Health Law and Policy Commons^™

Barriers To Access To Abortion Through A Legal Lens, Jocelyn Downie, Carla Nassar

Articles, Book Chapters, & Popular Press

In addressing whether the procedure for obtaining abortions was operating equitably across Canada, the 1977 Badgley Report concluded that for many women, access to abortion was “practically illusory.” Sadly, although abortion on request became legally permissible for Canadian women in 1988, access to a safe and legal abortion remains practically illusory for many women today. A woman seeking an abortion in Canada must overcome numerous barriers. She must find a way to secure for herself some of the limited resources that our health care system provides for abortion. She must also expend her own, often scarce, personal resources: her time, …

Judicial Reasoning About Pregnancy And Choice, Jocelyn Downie, Chris Kaposy

Articles, Book Chapters, & Popular Press

Women in Canada are at risk of abortion becoming increasingly difficult to access. In its landmark 1988 ruling, R. v. Morgentaler, the Supreme Court of Canada struck down the prohibition of abortion in section 251 of the Criminal Code on the grounds that it violated a section of the Charter of Rights and Freedoms which guarantees, among other things, "security of the person". However, all of the justices who ruled that section 25 unconstitutional nonetheless claimed that protecting the fetus is a valid objective of federal legislation, leaving open the possibility that a different and carefully crafted law against abortion …

Inadmissible, Eh?, Jocelyn Downie, Ronalda Murphy

Articles, Book Chapters, & Popular Press

In this commentary, we respond to Stacey Tovino's invitation to reflect further on specific legal issues she raises in relation to functional magnetic resonance imaging (fMRI) and the law (Tovino 2007). Specifically, we take up the issue of evidence law. We do this from a Canadian perspective because, unlike in the United States, this topic has not "been debated for almost 10 years" here (Tovino 2007, 44).

Pediatric Neuroimaging Ethics, Jocelyn Downie, Jennifer Marshall

Articles, Book Chapters, & Popular Press

Neuroimaging has provided insight into numerous neurological disorders in children, such as epilepsy and cerebral palsy. Many clinicians and investigators believe that neuroimaging holds great promise, especially in the areas of behavioral and cognitive disorders. However, concerns about the risks of various neuroimaging modalities and the potential for misinterpretation of imaging results are mounting. Imaging evaluations also raise questions about stigmatization, allocation of resources, and confidentiality. Children are particularly vulnerable in this milieu and require special attention with regards to safety guidelines and modality adaptations. This article examines pediatric neuroimaging practice through an ethics lens. Most authors in the field …

Turning The Health Professional Carousel: Is Canada Undermining Human Rights In Developing Countries?, Karinne Lantz

Articles, Book Chapters, & Popular Press

This article will address the issue of health professional migration, with a specific focus on how this migration affects health systems in developing countries. The central question being examined is whether or not states have an obligation to ensure that their policies – or actions by private actors based in their states – do not undermine the delivery of healthcare in other states. After exploring this obligation, this article will analyze how the issue may be effectively addressed by drawing upon the experience of the United Kingdom; how successful has the U.K. been in meeting its obligation? What are the …

A Comprehensive Analysis Of Mri Research Risks: In Support Of Full Disclosure, Jennifer Marshall, Toby Martin, Jocelyn Downie, Krisztina Malisza

Articles, Book Chapters, & Popular Press

Magnetic resonance imaging (MRI) procedures have been used for over 20 years. This modality is considered relatively safe and holds great promise. Yet, MRI has a number of risks. In order for MRI research to meet the Canadian standard of disclosure, the investigator must communicate and make note of all risks in their research protocols and consent forms. Those creating and reviewing research protocols and consent forms must take notice of the different circumstances under which MRI poses a risk. First, this paper will describe the current standard of disclosure in Canada for research participants. Second, the paper will provide …

When Is It Permissable To Dismiss A Family Who Refuses Vaccinces? Legal, Ethical And Public Health Perspectives, Beth Halperin, Ryan Melnychuk, Jocelyn Downie, Noni Macdonald

Articles, Book Chapters, & Popular Press

Although immunization is one of the most important health inter- ventions of the 20th century, cases of infectious disease continue to occur. There are parents who refuse immunization for their children, creating a dilemma for the primary care physician who must consider the best interest of the individual child as well as that of the commu- nity. Some physicians, when faced with parents who refuse immuniza- tion on behalf of their children, choose to dismiss these families from their practice. Given the existing shortage of primary care physicians across Canada, this decision to dismiss families based on vaccine refusal has …

Testing The Waters: Jurisdictional And Policy Aspects Of The Continuing Failure To Remedy Drinking Water Quality On First Nations Reserves, Constance Macintosh

Articles, Book Chapters, & Popular Press

This paper considers why, from a policy and legal perspective, there is such a disparity between the water quality on First Nations reserves, and that experienced in the majority of other Canadian communities. This involves engaging with how jurisdictional allocations, governmental policies, statutory or policy-del-egated mandates, and operational practices con-verge. In this discussion, two inter-related tensions emerge. The first is between Aboriginal aspirations to self-govern and community capacity to effectively engage in governance activities. The second is Canada's proper role and responsibilities in resolving the governance/capacity tension, and in resolving the water quality problems.

This paper ultimately concludes that the …

Achieving Transparency In Implementing Abortion Laws, Rebecca Cook, Joanna Erdman, Bernard Dickens

Articles, Book Chapters, & Popular Press

National and international courts and tribunals are increasingly ruling that although states may aim to deter unlawful abortion by criminal penalties, they bear a parallel duty to inform physicians and patients of when abortion is lawful. The fear is that women are unjustly denied safe medical procedures to which they are legally entitled, because without such information physicians are deterred from involvement. With particular attention to the European Court of Human Rights, the UN Human Rights Committee, the Constitutional Court of Colombia, the Northern Ireland Court of Appeal, and the US Supreme Court, decisions are explained that show the responsibility …

Respecting Adolescents' Confidentiality And Reproductive And Sexual Choices, Rebecca Cook, Joanna Erdman, Bernard Dickens

Articles, Book Chapters, & Popular Press

Adolescents, defined as between 10 and 19 years old, present a growing challenge to reproductive health. Adolescent sexual intercourse contributes to worldwide burdens of unplanned pregnancy, abortion, spread of sexually transmitted infections (STIs), including HIV, and maternal mortality and morbidity. A barrier to contraceptive care and termination of adolescent pregnancy is the belief that in law minors intellectually mature enough to give consent also require consent of, or at least prior information to, their parental guardians. Adolescents may avoid parental disclosure by forgoing desirable reproductive health care. Recent judicial decisions, however, give effect to internationally established human rights to confidentiality, …

Guiding Patrons To Online Health Information: Can Librarians Be Found Liable?, Elaine Gibson

Articles, Book Chapters, & Popular Press

The amount of health information available on the Internet is growing rapidly and information intermediaries are increasingly being asked to help information seekers find and make sense of this information. This activity is for the most part benign from a legal perspective. However, there is a small possibility that, should the intermediary steer an information seeker to information that proves harmful to the seeker, the intermediary may be found liable for injuries incurred. In this paper, we examine the theoretical underpinnings of the relevant laws, clarify the risks, and recommend ways to minimize risk.

Respecting Adolescents' Confidentiality And Reproductive And Sexual Choices, Rebecca J. Cook, Joanna Erdman, Bernard M. Dickens

Articles, Book Chapters, & Popular Press

Adolescents, defined as between 10 and 19 years old, present a growing challenge to reproductive health. Adolescent sexual intercourse contributes to worldwide burdens of unplanned pregnancy, abortion, spread of sexually transmitted infections (STIs), including HIV, and maternal mortality and morbidity. A barrier to contraceptive care and termination of adolescent pregnancy is the belief that in law minors intellectually mature enough to give consent also require consent of, or at least prior information to, their parental guardians. Adolescents may avoid parental disclosure by forgoing desirable reproductive health care. Recent judicial decisions, however, give effect to internationally established human rights to confidentiality, …

In The Back Alleys Of Health Care: Abortion, Equality And Community In Canada, Joanna Erdman

Articles, Book Chapters, & Popular Press

The decriminalization of abortion in Canada ensured neither its availability nor accessibility as an integrated and publicly funded health service. While Canadian women are increasingly referred to or seek abortion services from single-purpose clinics, their exclusion from public health insurance often render these services inaccessible. This article considers denied funding for clinic abortion services from the perspective of the Canadian constitutional guarantee of sex equality. The article focuses on the 2004 Court of Queen's Bench's judgment in Jane Doe I v. Manitoba, which framed denied public funding for clinic abortion services as a violation of women's equality rights under the …

Abortion: Ensuring Access, Sanda Rodgers, Jocelyn Downie

Articles, Book Chapters, & Popular Press

Access to reproductive health care is essential to women’s health, and for some women, abortion is a key component of that care. But not all women in Canada have adequate, or in some cases any, access to abortion. It is important for Canadian physicians to know the facts about access to abortion so that they can better protect and promote the health of their female patients.

Emergency Contraception, Abortion And Evidence-Based Law, Rebecca Cook, Bernard Dickens, Joanna Erdman

Articles, Book Chapters, & Popular Press

Courts and legal tribunals increasingly decline to serve as religious or moral guardians, and require social evidence to support litigants' claims. Recent cases on emergency contraception and abortion are examined to show how judicial interpretations can take account of evidence of the impact that different understandings of the law will have for how ordinary people can plan their lives and reproductive choices. In an emergency contraception case, an interpretation was rejected that would have criminalized choices that millions of decent, law-abiding physicians, pharmacists and women routinely make. In an abortion case, three judges unanimously rejected a government ministry's defence of …

Indigenous Self-Determination And Research On Human Genetic Material: A Consideration Of The Relevance Of Debates On Patents And Informed Consent, And The Political Demands On Researchers, Constance Macintosh

Articles, Book Chapters, & Popular Press

Genetic research involving indigenous populations provokes many legal, ethical and cultural issues. Arguably, of these issues, two dominate the literature. The first is whether human genetic materials are or ought to be patentable, which is often argued against on the basis that such patents offend human dignity generally and are culturally offensive to many indigenous peoples. The second is whether researchers must obtain informed consent from representatives of indigenous groups as a whole before attempting to obtain consent for participation from individual members of that group. I argue that there is limited benefit in continuing to debate the patentability of …

Problematic Principles: The Cma On Public/Private Health Care, Jocelyn Downie, Nuala Kenny, Chantelle Rajotte

Articles, Book Chapters, & Popular Press

In June 2006, the Canadian Medical Association [CMA] published a discussion paper, "It's about access! Informing the debate on public and private health care," to evaluate how best to manage the public and private health care sectors in order to improve access to high-quality health care. The report comes at a critical time for the health care system in Canada, with the talk of renewal and reform at the forefront of public discussion. In their report, the CMA "identified 10 first-order policy principles that should guide any policy and decision-making related to the public-private interface." The CMA's use of these …

The Boundaries Of Medicare: Tensions In The Dual Role Of Ontario's Physician Services Review Committee, Colleen M. M. Flood, Joanna Erdman

Articles, Book Chapters, & Popular Press

In this research, we describe and analyse the Physician Services Committee (PSC) in Ontario, focusing on its role in determining what physician services are publicly funded and what services are de-listed (i.e. no longer eligible for public funding). We explain how the PSC's role in determining the boundaries of Medicare is in tension with its role as a medium for labour relations between the government and the medical profession. We suggest that while the values of privacy, secrecy and a lack of transparency may enhance the PSC's fulfillment of its labour relations mandate, they impede the Committee's successful fulfillment of …

Steering And Rowing In Health Care: The Devolution Option?, Colleen Flood, Joanna Erdman, Duncan Sinclair

Articles, Book Chapters, & Popular Press

Publicly funded health care systems are often the subject of heated policy debates. All too often (particularly in Canada), these debates focus on the prohibitive costs, the resultant taxation levels, and the questionable efficiency and outcomes associated with a publicly funded system. Moreover, the institutionalization of the system and the entrenchment of its many stakeholders make effecting change particularly difficult. In this article, the authors begin with an assessment of the drawbacks of the Canadian health care system in the federal-provincial context and its resulting gaps in governance (steering), in management (rowing), and in overall accountability (apart from that offered …

The Boundaries Of Medicare: Tensions In The Dual Role Of Ontario's Physician Services Review Committee, Colleen Flood, Joanna Erdman

Articles, Book Chapters, & Popular Press

In this research, we describe and analyse the Physician Services Committee (PSC) in Ontario, focusing on its role in determining what physician services are publicly funded and what services are de-listed (i.e. no longer eligible for public funding). We explain how the PSC's role in determining the boundaries of Medicare is in tension with its role as a medium for labour relations between the government and the medical profession. We suggest that while the values of privacy, secrecy and a lack of transparency may enhance the PSC's fulfillment of its labour relations mandate, they impede the Committee's successful fulfillment of …

Shooting Ourselves In The Foot: Why Mandatory Reporting Of Gunshot Wounds Is A Bad Idea, Merril Pauls, Jocelyn Downie

Articles, Book Chapters, & Popular Press

A recent position statement by the Ontario Medical Association’s Section on Emergency Medicine called on the Ontario government to pass a law requiring physicians to report gunshot wounds to police. The Ontario government quickly passed a motion to “introduce legislation to require hospitals and physicians to report gunshot wounds and knife injuries to their local police service.” The goals behind the position statement are laudable: “to assess and reduce immediate public risk and to collect data to inform future prevention strategies.” However, mandating that physicians report gunshot wounds is an ill-conceived response to the problem of gun-related violence. It will …

Revisioning The Oversight Of Research Involving Humans In Canada, Jocelyn Downie, Fiona Mcdonald

Articles, Book Chapters, & Popular Press

When individuals are asked to participate in research they should be able to assume that the research "is well designed and well executed, that the investigator is competent to undertake the study, that the study will be run efficiently, safely, and ethically and that the deviations from good practice will be identified and corrected." The central question that we focus on in this paper is whether the governance mechanisms that are currently in place to regulate the conduct of research involving humans are adequate to enable those who are approached to participate in research to make these assumptions. This review …

Protecting Human Research Subjects: A Jurisdictional Analysis, Jennifer Llewellyn, Jocelyn Downie, Robert Holmes

Articles, Book Chapters, & Popular Press

The most recent speech from the throne contained a pledge from the federal government to "work with provinces to implement a national system for the governance of research involving humans, including national research ethics and standards." This commitment signals a desire on the part of the federal government to address concerns about the inadequacies of the current governance of health research involving humans (RIH). To this end, Health Canada's Ethics Division is currently exploring the ways in which such a national governance system for RIH might be implemented. It is important for the federal government, as it moves toward making …

Protecting Human Research Subjects: A Jurisdictional Analysis, Jennifer Llewellyn, Jocelyn Downie, Robert Holmes

Articles, Book Chapters, & Popular Press

The most recent speech from the throne contained a pledge from the federal government to "work with provinces to implement a national system for the governance of research involving humans, including national research ethics and standards." This commitment signals a desire on the part of the federal government to address concerns about the inadequacies of the current governance of health research involving humans (RIH). To this end, Health Canada's Ethics Division is currently exploring the ways in which such a national governance system for RIH might be implemented. It is important for the federal government, as it moves toward making …

Industry And The Academy: Conflicts Of Interest In Contemporary Health Research, Jocelyn Downie

Articles, Book Chapters, & Popular Press

The case of Dr. Nancy Olivieri, the Hospital for Sick Children (HSC), the University of Toronto, and Apotex Inc. (hereinafter the "Olivieri case") is critically important to an understanding of the issues central to contemporary health research and the safety of research participants. First, the case illustrates the huge stakes in such research – not only billions of dollars, but the health of Canadians. Second, the case played out at a crucial time in the history of the regulation of health research. Like other recent high-profile cases, it challenged the ways in which research is governed at the local and …

Genetic And Metabolic Screening Of Newborns: Must Health Care Providers Seek Explicit Parental Consent?, Sheila Wildeman, Jocelyn Downie

Articles, Book Chapters, & Popular Press

In this paper, we provide some background on the history of newborn screening and the legal context within which questions regarding consent must be answered, and then turn to the various arguments that can be made for and against the current approach to parental consent to genetic and metabolic tests administered as part of provincial/territorial newborn screening programs. In the end, we conclude that either practice should be changed to align it with current law such that explicit parental consent is sought for the established tests, or that advocates for maintaining current practices should lobby for legislation permitting newborn screening …

Genetic And Metabolic Screening Of Newborns: Must Health Care Providers Seek Explicit Parental Consent?, Sheila Wildeman, Jocelyn Downie

Articles, Book Chapters, & Popular Press

In this paper, we provide some background on the history of newborn screening and the legal context within which questions regarding consent must be answered, and then turn to the various arguments that can be made for and against the current approach to parental consent to genetic and metabolic tests administered as part of provincial/territorial newborn screening programs. In the end, we conclude that either practice should be changed to align it with current law such that explicit parental consent is sought for the established tests, or that advocates for maintaining current practices should lobby for legislation permitting newborn screening …

Health Care Ethics Experts In Canadian Courts, Jocelyn Downie

Articles, Book Chapters, & Popular Press

In this paper, I will first describe the traditional approach to the use of experts in Canadian courts. Then I will consider whether, on this approach, health care ethics experts should be permitted to testify in Canadian courts. I will argue that they should be permitted to testify but caution should be exercised by the courts, the parties, and the experts themselves. The objective of the paper is to highlight the strengths and raise some concerns about the weaknesses of a practice that appears to be growing, so that the potential harmful consequences might be anticipated, problems with the practice …

Egregious Inaction: Five Years After 'Of Life And Death', Jocelyn Downie

Articles, Book Chapters, & Popular Press

In November 1999, the Standing Senate Committee on Social Affairs, Science and Technology was authorized to examine and report upon developments since the release of Of Life and Death, the final report of the Special Senate Committee on Euthanasia and Assisted Suicide. A subcommittee to update Of Life and Death was therefore established. On February 14, 2000, I participated in the first panel of witnesses before this subcommittee. In light of the subcommittee's mandate, I set myself the following two tasks: first, to update the legal status sections of Of Life and Death by reporting on any changes to the …

The Contested Lessons Of Euthanasia In The Netherlands, Jocelyn Downie

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In this paper, while I will conclude that the Dutch experience should give us some concern about a slippery slope, I will, more importantly, also conclude that it should not give us the level of concern suggested by some commentators. I will argue that it does not provide a basis on which to conclude that assisted suicide and voluntary active euthanasia should not be decriminalized in Canada. Rather, it provides a basis for proceeding with caution and developing a permissive regime that places barriers on the slope and contains mechanisms by which slippage down the slope can be detected (and, …