The number of medically-assisted deaths in Canada’s prisons a concern for some experts
Canada has performed nine medically-assisted deaths among prisoners in the last seven years, more than any other country which tracks and records such data.
The number of federal prisoners requesting medically-assisted death (MAID) in Canada has also increased, with 27 asking for permission to die between June 2016, when the legislation came into effect, and March 31 this year, according to information provided by Correctional Services of Canada (CSC) following an Access to Information Act request.
Only three other countries — Switzerland, Belgium, and Spain — have publicly acknowledged one euthanasia death each for a prisoner. Two of them were performed in February this year, the other in 2022.
Jessica Shaw, an associate professor of social work at the University of Calgary who has been studying assisted death in prisons and submitted the access to information request, said she is worried about the lack of transparency in reporting cases and how decisions are made.
“Canada is the leading provider of assisted death for prisoners,” she said. “It would appear to me that there’s a very different process when it comes to people who are dying through assisted death in prison than it is for… the general population of Canada.”
According to the data, the number of inmates requesting MAID is up from five in 2018; however, the data is heavily redacted.
The document also shows that a third of all requests for MAID from prisoners are approved. The rate of approvals is also significantly lower than the 81 per cent approval rate in the general population. No other information was provided on the medical reasons for the MAID requests, and why requests were rejected .
“For privacy reasons, we are currently unable to provide a further breakdown of these numbers,” a spokesperson for Correctional Services Canada told CTV News in an emailed statement on April 26.
However, Shaw described the lack of details as “secretive in many ways.”
“We worry about what’s happening,( and) what’s not happening behind, behind bars and behind closed doors,” she added.
The lack of transparency also troubles Ivan Zinger, the Correctional Investigator of Canada. Zinger says his agency has a mandate to investigate all deaths of federal prisoners.
However, MAID-related deaths are not included in these investigations, he said, despite multiple recommendations from his office to open access to information to allow investigators to review cases.
“For some extraordinary reason, Corrections (Services Canada) was able to get an exemption of that requirement,” said Zinger told CTV News. “We keep raising it (the matter). But we don’t have data and they don’t have the obligation to provide us with data. And that’s the problem.”
MENTAL ILLNESS and MAID IN PRISON
In 2020, Canada’s federal prisons housed an estimated 14,000 men and women, with a further 9,000 on parole. Studies show that a growing number of inmates are aged over 50, putting them at risk of cancer and other diseases which might qualify them for medically-assisted death.
In March next year, another concern looms for Zinger and Shaw, as the criteria for applying for MAID will likely expand to include mental illness as a sole reason for requesting assisted death.
Zinger says data from CSC indicates 75 per cent of those imprisoned federally have a current mental health diagnosis, while other studies show prison life itself can worsen mental health.
“If the provisions are extended to include mental illness, there could be a lot more people that become eligible,” Zinger said, calling for more transparency in discussing MAID among prisoners. ” I believe that Corrections (Services Canada) should be reporting it in an open way…..so that we can track it better and we can ensure that how it’s being provided is in sync with the legislation and human dignity.”
Canada is the only country in the world that has approved medically assisted death as a right for prisoners, with guidelines on how it is to be provided. Requests from inmates first go to a prison official who then decides if the prisoner can proceed with the application with two outside medical assessors. But, unlike applications involving the general public, prisoners cannot choose the assessor nor ask for a second opinion.
Shaw is concerned that some of the procedures, including having guards during MAID-related appointments, may pressure prisoners into a decision.
“We really need to attend to whether or not someone can adequately consent when they’re being watched by a prison guard, for example… or whether anyone has free choice when so many of their rights have been taken away,” she added.
Jessica Shaw, an associate professor of social work at the University of Calgary. (submitted by Jessica Shaw)
Shaw spent time in prisons interviewing inmates about assisted death prior to the pandemic for her research. She says some expressed fears about raising the issue of MAID, worried they would be labelled suicidal by prison staff, which they claimed would lead to them placed in solitary confinement for their own safety.
Her other concern is whether the guidelines, and training of assessors, will adequately assess whether inmates who request MAID are, in fact, attempting to escape prison life.
In a study she co-authored in 2021, Shaw spoke to one inmate, “James,” whose identity was protected as they were advocating for MAID as a way out of their life sentence.
“There’s over 400 dangerous offenders in Canada,” she says “James” told her. “So why not give us another option? Instead of having the taxpayers pay millions of dollars (for our prison time), why not just give us that option to go to sleep?.”
A study in 2015 from Belgium highlighted a similar ethical problem. Researchers reported on 17 requests for euthanasia made by long-term prisoners who were “motivated by the constant and unbearable psychological suffering of detention.” The study reported that all of the requests were eventually declined, with authors warning that it is important for people in detention see assisted death as an “exception to be used with great caution.”
“Prison itself may be a contributing factor to decisions about wanting to end your life, right? That’s a challenge,” said Catherine Latimer, executive director of the John Howard society, a not-for-profit agency promoting what its website calls “humanity in justice.”
She says her society believes prisoners have a right to the same services as all Canadians, including MAID. However, she has concerns as to whether medical services offered to prisoners are equal to those outside of prison because they are constrained by security and cost issues.
“My concern is we should be very vigilant about making sure that people who have mental illnesses in prison are getting the assistance that they need,” she added.
Dr. Lilian Thorpe is one of the first MAID providers to speak publicly about offering assisted death for prisoners. She is a geriatric psychiatrist and a professor in the department of Community Health and Epidemiology and Psychiatry in Saskatoon.
One inmate she assisted was allowed out of prison early and admitted to a hospital facility, where he spent his final hours with family before getting a medically-assisted death.
“(They ) had a lot of contact with family, that’s what they wanted. They wanted out of prison. And, you know, they were bed bound and very sick. But they were able to die in the way that they wanted which is with the families there,” she told CTV News.
According to the access to information data Shaw obtained, of the eight cases of MAID listed at the time of her report, seven were performed outside of prisons.
Another inmate with advanced stage cancer was given MAID in prison. Dr. Thorpe, who was also the physician on this case, said it was the prisoner’s wish to die behind bars. “He did not want to be discharged because he had been in corrections basically all his adult life and he wanted to be with people that he knew and his closest supports are actually in that facility,” she said.
However, there are other experiences that worry Zinger. In one of the early cases of MAID, detailed in a federal report, one inmate was “shackled to the bed” with officers nearby as the procedure occurred. Zinger supports the idea that all palliative and MAID should be treated out in the community, as those who are ill and dying are of little risk to the public.
“The best way of dealing with this is to try to get people out earlier…where care can be provided in a better setting than inside of penitentiary or even in a hospital with correctional staff at the door,” he added.
Correctional Services of Canada told CTV News in an email that it “is responsive to the needs of offenders, including quality and compassionate palliative and end of life care.”
Shaw, meanwhile, intends to keep tracking MAID developments globally and asking questions of Canada’s processes in this emerging ethical discussion.
Manufacturers Blues: Staffing Not a Problem, But their Inadequate.
We have been experiencing staffing problems for some time. Finding skilled workers within the manufacturing sector has been challenging but these past 2 years most difficult, not because there are no workers being interviewed, but because there are many showing up for their interviews and testing. The interviews go well, with their enthusiasm showing. We appreciate that a lot. But when they do their actual testing it’s another story.
Initial Interview usually goes without a hitch.
Testing shows us their capabilities and possible potential should we be willing to train them further.
We test these individuals as welders, sheet metal workers, press brake operators, plastics, and millwork specialists.
The problem we face is threefold. 1st off they have no real experience like they just graduated from welding school. We ask them to weld their name onto a plate, which is easily done if you have the experience. Many burn through the heavy plates or handle the equipment not very well. The secondary problem is their extensive demands from private washrooms, when they are willing to work(not our scheduled period), excessive wages far beyond the average wage. Over time employment is haphazard at best, nonexistent as they refuse. They even want schooling in the trade, while letting it be known that the wage they receive will always limit their loyalty to the firm. A buck or two elsewhere and bye, bye. The third problem is that most want to unionize, and have been told to demand the most up front even though they have not proven themselves worthy of advanced pay. For most private firms unionizing will kill the firm, with excessive costs dragging down any form of profitability. We have 15-25 laborers at a time with the option of doubling that when business gets busy usually in spring-summer-fall.
Strange things that happen are the employees showing up with a six-pack of beer, taking 1-2 hour lunches, and often going to management asking for wage advances even when they have not been with us but for a few weeks. The provincial and federal government agencies who have these individuals trained seem to be the people indoctrinating the workers with unrealistic expectations and demand formulas.
There are many choice employee’s out there, but their wage/salary demands remain extremely high for an industry that is just surviving in North America. The pandemic and people leaving their jobs to become self-employed or simply home bodies until they find that perfect job with a perfect wage have driven up our costs drastically, and all the while we are trying to compete with foreign exporters.
Our Provincial and Federal Governments seem unwilling to assist us in finding excellent experienced employees, instead having people trained in the basics, and relying upon private industry to train these people, who will in a short matter of time leave us and go to someone else who will pay them more. The expense, time, and effort of our firm run at a loss when we train someone, but this gamble pays off occasionally. Our governments are staffed by unionized personnel, who will push unionization onto anyone they come in contact with. Not neutral, or objective, but actual union recruiters and propagandists.
Our firm has looked at moving to friendlier regions down south, but the nationalist within us persists in our Canadian Financial Adventure in Ontario.
The FDA says people are confusing poppers with energy shots, and dying. Experts want proof
It’s not unusual for the packaging of one product to resemble that of another, potentially leading to mix-ups. But the U.S. Food and Drug Administration (FDA) has warned people who drink energy shots to make sure they’re not accidentally chugging a bottle of poppers — or they might end up sick or dead.
“Don’t be fooled. These poppers, often purchased online or in novelty stores, are unapproved products and should not be inhaled or ingested, regardless of how they are packaged, labelled or displayed,” the FDA notes in its online warning shared in recent social media posts.
But those who work in LGBTQ sexual health say the FDA’s warning that people are confusing poppers with energy shots, with sometimes dire consequences, may actually be doing more of a disservice.
Such messaging “borders on inflammatory” and may contribute to the “the stigmatization of the product [and] the stigmatization of the person who’s using poppers,” said Rod Knight, an associate professor at the at Université de Montréal’s School of Public Health, who has also conducted research on poppers.
Poppers are a chemical substance that belongs to a class of drugs known as alkyl nitrates. When they’re inhaled as vapour, from a small liquid-filled bottle wrapped in a colourful plastic label, the user can almost instantly get the short-lasting, light-headed sensation of a head rush, Knight explained.
He explained they also relax the sphincter muscle of the anus, making receptive anal sex more comfortable for some people. Poppers have been popular among gay, bisexual and other men who have sex with men for decades.
A single mistake can prove fatal. We continue to receive reports of people dying or being severely injured after consuming poppers that resemble, and often mistaken for, popular energy shots. Drinking or inhaling poppers seriously jeopardizes your health. <a href=”https://t.co/fojEcP7J9z”>https://t.co/fojEcP7J9z</a> <a href=”https://t.co/LJlPAnbfOY”>pic.twitter.com/LJlPAnbfOY</a>
Knight acknowledges that there are sometimes side effects, which may include nausea, headaches, reduced blood pressure — alkyl nitrates are vasodilators, meaning they open blood vessels — and even vision issues. But he suggested such side effects “can be remedied through change of usage patterns.”
According to the FDA’s website, they are usually purchased in sex shops or online — often labelled as other products such as leather cleaner or deodorizers — even though the agency recommends against using them. Alkyl nitrates as poppers are unauthorized in Canada and Health Canada has cracked down on the sale of them since 2013, though they’re not necessarily illegal to purchase, possess or consume.
Does the FDA claim pass the sniff test?
Energy shots are flavoured beverages containing some amount of caffeine, and vitamins or other natural substances that purportedly boost your energy, like ginseng or ginkgo biloba. They’re sold in small bottles with colourful plastic labels. They’re commonly found at convenience stores, supermarkets or bought online.
If by some chance you had both products side-by-side and didn’t realize your mistake by the time you peeled off the plastic and cracked open the bottle, the distinct smell of poppers should be a red flag, explained Adam Awad, the communications manager for the Gay Men’s Sexual Health Alliance in Toronto.
“If you’re about to drink a 5-Hour Energy drink [a popular energy shot brand] and it smells like nail polish remover, you know, maybe you should ask yourself some questions before touching it to your lips,” he said.
Awad said he isn’t aware of any cases of people dying from a poppers-related mishap like the FDA described — a claim the agency previously made in 2021 — but he said he “would be very keen to see any evidence that they’ve got or reports on the actual number of cases.”
CBC News reached out to the FDA for data on injuries or death related to the accidental oral ingestion of poppers and an explanation for the social media warning, but did not receive a response.
In 2012, however, the agency stated that it was investigating 13 deaths and 33 hospitalizations related to the consumption of 5-Hour Energy drinks.
But if serious or fatal mix-ups with poppers and energy shots are happening, it would certainly be a dangerous situation, said Knight. He said he’s curious to know in what context such a serious mistake might have happened and whether there were other contributing factors to these incidents.
There is also a flip side to poppers, Knight said, that health agencies like the FDA and Health Canada do not mention in their cautionary messaging.
“This drug is being used by gay and queer men for very therapeutic reasons,” Knight said. “[Poppers] can prevent muscle spasm and injury during receptive anal intercourse.”
The Early Edition7:57We discuss what ‘poppers’ are, and the ban of them in Canada
Should Canada ease its restrictions on poppers?
Health Canada states alkyl nitrites can only be used when prescribed by a doctor, but there are currently no approved products sold as poppers. In a statement to CBC News, the agency said “there have been no submissions filed by any company [or] manufacturers for authorization of a popper product.”
Knight said it would be difficult and unlikely for many producers to go through the clinical trials and regulatory processes needed to get approval for prescription use and, even if that did happen, it would only create other barriers to accessing the drug.
“This drug is not really well known among a lot of clinicians, except for those who specialize in sexual health,” he said.
He said the current restriction has done little to prevent people from acquiring poppers one way or another, whether it’s ordering them online, buying them over the border in the U.S. or procuring them by some other means.
He noted a survey from the Community-Based Research Centre that showed only a slight drop in the percentage of people using poppers, after the ban on sales, and had little effect on regular use.
“If this was a drug that was being used among, for example, straight guys at a rate of 30 per cent of straight guys across Canada, there would be a very different approach to how the drug would be treated,” he said.
He believes the restriction has done more harm than good, pushing poppers into a form of “illicit market,” making it unclear what ingredients they may contain because manufacturers aren’t “incentivized” to label their products with accurate health information.
There is also the possibility poppers may be packaged in a way that resembles other products in order to “disguise them” because of the restriction, added Awad, potentially setting up that very mixup scenario.
Why are mosquitoes so bad in 2023?
They’re thirsty bloodsuckers that annoy those who cross into nature, feasting on their salty life source while leaving behind red, itchy bumps.
And this year across Canada, it seems the pesky insects are worse than ever.
Those who’ve wondered about an increase in mosquitoes may be right, according to Laura Ferguson, assistant professor of biology at Acadia University in Nova Scotia.
“It’s definitely been a trend to some extent that people are noticing anecdotally,” she told CTVNews.ca in an interview on Friday. “New Brunswick, in particular, over the last couple of years, has noticed big bursts in mosquito populations, especially in this mid- to late spring.”
Why mosquitoes may be worse than normal in some areas has more than one answer.
WHY MOSQUITOES ARE SO BAD THIS YEAR
Ferguson works with a team to study mosquitoes, understand the different species and track their abundance across North America.
“It’s for a few different reasons why we’re seeing more mosquitoes than we may have at least in the past couple of decades or so,” she said.
The first contributing reason is that there are more species of mosquitoes than in years past.
Different species travel with human goods across the world. They then breed in their new homes, creating populations of specific types of mosquitoes where they’d never existed before.
“Here in Nova Scotia for instance, we didn’t have a (species) a couple of decades ago — it came over from Japan in tire, we think — and it’s just exploded across the province and you can find it anywhere now,” Ferguson said.
Additionally, Ferguson said, warmer winters caused by climate change allow mosquitoes that would die off in the winter to survive and continue reproducing.
Along with being able to survive the milder weather, some types of mosquitoes are able to reproducer faster in warm temperatures because of the type of insect they are. Ferguson says mosquitoes are ectotherms, meaning their regulation of body temperature depends on external sources like the sun.
Precipitation also plays a factor in how well mosquitoes can survive, because they lay eggs in stagnant water.
Ferguson said if it’s a particularly dry spring there may be fewer mosquitoes around, depending on the species. Others lay eggs in the fall, so there would only be a large drop in mosquitoes if the previous year was dry.
Another theory that needs more research, Ferguson said, is the waning effects of the chemical Dichlorodiphenyltrichloroethane (DDT), which was used in the past to control insects in crops, but was phased out in the 1970s due to its harm on other species.
Despite this, the chemical can still be found in water and is circulating in ecosystems.
“Those kinds of holdover effects from these really persistent insecticides may have also suppressed mosquito populations for a few decades,” she said. “And now we’re experiencing a bit of this rebound of these populations as these insecticides and their effects start to wear away in the environment.”
WHAT CAN BE DONE ABOUT MOSQUITOES?
Unfortunately, all these factors lead to an increase in mosquitoes, a problem without fast solutions.
“I think for the most part, what we need to do is just figure out the ways to protect ourselves from contact with mosquitoes because they are a part of the ecosystem,” Ferguson said.
“On a regular basis it’s going to be things like hanging out in a screened porch instead of right outside, making sure that you dump standing water anywhere in your yard.”
Using repellents like DEET and some natural oils can help when out in the woods, Ferguson said.
“Wear light colours, long sleeves, those kinds of things to reduce the area of your body that’s exposed to potential bites,” Ferguson said. “That kind of thing is sort of our best bet of that trying to sort of prevent our contact with them as much as possible.”
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