ObjectivesPrevious studies found a general increase in prejudice against Chinese people during the first months of the pandemic. The present study aims to consider inter-individual heterogeneity in stability and change regarding prejudice involving Chinese people during the pandemic. The first objective is to identify and describe different trajectories of prejudice over a seven-month period during the pandemic. The second and third objectives are to test the association between trajectory group membership and antecedent variables such as: socio-demographic factors and two psychological (...) mechanisms, namely economic threat and global citizenship identification.MethodsA representative Canadian sample according to age, gender and province of residence, was recruited for a 10-wave survey starting from April 2020 to December 2020. First, a group-based modeling approach was used to identify trajectories of prejudice. Second, a multinomial logistic regression model was used to test associations between membership in trajectories and antecedents.ResultsFour trajectories were identified. The first three trajectories have a low, high or very high level of prejudice against Chinese people which is relatively stable over time. The fourth trajectory reports low levels of prejudice in favor of Chinese people which become more positive throughout 2020. Regarding socio-demographic factors: gender is not associated with trajectory group membership, younger people are more likely to follow the trajectory in favor of Chinese people and conservatives are more likely to follow the highest trajectories against Chinese people. Regarding some psychological mechanisms: personal but not collective economic threat is associated with the trajectory in favor of Chinese people. Finally, the highest levels of prejudice are found when the strategy of identification is more local rather than global.ConclusionThe present study shows that Canadians differ in terms of both their level and change in prejudice against Chinese people throughout the pandemic with some socio-demographic groups being more likely than others to be associated with prejudice. The results also suggest that a promising way to tackle the major social issue of prejudice is to highlight a vision of the world where individuals are all “global citizens” facing the same challenge. (shrink)

Drug regulatory bodies aim to ensure that patients have access to safe and effective drugs; however, no matter the quality of pre-licensure studies, uncertainty will remain regarding the safety and effectiveness of newly approved drugs until a large and diverse population uses those drugs. Recent analyses of Canada’s post-market drug surveillance system have found that Canada is not keeping pace with international requirements for PMDS, and have noted that efforts must be improved to monitor and address the safety and (...) effectiveness of approved drugs among vulnerable populations. Given the uncertainty that exists when drugs enter the market, some have suggested that the precautionary principle is relevant to guiding decision-making in this context. This paper responds to recommendations that the Canadian PMDS system should be responsive to the health needs of vulnerable populations by assessing the utility of deploying the precautionary principle to guide a post-market strategy for vulnerable populations. (shrink)

The mechanisms of longevity have been the subject of investigations for a number of years. Although the role of genetic factors is generally acknowledged, important questions persist regarding the relative impact of environmental exposures, lifestyle characteristics, and genes. The BALSAC population register offers a unique opportunity to study longevity from an intergenerational and genealogical point of view. Individuals from the Saguenay-Lac-St-Jean population who died at age 90 or older between 1950 and 1974 were selected from this database (n (...) = 576), along with a control group of individuals born in the same period who died between 50 and 75 years of age. For these subjects and controls, spouses’ ages at death and parental ages at death and at their birth were investigated using regression analysis. Genealogical reconstructions were carried out for each individual, and various analyses were performed on both groups. Both fathers’ and mothers’ mean ages at death were significantly higher among the longer-lived cases than among controls whereas spouses’ ages at death and parental ages at birth had no effect. Regression analysis confirmed the positive effect of both fathers’ and mothers’ age at death. Mean kinship coefficients for the parents’ generations displayed significant differences, indicating that kinship was higher among subjects than controls (this effect was stronger among the oldest 10% of the subjects). Frequencies and genetic contributions of ancestors were very similar for the two groups, and none of these ancestors appeared more likely to have introduced genetic variants involved in longevity patterns in this French Canadian population. (shrink)

BackgroundThe Supreme Court of Canada removed the prohibition on physicians assisting in patients dying on 6 February 2015. Bill C-14, legalising medical assistance in dying in Canada, was subsequently passed by the House of Commons and the Senate on 17 June 2016. As this remains a divisive issue for physicians, the Canadian Neurosurgical Society has recently published a position statement on MAID.MethodsWe conducted a cross-sectional survey to understand the views and perceptions among CNSS members regarding MAID to inform its (...) position statement on the issue. Data was collected from May to June 2016.ResultsOf the 300 active membes of the CNSS who recevied the survey, 89 respondents completed the survey, 71% of whom were attending neurosurgeons and 29% were neurosurgery residents. Most respondents,74.2%, supported the right of physicians to participate in MAID with 7.8% opposing. 37% had current patients in their practice fitting the criteria for MAID. 23.6% had been asked by patients to assist with MAID, but only 11% would consider personally providing it. 84% of neurosurgeons surveyed supported the physicians’ right to conscientious objection to MAID while 21% thought attending surgeons should be removed from the inquiry and decision-making process. 43.8% agreed that the requirment to refer a patient to a MAID service should be mandatory. Glioblastoma multiforme, quadriplegia/quadriparesis secondary to spinal tumour/trauma and Parkinson’s disease were the most common suggested potential indications for MAID among the neurosurgical population.ConclusionsOur results demonstrate that most neurosurgeons in Canada are generally supportive of MAID in select patients. However, they also strongly support the physicians’ right to conscientious objection. (shrink)

Direct to consumer offerings of unproven stem cell interventions is a pressing scientific and policy issue. According to media reports, providers of SCIs have emerged in Canada. This study provides the first systematic scan of Canadian providers and associated trends and claims. The study sample consisted of 15 websites retrieved from a Google™ keyword search. The websites were assessed by a rater using a peer-reviewed coding frame that queried treatment location, stem cell offerings, treatment claims, supporting evidence, and legal (...) and regulatory compliance. A second rater reviewed a subset of the websites for purposes of inter-rater reliability. Disagreements between raters were resolved by consensus. Data collected by the raters was analyzed in SPSS. Physicians are the dominant treatment providers in Canada. Providers operate in urban and semi-urban areas in the most populous provinces. SCIs provided are mainly autologous adult stem cells for multiple conditions including musculoskeletal disorders, spinal cord injury and diabetes. Efficacy and benefits of treatment are prominently and positively portrayed, while risks are not mentioned or portrayed as trivial. Regulatory concerns are not discussed. The involvement of physicians in promoting and providing unproven and unapproved SCIs raises significant ethical, legal and regulatory concerns. Treatment claims and trends appear to contravene applicable professional standards, statutory obligations, and consumer protection laws. While the number of providers observed is still marginal, urgent and proactive regulatory response is needed to prevent proliferation of a potentially exploitative and harmful market for unproven SCIs in Canada. (shrink)

BackgroundWhile ethicists have for many years called for human subject trial participants and, in some cases, local community members to benefit from participation in pharmaceutical and other intervention-based therapies, little is known about how these discussions are impacting the practice of research ethics boards that grant ethical approval to many of these studies.MethodsTelephone interviews were conducted with 23 REB members from across Canada, a major funder country for human subject research internationally. All interviews were digitally recorded and transcribed verbatim. After (...) coding, the data was analyzed to identify central themes and topics. Themes were identified, application of the themes was confirmed, and these themes were then used to populate the findings of this manuscript.ResultsOur analysis of the interviews identified two primary themes when considering what benefits are owed to research participants and their communities. 1) Most study participants felt that given that these studies are led by persons in the role of researcher rather than health care provider, they had a limited obligation to provide benefits to study participants. 2) These REB members were all working in Canada, a high income country where most residents enjoy high levels of access to health care. As a result of this context, the study participants tended to focus on ethical concerns including obtaining informed consent and avoiding undue inducement to participate in research rather than ensuring that study participants directly benefit from successful trials.ConclusionsResearch on REB members’ attitudes toward what benefits are owed to study participants and community members is needed in other countries in order to determine how context affects these attitudes. (shrink)

Nursing research in palliative care raises specific and challenging ethical issues. Questions have arisen about whether such research is morally justified, given the low likelihood of direct benefit to dying patients as research participants. The Canadian Code of ethics for registered nurses outlines eight primary values intended to guide nursing practice. We use these values to explore the moral dimensions of research with the palliative care population. Our conclusion is that palliative care research is needed to foster excellent (...) care for these patients and their families, but that nurses must remain constantly vigilant to ensure that participants are protected from resultant harms. Through this exploration we highlight particular considerations that nurse researchers must contemplate when accessing a vulnerable population. (shrink)

This study examines whether Canadian governments have adapted budgets for the ageing population in accordance with norms of intergenerational justice. Public finance data in 2016 are analysed compared to 1976 in light of three constructs: the elderly/non-elderly ratio of social spending change, intergenerational reciprocity, and ability to pay. Findings include that governments increased per capita spending for seniors 4.2 times faster than for those under the age of 45; public finance requires younger Canadians to contribute 22%-62% more in (...) income taxes for the elderly now by comparison with 1976; and the contemporary ageing population has a greater ability to pay than cohorts immediately before and after them. (shrink)

Subjective and psychophysiological emotional responses to music from two different cultures were compared within these two cultures. Two identical experiments were conducted: the first in the Congolese rainforest with an isolated population of Mebenzélé Pygmies without any exposure to Western music and culture, the second with a group of Western music listeners, with no experience with Congolese music. Forty Pygmies and 40 Canadians listened in pairs to 19 music excerpts of 29–99 s in duration in random order (eight from (...) the Pygmy population and 11 Western instrumental excerpts). For both groups, emotion components were continuously measured: subjective feeling (using a two- dimensional valence and arousal rating interface), peripheral physiological activation, and facial expression. While Pygmy music was rated as positive and arousing by Pygmies, ratings of Western music by Westerners covered the range from arousing to calming and from positive to negative. Comparing psychophysiological responses to emotional qualities of Pygmy music across participant groups showed no similarities. However, Western stimuli, rated as high and low arousing by Canadians, created similar responses in both participant groups (with high arousal associated with increases in subjective and physiological activation). Several low-level acoustical features of the music presented (tempo, pitch, and timbre) were shown to affect subjective and physiological arousal similarly in both cultures. Results suggest that while the subjective dimension of emotional valence might be mediated by cultural learning, changes in arousal might involve a more basic, universal response to low-level acoustical characteristics of music. (shrink)

Background Noninvasive prenatal testing (NIPT) provides important benefits yet raises ethical concerns. We surveyed Canadian pregnant women and their partners to explore their views regarding pressure to test and terminate a pregnancy, as well as other societal impacts that may result from the routinization of NIPT.Methods A questionnaire was offered (March 2015 to July 2016) to pregnant women and their partners at five healthcare facilities in four Canadian provinces.Results 882 pregnant women and 395 partners completed the survey. 64% (...) of women anticipated feeling no pressure to take the test if it were offered routinely, and 39% were not concerned about routinization leading to increased pressure to terminate a pregnancy of a fetus with Down Syndrome. Regarding other social concerns possibly resulting from routinization, pregnant women were most concerned regarding a reduction in resources available for people with Down Syndrome and their families and least concerned regarding a decrease in the population of people with Down Syndrome.Conclusions Our findings reflect the concerns expressed by pregnant women and their partners, both personal (pressure to test, pressure to terminate) and societal (e.g., regarding potential negative impact on people with disabilities and their families). Even if most women were not concerned about feeling pressured to test due to NIPT routinization, a large minority express concerns that should not be taken lightly. Moreover, a majority of respondents were concerned regarding pressure to terminate pregnancies due to NIPT routinization as well as regarding most societal impacts they were queried on, especially the possible future reduction in resources available for people with DS and their families. Canadian policy-makers should consider these potential negative ramifications of NIPT and ensure that appropriate social policies accompany its implementation. (shrink)

In Canada, all research conducted by individuals associated with universities must be subjected to review by research ethics boards (REB). Unfortunately, decisions reached by REBs may seriously compromise the integrity of university-based research. In this paper attention will focus on how requirements of REBs and a legal department in four Canadian universities affected response rates to a survey of domestic and international students. It will be shown that in universities in which students were sent a legalistic cover letter to (...) a mail survey, or were required to sign a consent form, lower response rates were achieved than in universities in which students were sent a relatively friendly letter. In turn, lower response rates resulted in: sample characteristics that deviated from population characteristics; a reduction in the possibility of testing research hypotheses; and increased survey costs. As a consequence, it is argued that the unreasonable demands of REBs are seriously compromising the quality of research that can be carried out on Canadian university students. (shrink)

Prior research has demonstrated that accountants differ from the general population on many personality traits. Understanding accountants’ personality traits is important when these characteristics may impact professional behavior or ability to work with members of the business community. Our study investigates the relationship between Machiavellianism, ethical orientation, anti-intellectualism, and social desirability response bias in Canadian accountants. We find that Canadian accountants score much higher on the Machiavellianism scale than U.S. accountants. Additionally, our results show a significant relationship (...) between Machiavellianism and relativism, idealism, anti-intellectualism, and social desirability response bias. Our results indicate that professional Canadian accountants may not share the same personality characteristics as U.S. accountants. We extend previous research investigating Canadian accountants, by explicitly recognizing the impact of social desirability response bias, and by including anti-intellectualism. (shrink)

Medical assistance in dying was legalized by the Supreme Court of Canada in June 2016 and became a legal, viable end of life care option for Canadians with irremediable illness and suffering. Much attention has been paid to the balance between physicians’ willingness to provide MAiD and patients’ legal right to request medically assisted death in certain circumstances. In contrast, very little attention has been paid to the challenge of making MAiD accessible to vulnerable populations. The purpose of this paper (...) was to examine the extant literature and resources that are available on the provision of MAiD in Canada. We found that the provision of EOLC in Canada offers insufficient access to palliative and EOLC options for Canadians and that vulnerable Canadians experience disproportional barriers to accessing these already limited resources. Consequently, we argue that palliative care, hospice care and MAiD must be considered a spectrum of EOLC that is inclusive and accessible to all Canadians. We conclude by imploring Canadian healthcare professionals, policy makers and legislators to consider MAiD as a viable EOLC option for all Canadians. (shrink)

Epigenetics – the study of mechanisms that influence and modify gene expression – is providing unique insights into how an individual’s social and physical environment impact the body at a molecular level, particularly in populations that experience stigmatization and trauma. Researchers are employing epigenetic studies to illuminate how epigenetic modifications lead to imbalances in health outcomes for vulnerable populations. However, the investigation of factors that render a population epigenetically vulnerable present particular ethical and methodological challenges. Here we are concerned (...) with demonstrating how, in targeting certain populations for epigenetic research, this research may be pathologizing socio-cultural and medical practices in those populations in a way that increases their vulnerability. Using a case study approach, this article examines three vulnerable populations currently of interest to epigenetic researchers – Indigenous, autistic, and transgender populations – in order to highlight some of the challenges of conducting non-stigmatizing research in epigenetics. (shrink)

Early in the COVID-19 pandemic, journalists and scholars noted differences between Asians and North Americans in their support for public mask use. These differences were primarily assumed to be due d to variations in ethnocultural norms and practices. To better ascertain people’s motives for wearing masks and potential cultural differences in these rationales, this comparative, mixed-methods research examines Chinese and non-East Asian Canadians’ mask use attitudes utilizing online group interviews and a nation-wide survey Study 1, conducted in the early stages (...) of the pandemic, captured an ambivalent, yet evolving attitude toward public mask use among the non-East Asian Canadians, which differed from their Chinese counterparts who more uniformly perceived mask use favorably. Study 2, conducted 2 months later, suggests that both groups primarily wore masks for disease protection- and prevention-related reasons. However, age and education appeared to influence the mask wearing frequency of the non-East Asian Canadians, for whom public mask use was less prevalent and normative. The attitudinal differences in public mask use call for targeted strategies to support mask wearing for different ethnocultural groups, which may be achieved partially through enhancing interethnic understanding on the diversified use of and opinions about masks. The findings suggest that favorable social norms, along with evidence-based information campaigns involving personal appeals may encourage greater mask use by the non-East Asian population. (shrink)

While different worries about population size are present in public debates, political philosophers often take population size as given. This paper is an attempt to formulate a Rawlsian liberal egalitarian approach to population size: does it make sense to speak of ‘too few’ or ‘too many’ people from the point of view of justice? It argues that, drawing on key features of liberal egalitarian theory, several clear constraints on demographic developments – to the extent that they are (...) under our control – can be formulated. Based on these claims, we can clarify both the grounds and content of our obligations to future generations. (shrink)

As part of a survey of the biological history of Alpine populations, the lineages of all the families of the Vallouise valley (a French of the Hautes Alpes) have been reconstructed over several centuries. The genealogies have been included in a computerized population record, known as 20th centuries)Canadian programme Analypop. Most of the professions of the family heads were included in the files. In this study, various profession groups were identified and their descents determined over successive generations. In (...) this mountain area, where over 92% of marriages took place among relatives during the 19th century, the profession groups modulated their descents according to chosen strategies, sometimes with considerable differences among groups but with a remarkable consistency of behaviour. Moreover, there was weak interpenetration in the descents of each profession at both the 2nd and 3rd generations. (shrink)

The continuing spread and development of electronic data interchange in health care settings is fuelling a significant global debate about the practicality, ethics, and legality of such a practice. The uncertainties implicit in this debate are particularly acute in the context of disease or population groups for whom multidisciplinary, multipleagency teamworking has become acknowledged as the “best practice” for providing effective and timely care or support. The greying of the population is a demographic phenomenon that will have a (...) profound impact on the health care system, social care agencies, and caregivers, and will require a greater degree of service coordination in order to meet the complex care needs of both care-receiver and caregiver. (shrink)

The continuing spread and development of electronic data interchange in health care settings is fuelling a significant global debate about the practicality, ethics, and legality of such a practice. The uncertainties implicit in this debate are particularly acute in the context of disease or population groups for whom multidisciplinary, multipleagency teamworking has become acknowledged as the “best practice” for providing effective and timely care or support. The greying of the population is a demographic phenomenon that will have a (...) profound impact on the health care system, social care agencies, and caregivers, and will require a greater degree of service coordination in order to meet the complex care needs of both care-receiver and caregiver. (shrink)

In order to ensure an adequate and ongoing protection of individuals participating in scientific research, the impacts of new biomedical technologies, such as Next Generation Sequencing , need to be assessed. In this light, a necessary reexamination of the ethical and legal structures framing research could lead to requisite changes in informed consent modalities. This would have implications for Institutional Review Boards , who bear the responsibility of guaranteeing that participants are verifiably informed, and in sufficient detail, to understand the (...) reality of genetic research as it is practiced now. Current literature allowed the identification of key emergent themes related to the consent process when NGS was used in a research setting. (shrink)

Law enforcement’s troubled interactions (characterised by unusually harsh, arbitrary, unjust, and racist interactions and attitudes) with minority and marginalised populations in Canada and other western countries are well documented. Against the backdrop of such scholarship, this paper attempts to make sense of alternative perceptions held by some sex workers of colour about police officers’ attitudes or behaviours towards minority and marginalised communities. Using qualitative interview data, this paper explains how some sex workers of colour in Canada actively interpret the character (...) of law and legality to negotiate power imbalances when interacting with police officers. The main aim here is to show how research participants produce a counter-narrative and a polarised image (instead of a fixed one) of police officers as simultaneously ‘compassionate’ and ‘prejudiced’ social control agents, bringing out the symbiotic tensions between such dichotomous characteristics. (shrink)

While sexual and gender minorities are at increased risk for poor health outcomes, there is limited data regarding patient-provider interactions. In this study, we explored the perspectives of LGBTQ patients and their encounters with physicians in order to improve our understanding of patient-physician experiences. Using purposive selection of self-identified LGBTQ patients, we performed fourteen in-depth semi-structured interviews on topics of sexual orientation and gender identity, as well as their perceived role in the patient-provider relationship. Coding using a modified grounded theory (...) approach was performed to generate themes. We identified three major themes that demonstrate the complexity of LGBTQ patient experiences. The first, Lacking trust, identifies mistrust and loss of the physician-patient relationship resulting from physicians’ poor or judgmental communication, or from physicians making assumptions about gender, using incorrect pronouns, and not recognizing heterogeneity within the transgender community. A second theme, Being vulnerable, describes the challenges and fears related to comfort of patients with disclosing their sexual orientation and/or gender identity. A final theme, Navigating discrimination, outlines racial or ethnic discrimination which creates an additional burden on top of illness and stigmatized identity. Our results reveal the complex needs of individuals with multiple stigmatized identities when developing relationships with providers. By using an intersectional perspective that appreciates the plurality of patients’ identities, providers can help to improve their relationships with LGBTQ patients. Incorporating intersectional training for medical students and residents could greatly benefit both LGBTQ patients and their physicians. (shrink)

Canadian Schools of Nursing rest upon white, colonial legacies that have shaped and defined what is valued as nursing knowledge and pedagogy. The diversity that exists in clinical nursing and is emerging within the graduate student population is not currently reflected within nursing faculty and academic leadership. Black, Indigenous, and People of Color (BIPOC) nurse leaders, historically and presently, are repeatedly left unacknowledged as knowers and keepers of nursing knowledge. This lack of diversity persists across nursing knowledge generation, (...) research, and healthcare practices that ultimately aim to serve the increasingly diverse Canadian population. This narrative inquiry study examined the experiences of eight BIPOC graduate nursing students as they navigated white academic nursing spaces. The findings are presented to reflect their experiences of entrenched in whiteness, erasure of identity, and navigating belonging. These study findings highlight the importance of surfacing academic nursing history shaped by colonialism and racism, the need to diversify nursing faculty and the graduate nursing student population, and implementing nursing curricular and syllabi audits to ensure that they reflect the multitude of ways of knowing to expand dominant Eurocentric and Western knowledge in nursing education. (shrink)

The aim of this paper is to account for the effect of mother's death on child survival in a historical population. Using comprehensive data on the early French Canadian population of Quebec, evidence is provided for a higher risk of dying for motherless children that remains significant over all childhood and long after the death of the mother. The specific effect of the loss of maternal care was estimated by comparing mortality before and after mother's death, furnishing (...) a means to control for family heterogeneity. No differential in investment between genders was detected before age 3, but older girls suffered a three-fold higher susceptibility to mother's death than their male counterparts. This suggests that grown-up girls assuming the responsibilities of the missing mother had a lower chance of survival. (shrink)

Populated by lesbian, gay, bisexual, trans*, queer (LGBTQ) and allied youth, school-based gay straight alliances (GSAs) offer a unique opportunity to re-imagine or redefine youth subjectivity, especially with regards to the intersections of sexual orientation, gender identity, and civic rights. Tracing the evolution of youth subjectivity from the emergence of Canadian schooling in the 1860s, I turn to Ontario’s Bill 13 as a recent example of how GSAs are subverting, or resisting these norms, and in so doing, operate as (...) a kind of counter-public. Drawing from Jenks’ (2005) archetypes of the Dionysian and Apollonian child, I assert that GSAs can embody a third type of child subjectivity, the Athenian child (Smith, 2011; 2014) and, in so doing, provide theoretical space to reconstitute subjectivity for all youth. (shrink)

Indigenous populations in New World nations share the common experience of culture contact with outsiders and a prolonged history of prejudice and discrimination. This historical reality continues to have profound effects on their well-being, as demonstrated by their relative disadvantages in socioeconomic status on the one hand, and in their delayed demographic and epidemiological transitions on the other. In this study one aspect of aboriginals’ epidemiological situation is examined: their mortality experience between the early 1980s and early 1990s. The groups (...) studied are the Canadian Indians, the American Indians and the New Zealand Maori (data for Australian Aboriginals could not be obtained). Cause-specific death rates of these three minority groups are compared with those of their respective non-indigenous populations using multivariate log-linear competing risks models. The empirical results are consistent with the proposition that the contemporary mortality conditions of these three minorities reflect, in varying degrees, problems associated with poverty, marginalization and social disorganization. Of the three minority groups, the Canadian Indians appear to suffer more from these types of conditions, and the Maori the least. (shrink)

Canadian video game developer BioWare’s critically acclaimed Mass Effect video game series has been called the most important science fiction universe of a generation. Whether or not one is inclined to agree, it cannot be denied that Mass Effect matters. It matters not only because of its brilliant narrative and the difficult questions it asks, but also because, as bioethicist Kyle Munkittrick writes, it reflects society as a whole. Mass Effect is a sci-fi epic in the truest sense, spanning (...) over years and across hundreds of planets tucked away in the darkest corners of the galaxy, populated with dozens of species with their own histories, beliefs, cultures, and technologies. Academics and dedicated fans have explored the numerous facets of the game, from its philosophy to time and temporality, fandom ethnographies, and ethics. This article proposes to explore the boundaries of alien sex and the desire for alien others as represented in sci-fi role playing games, and their reinterpretation by fans. Science fiction role playing games in particular enable the production of sexual modalities outside of the constraints of heterosexual norms. Alien sex, animal sex, or monstrous sex are common tropes in fantasy and sci-fi media—the vampire, the werewolf, and monstrous non/in-humans are eroticized and construed conduits of a mainly female sexual desire. However, the example I would like to approach is slightly more radical, both in terms of execution and in terms of media audience response: examples of “alien sex” as illustrated in the Mass Effect video game series, whose canonical representation of alien-human romances invite some interesting questions about either the potential exacerbation, or the rendering-unintelligible of sexual difference, as well as about cross-species desire and about the ontology of the natural and the artificial. (shrink)

Canadian and American population-based research concerning sexual and/or gender minority populations provides evidence of persistent breast and gynecologic cancer-related health disparities and knowledge divides. The Cancer's Margins research investigates the complex intersections of sexual and/or gender marginality and incommensurabilities and improvisation in engagements with biographical and biomedical cancer knowledge. The study examines how sexuality and gender are intersectionally constitutive of complex biopolitical mappings of cancer health knowledge that shape knowledge access and its mobilization in health and treatment decision-making. (...) Interviews were conducted with a diverse group of sexual and/or gender minority breast or gynecologic cancer patients. The LGBQ//T2 cancer patient narratives we have analyzed document in fine grain detail how it is that sexual and/or gender minority cancer patients punctuate the otherwise lockstep assemblage of their cancer treatment decision-making with a persistent engagement in creative attempts to resist, thwart and otherwise manage the possibility of discrimination and likewise, the probability of institutional erasure in care settings. Our findings illustrate the demands that cancer places on LGBQ//T2 patients to choreograph access to, and mobilization of knowledge and care, across significantly distinct and sometimes incommensurable systems of knowledge. (shrink)

Research suggests that Canadian police officers are exposed to trauma at a greater frequency than the general population. This, combined with other operational stressors, such as risk of physical injury, high consequence of error, and strained resources, can leave officers less resilient to organizational stressors. In my experience, a significant and impactful organizational stressor is ineffective leadership, which include leaders who are non-supportive, inconsistent, egocentric, and morally ambiguous. Ineffective leadership in the context of paramilitary police culture has been (...) recognized as psychologically distressing. Further, moral injury may result when leadership fails to meet officers’ needs, expectations, and values. Ineffective leadership and resulting moral injuries are an understudied area in the literature. This review will help provide a comprehensive context of policing and the impact of ineffective leadership on police mental health. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reaching the Age of Majority:The Life Trajectory of the CIHR Institute of AgingYves Joanette, Anne Martin-Matthews, Réjean Hebert, and Joanne GoldbergThe Canadian Institutes of Health Research (CIHR) was created in 2001 under the Canadian Institutes of Health Research Act S.C. 2000, c. 6 (Government of Canada, 2000). The creation of CIHR was in follow-up to the Canadian Medical Research Council (MRC) as well as to the (...) National Health Research and Development Program of Health Canada that, up until that point in time, had supported the breadth of health research in Canada. Two important characteristics of CIHR were crucial for the development of research on aging. The first was that CIHR, unlike MRC, was entrusted with the challenge of supporting the whole spectrum of health research, from the basic biomedical perspective to clinical research, research on health services and policies as well as social aspects of health research, not to mention research on ethics and other perspectives (including the science of research). The second characteristic of the nascent CIHR that impacted the community of research on aging was the decision that a small part of the overall CIHR budget would be used to address priority-driven questions or topics (strategic competitions), while the majority of the budget would be invested in grants and awards programs that would be investigator-initiated, as in the time of the MRC (open competition). Since its inception, CIHR has included 13 institutes that are central to the priority-driven actions. Institutes not only play an important convener role within their communities and among their stakeholders, but they are also expected to listen to the needs, gaps and opportunities in their area and to introduce initiatives---most of the time involving more than one Institute---in order to tackle these needs and gaps and to seize upon the opportunities.The Institute of Aging was introduced at the same time as the other 12 Institutes and it is clear that many challenges were awaiting the new Institute since, at that time, research on aging was still in its early years. This article is about the trajectory of the CIHR Institute of Aging in its first 18 years of existence. Having now reached an age that is either the age of majority or quite close to it, it is important to be able to provide a reflection on the evolution of the priorities over this period, while also taking a peek at some of the priorities that will surely come in the near future.The Early Years (2001-2004)The founding Scientific Director of the Institute of Aging was Dr. Réjean Hébert. A well-known and prolific [End Page 1] geriatrician and researcher, Dr. Hébert was the perfect person to launch the Institute. One of his first actions was, in fact, to harmonize the French and English names of the Institute. In French, the name of the Institute focused on Aging (Institut du vieillissement) while, in English, the name of the Institute focused on Healthy Aging. The CIHR Institute of Healthy Aging thus became the CIHR Institute of Aging in all versions of its documentation. But above and beyond this important name change, the real work of Dr. Hebert, accompanied by the first Institute Advisory Board1, chaired by Prof. Dorothy Pringle, was to identify the gaps, the needs and the opportunities. After a rigorous process came the first Strategic Plan of the CIHR Institute of Aging, which was clearly influenced by Dr. Réjean Hébert's vision of the aging population as an opportunity, instead of a catastrophe, for our society that comes, of course, with its own challenges. Dr. Hébert left CIHR during his first mandate as he was called upon to become the Dean of his Faculty, and then went on to become the first CIHR Scientific Director to sit as a Minister of Health and Social Services in the Québec Government. The main outcomes of Dr. Hebert's years (2001-2004) can be summarized as follows2.• Organizing many workshops and meetings to ensure that the Institute of Aging would become the premier national convener for research on aging, bridging between disciplines... (shrink)

Stem cell tourism is a small but growing part of the thriving global medical tourism marketplace. Much stem cell research remains at the experimental stage, with clinical trials still uncommon. However, there are over 700 clinics estimated to be operating in mostly developing countries – from Costa Rica and Argentina to China, India and Russia – that have lured many patients, mostly from industrialized countries, driven by desperation and hope, which in turn continue to fuel the growth of such tourism.While (...) much research has focused on such dimensions as the promotions that allow such businesses to make their services known, media coverage, some patient research, and regulatory conditions for developing country clinics, little attention has been paid to the non‐affected members of the general population, the future potential users of such services. This empirical study based on five focus group discussions with a diverse group of healthy adults in a Canadian city, explored participant views of patients who use stem cell tourism services, the likelihood they would avail themselves of such services if they were to suffer similar illnesses, and the conditions under which they might do so, and the impact that admonitions and advice from international expert bodies might have on their decisions. Our findings suggest that these healthy adults are sympathetic to the drivers of hope and desperation, and, despite cautions about research limitations, may seek such treatments themselves under similar conditions. These findings are discussed in the context of the policy and ethical issues raised by this form of medical tourism. (shrink)

Canada and California each introduced legislation to permit medical assistance in dying in June, 2016. Each jurisdiction publishes annual reports on the number of deaths that occurred under their respective legislations in the previous years. The numbers are disturbingly different. In 2021, 486 individuals died under California’s End of Life Option. In the same year 10,064 Canadians died under that country’s Medical Assistance in Dying (MAiD) legislation. California has a slightly larger population than Canada, and while medically assisted deaths (...) as a percentage of total deaths remained virtually unchanged in California from 2020-2021, Canada saw a 30% increase from 2020 to 2021. This essay examines some of the factors propelling Canada down the slippery slope of medically assisted suicide, as well as those that may be keeping California and other US jurisdictions from taking the slide. At a time of increasing pressure in many jurisdictions (both nationally and internationally) to liberalize access to medical assistance in dying, some lessons from this comparative analysis are offered. (shrink)

The secession issue appears to many contemporary thinkers to reveal a fatal flaw in the idea of national self-determination. The question is whether national minorities who come to want to be politically self determining should be allowed to separate from the parent state and form one of their own. Here the idea of national self-determination may lead us in one of two opposing directions. If the minority group in question regards itself as a separate nation, then the principle seems to (...) support its claims: if the Québécois or the Catalans come to think of themselves as having national identities distinct from those of the Canadians or the Spanish, and to seek political independence on that basis, then if we are committed to national self-determination we should support their claims. But we then face the challenge that once national identities begin to proliferate there is no feasible way of satisfying all such claims, given elementary facts of geography and population spread. (shrink)

Scholars have identified crimmigration – or the criminalization of “irregular” migration in law – as a key issue affecting migrant access to justice in contemporary immigrant-receiving societies. Yet the gendered and racialized implications of crimmigration for diverse migrant populations remains underdeveloped in this literature. This study advances a feminist intersectional approach to crimmigration and migrant justice in Canada. I add to recent research showing how punitive immigration controls disproportionately affect racialized men from the global south, constituting what Golash-Boza and Hondagneu-Sotelo (...) have called a “gendered racial removal program”. In my study, I shift analytical attention to consider the effects of the contemporary crimmigration system on migrant women survivors of gender-based violence. While such cases constitute a small sub-group within a larger population of migrants in detention, nevertheless scholarly attention to this group can expose the multiple axes along which state power is enacted – an analytical strategy that foundational scholars like Crenshaw used to theorize “structural intersectionality” in the US. In focusing on crimmigration in the Canadian context, I draw attention to the growing nexus between migration, security, and gender-based violence that has emerged alongside other processes of crimmigration. I then provide a case analysis of the 2013 death while in custody of Lucía Dominga Vega Jiménez, an “undocumented” migrant woman from Mexico. My analysis illustrates how migrant women’s strategies to survive gender-based violence are re-cast as grounds for their detention and removal, constituting what I argue is a criminalization of survivorship.The research overall demonstrates the centrality of gendered and racialized structural violence in crimmigration processes by challenging more universalist approaches to migrant justice. (shrink)

Background The COVID-19 pandemic has forced rapid and widespread change to standards of patient care and nursing practice, inevitably leading to unprecedented shifts in the moral conditions of nursing work. Less is known about how these challenges have affected nurses’ capacity to meet their ethical responsibilities and what has helped to sustain their efforts to continue to care. Research objectives 1) To explore nurses’ experiences of striving to fulfill their ethical responsibilities of care during the COVID-19 pandemic and 2) to (...) explore what has fostered nurses’ capacity to fulfill these responsibilities. Research Design A generic qualitative approach was used incorporating concepts coming from fundamental features of care. Participants Twenty-four Canadian Registered Nurses from a variety of practice settings were interviewed. Ethical Considerations After receiving ethics approval, signed informed consent was obtained before participants were interviewed. Findings Four themes were identified. 1) Challenges providing good care in response to sudden changes in practice. 2) Tensions in juggling the responsibility to prevent COVID-19 infections with other competing moral responsibilities. 3) Supports to foster nurses’ capacity to meet their caring responsibilities. 4) The preservation of nurses’ moral identity through expressions of gratitude and health improvement. Discussion Infection control measures and priorities set in response to the pandemic made at distant population and organizational levels impacted nurses who continued to try to meet the ideals of care in close proximity to patients and their families. Despite the challenges that nurses encountered, the care they received themselves enabled them to continue to care for others. Nurses benefited most from the moral communities they had with their colleagues and occasionally nurse leaders, especially when they were supported in a face-to-face manner. Conclusion: Moral community can only be sustained if nurses are afforded the working conditions that make it possible for them to support each other. (shrink)

Cultural appropriateness has become an important conceptual tool for health care professionals serving diverse patient populations. Physicians and other health care providers working in urban communities are increasingly challenged to provide care that is responsive to the health needs and beliefs of immigrants, refugees and other newcomers to mainstream health services. This paper argues that notions of cultural 'sensitivity' or 'competency' help health practitioners acknowledge professional and biomedical biases, but also risk dehistoricizing and hence disempowering newcomers by failing to recognize (...) culture as a dynamic process. Without attention to the ways in which newcomers actively produce culture and make sense of illness experience, health care workers ignore the contexts in which people. become ill and hence cannot act as healers. By presenting the case of one newcomer to the Canadian health care system, I argue that narratives provide a valuable tool for health practitioners to understand how newcomers actively engage and come to terms with illness, without defining them as determined by a set of cultural beliefs or practices. (shrink)

Utilizing social semiotic approaches, this article addresses how genetic researchers’ organizing narratives have involved extensive ontological and epistemological violence in their objectification Karitiana Indigenous people of Western Brazil. The paper analyses how genetic researchers have represented the Karitiana in the US and Canadian courts, post-9/11 forensic identification technology development, and patents. It also considers disputes over the sale of Karitiana cell lines by the US National Institutes of Health-funded Coriell Cell Repositories. These case studies reveal how the prominent (...) class='Hi'>population geneticist Kenneth K. Kidd of Yale University and other genetics researchers have constituted the Karitiana as Extreme Other; liminal figures who define the boundaries of humanity. Originally sampled in 1987 by a Yale University epidemiologist, forensic genetic researchers have since utilized Karitiana cell lines to metonymically represent the Karitiana. The practices of objectification have imposed a genetically distinct special status upon the Karitiana that restricts recognition of their self-determination, rights and dignity, and which imposes onerous obligations to serve as research objects for the greater good of Humanity. The Karitiana are included as biological labour, but excluded from decision-making or asserting any other claims. Scientists have organized and maintained biotechnologically-mediated colonial relationships in which they and their institutions extract nearly all immediate and tangible benefits. The fusing of genetic research’s ontological and epistemological violence with the violence of state legal institutions raises important questions about the scope and practices of sovereignty, particularly in determining and enforcing states of exception through violence. (shrink)

Standardization has emerged as the dominant principle guiding the organization and provision of healthcare, with standards resultantly shaping how nurses conceptualize and deliver patient care. Standardization has been critiqued as homogenizing diverse patient experiences and diminishing nurses’ skills and critical thinking; however, there has been limited examination of the philosophical implications of standardization for nursing knowledge and practice. In this manuscript, I draw on Foucault's philosophy of order and categorization to inform an analysis of the consequences of healthcare standardization for (...) the profession of nursing. I utilize three exemplars to illustrate the impact of the primacy of standardized thinking and practices on nurses, patients and families: pain assessments using the 0‐10 pain scale; patient triage emergency departments through the Canadian Triage and Acuity Scale; and determination of cause of death within the context of the current opioid crisis. Through each exemplar, I demonstrate that standardization reductively constrains nursing knowledge and the health and healthcare experiences of patients and populations. I argue that the centrality of standardization must be re‐envisioned to embrace the complexity of health and more effectively and meaningfully frame nursing knowledge and practice within healthcare systems. (shrink)

Even Americans who have only a vague knowledge of health policy know that the U.S. is different. We do not have “socialized medicine,” like our European or Canadian neighbors. We believe that health care is not rationed here, and that, unlike citizens of other nations, we do not have to wait in long queues when we need medical care. We believe that U.S. health care is the best in the world.At the same time, the U.S. spends more on health (...) care - both per capita and as percentage of gross domestic product - than other nations do. One in six non-elderly Americans has no health insurance, and voluminous studies show that lack of health insurance has a dramatic effect on both access to care and on health status. Furthermore, on many of the most important indicators of population health, such as infant mortality and life expectancy, the U.S. scores worse than do other nations. (shrink)

Even Americans who have only a vague knowledge of health policy know that the U.S. is different. We do not have “socialized medicine,” like our European or Canadian neighbors. We believe that health care is not rationed here, and that, unlike citizens of other nations, we do not have to wait in long queues when we need medical care. We believe that U.S. health care is the best in the world.At the same time, the U.S. spends more on health (...) care - both per capita and as percentage of gross domestic product - than other nations do. One in six non-elderly Americans has no health insurance, and voluminous studies show that lack of health insurance has a dramatic effect on both access to care and on health status. Furthermore, on many of the most important indicators of population health, such as infant mortality and life expectancy, the U.S. scores worse than do other nations. (shrink)

In Canada, as in many developed countries, healthcare conscientious objection is growing in visibility, if not in incidence. Yet the country's health professional policies on conscientious objection are in disarray. The article reports the results of a comprehensive review of policies relevant to conscientious objection for four Canadian health professions: medicine, nursing, pharmacy and dentistry. Where relevant policies exist in many Canadian provinces, there is much controversy and potential for confusion, due to policy inconsistencies and terminological vagueness. Meanwhile, (...) in Canada's three most northerly territories with significant Aboriginal populations, whose already precarious health is influenced by funding and practitioner shortages, there are major policy gaps applicable to conscientious objection. In many parts of the country, as a result of health professionals' conscientious refusals, access to some legal health services – including but not limited to reproductive health services such as abortion – has been seriously impeded. Although policy reform on conscientious conflicts may be difficult, and may generate strenuous opposition from some professional groups, for the sake of both patients and providers, such policy change must become an urgent priority. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:中国音乐教育与国际音乐教育 [Chinese Music Education and International Music Education] by Jianhua GuanMengchen LuJianhua Guan, 中国音乐教育与国际音乐教育 [Chinese Music Education and International Music Education] (Nanjing: Nanjing Normal University Press, 2013)In Chinese Music Education and International Music Education, Jianhua Guan examined Chinese music education and curriculum in relation to other countries’ music education through the lenses of internationalization. Written in Chinese, there were three sections with several chapters in each and one (...) appendix that documented interviews with American music educators such as Bennett Reimer.In the first section entitled, “On the Philosophy and Culture of Music Education,” Guan pointed out that global cultural development in the twenty-first century has influenced Chinese music education. He wrote richly on a diverse array of topics, including globalization, music education based on Chinese culture, music education during the Space Age, Chinese music education in institutions of higher learning, philosophy of music education, and the internationalization of music education. He concluded the first section by introducing the ideas of Chinese music educator Dan Zhaoyi, Chinese musicologist Wang Guangqi, American postmodern cultural and music education, and Reimer’s philosophy of music education. [End Page 194]The second section, “Music Education Curriculum and Teaching,” began by examining challenges faced by the twenty-first century Chinese music classroom. Subsequently, he discussed how teaching approaches in Chinese music education have changed in the twenty-first century, how traditional Chinese music may be taught in the Chinese classroom, and music as part of a multidisciplinary curriculum in secondary education. This was followed by a survey of thirty years of Chinese music education, music education in American universities (such as Wesleyan University), and the Suzuki mother tongue approach to music education. Throughout this section, Guan’s writings were interspersed with chapters translated from writings by Canadian, American, and Japanese scholars, such as in the chapter on “How Music Help Students’ Cognitive Development.” There was also a translation of an introduction to the Indian concept of Guru-Shisya Parampara.In the final section, entitled “On International Multicultural Music Education,” Guan discussed diverse approaches to music education in various parts of the world. Furthermore, he noted the writings of scholars such as Bruno Nettl and Alan Merriam, as well as James Albert Banks, Ram Mahalingam, and Cameron McCarthy. To create awareness of the international music education community, he covered important organizations such as the International Society for Music Education (ISME) as well as the United Nations Educational, Scientific and Cultural Organization (UNESCO). Discussing issues closer to China, he compared the issue of race in China with that of the United States, noting that racial problems are less pronounced in China due to its non-immigrant population. He concluded by writing about Chinese approaches to multicultural music education, making references in particular to two important conferences in China. Following the third section of the book, Guan presented interview transcripts with music educators such as Bennet Reimer.There is much to recommend about Guan’s work. First, he argued that philosophy of music education should be undergirded by culture, a position which he coined “music cultural philosophy” (yinyue wenhua zhexue 音樂文化哲學).1 For him, as the twenty-first century is one that is marked by globalization and multicultural development, musical traditions from different cultures, languages, ethnicities, and religions should not be neglected. Meanwhile, the establishment of the International Society for Music Education (ISME) creates an environment to better understand the inter-relationships between diverse cultures within music education.2 Guan argued for the importance of embracing diverse musical traditions for now and the future, navigating music education in China toward a multicultural philosophy. As music is related to history, culture, and human behavior, it is crucial for us to connect our cultures to others through music and contribute to societal development. In emphasizing the role of culture, Guan [End Page 195] contributed richly to philosophy of music education in China, which has in recent years been influenced by major philosophies from the West. He encouraged China to look within itself to shape its own philosophical thinking.Second, Guan appealed for China to have its own music education system, one which places traditional Chinese music and Chinese culture at its core, so as to free China from... (shrink)

We live in the era of Facebook, Fitbit, and Skype. As such, it would be unreasonable to expect that the healthcare industry would not see the same kind of globalization as do our social spheres and consumer activities. Indeed, the explosion of information technology, the ease of transcontinental travel, and the emergence of a more globally aware citizenry allows for scientific collaboration that has had many positive effects on global health. However, the economic and structural disparities between systems of healthcare (...) delivery in the industrialized world and parts of the developing world have created a monster in the form of an international medical tourism industry that endangers the health and safety of citizens of the host country as well as visiting patients. Not only does the practice of medical tourism pose a practical danger to those in direct contact with the industry, but it brings up troubling philosophical problems centering on national responsibility and the commodification of healthcare, among other important issues. In the United States, the driving force behind international medical tourism is the exorbitant cost of healthcare, particularly for the uninsured but also for the underinsured and those who experience catastrophic medical expenses from chronic illness or sudden health crises. Not only have individuals begun to look outside the U.S. for surgical procedures and other expensive therapies, but employers have begun to toy with the idea of outsourcing the medical care of the employees they insure in order to cut costs. In other industrialized nations, the issues that underpin international medical tourism are related to healthcare rationing and reflect different shortcomings in the delivery of healthcare in those nations, such as the United Kingdom and Canada, that have single-payer systems. Yet the regulatory and philosophical implications for both patients and hosts of international healthcare are largely the same. The challenge of regulating international trade in medical care is obvious and becomes particularly acute when there are insurers and employers involved. Complicating matters further, medical care that takes place outside the country of origin of the patient is often brokered by “medical concierge services,” which, though quick to claim indemnity from any harm arising from substandard or inappropriate medical care, cannot be divorced from responsibility for the health outcomes of their clients. Agreements hashed out between concierge services and patients specify that any remedy for harm stemming from their medical care must be pursued within the confines of the law of the host country, but the practical implications of this are troublesome. How can a foreign patient—often without either linguistic or cultural competency in the host country—be expected to navigate the complexity of a foreign legal system, particularly one that may be far less developed than his home country? Furthermore, if insurance companies and employers are involved with such care, who pays for an adverse result or determines responsibility for harm that may befall the patient? Under which countries’ laws? If a patient travels to Singapore for sexual reassignment surgery or a cardiac valve repair, returns to the States and suffers complications, who pays for the restoration of her health? Beyond legal standards and judicial remedies for harm to patients seeking care on the international market, there is the question of what ethical standards and norms apply to such patients. What effect does it have on American patients, for example, to receive care within a system that does not emphasize autonomy and informed consent the way they are used to? Why should foreign physicians care about the cultural mores of their patients’ country of origin? Can they be expected to grasp cultural differences between American, Canadian, and British patients? The medical concierge might respond, “Well, buyer beware!” This is unreasonable: It is nearly impossible for any patient to accurately assess the various options, risks and benefits that go with a particular medical treatment, much less the patient who is attempting to do so on the international market. And the crass invocation of the doctrine of caveat emptor betrays a view of healthcare as a commodity that is naive and inappropriate. Paramount in my mind, however, are the practical implications for the care of the citizens of developing nations that host international patients and the broader philosophical issue of what the goals of the medical profession as a whole and each country’s individual healthcare system should be. While I understand the argument that international medical tourism creates great economic gains for developing nations, which can then be channeled toward the care of their citizenry as a whole, there is much reason to doubt that this “trickle-down” model of economics provides real benefits for underserved, whether in healthcare or other arenas. What is more likely is that, while lucrative international “medi-cities” may keep bright doctors in their home countries, it is also likely to lure them away from the institutions that serve the lion’s share of their countrymen. With the concentration of talented native doctors in private hospitals that serve citizens of the developed world, the population at large is left to obtain care at institutions that suffer “brain drain” from the flight of talented local staff to more prestigious, often “brand name,” institutions that give them more Western-like salaries while allowing them to practice in their countries of origin. The very fact that citizens of the wealthiest nations in the world are forced to go abroad for life-saving care speaks to an abdication of national responsibility on the part of their home countries. The provision of health care is one of the principal responsibilities of any nation and it is unacceptable that a nation with the strength and wealth of the United States would take advantage of the weaker political and economic situations of developing nations in order to shirk its responsibility to its fellow citizens. If we take care of our countrymen and take pride in an equitable system of healthcare delivery, there will be no need to shrug our shoulders and say “Buyer beware” to the patient who heads to the Philippines for heart surgery. (shrink)

Rationale, aims and objectives This randomized controlled trial was designed to evaluate the 2-year costs and effects of a proactive, public health nursing case management approach compared with a self-directed approach for 129 single parents (98% were mothers) on social assistance in a Canadian setting. A total of 43% of these parents had a major depressive disorder and 38% had two or three other health conditions at baseline. Methods Study participants were recruited over a 12 month period and randomized (...) into two groups: one receiving proactive public health nursing and one which did not. Results At 2 years, 69 single parents with 123 children receiving proactive public health nursing (compared with 60 parents with 91 children who did not receive public health nursing services) showed a slightly greater reduction in dysthymia and slightly higher social adjustment. There was no difference between the public health and control groups in total per parent annual cost of health and support services. However, costs were averted due to a 12% difference in non-use of social assistance in the previous 12 months for parents in the public health nursing group. This translates into an annual cost saving of $240 000 (Canadian) of costs averted within 1 year for every 100 parents. Conclusions In the context of a system of national health and social insurance, this study supports the fact that it is no more costly to proactively service this population of parents on social assistance. (shrink)

One of the arguments that is often advanced in defence of the public health care system in Canada appeals to the idea that medical care should not be treated as a “commodity.” The recent Romanow Report on the Future of Health Care in Canada, for instance, says that, “Canadians view medicare as a moral enterprise, not a business venture.”1 Public provision is then urged on the grounds that this is the only mode of delivery compatible with this constraint. This argument (...) has received surprisingly little scrutiny, despite the important role that it plays in structuring the recommendations of the report, not to mention the broader public debate. This is unfortunate, since not only is it, in my view, a bad argument, but it is one that actually obscures the rationale for the current public system. It encourages the widely shared misperception that health care is a pure public good in our society (financed through taxation, then provided “for free” to all citizens). Provincial governments in Canada do not, for the most part, deliver health care services directly to the population. What they provide instead is health insurance. They rely primarily upon the private sector to deliver care. Thus the Canadian health care system more closely resembles what is often described as a quasi-market, or a “public market.” The justification for the role of the public sector in health care can be traced back to market failure in the insurance sector, and not in the market for health care services. (shrink)

How social workers do construct what is ‘ethical’ in their work, especially when they are positioned at the intersection of multiple paradoxes, including that of two opposing responsibilities in society: namely, to care for others but also to prevent others from harm? Paradoxes in practice are especially complicated to manage in the neoliberalism of the Global North where the priority of efficiency has been heightened and the obligation towards the most vulnerable has been weakened. Taking data from a Canadian (...) study, this paper delineates the structural paradoxes of practice and elaborates on the concept of ethical trespass, especially in times of austerity. Ideas are illustrated with case material from participants who were practitioners working with a population of young single impoverished mothers. Impacts of the discourses on single mothers, resource inadequacies, and increased surveillance on clients are discussed, and the effects on workers such as individualization and burnout will be outlined. Despite the challenges, practitioners in the study found ways to minimize trespass and act ethically. The strategies employed included problematizing the helping relationship, being a responsible traitor, dissident speech, and the use of contextualized practice. (shrink)