Challenging the “Six-month Sober” Rule for Liver Transplants in Canada

Contributed by Annelise Harnanan

Introduction: The Six-Month Sober Rule

Many of the transplant programs across Canada require patients to abstain from alcohol for six months before becoming eligible to be placed on a waitlist for a liver transplant. Generally, reasons for the rule (often referred to as the “six-month sober rule”) are based on the scarcity of donated livers available for transplantation. Indeed, in 2017, Ontario’s transplant agency, Trillium Gift of Life Network, (Trillium) stated that “the number of patients needing a transplant continues to exceed organs available for transplant.”

The six-month rule appears to stem from a concern that a person with alcohol-related liver disease will return to a pattern of alcohol consumption, which could cause complications with the new liver or a recurrence of liver disease. It has been suggested that this perception is based on a study published in 1994 on recidivism after liver transplants in patients with end-stage alcohol liver disease. The authors of the study claimed that only one variable was associated with a return to alcohol abuse: sobriety from alcohol for less than six months. The authors concluded that this finding supported sobriety from alcohol for at least six months as a selection criterion for liver transplants. The six-month rule could also be based on a perception that this period of abstinence would provide sufficient time for a patient’s health to improve “to the point that liver transplantation may not be needed.”

13041_lores.jpg A liver tissue extract from an individual with alcohol liver disease. || (Source: Centers for Disease Control and Prevention Public Health Image Library // World Health Organization)

Despite mounting criticisms, Trillium stated that it did not intend to abolish the rule given that there was insufficient evidence to support such a change. Trillium did, however, launch a three-year pilot program in 2018 to gather evidence to determine whether or not there is a scientific basis for changing the rule.  Continue reading “Challenging the “Six-month Sober” Rule for Liver Transplants in Canada”

Elevated Incidence of Mental Illness in the Legal Profession

Contributed by Darena Muça

Mental illness is a serious problem that impacts all members of society. Mental illness or addiction issues will affect approximately one out of five Canadians in their lifetime, according to the Center of Addiction and Mental Health (CAMH) $51 billion annually. In 2004, the Standing Senate Committee on Social Affairs, Science and Technology issued an Interim Report on Mental Health, Mental Illness and Addiction, which revealed high rates of psychological distress (depression and anxiety) among the Canadian workforce. However, certain professions are more acutely affected by mental illness. According to a survey from 2012 by the Canadian Bar Association (CBA), 58% of lawyers, judges, and law students surveyed had experienced significant stress/burnout, 48% had experienced anxiety and 25% had suffered from depression. This article examines how excessive working hours, difficulties balancing work and life, and a high-pressure and competitive environment may contribute to high incidences of mental illness in the legal profession.

Excessive working hours

The standard number of hours worked by employees in federally regulated industries is 40 hours per week, with a maximum of 48 hours per week in some cases. However, these provisions do not apply to all employees, and certain professions such as lawyers, are excluded from these national standards. As such, as suggested in the Senate’s report, lawyers might be at a higher risk of psychological distress because of excessive working hours. Continue reading “Elevated Incidence of Mental Illness in the Legal Profession”

Using the Law to Respond to the Anti-Vaccination Movement

Contributed by Alanna Crouse

In 1998, Andrew Wakefield published a scientific paper in the highly prestigious journal The Lancet proclaiming a connection between autism and the measles, mumps, and rubella (MMR) vaccine. It was later discovered that Wakefield’s study not only exemplified bad science but was outright fraudulent. An extensive investigation revealed that Wakefield altered the data to make it fit his claim and that his research was funded by lawyers who were representing parents involved in a lawsuit against vaccine manufacturers. Together, these findings shook the scientific community and led The Lancet to retract the paper. Unfortunately, it was too late, as the anti-vaccination movement had already begun.

Contrary to Wakefield’s claim, vaccines are one of the great marvels of the medical world. Prior to their discovery, infectious diseases were the leading cause of death worldwide. After they came into use in Canada, death by infectious disease fell to 5% of all deaths across the country. Accordingly, cases of measles, mumps, rubella, and diphtheria all dropped by 99%, while polio was eradicated altogether. Thus, in a matter of decades, we put to rest some of the most prominent causes of death in the world.

Despite the drastic improvement in public health and two decades’ worth of evidence establishing the safety of vaccines, Wakefield’s unscientific and unethical publication has emboldened a public health crisis that remains in full effect today. A Canadian study in 2010 revealed that 65% of women and 72% of men either believed the MMR vaccine was unsafe, or they were unsure whether or not it caused autism. This attitude has manifested in what organizations like the Public Health Agency of Canada and the Canadian Paediatric Society have deemed “suboptimal” coverage rates of immunization, and subsequently, a rise in measles outbreaks since 2011.

Given the serious and widespread impact of the anti-vaccination movement, it’s no surprise that legislators and academics alike have begun to ask if and how the law can provide a solution to the rising threat. Two potential solutions include enacting legislation, and the law of extra-contractual obligations. Continue reading “Using the Law to Respond to the Anti-Vaccination Movement”

Dying with Dignity: The Growing Importance of Palliative Care in Canada

Contributed by Anita Sengupta

Introduction

In early 2010, Kathleen Carter, an 89-year-old Canadian woman, decided to die with dignity and travelled to Switzerland, where medically assisted dying is legal. Kathleen suffered from spinal stenosis, a terminal disease, and worried that her death would be “slow, difficult, unpleasant, painful, [and] undignified” (para 12). Although Kathleen was able to die on her own terms, her family believed that she should have been allowed to die at home in Canada, surrounded by her family and friends. This led to the landmark Supreme Court of Canada case, Carter v. Canada (Attorney General), February 2015, which ruled that the criminalization of Medical Assistance in Dying (MAiD) in Canada was contrary to section 7 of the Canadian Charter of Rights and Freedoms, namely an individual’s right to life, liberty and security of the person. In June 2016, in response to this decision, the government passed Bill C-14 to amend the Criminal Code, thereby allowing physicians in Canada to provide medical assistance in dying if certain conditions are met.

An important condition to providing medical assistance in dying is that the patient must give informed consent. In Carter v. Canada, the trial judge said, “[…] physicians should ensure that patients are properly informed of their diagnosis and prognosis and the range of available options for medical care, including palliative care interventions aimed at reducing pain and avoiding the loss of personal dignity” (para 106). This ruling not only made MAiD legal, but it also prompted the development of legislation focused on improving palliative care, which was recognized as a viable alternative to MAiD. Continue reading “Dying with Dignity: The Growing Importance of Palliative Care in Canada”

Improving Health Outcomes through Poverty Reduction: Part II

Contributed by: Gary Lai

The following is Part II of Gary Lai’s investigation into the link between poverty and health outcomes. Part I is available here.

Economic Inequality and Health Inequality

There is a large array of political tools to advocate for the poor in the framework of The Canada Health Act (1984). For Example, Dennis Raphael, from York University, proposed a series of actions to reduce poverty and health inequality. He cited the Health of Canada’s Children Report, which reported a deep divide between the health of children who are poor and those who are not. Statistics Canada attributes 22% of mortality differences among Canadians to income differentials. In the University of Sussex’s Richard Wilkinson’s book Unhealthy Societies, he writes, “increasing economic inequality decreases social cohesion, increases individual malaise, and produces the conditions by which increased mortality and morbidity occur.” Raphael also mentioned that the Ottawa Charter for Health Promotion included income as a basic prerequisite for health. He wrote that the public, organizations, and the government could respond to a public health issue like this through recognition of the impact of politics, government policy development and implementation, and community involvement on health.

Raphael is not the only scholar advocating a political solution. Deanna Williamson, of the University of Alberta, claimed that the health of individual Canadians in poverty requires a concerted effort to alter the “fundamental structural conditions contributing to poverty.” She suggested more research in this area. Continue reading “Improving Health Outcomes through Poverty Reduction: Part II”