find, you get what you need.” The recent flurry of discussions around a new cancer centre in Calgary forces us to ask whether this is a need or a want.

Almost one in two Albertans will develop cancer in their lifetime, and one in four will die from this disease. Another way of looking at this is to realize that there were 14,500 new cancer cases diagnosed in 2009, and there are an estimated 80,000 people living with cancer in our province. About 85 per cent of these cancer patients will be seen and treated at cancer centres around the province. The Tom Baker Cancer Centre in Calgary is one of two major centres in the province, currently sees 150,000 patient visits annually and is the major referral centre for cancer care in southern Alberta.

So what is it that Albertans need when it comes to cancer care, and how has the system responded to this? Albertans with cancer need to receive state-of-the-art treatments in a timely, respectful manner; they should have access to care as close to home as possible; and they should not suffer pain or emotional distress. We also believe that Albertans should have access to prevention strategies that reduce the incidence of cancer and screening that finds the disease at an early, curable stage.

Until the second half of the last decade, Alberta’s health system responded well to these needs. For example, by the early 2000s the province had built up a network of facilities across the province, was highly responsive to cancer drug treatment requests and supported the purchase of expensive radiotherapy equipment in Edmonton and Calgary. Alberta was considered one of the best places to receive cancer treatment, and the place to work if you were a cancer specialist. This was evidenced by the successful recruitment of medical specialists, researchers, nurses and other professionals.

The rapid growth of Alberta’s population, continued increase in cancer numbers, success in recruitment and the change in our health system have all contributed to a growing capacity problem for us. Facilities in Edmonton and Calgary have outstripped their space, leading to a significant impact on patient experience. Cancer care has worked with the province to identify solutions, including the distribution of radiotherapy to smaller cities, plans to expand buildings in Edmonton and Calgary, and using leased space to tide us over for the medium term. We are also improving efficiencies within our centres to increase patient throughput.

The TBCC responded by moving some functions off site, because there was no available expansion space at Foothills Hospital. Since 2003, we have completed two phases of renovations in leased space at the Holy Cross Hospital, and the space we are currently renovating will allow us to expand treatment facilities at the Tom Baker site, so we can sustain our comprehensive service to cancer patients for southern Alberta for at least another three years. A few years ago, we also relocated many of the day procedures that we previously performed within the TBCC to the Foothills, but it is apparent that the rest of the system has minimal capacity to accommodate any further growth. Finally, we are in discussion with South Health Campus planners to see whether that space will provide us options for dealing with our space crunch in the medium term.

How have these decisions affected patient experience in Calgary? As I write this, patients experience serious overcrowding in our facilities, are made to travel between sites for various parts of their clinical care and some of them have excessive wait times to get in to see oncologists.

Fortunately, the wait times for treatment other than surgery continue to fall within our guidelines of two weeks for chemotherapy and eight weeks for radiotherapy. But the fragmentation of services into two sites means patients cannot take advantage of all services at one time. A further complication of providing clinical services across the city is that our clinical staff becomes less efficient by having to include transit times into their day. Simply put, distributing the services of one cancer centre within a city provides a suboptimal patient experience compared with full-service cancer centres.

Predictions tell us that by 2013, when the breathing room provided by Holy Cross will have been exhausted, we can expect to be seeing six to eight per cent more new cases, and to be treating 10 per cent more patients. Although the opening of Lethbridge radiotherapy facilities will help us deal especially with radiotherapy referrals, and the increase in throughput initiatives will gain some efficiencies in chemotherapy treatments, it is predicted that we will be facing severe shortages in Calgary by 2013. Given the budgetary pressures facing Alberta Health Services, it will take significant focus on our part to see a co-ordinated strategy for cancer in the next 12 months. The short-and medium-term solutions we have employed have allowed us to provide excellent care, albeit of a somewhat fragmented nature.

AHS has made efforts to respond to cancer patients’ needs in the short term, but we now must challenge ourselves to move away from a “building the new system” mode into focusing on how to address the longer-term needs of patients, including the particular needs of cancer patients in Calgary.

As a medical leader within AHS Cancer Care, I am ready to support any planning process that ensures that future patients in Calgary are provided a superior experience, and that we are able to address their need to receive timely, quality care.

Peter Craighead, MD FRCPC, is senior radiation oncologist and director of the Tom Baker Cancer Centre.

Read more: http://www.calgaryherald.com/health/coming+cancer+crunch/2695990/story.html#ixzz0iXuD3sPl

Fatal Lobby

Re: “Ottawa ‘has gone too far’ on flavoured smokes ban,” Feb. 20.

I was dismayed to read about the federal government being pressured to rescind the ban on flavoured tobacco by congressmen from Indiana, Kentucky and Virginia. Tobacco is the leading preventable cause of heart disease, stroke, emphysema and cancer, the four leading causes of death in Canada and the U.S. I am a specialist in lung diseases and see the devastating effects of the tobacco epidemic daily.

Most people think tobacco-related diseases are primarily diseases of the elderly, but young people are also affected. One of my saddest memories was my last visit to a 38-year-old patient dying from lung cancer who was reading a pamphlet titled, How To Tell Your Young Children That You Are Dying. She had started smoking in junior high with friends and was unable to quit. Flavoured tobacco, not just the candy-flavoured types, but those blended to reduce the harshness of some tobaccos only have one purpose — to hook young people.

Once people are hooked, they will smoke anything to get their nicotine fix. These politicians are beholden to the tobacco industry and its lobby and don’t focus enough on the devastating effect tobacco has on Canadians and their families. Nor do they care about its huge costs to our healthcare system.

Non-smokers are also hurt by tobacco’s health consequences. A doctor’s office or a hospital bed used by a smoker only delays access to, and increases wait times for, non-smokers when they need health care.

Stephen Field, MD, Calgary Stephen Field is a clinical professor of medicine at the University of Calgary medical school

© Copyright (c) The Calgary Herald

Teaching hospitals and consent

From Tuesday’s Globe and Mail Published on Tuesday, Feb. 02, 2010 12:00AM EST

Re Time To End Pelvic Exams Done Without Consent (Life, Jan. 28): Medical students would not “parade” into the operating room after a gynecologic procedure is finished, to undertake a pelvic floor examination on an anaesthetized woman. The usual practice is for a single medical student to be present throughout as a member of the surgical team.

In Calgary, patients give written consent for medical students to be involved in their surgical care, including medically necessary examinations, and patients are specifically informed before surgery, by the surgeon, that they may be examined by a trainee. If a patient objects, their wishes are honoured.

A medical student can only undertake a pelvic exam if the exam is required as part of surgery and the student is part of the surgical team.

Dr. Sara Wainberg’s paper discussed women’s attitudes to pelvic floor examinations being undertaken by medical students, in relation to consent. The concern expressed by a number of scholars is whether implicit consent for pelvic-floor exam under anesthetic, by a trainee, as recommended by the Society of Obstetricians and Gynecologists of Canada guidelines, is sufficient.

Implicit consent should be supplemented by the surgeon explicitly informing the patient that she may be examined by a trainee, as stressed by the guidelines. Of paramount concern is the need for medical students to learn basic examination techniques in a safe, well supervised setting. In the case of pelvic examination on an anaesthetized woman, it is also important to ensure the patient is adequately informed.

Sue Ross, director of research; R. Douglas Wilson, head, Obstetrics and Gynecology, University of Calgary

Two UCalgary clinician scientists named Canada’s Top 40 Under 40 2008

By Andrea Di Ubaldo

Dr. Fiona Costello: photo provided

Dr. Fiona Costello: photo provided

As Albert Einstein once said, “Life is like riding a bicycle. To keep your balance you must keep moving.”

Indeed, Dr. Fiona Costello and Dr. Andrew Demchuk seem to have found their perfect balance by constantly moving. Both were recently named to the Caldwell Partners International’s Top 40 Under 40 list.

The award is given to individuals who have shown vision and leadership; innovation and achievement; impact; community involvement and contribution; and growth / development strategy. Out of approximately 1200 nominees, Costello and Demchuk are two out of six physician scientists awarded this honour as chosen by an independent advisory board.

Balancing, more like juggling

Dr. Andrew Demchuk: photo provided

Dr. Andrew Demchuk: photo provided

For Demchuk, co-leader of the Attacking Stroke program at the Hotchkiss Brain Institute in the Faculty of Medicine, it’s all about the ‘Big 5’: education; administration; research; clinical care; and family. Not necessarily in that order.

“I try to do all things because I like all five,” Demchuk says. “I have a great wife who manages most of the day-to-day raising of our two boys; I’m a quality time kind of guy, so I get to do the fun stuff with the boys at night and on weekends.”

Demchuk is the director of the Calgary Stroke Program, chair of Pillar 2 (Acute Care and Emergency Services) of the Alberta Provincial Stroke Strategy, past-chair of the Board of Directors of the Heart and Stroke Foundation of Alberta, NWT and Nunavut, and an associate professor with the Departments of Clinical Neurosciences and the Department of Radiology at UCalgary.

In addition to his teaching and clinical practice, Demchuk is also a world-renowned researcher whose primary research interests lie in the area of cerebral vascular imaging and its application in developing new treatments for those who have suffered from stroke.  .
He admits to verging on workaholic status, as a director, teacher, researcher, physician, husband and father.

Kids keep things in perspective

“I have four kids aged eight, five, three and six-months. It’s often a gong show,” Costello laughs. “I’m married to a great guy, who has a very demanding career. It’s tough to balance, but we work well together.”

Costello is a clinician scientist and co-director of the NeuroProtection and Repair Evaluation Unit (NPREU) with the Arresting Multiple Sclerosis (MS)  program at the Hotchkiss Brain Institute at the Faculty of Medicine and an associate professor in the Department of Clinical Neurosciences. Her research and clinical expertise are in the areas of neuro-ophthalmology and multiple sclerosis.  Together with her collaborators, she has been awarded $2.5 million research grant funding to implement a novel experimental model of MS she has developed in ongoing studies.

“I use the visual system as a means of finding new ways to look at old problems.
The eye can give us many insights into mechanisms of brain injury, and help us better understand diseases like multiple sclerosis,” she says.

“It’s a great honour because this award isn’t restricted to the medical community,” 39-year-old Costello says. “Everyone goes in on an even playing field, all experts in their respective areas.”

Demchuk, also 39, believes it’s an honour for both him and his team. “It’s a bit of validation for all of the hours and days of work we put in. My CV would be miniscule without a team.”

Costello says her kids have made her a better physician and person and much better at time management. “My kids have forced me to be more focused and less self – indulgent with my time.”

“And kids don’t care what awards you’ve won,” she adds.

About the Faculty of Medicine at the University of Calgary
UCalgary’s Faculty of Medicine is a national leader in health research with an international reputation for excellence and innovation in health care research, education and delivery. We train the next generation of health practitioners and move new treatments and diagnostic techniques from the laboratory bench to the hospital bedside, improving patient care.  For more information visit http://medicine.ucalgary.ca. or follow us on twitter.com @UofCMedicine.

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Doctor Shortage Symposium: Controversially educational

By Andrea Di Ubaldo

Pick a hot topic, add some industry professionals, invite everyone you can think of. What do you get? A Medical Student Health Policy Symposium that is both educational and, as the organizers hope, a little bit controversial.

2nd Annual Medical Student Health Policy Symposium

2nd Annual Medical Student Health Policy Symposium: Event poster

The symposium will be on May 7, 2009 from 7:00 p.m. to 9:30 p.m. in the Faculty of Medicine’s Libin Lecture Theatre at the Health Sciences Centre.

Alaina Aguanno, a third-year medical student, and Kevin Wasko, a first-year medical student at the University of Calgary, are co-organizers of this year’s symposium which will discuss Canada’s doctor shortage. The two also sit on the students’ council as Vice-Presidents of External Affairs for their respective classes.

“We hope that this symposium answers a few questions but stirs up many more,” Aguanno says. “The issues we are discussing are complex – contributing factors and management strategies will only scratch the surface of the potential for the topics surrounding this issue.”

“We hope attendees will gain a better understanding of the physician shortage in Canada and what is being done to address the issue,” Wasko adds.

The annual symposium was created last year by Aguanno, who holds a masters of science in the areas of health policy and health economics and wanted to share her passion for these topics.

“I created the symposium because I felt that health-care professionals, and especially medical students like me, could benefit from a greater understanding of the social, political and economic context of the system in which we work,” Aguanno says.

Only in its second year, the event will feature many high-profile speakers, including the Hon. Ronald Liepert, Minister of Health and Wellness along with the presidents of the Canadian Medical Association (CMA) and the Alberta Medical Association (AMA), Drs. Robert Ouellet and Noel Grisdale, and professors from UCalgary and the University of British Columbia.

“We invited the people who we thought were best-suited to answer our questions and they said yes!” Aguanno says excitedly. “Our speakers have been very enthusiastic about this event, both last year and again this year; we are fortunate to have such dedicated teachers and leaders.”

Last year’s symposium examined public, private and mixed models of health care financing and featured Dr. Brian Day, CMA president, and Dr. Darryl LaBuick, AMA president, along with Dr. Tom Noseworthy, professor and head of the Department of Community Health Sciences and director of the Centre for Health and Policy Studies at UCalgary.

“We’re really excited about this year’s event. With the enthusiastic support we received last year, the first symposium was at maximum capacity,” Aguanno smiles.

Learn more about the 2nd Annual Medical Students Health Policy Symposium.

About the Faculty of Medicine at the University of Calgary
UCalgary’s Faculty of Medicine is a national leader in health research with an international reputation for excellence and innovation in health care research, education and delivery. We train the next generation of health practitioners and move new treatments and diagnostic techniques from the laboratory bench to the hospital bedside, improving patient care.  For more information visit http://medicine.ucalgary.ca. or follow us on twitter.com @UofCMedicine.

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Faculty of Medicine professor awarded national research chair

Dr. Lynn McIntyre (front row, third from left) with five other researchers awarded chair in New Perspectives in Gender, Sex and Health from CIHR.

Dr. Lynn McIntyre (front row, third from left) with five other researchers awarded chair in New Perspectives in Gender, Sex and Health from CIHR.

A UCalgary Faculty of Medicine professor and researcher–whose passion for eradicating global food insecurity has taken her as far away as Bangladesh to study the issue–has been awarded a research chair in New Perspectives in Gender, Sex and Health by the Canadian Institutes of Health Research (CIHR).

As part of research chair program created by the CIHR’s Institute of Gender Health (IGH), Dr. Lynn McIntyre, professor, Department of Community Health Sciences, was awarded the chair along with five other leading health researchers from across Canada.

“The chairs are producing cutting-edge research with enormous potential to improve the health of Canadians, such as Dr. McIntyre’s research on hunger and food insecurity domestically and internationally,” says Dr. Joy Johnson, Scientific Director of the Institute of Gender and Health. “Her work focuses on women and children, the most frequent victims of food insecurity both in Canada and in other countries.”

McIntyre’s work–which is in line with the first Development Millennium Goal of halving world hunger by 2015–took her to Bangladesh where she studied hunger amongst both urban and rural populations.

During the in-depth study, McIntyre spoke to groups of highly vulnerable woman, living on less than one dollar a day and responsible for providing for their families. The intense field work included door-to-door recruitment and speaking to these women about food insecurity and hunger in various remote locations and in the slums of Dhaka.

In Bangladesh to present findings

Her principal finding was a need for a whole person development approach–a readjustment of available health care services to ensure they meet the needs of these women and others like them. McIntyre is currently in Bangladesh sharing her findings with government officials and non-profit agencies.

“The women have told me, ‘We knew when we met you that you were going to do something for us,’ and I am doing my best to bring improved understanding to those who really can do something for millions of women like them,” says McIntyre.

Closer to home, McIntyre is part of a study looking at social policies in Canada created between 1996 and 2006, focusing on their impact on national food insecurity. She’s also working with Alberta Health Services as they begin investigating the impacts of food insecurity on their patient population, the first clinical site in Canada to do this.

The IGH created the research chair program to expand and strengthen research capacity relevant to gender (socio-cultural experiences), sex (biological factors) and health in Canada. It is intended for health researchers who have developed a reputation for excellence in research, and to support outstanding research programs that enhance the health of Canadians.