Law Commons^™

Making "Medical": How Psychedelics Are Becoming Legal In Canada, Agnieszka Doll

Dalhousie Law Journal

As legal restrictions loosen, psychedelic-assisted therapies are advancing at an unprecedented pace and scope in Canada and the US. Presented as a miracle cure for post-traumatic stress, depression, and other psychological disorders, psychedelics are being touted to treat post-pandemic mental health crises. In this paper, drawing on Science and Technology Studies, I ethnographically trace the ongoing process and practices involved in transforming illegal psychedelics into a regulated medicine in Canada, paying particular attention to regulatory pathways and the development of networks involved in psychedelic advocacy. Using these pathways as a methodological “sampling device,” I map the main actors, their mutual …

Artificial Intelligence In Canadian Healthcare: Will The Law Protect Us From Algorithmic Bias Resulting In Discrimination?, Bradley Henderson, Colleen M. Flood, Teresa Scassa

Canadian Journal of Law and Technology

In this article, we canvas why AI may perpetuate or exacerbate extant discrimination through a review of the training, development, and implementation of healthcare-related AI applications and set out policy options to militate against such discrimination. The article is divided into eight short parts including this introduction. Part II focuses on explaining AI, some of its basic functions and processes, and its relevance to healthcare. In Part III, we define and explain the difference and relationship between algorithmic bias and data bias, both of which can result in discrimination in healthcare settings, and provide some prominent examples of healthcare-related AI …

Conflicts Of Interest In Self-Regulating Health Professions Regulators, Andrea Macgregor

Dalhousie Law Journal

This article analyzes a set of related complaints and informal reports made to the Nova Scotia College of Chiropractors with respect to an alleged breach of the College’s advertising policy. This analysis assessed situational elements of conflicts of interest in the complaint process, particularly dual roles and competing professional interests, against the Childress et al framework of ethical public health decision-making and the conflict-of-interest standards in the Nova Scotia Chiropractic Act and Regulations.

The analysis concludes that the legislative scheme fails to adequately regulate conflicts of interest and bias in the College’s disciplinary decision-making processes through weak or unarticulated standards …

Faith And/In Medicine: Religious And Conscientious Objections To Maid, Daphne Gilbert

Dalhousie Law Journal

Across Canada, health care institutions that operate under the umbrella of religious traditions refuse to offer medical assistance in dying (MAiD) on the grounds that it violates their Charter-protected rights to freedom of religion and conscience. This article analyses the Supreme Court jurisprudence on section 2(a) and concludes that it should not extend to the protection of institutional rights. While the Court has not definitively pronounced a view on this matter, its jurisprudence suggests that any institutional right to freedom of religion would not extend to decisions on publicly-funded and legal health care. MAiD is a constitutionally-protected option for individuals …

Does “No, Not Without A Condom” Mean “Yes, Even Without A Condom”?: The Fallout From R V Hutchinson, Lise Gotell, Isabel Grant

Dalhousie Law Journal

In R v Kirkpatrick, the Court of Appeal for British Columbia held that consent to sexual activity cannot be established where a man proceeds with unprotected vaginal intercourse when his sexual partner has insisted on a condom. While this finding should be uncontroversial, it is in fact contrary to the Supreme Court of Canada ruling in R v Hutchinson. In this comment we argue that the approach taken in Kirkpatrick is correct and consistent with the landmark decision in R v Ewanchuk. We urge the Supreme Court of Canada to reconsider its majority judgment in Hutchinson in order to fully …

The Opioid Crisis As Health Crisis, Not Criminal Crisis: Implications For The Criminal Justice System, Haley Hrymak

Dalhousie Law Journal

The criminal justice system’s response to the opioid crisis exacerbates risks faced by people using drugs and is harmful to public health. Interviews with 11 interviewees including defence counsel, probation officers, and public interest lawyers and advocates revealed three key challenges of working in the criminal justice system during the opioid crisis. First, there is a lack of understanding of addiction within the criminal justice system. Second, as a result of the opioid crisis, fentanyl trafficking sentencing decisions in British Columbia emphasize the need for lengthier prison sentences, which disproportionately affects people who use substances. Third, the conditions on bail …

Moneyball In The Era Of Biometrics: Who Has Ownership Rights Over The Biometric Data Of Professional Athletes?, Christopher Casher

Dalhousie Journal of Legal Studies

The 2003 release of Michael Lewis’s book, Moneyball, brought into the mainstream a new paradigm for professional sports management: the use of statistical analysis to identify currently undervalued athletes in an effort to gain a competitive advantage. This pressure to accurately value athletes has led, in part, to the widespread collection of professional athletes’ biometric data. While biometric data can create many benefits, its misuse can lead to detrimental outcomes for the athletes, including inequitable contract negotiations, loss of potential revenue from monetization of said data, and a loss of privacy. Thus, this paper seeks to determine who holds the …

A Comparative Analysis Of Voluntariness Safeguards And Review Procedure Under Oregon And The Netherlands' Physician Assisted Dying Laws, Michaela Estelle Okninski

Dalhousie Law Journal

This article provides a comparative statutory analysis of the requirements for a voluntary decision in a request for physician assisted dying under Oregon's Death with Dignity Act and the Netherlands' Termination of Life on Request and Assisted Suicide (Review Procedures) Act. This comparative analysis aims to provide insight into how voluntariness is determined in practice and how the review procedure is conducted, with a view to identifying strengths and limitations within a legislative framework. First, the legislative safeguards aimed at protecting a voluntary decision are discussed. This is followed by an examination of the review procedure. This article concludes by …

Legalizing Assisted Dying: Cross Purposes And Unintended Consequences, Emily Jackson

Dalhousie Law Journal

In the UK, assisted dying continues to be unlawful, and pro-legalization campaigners have made use of human rights based applications for judicial review and Private Members Bills in order to try to change the law. Interestingly, however, the proposed statute would not offer an assisted death to many of the litigants who have sought to force Parliament's hand. This article considers whether this a one-off peculiarity, or whether there might be other mismatches between what the law can achieve and what matters most to people who are seeking an assisted death for themselves. It also explores what seems to be …

Foreseeably Unclear: The Meaning Of The "Reasonably Foreseeable" Criterion For Access To Medical Assistance In Dying In Canada, Jocelyn Downie, Kate Scallion

Dalhousie Law Journal

Canada's medical assistance in dying legislation contains the eligibility criterion "naturaldeath has become reasonably foreseeable." The phrase "reasonably foreseeable" is unfamiliar and unclear. As a result of ongoing confusion about its meaning, there is reason to be concerned that under- or over-inclusive interpretations of the phrase are adversely affecting access to MAID. With critical interests at stake (eg access to MAiD and potential criminal liability), it is essential that the meaning of the phrase be clarified. Furthermore, the meaning of "reasonably foreseeable" will be at issue in the Charter challenges to the federal MAiD legislation currently before the courts in …

Euthanasia By Organ Donation, Michael Shapiro

Dalhousie Law Journal

Euthanasia, the administration of therapy designed to hasten death, particularly in patients with intolerable suffering, has been gaining in acceptance in countries around the world, most recently in Canada. Organ donation from deceased organ donors has always been performed under the strictures of the dead donor rule, the requirement that donors be declared dead prior to any organ recovery. Recent scientific and ethical investigations, however, have questioned whether all donors, whether pronounced based on neurologic (brain death) or circulatory criteria are, in fact, dead. One potential approach to this quandary would be to abandon the fiction imposed by the dead …

Physicians' Attitudes, Concerns, And Procedural Understanding Of Medical Aid-In-Dying In Vermont, Teresa Ditommaso, Ari P. Kirshenbaum, Brendan Parent

Dalhousie Law Journal

The general purpose of the current study was to collect data on physicians' attitudes towards Act 39, the medical aid-in-dying act that was legislatively approved in 2013. Given the recent nature of the implementation of Act 39, this is the first such study to be conducted in the State of Vermont. The survey was quantitative in nature and addressed three distinct aspects of legalized prescribing of life-ending medication, these being physicians': (I) attitudes regarding ethics and legality of Act 39, (11)understandings of the policies and procedural requirements under the law, including their belief in legal immunity from penalty, and (I1) …

Trying And Dying: Are Some Wishes At The End Of Life Better Than Others?, Oliver J. Kim

Dalhousie Law Journal

In the United States, efforts to create a "rightto try," or to provide access for the terminally ill to try experimental drugs, have seen overwhelming success in passing state legislatures. This success provided the foundation for advocates' long-term goal of a federal right to try. Yet proposals ranging from very modest advance-care-planning consultations to the "rightto die,"or medical aid in dying, face steep political challenges despite seeming public support. This paper discusses the legal underpinnings of both "rights" and the current political and policy debate over each. More often than not, these "rights" are grantedthrough legislation rather than judicial decisions, …

Questioning Polst: Practical And Religious Issues, Lloyd Steffen

Dalhousie Law Journal

The Physician Orders for Life Sustaining Treatment (POLST) is a one-page transferrable medical chart insert designed to facilitate physician-patient communication about a patient's wishes at the end of life. The document as a chart addition is in widespread use today, but various criticisms have been leveled at POLST, the most serious being that POLST creates a slippery slope to illicit active euthanasia. This article examines the criticisms and finds that they fit two categories, the first being practical implementation problems. These problems are correctable given more and better training of medical care staff. The second and more serious ethical charge …

Informing The Future Of End-Of-Life Care In Canada: Lessons From The Quebec Legislative Experience, Michelle Giroux

Dalhousie Law Journal

There have been numerous and challenging developments respecting endof-life care in Canada. In Quebec, political consensus and changes in public opinion led to the adoption of end-of-life care legislation. This paper discusses the context and foundation of that reform and reviews its content with the objective of informing the future of end-of-life care in Canada. In the first part of the paper I explore the balancing of the right to life and autonomy, with a focus on the approach chosen in Quebec by the Legal Experts Panel Report. In Part 11, I discuss Quebec's adoption of An Act Respecting End-of-Life …

Cross-Cultural Dynamics In Palliative Care: The Emerging Canadian Scenario, Chidi Oguamanam

Dalhousie Law Journal

As modern technologies leverage medical sciences, life expectancy is on the rise in Canada, and indeed globally with a remarkable increase in the elderly population in need of health care. The same is true of the diversity of cultural groups who are now patrons and stakeholders in Canada's health care landscape. An emergent feature ofthis landscape is the complexity ofcontexts for negotiating and mediating medical care delivery at the end of life. This paper examines the gaps in regulatory and legal interventions as well as the gaps and opportunities to negotiate the transition to palliative care in cross-cultural contexts that …

The Future Of Health Law: How Can Law Meet Emerging Health Challenges?, Colleen M. Flood, Lorian Hardcastle

Dalhousie Law Journal

Canadians have often prided themselves on having one of the best health-care systems in the world, but in recent years our system has fallen to the bottom of relevant international comparisons. Incremental attempts to improve the system have not resulted in significant improvements and the reality is that our most pressing challenges can be addressed only through ambitious, systemic reforms. For example, it is well established that Canada's patchwork scheme for providing long-term care will not scale to meet growing needs as a quarter ofthe population enters retirement age over the next two decades.' As yet further examples, the Canadian …

Imagining Global Health With Justice, Lawrence O. Gostin

Dalhousie Law Journal

This article offers a way to achieve global health with justice as a global health imperative. It is possible to have global health without justice, meaning that improvements in health outcomes could be achieved, but without a fair distribution of the benefits of good health. It is also possible to have justice without global health, where health outcomes are evenly distributed across the population but overall health is not improved. With this understanding, this article challenges current ways of understanding global health, and argues that absolute reductions in morbidity and premature mortality are not robust indicators of success in the …

Modernizing The Canada Health Act, Colleen M. Flood, Bryan Thomas

Dalhousie Law Journal

The Canada Health Act (CHA) was adopted in 1984, to shore up a health-care system conceptualized in the 1960s. Under the CHA, universal coverage is limited to "medicallynecessary" hospital and physician services, to the exclusion of vital goods and services such as outpatient pharmaceuticals, dental care, long-term care, and many mental health services. Inequities resulting from these gaps in public coverage are partly to blame for pushing Canada's health system to the bottom ofrecent international rankings. But there is more to modernizing Canada s health care system, we argue, than filling these gaps in universal coverage. Every major health system …

A Consumer Protection Perspective On Regulation For Healthier Eating, Barbara Von Tigerstrom

Dalhousie Law Journal

This article explores the potential for a consumer protection perspective to complement public health approaches in designing and justifying laws that aim to promote healthier eating, such as food labelling regulations or restrictions on marketing and advertising. Consumer protection and public health are distinct perspectives, but they share the goal of protecting health and both accept the need for regulation to protect important interests. Consumer protection objectives could be used to defend public health measures that are challenged as infringing rights or restricting trade. Insights from consumer law and scholarship could also contribute to discussions about when regulatory intervention to …

A Goal-Oriented Understanding Of The Right To Health Care And Its Implications For Future Health Rights Litigation, Michael Da Silva

Dalhousie Law Journal

International human rights law recognizes a right to health. A majority of domestic constitutions recognize health-related rights. Many citizens believe that they have a moral right to health care. Some theorists agree. Yet the idea of a right to health care remains controversial. Specifying the nature of such a right invites more controversy. Indeed, most models of the right face persistent problems that threaten to undermine the conceptual coherence of a right to health care. This article accordingly sketches preliminary arguments for a new, goal-oriented model of the right to health care. It explains that the model avoids most of …

And Miles To Go Before I Sleep: The Future Of End-Of-Life Law And Policy In Canada, Jocelyn Downie

Dalhousie Law Journal

This paper reviews the legal status of a number ofend-of-life law and policy issues that have, to date, been overshadowed by debates about medical assistance in dying. It suggests that law reform is needed in relation to palliative sedation without artificial hydration and nutrition, advance directives for the withholding and withdrawal of oral hydration and nutrition, unilateral withholding and withdrawal of potentially life-sustaining treatment, and the determination of death. To leave the law in its current uncertain state is to leavepatients vulnerable to having no access to interventions that they want or at the other extreme, being forced to receive …

Approval Of New Pharmacogenomic Tests: Is The Canadian Regulatory Process Adequate?, Yann Joly, Emma Ramos-Paque

Canadian Journal of Law and Technology

In the first part of our analysis, we will examine the impact which pharmacogenomics is expected to have on drug research and development, on the drug approval process and on post-marketing surveillance and clinical practice. This will allow us to show how pharmacogenomic testing could be beneficial to drug companies, regulatory bodies, and patients. The second part of our analysis will focus on the regulatory framework applicable to the approval of pharmacoge- nomic tests in Canada, although we are aware of the fact that most manufacturers decide to approve their tests outside of Canada. As mentioned, the applicable regu- lations …

Canadian Personal Data Protection Legislation And Electronic Health Records: Transfers Of Personal Health Information In It Outsourcing Agreements, Dara Lambie

Canadian Journal of Law and Technology

Personal data protection and privacy of personal health information in the electronic era is a broad topic that includes consent, security measures and access considerations. The focus of this article is on one component of the larger picture: data transfers of personal health information that occur in the context of informa- tion technology (“IT”) outsourcing. If the societal good envisioned by an inter-jurisdictional EHR is to be fully realized, then the necessity of outsourcing is a reality that must be addressed.

How I Learned To Stop Worrying And Love The Gats: An Examination Of The Impact Of The General Agreement On Trade In Services On The Canadian Health-Care System, Brian N. Zeiler-Kligman

Dalhousie Law Journal

There is perhaps no more cherished Canadian institution than our universal health-care system, Medicare. Despite Canadians' fondness for Medicare, there are often allegations that various external elements threaten Medicare's viability. One of these oft-cited elements is the General Agreement on Trade in Services (GATS), which some have claimed will force the privatization of all public services. The truth in such claims is tested by examining the effect the GATS is likely to have on the Canadian health-care system. The examination includes an interpretation of GATS Article 1.3 through a textual analysis. GATS' impact on this system is explored on three …

In (Or Out Of) The Marketplace Of Ideas: Warf V. Geron And Lessons For Canada, Matthew Herder

Dalhousie Journal of Legal Studies

Four days after President George W. Bush addressed America regarding human embryonic stem cell ("hESC") research in August 2001, a lawsuit was filed by the Wisconsin Alumni Research Foundation (“WARF”) against Geron Corporation ("Geron"). WARF holds patents in respect of hESC technologies pioneered by James Thomson. The parties were unable to negotiate licences for additional hESC types. In January 2002, WARF and Geron announced that a new agreement had been reached. This paper examines the antecedent question: should the hESC technologies have been patentable in the first place? The reason for pursuing hESC research appears to be the possibility to …

Balancing Regional Government Health Mandateswith Federal Economic Imperatives: Perspectives Fromnova Scotia And Illinois, John Blum

Dalhousie Law Journal

This article focuses on current health policy changes in Canada and the United States at the federal and regionallevels. The Canadian discussion centres on the integrity of the Canada Health Act in the era of the Canada Health and Social Transfer, and the strategies that provincial governments have pursued to cope with persistent funding constraints. On the American side, the article examines the role of private sector managed care plans in filling a health policy void resulting from the demise of the Clinton Health Security Act. Two specific regional government health reform initiatives in Nova Scotia and Illinois are discussed …

Managed Competition Reform In The Netherlandsand Its Lessons For Canada, Frederik T. Schut, Herbert Egm Hermans

Dalhousie Law Journal

This article provides an economic and legal perspective on the managed competition reforms within the Netherlands. After an examination of the rationale and the main features of the reforms, a number of problems and dilemmas that were encountered during the implementation process will be highlighted. The authors conclude that although the logic of the managed competition model is appealing, its implementation is quite complicated and requires a strong government with a continued commitment to set and enforce the rules of competition. If these preconditions are not met, the prospects of a successful introduction of managed competition are bleak. Despite its …

In Search Of Universality, Equity, Comprehensivenessand Competition: Health Care Reform And Managedcompetition In Israel, Carmel Shalev, David Chinitz

Dalhousie Law Journal

Israel's ongoing health reform provides lessons regarding attempts to combine universal coverage under national health insurance with a version of managed competition. Based on principles of 'justice, equality and mutual aid," Israel's National Health Insurance Law, 1994 guarantees access to a broad basket of basic services to be provided by four competing sick funds, and the availability of resources adequate to finance the basket. The new rights of citizens to universal coverage and to move freely among sick funds constituted a major policy breakthrough. However, successive amendments to the Law reflect continuing controversy over the amount of resources required to …

"Cinderella" Services In The Nhs Internal Market:Does Contracting Make A Difference?, David Hughes, Siobhan Mcclelland, Lesley Griffiths

Dalhousie Law Journal

This paper examines the impact of the NHS internal market reforms on an aspect of equity in the British system that features little in recent policy commentary: the allocation of resources between acute services for the entire population and nonacute services for the elderly, the mentally ill, and the disabled (the so-called "Cinderella" services). The authors' research on health planning and contracting in the NHS in Wales suggests that patterns of services have remained largely unchanged, and that pressures in the reformed system, such as the Patient's Charter initiative, prevent any major reallocation of resources away from the acute sector. …