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Is there a point when MAID aligns with the Hippocratic Oath?

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9 months ago

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Photo Credit: Kampus Production

BY W. GIFFORD- JONES MD & DIANA GIFFORD-JONES

Readers of a great age face a common problem. It’s called frailty or general weakness. The frail elderly are at risk of falls that require hospitalization, often leading to palliative care. As the condition progresses, independent living at home can become impossible. For people who have reached the end of their desire to continue, frailty presents a medical dilemma for doctors. How much frailty is needed before the doctor allows, “There’s reason enough to end life by Medical Assistance in Dying (MAID),” and would a veterinarian be the better professional to make this decision?

One of the conditions that doctors must decide at the end of life is whether weakness is reversible. This obviously makes sense when considering life or death situations, but frailty is not like a mathematical problem where there is a right or wrong answer.

Many readers know that I have always fought to end needless suffering. I have followed the edict of Hippocrates, the Father of Medicine, who taught that doctors should do no harm. To my mind, allowing crushing agony to continue is more than terribly harmful.

It is because of this attitude that I fought for five years against well-known organizations, such as the Royal Canadian Mounted Police, pharmacists, and politicians who vigorously fought against the legalization of heroin to ease the pain of terminal cancer.

Two things finally helped to legalize heroin. I visited England and Scotland where heroin had been available for 90 years for pain relief. I talked to experts about pain control, which showed that the troubling perceptions surrounding heroin were wrong. I delivered in person forty thousand handwritten letters from readers who had seen loved ones die in pain to the Minister of Health in Ottawa. In 1984, heroin was legalized in Canada to treat pain for terminal cancer patients.

A CMAJ article reported that 53 patients who selected MAID had suffered “multiple geriatric syndromes,” a combination of medical, social and other conditions that involved unbearable suffering. These patients did not have a life-threatening disease, but their lives had degenerated to such a state that a decision to use MAID aligned with the Hippocratic oath.

Other studies show that once severe frailty occurs, patients live 3.5 to four years. Weaknesses often lead to great frustration and depression.

There is no universal answer to this dilemma for doctors. Some physicians will never end lives by MAID due to religious, moral, or ethical grounds. For them, there is no compromise.

My family, on the contrary, is quite pragmatic about the end of life. They know I would not want to suffer from severe frailty. A decision to conclude enough is enough would depend on my: doctor, wife, and children. I have only half-jokingly expressed the opinion that I would want a veterinarian to help make the decision. I know how veterinarians ease the suffering of animals.

Our family has seen the lives of several much-loved dogs ended by painless injection when they are in agony. It’s a shattering moment to bear. But it has always seemed consoling to me that veterinarians and families, without being able to converse with pets, know when their suffering is unbearable and needs to end. Yet some doctors, who are able to discuss this matter with patients, often allow severe weakness and suffering to continue much too long.

So, doctors should listen hard when patients say, “Please, I want to die and end this agony.” After all, the patient is the only one who knows the extent of the pain. Prolonging unbearable pain makes no sense, not to the veterinarian.

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Dr. W. Gifford-Jones, MD is a graduate of the University of Toronto and the Harvard Medical School. He trained in general surgery at Strong Memorial Hospital, University of Rochester, Montreal General Hospital, McGill University and in Gynecology at Harvard. His storied medical career began as a general practitioner, ship’s surgeon, and hotel doctor. For more than 40 years, he specialized in gynecology, devoting his practice to the formative issues of women’s health. In 1975, he launched his weekly medical column that has been published by national and local Canadian and U.S. newspapers. Today, the readership remains over seven million. His advice contains a solid dose of common sense and he never sits on the fence with controversial issues. He is the author of nine books including, “The Healthy Barmaid”, his autobiography “You’re Going To Do What?”, “What I Learned as a Medical Journalist”, and “90+ How I Got There!” Many years ago, he was successful in a fight to legalize heroin to help ease the pain of terminal cancer patients. His foundation at that time donated $500,000 to establish the Gifford-Jones Professorship in Pain Control and Palliative Care at the University of Toronto Medical School. At 93 years of age he rappelled from the top of Toronto’s City Hall (30 stories) to raise funds for children with a life-threatening disease through the Make-a-Wish Foundation.  Diana Gifford-Jones, the daughter of W. Gifford-Jones, MD, Diana has extensive global experience in health and healthcare policy.  Diana is Special Advisor with The Aga Khan University, which operates 2 quaternary care hospitals and numerous secondary hospitals, medical centres, pharmacies, and laboratories in South Asia and Africa.  She worked for ten years in the Human Development sectors at the World Bank, including health policy and economics, nutrition, and population health. For over a decade at The Conference Board of Canada, she managed four health-related executive networks, including the Roundtable on Socio-Economic Determinants of Health, the Centre for Chronic Disease Prevention and Management, the Canadian Centre for Environmental Health, and the Centre for Health System Design and Management. Her master’s degree in public policy at Harvard University’s Kennedy School of Government included coursework at Harvard Medical School.  She is also a graduate of Wellesley College.  She has extensive experience with Canadian universities, including at Carleton University, where she was the Executive Director of the Global Academy. She lived and worked in Japan for four years and speaks Japanese fluently. Diana has the designation as a certified Chartered Director from The Directors College, a joint venture of The Conference Board of Canada and McMaster University.  She has recently published a book on the natural health philosophy of W. Gifford-Jones, called No Nonsense Health – Naturally!

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Technology

How Toronto’s Caribbean Community is Leading in Digital Innovation

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2 weeks ago

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April 16, 2024

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Toronto’s Caribbean community is making significant strides in the realm of digital innovation, reflecting a vibrant and dynamic force within the city’s tech sector. This burgeoning influence spans across various sectors, including technology incubation, digital education, and entrepreneurship, underscoring a profound impact on Toronto’s digital economy.

Fostering a Culture of Innovation

The Caribbean community in Toronto is actively contributing to a culture of innovation that is pivotal for the city’s future advancements. Through collaboration with local and international businesses, startups, and academic institutions, this community is part of the driving force behind Toronto’s position as a hub for innovation. The city is home to over 70 incubators, accelerators, and co-working spaces, offering programs that support startups in technology, manufacturing, food production, fashion, arts, and music.

Central to this ecosystem is the MaRS Centre, one of the world’s largest urban innovation hubs, which houses entrepreneurs building Canada’s next generation of growth companies. Toronto’s impressive tech industry, supported by giants like Microsoft, IBM, Cisco, Google, and Facebook, benefits from the diverse talents and innovative spirit of the Caribbean community​​.

Digital Education and Entrepreneurial Spirit

The Toronto Caribbean community’s commitment to digital education and entrepreneurship is evident through initiatives such as the Toronto Reference Library. This hub invites users of all ages and skill levels to explore digital creation, offering activities and workshops on topics like 3D printing, graphic novel book clubs, and crafting circles. Such programs are crucial for fostering a culture of lifelong learning and innovation, enabling community members to acquire and refine digital skills.

Contribution to the Digital Economy

In the rapidly evolving digital economy, Toronto’s Caribbean community is not just a participant but a trendsetter. This is evident in the diverse range of digital services thriving in the city, including sectors such as life sciences and healthcare. The community’s innovative spirit contributes significantly to the city’s standing as a leading North American tech hub, with a vibrant biotechnology cluster and a comprehensive network of hospitals, research institutes, business incubators, and venture capital organizations. Also, initiatives like the Caribbean Digital Summit and The LEGUP Wealth Symposium featuring leaders from Caribbean governments and the tech industry, exemplifies the community’s active engagement and leadership in digital transformation and governance on a broader scale​​.

The real-time table games in Canada exemplify the wide array of online services prospering under this innovative umbrella. This digital sector benefits from the technological advancements and entrepreneurial drive within the Caribbean community, illustrating the diverse impact on Toronto’s digital landscape.

Toronto’s Caribbean community is playing a pivotal role in shaping the city’s digital innovation landscape. Through a commitment to education, entrepreneurship, and collaboration, this vibrant community is contributing to Toronto’s reputation as a global hub for technology and innovation. The synergy between the Caribbean community and the broader tech ecosystem in Toronto is proof of the power of diversity in driving progress and creativity in the digital age.

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Technology

Jamaica’s Back-to-Back CONCACAF Gold Cup Final Appearances

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2 months ago

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March 11, 2024

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Jamaica, a small island in the Caribbean, may not be one of the first countries that come to mind when you think of soccer. However, in recent years, the Reggae Boyz have been making waves. And following the underdog stories unfolding at the current African Cup of Nations, the Jamaicans may well feel that success is just around the corner.

2024 – A Big Year For International Football

In the Ivory Coast this winter, AFCON has been making waves following the stunning early exits of almost every heavy hitter. The likes of Algeria, Tunisia, and Ghana all bowed at the group stage, while Egypt and Morocco followed them in the round of 16.

But it isn’t just Africa that has a continental competition taking place this year. Both the 2024 European Championships and Copa America will take place, tournaments that online sports betting sites have made England and Argentina the favorites to win, respectively. Caribbean involvement will have to wait until next year when the 2025 CONCACAF Gold Cup gets underway, and Jamaica will be hoping to channel their success from years gone by into action.

2015

The 2015 CONCACAF Gold Cup was held in Canada and the United States, with Jamaica competing against some of the best teams from North and Central America. Despite being underdogs in many matches, the Reggae Boyz managed to make it all the way to the final. Inspired by the performances of former Premier League wingers Jobi McAnuff and Gareth McCleary, the Caribbean outfit defeated the highly-rated Costa Rica to top Group B.

That set up a meeting with Haiti in the quarterfinals, and a goal from former Derby County man Giles Barnes was enough to secure a narrow 1-0 victory. In the semifinals, they met a much fancied United States in front of 70,000 raucous fans at the Georgia Dome. But they weren’t intimidated, racing into a two-goal lead before clinging on for dear life in the second half and eventually running out 2-1 victors. Unfortunately, they were ultimately downed 3-1 by Mexico in the final, but not before they had captured the hearts of North America.

2017

Two years later, in 2017, Jamaica once again found themselves in the final of the tournament. This time around they faced the reigning champion Mexicans in the group stage, holding them to a goalless draw. Victories against Curacao and a draw with El Salvador were enough to seal their spot in the knockout round however, they headed into the latter stages as an unfancied side once more.

In the quarterfinals, the Jamaicans duly brushed aside Canada thanks to goals from Shaun Francis and Romario Williams. That set up a meeting with Mexico once again, and this time around, they would have their redemption. Fullback Kemar Lawrence scored the only goal of the game in the 88th minute, leaving El Tri stunned and sealing the Reggae Boyz’ spot in the final.

There, they faced off against the hosting United States at Levi’s Stadium in Santa Clara, California – home of the San Francisco 49ers. The Jamaicans were hoping to repeat their heroics of two years prior and come out on top, however, this time around it was the Stars and Stripes that ran out victorious. With the contest level at one goal apiece, Seattle Sounders striker Jordan Morris popped up with an 88th-minute winner to secure the victory.

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Business

Victim Services of Durham Region invites Ontario schools and youth to Youth Violence Prevention Symposium

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2 months ago

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February 24, 2024

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BY PAUL JUNOR

Victim Services of Durham Region (VSDR) is committed to educating and informing young people with the knowledge and education they need to make informed decisions regarding critical issues that affect their lives.

In order to fulfill its mission, it will be hosting its annual online Youth Violence Prevention (YVP) Symposium. It will take place over a two-week period on Monday, February 26th and Friday, March 8th, 2024.It will be geared to Grades: 7, 8 and 9 students who will be able to access it using the online learning platform, Learn Worlds.

VSDR has been active over the years in the Durham Region where it has provided a range of services to help those affected and impacted by crime, or sudden tragedies. It is the only one of its kind that offers specialized services and support 24/7, 365 days per year to these individuals.

Their vision is to have a safe community where people are supported, empowered and thriving. The press release states that they provide trauma-informed, anti-oppressive crisis intervention services, including emotional support, safety planning, and financial assistance. In addition, there are translation services available in over 300 languages to those who need them. Case management services are also available, which assist individuals to bypass bureaucratic roadblocks with available:

subsidized housing, income support, medical and police services.

VSDR provides tailored support to survivors and witnesses of all crimes; 85% of its clients have experienced gender-based violence, including: survivors of intimate partner violence, sexual assault and human trafficking.

Some of the programs VSDR offers are:

  • Crisis Response
  • System Navigation
  • Victim Quick Response Program
  • Human Trafficking Prevention/Intervention
  • Youth Prevention Workshops
  • Professional Training
  • Hotel Staff Training

The symposium will consist of accessible online modules that will be broken down into educational content, specific videos and in-class activities that are grade specific and align with curriculum targets. The six modules per grade are:

  • Consent & Healthy Relationships
  • Human Trafficking
  • Online Safety, Cyber Bullying and Image Sharing
  • Teen Dating Violence
  • Gang Violence & Peer Violence
  • Empowerment & Self-Care

The following are aims of the symposium:

  • Protect and empower young people.
  • Engage with issues like human trafficking, consent, healthy relationship, sextortion, teen dating violence, gang awareness, and cyber safety.
  • Provide insights on vulnerabilities and risk factors through activities and presentations.

Through partnerships with schools and educators it has been possible to:

  • Provide interactive online modules, games and videos.
  • Focus on learning in a safe setting.
  • Information on where to seek support provided on the event day and beyond.

Since 2020, the annual Violence Prevention Symposium has made a significant impact in the lives of young people as its program evolves from just focusing on Anti-Human Trafficking to issues that reflect emerging youth trends.

Some of the Impactful Results are:

  • Youth knowledge increased from 35% to 97%
  • Over 300% decrease in the number of youths educated since 2020
  • 48 disclosures received in 2023 as a result of symposium education.

VSDR is anticipating great things from the 2024 symposium. They will continue to adapt and adjust the programs and services they deliver in light of the changing landscape and rapidly evolving world of teenagers.

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