AIDS and Medical Aid in Dying - are there lessons to be learned?

Canadians debate currently where to draw the line in the sand in terms of eligibility criteria for medical aid in dying. The federal government is determined to push thru a bill that is uncontroversially unconstitutional by limiting access to terminally ill patients.

Today the Globe and Mail (a paper that supports our government's restrictive approach to medical aid in dying) published an unusually thoughtful commentary by Konrad Yakabuski in support (you won't be surprised to hear) of said restrictive approach.

Yakabuski and I have something in common, something important. We both lived thru the early years of the HIV/AIDS epidemic, we both lost loved ones to the disease. Yakabuski mentions that his brother and several friends of his died of the ravages of AIDS, 'with dignity, the old-fashioned way'. Yakakuski's main point (a very reasonable point) is that eventually treatments for HIV infection came about that permit HIV infected individuals today to live basically healthy lives. If medical aid in dying would have been available to them, some HIV infected patients may have chosen to end their lives prematurely, however, if they had decided to stick it out, they might have been able to hang on for long enough to benefit from the life preserving drug regimes that exist today. He then makes the same claim about anti-depressants (arguably he is terribly mistaken on that frontier, but that's unimportant for the purpose of his broader point, it doesn't rely on him being right on that count).

Well, I'm a gay man who has seen very many of his friends succumb to HIV infection in the same years that Yakabuski writes about, and I disagree entirely with his argument and his policy recommendations. You won't be able to see this response in the Globe and Mail, unfortunately, because the paper has been reduced to a propaganda vehicle for a restrictive assisted dying regime.

There has been some debate both among medical ethics people, but certainly also among HIV infected people about medical aid in dying, in the 1980s. One leading bioethics journal, the Hastings Center Report, published many years back a piece by my friend, the late Michael Callen, entitled 'If I have AIDS, then let me die now.' Michael had, of course, no intention whatsoever, to die on AIDS. In fact, years after he published his commentary he wrote a book called Surviving AIDS. Eventually he succumbed to the disease, shortly before life-preserving treatment regimes came onto the market. I have lost far too many friends like Michael.

But I digress, let's return to Yakabuski's commentary. Why would educated AIDS activists, like Michael, have written a commentary for a mainstream medical ethics journal in which they argued that they should be able to receive medical aid in dying when they thought their time had come? Simply put, it was about self-determination. Something maligned by Canadian anti-choice activists as 'autonomy fundamentalism' (not Yakabuski's words!). It was a choice for Michael to make for himself, not for me, not for government, it was his call to make.

The problem with timelines in this context is that we can never know whether, if at all, and when a successful treatment for a particular ailment comes onto the market. Yakabuski briefly mentions the horrible deterioration in health and quality of life HIV infected people in those days experienced. It was worse than that, they had seen friends and lovers wither away, they knew what was coming their way. It's all nice and well to describe this withering away as 'dignified and old-fashioned', but frankly, for many of these young people who died during those years there was nothing dignified about their dying, and no amount of hand-holding and caring would have made their disintegrating lives any more dignified. I am deeply troubled about the euphemisms Yakabuski deploys to describe what was actually happening in our community. I also have no doubt that that is how he subjectively experienced or remembers his brother's death. It is not an experience that is representative of how dying of HIV was experienced by many, if not most, of those who died in those years.

The question then, surely, is whether these patients were entitled to call it a day when they decided they had enough, or whether the state had any right (as the Liberal government's legislation proposes) to force them to stick around and deny them access to medical aid in dying on the ground that some drug might come about. My answer: Of course they were entitled to make those choices and see those choices respected and supported. That the state would think it has a role to play in forcing such patients to stick around no matter what, or commit suicide by some gruesome means, is just mind boggling.

HIV is different to depression, of course, in that it was actually an illness where death would have been reasonably foreseeable, so HIV patients arguably would have met the standard set out in the restrictive government draft legislation of bill C14.

I have published a year ago with Suzanne van de Vathorst a lengthy piece on treatment resistant depression and medical aid in dying. May be take a minute or two to read it. It's available here. The same link will also take you to published responses, including one or two making Yakabuski's case, as well as our considered response to those arguments. The article also supplies hard data on the actual large scale failure of available treatment modalities that Yakabuski glosses over in his piece. The argument here is the same as above, if a patient is competent at the time of decision-making and he or she does not consider their lives worth living, and available treatment options have been exhausted, we as a society have no right whatsoever to force such people to stick around in the hope that some treatment might come about during their lifetime. It's a decision only such patients can make for themselves. Whatever they decide, they deserve our support.

Health Care - Not an Issue for Major Political Parties in Canada's Federal Election Campaigns

It's a somewhat surreal election campaign that is currently in full swing in Canada. It stays clear of issues of vital importance to Canada and Canadians. There we have a rapidly ageing population and really we need a national seniors strategy that accounts for that. One can nearly feel sorry for the Canadian Medical Association here. The association tried hard during the last few months to make this issue an issue in the current election campaign. It was rightly supported by sympathetic journalists such as the Globe and Mail's Andre Picard. Yet, for all those efforts, the issue gained no traction with any of the major parties. Our federal leaders' heads remain firmly planted deep in sand, with no effort made to look ahead and address major, dramatic challenges to our health care system. Instead we were treated to a good two weeks' worth of Mike Duffy and the usual corrupt shenanigans that are a hallmark of Prime Minister Harper's political operation.

I spoke yesterday to a journalist interviewing me on the state of federal and provincial planning with regard to the implementation of our Supreme Court's decision  on assisted dying. He asked why the political parties, in my estimation, haven't taken up this issue in their respective campaigns? He was puzzled that an issue that enjoys broad support among Canadians is ignored by the major political parties. What was I to say other than 'I don't get it either'. A new poll, released today, confirms what I told the journalist yesterday, it is not only the case that the vast majority of Canadians want to see the decriminalization of assisted dying, it is also the case that the vast majority of conservative party voters supports the decriminalization. 77% of Canadians generally support decriminalization and a whopping 67% of conservative party voters and 84% of NDP voters. This does beg the question why none of the mainstream parties have leveled with their supporters and the general voting public on how they would implement the Supreme Court judgment. I do still wonder why Prime Minister Harper appointed an advisory panel stacked with discredited anti-choice activists, given that the majority of his party's supporters is in favor of decriminalization. Why on earth would he stack his panel with folks known to be opposed to decriminalization? I sometimes wonder about the credit that is given to Mr Harper who is hailed as a master political tactician. His whole election campaign seems a shambles to me.

Globe and Mail misleads about HIV/AIDS legal basics and vaccine research

Hmm, the Globe and Mail newspaper, Canada's only paper that comes reasonably close to being a national quality outlet, decided to contribute to today's World AIDS Day by offering a list of nine things we should know about HIV.  Good idea, questionable execution.

Under point five the paper informs us in the subheading going with point five (out of nine)

'5. In Canada, it’s is illegal for HIV-positive people to have sex without disclosing their status.'

Except... it isn't actually illegal for HIV-positive people to have sex without disclosing their status. As the journalist responsible for the list notes in the paragraph right under the subheading,
'A more recent Supreme Court ruling stated that a person living with HIV does not have to disclose their status before having vaginal sex if a condom is used and the person has a low viral load.'

That's actually the case. Canadians who happen to be HIV-positive, have an undetectable viral load and use condom during sexual intercourse are not under a legal obligation to disclose their HIV-status to their sex partners.

Important lesson. Make sure to scan more than just the subheadings of the Globe and Mail.

The journalist writing up the nine point list of random 'facts' made up another 'fact' altogether:

'8. The first and only preventative HIV vaccine is being developed in Ontario, but it still has a way to go.'

Reality check:  lots of preventative vaccine candidates are being tested in clinical trials. They pretty much all flamed out to date without doing much. The Globe and Mail journalist responsible for the nine point list links this particular 'fact' to a 2013 article in a business paper alerting readers to the fact that a team at Western University succeeded in testing their vaccine candidate in a phase 1 clinical trial. Phase 1 clinical trials only test for toxicity, no more. So, the long and short of it is that nothing much is being 'developed' on the preventative vaccine front in Ontario. Here's the Globe and Mail take on this: 'Preliminary clinical trial results appear positive but there are still many hurdles to overcome, including manufacturing and regulatory approval.' That's a funny way of looking at a vaccine candidate that has - according to the report the Globe and Mail article uses as reference - barely emanated from phase 1. If you think that manufacturing and regulatory approval are the relevant hurdles to take when it hasn't been established that the agent actually works as a preventative agent, you might want to reconsider your investment strategies as far as pharmaceutical companies are concerned.

This hyping of clinical research in the absence of firm evidence seems to become standard journalistic operating procedure in this country, ever since experimental agents were randomly promoted to Ebola vaccines by eager journalists across the country.

Check out the Globe and Mail piece, some of the other 'facts' seems suspicious, too, but I don't have the time to fact-check this particular list of 'facts' in detail.

In Saskatchewan, where the prevalence rate is three times the national average, a person is infected even more frequently.. A person is infected with HIV in Canada every three hours.

In Saskatchewan, where the prevalence rate is three times the national average, a person is infected even more frequently.

Is it that difficult to get your questions right, Globe and Mail?

The Globe and Mail newspaper has done a pretty sterling job covering the ongoing proceedings on end-of-life matters in Canada. Reporting has been well-informed and its editorialising has been supportive of the decriminalisation of assisted dying in the country.

Yesterday though, the paper flunked it. It tried to have yet another for-and-against on the subject matter. I don't blame the paper, the issue is currently heard by the Supreme Court of Canada, it's a big issue (right next to that non-issue, Ebola scare in Belleville). The for and against asked Margaret Somerville (mysteriously introduced as one of Canada's best-known experts on the subject) and Arthur Schafer to address the question of whether doctors should be permitted to accede to patient requests for assisted dying. Not unexpectedly, the two contenders had nothing new to say, but nonetheless their comments were the starting point for a lively debate among Globe and Mail readers.

What I found shocking is that the paper didn't manage to phrase the question correctly. It asked: 'Should patients be allowed to request suicide?' Well, obviously, this isn't the question at all.

Canadians are legally permitted to ask this question of anyone at any time. Nobody is questioning Canadians' right to request assisted dying (it's about assisted suicide/voluntary euthanasia, btw, not about suicide, dear Globe and Mail). The real issue is whether health care professionals should be permitted to accede to such requests. That the paper didn't quite get to asking its 'best-known experts'. Bit disappointing.

On academics blogging, writing newspaper columns, stuff like that

Should academics maintain blogs and do newspaper columns? If we decide to do so, should we insist on getting paid?

During a conversation I had with an academic at a top Australian research university he mentioned to me a colleague who he thought had burned-out as a serious researcher and who tended to spend his while writing newspaper columns and blog entries as opposed to doing serious work. He clearly didn't approve of academics spending their valuable and usually well-paid time writing content for blogs such as this one.  So, should we bother?

I got to be honest, academics working in areas that are of interest to the wider public should share their insights with that wider public. Say if you work on climate change in environmental science, or you work on obesity prevention, surely you have an obligation to inform the taxpayers that fund your job about your findings. Hiding your research outputs exclusively in highly specialized academic journals with their few hundred readers per average article output, seems almost irresponsible. It makes sense to maximize the impact of your work,

You'd object and point out that nothing stops you from doing other kinds of media work. Why not talk to journalists and let them repackage your research professionally. After all, unlike us academics they are trained at least in producing readable content. Well, truth be told, that's not exactly a risk-free activity. Often you talk to journalists for 30 min or longer over the phone and their 2 line quote manages to miscommunicate what you have been on about completely, or to a significant extent. Writing your own stuff means taking control of your public messaging.

Some have lamented that too many academics write these days free of charge for sites like the Huffington Post, thereby destroying journalists' jobs. I have got to be honest, I sympathize with this concern. I have, in the past, written free of charge for papers like Toronto's Globe and Mail or The Conversation. I have also written for The Guardian, but being the paper that it is, it paid without me even asking for it. I would probably still write free of charge for non-profit outfits like The Conversation. However, I think it's problematic to write free of charge for commercial outlets. It messes up the market for these sorts of creative outputs. It's also problematic because you subsidize with your freelancing the columns of these papers' staff columnists, some of whom are, well, dreadfully uninformed at the best of times.

I have accepted last year an invitation to write for the Kingston Whig-Standard, the local outlet of a massive conservative Canadian media conglomerate. The that time editor of the paper offered a column on anything I fancied writing on and a smallish fee. To that deal I agreed. It wasn't so much about the money, to be honest, because after paying taxes, it's really more of a token of gratitude than actual pay. The principle though, that you should get paid for such work is right. It's quite ok if the paper at one point tells me to go away and reallocates their limited freelance writing resources to another writer. That that person should then also be paid for their work is only right. Incidentally, that's why I have never written for the Huffington Post. It's also the reason why I hold newspaper subscriptions. People producing original content for your consumption should be paid.

It's funny how that column writing venture panned out. The paper (initially unbeknownst to me) enters my columns into a pool of content produced by any number of other freelancers and on a few occasions my columns ended up being reprinted in other papers owned by said conglomerate. Some probably saw more readers than my piece in the Toronto broadsheet. The paper also puts up the columns on its website. Initially they tweeted my columns but that has since ceased (I do that myself now, big deal). To my surprise, despite the smallish print circulation of the paper, my content also ended up with a reasonably wide reach. Nothing comparable to The Guardian, but still. I discovered that folks in Thailand had once a lively discussion about one of the columns. You never know where this stuff ends up! - The other week I ended up in the cinema. An elderly man sitting right beside me, whom I had never before seen in my life, thanked me for writing the columns. Apparently he is looking forward to reading them every weekend. Well, I'm sure there are also folks that really dislike them. It's inevitable.

Talking about reach. Yes, I tweet links to my columns and share them on google+. My tiny twitter followership is still tiny by Justin Bieber standards. It went from 70 or so to a bit under 300 people these days. Among these people though are a bunch of influential tweeters. If any one of them retweets links to my pieces they quickly attract a significant number of additional readers. The flip side is that there is plenty of sneering and one-line commenting on such occasions that one cannot reasonably and intelligibly respond to. - How a US Member of Congress ended up amongst my followers? Who knows. May be join him to find out whether it's quite worth it :). I'm @schuklenk

Reportedly Margaret Somerville is at it again in the Globe and Mail, celebrating her scholarship

Ha, an odd weekend this has been. Instead of completing a book chapter that's due next weekend I spent most of the time emptying the basement to prepare it for a major remodelling job. Hard labour probably feels a bit like that.

In any case, over the weekend a whole bunch of people have written to me about Margaret Somerville who seemingly had yet another Somerville-on-soapbox-with-megaphone piece in the Globe and Mail newspaper. An opinion piece in which she reportedly whinges about being judged by others based on her religious convictions and not her ideas.

It is so so tempting, of course, to contact the paper and ask for the opportunity to reply to this utter nonsense. Alas, I have sworn to myself not to read its Opinion pages (I don't access them on the internet either) while it keeps in its employ a columnist who is a known plagiarist. The lack of editorial integrity that goes with such misguided policies should have some consequences, one being my 'don't read, don't contribute' policy.

I'm note saying that the Globe and Mail isn't worth reading. It has many fine journalists and writers working for it, but for better or worse it is seriously tainted by its editorial decision to keep said plagiarist writing for it. You can't take a broadsheet quite seriously that operates like that.

So, I've got to be clear here, I am responding to what has been reported to me about said article (that I won't link to either). Ms Somerville seems essentially to be complaining about people judging her by her religious beliefs and not by her ideas.

Ms Somerville's views are not seriously discussed in bioethics, despite her hard work at selling herself as a bona fide bioethicist in her newspaper and other appearances. She doesn't publish in serious, mainstream bioethics outlets or serious mainstream international academic publishing houses. On her website there is zero evidence that she has any academic qualifications in biomedical ethics. For years she has been marketing herself as the founding director of some bioethics outfit at McGill University. Really Ms Somerville? Bragging about having founded something many years ago as evidence of current-day academic competence?

Despite Ms Somerville's reported protestations (in said article) to the contrary,  this empress is really naked. The reason why virtually nobody seriously engaged academically with her is that there is little academic professional output to engage with. She pontificates mostly in newspapers, and it's always predictably Catholic output. To give you just three examples: Catholic Church: Assisted Dying = bad. Ms Somerville: Assisted Dying = bad. Catholic Church: marriage equality = bad. Ms Somerville: marriage equality = bad. Catholic Church: abortion = bad. Ms Somerville: abortion = bad.

Ms Somerville - to give credit where probably it isn't actually due - has tried hard over the years to cover her Catholic agitprop in bioethics language. Among her favourite covers is 'human dignity'. As far as she is concerned, assisted dying violates human dignity. Human dignity here simply stands for a Catholic understanding of what it is to be human and what it is to live a dignified human life. There's nothing else Ms Somerville has actually to offer. There are no ideas to engage with.

I do encourage you to check out Ms Somerville's Wikipedia entry. It seems to be a hard-fought-over entry. There are ongoing debates about her being turned down as an expert witness by US Courts. The entry tries hard - at the time of writing - to persuade us that Ms Somerville is a serious academic by showing off two article in the first volume of an unknown journal propagating Christian family values. It is all a bit of a joke, to put it mildly. An anti-gay campaign outlet masquerading as an academic journal, not affiliated with any serious international publisher. The Table of Contents downloads as MS Word documents. Hilarity all around here.

Perhaps, Ms Somerville, you would be better off stopping crying in public that nobody takes you quite seriously in the academy. It is you, after all, who has given professionals working in the field that you unjustifiably claim as your own so very little reason to engage you as an intellectual. If I wanted to engage thoughtful Catholic bioethicists, there are plenty of them. We do argue with each other. The key phrase here is that we 'argue'. Ms Somerville doesn't argue, she pontificates.

Are paywalls the newspaper industry's salvation?

Ever more newspapers establish paywalls in order to get money out of netizens who happen to check for latest news. To be fair, when Rupert Murdoch started this craze (at the London Times), there was much mockery around, people promising to abandon the site etc etc. Murdoch started charging, of course, many years ago. Since then many newspapers who mocked him for his approach ('you are going from millions of visitors access your website to a few thousand or hundred thousand') are copying him. The thing is, while the newspaper is now read by significantly less people than it was prior to the paywall going up, the paywall is generating more money than the digital ads ever managed to.

Since then man other newspapers have begun doing the same. The Globe and Mail in Canada, The Telegraph in Britain, The Age in Australia are just a few examples for this emerging trend. Many more are following them as I write this. Usually you get a limited number of articles that you may read without paying for access, but then you've got to pay if you want more. Currently there is an easy way around paying. You simply clean your browser history (ie eliminate 'cookies') and you are back to zero as far as the article count is concerned. Realistically, however, some computer wiz employed by the newspapers will stop this subversive behaviour. And frankly, so they should.

Obviously, it is not unreasonable for newspapers to charge for what they deliver. There's a difference between investigative journalism produced by the New York Times and opinion journalism delivered free of charge by the Huffington Post. The problem I foresee, however, is that most people, when deciding to pay for access to a news website, will probably go for the best quality news outlet out there. Accordingly, the New York Times is rapidly racking up on-line subscribers. I cannot imagine the same would occur with regard to papers not delivering the same level of quality. To give you a good example of this: The New York Times has a habit of firing known plagiarists. Compare that to a Toronto based daily paper where a known plagiarist is still in full employ. If you had to decide where to spend your hard earned cash, would you swipe your credit card at the New York Times with its still impeccable standards or an alternative such as the Toronto paper. It seems to be a no-brainer to me. You might grab the few locally relevant pieces from the Toronto paper, but for in-depth journalism you'd spend your money at the New York Times or papers like it (and there are very few).

The other problem for the unnamed Toronto newspaper (and its equivalents in Britain, Down Under, Berlin, and wherever else), is that they are under-resourced, and it is widely known that they are under-resourced. Why would you want to spend your money to access the website of a newspaper that you now already isn't on top of its game due to a lack of journalistic resources?

To me, that seems to be the next problem in the paywall revolution. Many mainstream national newspapers, I suspect, will be going down, because they don't deliver the quality required to stay in the game any longer. Funnily, niche players such as the German taz newspaper (an unorthodox leftish daily paper) might have a decent shot at survival, because they have a dedicated audience not interested in reading only what the New York Times has on offer.

Either way, the paywall revolution might well be the last hurrah of many mainstay newspapers before they disappear altogether. We all will be worse off for it, I suspect. Will this regret make me subscribe to the plagiarist-employing Toronto paper. Who am I kidding?

Globe and Mail on End-of-Life Issues

Marina Jimenez of the Canadian national paper Globe and Mail initiated a meeting between three members of their Editorial Board and myself for a brief interview on end-of-life issues in Canada. The result is this Editorial and this interview. Check it out. Reading the spoken words now I realize how way more sophisticated written content is when compared to an interview transcript, let alone how typing errors like 'Advanced Directive' can sneak in (that can easily occur when one is not that familiar with the terminology). Interesting experience. I like the gist of the editorial, but be warned, do not assume that the views I express in the interview reflect necessarily the content of the Royal Society expert panel report that will be out later this year.

What Information Does Jack Layton Owe to the Public - if any?

Jack Layton, for my international readers, is the official Leader of the Opposition in Canada. He has been battling prostate cancer for some time. This week he announced his temporary withdrawal from his post, because a further cancer had been detected and needed to be treated. This all is, of course, terrible news both for Mr Layton personally, as well as for his party. Since then Canadian media outlets have begun speculating how bad his condition really is, pointing to his 'raspy voice' and the fact that he participated in Toronto's gay pride parade from the back of a ricksha, stuff like that. The question arose what levels of health disclosure public officials owe us. 


The Globe and Mail in Toronto's writer suggests that nothing short of a detailed disclosure of their health problems will do. He holds the disclosure the US President provides as a matter of course up as the gold standard. Of course, why such a standard should apply to an opposition politician (who isn't exactly in charge of the military or much else for that matter) isn't addressed in that article. There's no explanation in for why Mr Layton would owe us a full disclosure of his ailments along the standards the US President has to live up to. Why should Mr Layton's right to privacy not count? According to the G&M writer, it's because by having chosen to be in the public eye Mr Layton doesn't deserve much privacy. Really? 


Nothing could be further from the truth. Mr Layton owes us nothing at all with regard to the state of his health beyond stepping down when he is unable top fulfill his duties as an elected official, temporarily if he has reason to believe he will recover, or permanently if he has reason to believe he won't recover. We might be curious, but that doesn't establish a right to know on our part. Of course, Mr Layton has not stepped down as the elected representatives of his riding, so his electorate might want to ask him questions about his prognosis. After all, he can't currently meaningfully represent them. In case he's likely to recover he should say so, in case he's unlikely to recover he should resign his seat. However, does that mean he owes us details of his health situation? Not at all, it's none of our business. Do we need to know what other cancer he suffers from? Not at all, it's none of our business.


Elected officials owe their constituents just enough information as to permit them to make a determination on whether they remain (or will be in the foreseeable future) fit for office. No more, no less. The G&M writer offers us this silly line in his defence of his aggressive intrusion in Mr Layton's private life: 'Mr. Layton is a big boy. He can take it. The last thing he needs is pity.'  - The less said, the better.

Ouch, Marge Somerville is at it again

The Vatican's voice at McGill University, Margaret Somerville, in her endless campaign against any kind of sexual activity other than that of the heterosexual married kind, has struck again. Typically in the Globe and Mail, a Toronto based rag considered a quality paper in Canada. Here's what she had to say.

Here's my response (kinda doubt you'd see it in the paper, so I thought posting it here can't hurt :-). Umm... I take it all 'back'. Here's the edited version of the letter that the paper published.

Sir,

Margaret Somerville's obsession with other people's sexual conduct knows clearly no end.

The obvious flaw in what goes as her argument is this: if incestuous activities among competent adults are truly voluntary, and no offspring is forthcoming, why should the state inflict religious mores of Somerville's kind on such citizens? Volenti non fit injuria - Did our self-appointed ethics scholar really never come across this basic legal and ethical concept?

Somerville's piece suffers from a fairly basic, yet lethal logic error, namely the idea that nature could somehow tell us anything at all about the question of whether incest is a morally good or a bad thing. Even if it were the case that other primates avoid incest, this would tell us nothing about our moral obligations in that regard. They don't drive cars either, so, according to Somerville's fawlty towers logic we should presumably reconsider the use of all means of
modern transport.

The Globe and Mail is to be congratulated for having, once again, commissioned a piece of Somerville agitprop that mistakenly ended up under the heading of 'ethics'. It is unfortunate, that you delayed publication of Somerville's piece to a date after April 01.

Disabled kid can't sue the doctor responsible for the disability - in Canada

This is one of those 'I'm not a lawyer, but ...' type posts. Today's GLOBE&MAIL has a report about a court case in Canada. Basically a doctor prescribed an acne medicine that was known to lead to birth defects to a pregnant woman. The woman eventually gave birth to a disabled newborn (an ear missing, part of the newborn's face is paralysed).

The court's judgment rests on two claims: 1) 'because the woman and her fetus are one - both physically and legally - it is the woman whom the doctor advises and who makes the treatment decisions affecting herself and her future child.' This doesn't seem entirely unreasonable. 2) The second claim is that 'granting a child the right to sure doctors for damage caused before birth would also interfere with a woman's right to an abortion'. This seems truly implausible. One can hold consistently that fetuses do not have a right to be (ie grant women a right to abort for whatever reason they see fit), and at the same time that if the pregnant woman decides knowingly and voluntarily to carry it to term that certain duties of care are owed to it, eg the duty to offer it the best possible shot at a life worth living. Anita Kleinsmidt and I have advanced this argument (admittedly in a different context) in the American Journal of Public Health.

There is no contradiction in this point of view, because one can hold the view that moral standing begins at the moment of birth (or viability). However, if the pregnant woman decides not to avail herself of the option of abortion, it's highly probably that a viable child will be born. Any action undertaken by the mother that would reduce such off-spring's best possible shot at a life worth living would require very good reasons (eg the mother's life and future well-being at risk).

The doctor should have inquired whether or not there was a pregnancy prior to prescribing the medicine and/or it would have been necessary for him/her to inform the pregnant woman of the risk of birth defects in case the medicine is taken during pregnancy. The GLOBE&MAIL article seems to imply that the pregnant women did not give informed consent to this risk, because she wasn't informed as she should have been. The doctor clearly erred in his professional obligations both to the mother as well as to the fetus she decided to carry to term (unaware of the risk she subjected the fetus to, due to the doctor's negligence) if she/he failed to elicit informed consent from the pregnant woman at the time. For that reason it is surprising that the Court should have ruled that the child has no case against the doctor.

Robbing Peter to pay Bill: Mr Harper does AIDS

One must congratulate the Federal government of Canada on a pretty brilliant political move in terms of how it allocates its AIDS related resources. Mr Harper's government has decided to reallocate about 26 mio C$ within its AIDS budget. This amount is re-routed away from programs the government does not fancy much, politically. Funding for Ontario's community programs reportedly will be slashed by up to 30%. As one would expect, there has been quite a bit of an uproar in the community, ranging from gay men's AIDS groups to NGOs offering needle exchange programs to injecting drug users. So, all this looks much like a conservative government in conservative policy making action. On the face of it one should go about waving hands and writing bitter letters to newspaper editors - of which, no doubt, there will be many. After all, harm minimization programs for IV drug users work to some extent, and in light of rising numbers of HIV infections among gay men, any half-educated public health practitioner would have reason to be up in arms against Mr Harper's policies. Predictably, unless the provincial government steps in or other sources of funding for such community groups can be found, HIV infections will increase in Canada as a result of the cuts.
Here then is the brilliant bit of the government move. It re-routed the funding not to some conservative pet project or other, but to the Gates' Foundation's Vaccine Initiative. Gates offers to match every dollar provided with the foundation's own funds (well, really the taxes we pay to Microsoft for using its ubiquitous software). So, money is ultimately removed from the immediate fight against AIDS in Canada to the fight against AIDS in the world, particularly so in the developing world. After all, the ultimate solution to AIDS will not be found in prevention programs, it will be in a preventive vaccine - or it won't be a solution to begin with. It is that simple. While it is a bit surprising for a conservative government - actually, for any government - to prioritize much larger needs elsewhere over needs at home, arguably that is what we ought to do. If ever there was a policy aiming at the greatest good for the greatest number, this would probably qualify. A very ethical choice indeed! Or so it seems.
At a first glance, community based AIDS organizations criticizing Harpers government seem selfish at best. But only at a first glance, because, truth be told, in the big swing of things in the federal budget, these few millions to community based AIDS organizations are really neither here nor there. It would have been more than easy for Mr Harper's government to find the money for the Canadian AIDS vaccine initiative elsewhere if it had put its mind to it. There can be little doubt, the 'robbing peter to pay bill' kind of decision making that we are witnessing here, is politically motivated and has nothing at all to do with international public health priorities. The government's grand gesture in response to Mr Gates' even grander gesture suggests that some kind of hard ethical decision had to be made, when really there was no need for this at all.
We should wave our hands and write bitter letters to newspaper editors after all... unfortunately.