Almost half of Ontario youth miss school because of anxiety, study suggests.

At five years old, Shannon Nagy told her mother she wanted to die. In Grade 6, she missed almost the entire school year because more often than not, she couldn’t get out of bed.

Nagy, now 20, was diagnosed with anxiety, depression, attention deficit hyperactivity disorder and borderline personality disorder and was never able to finish high school. She spent most of her childhood immersed in a mental health care system that she said “did more harm than good.”

Her struggle to get help and the impact that struggle had on her education is a trend captured in a new survey commissioned by Children’s Mental Health Ontario, released Tuesday.

It found of the 18- to 34-year-olds surveyed across the province:

  • 46 per cent had missed school due to issues related to anxiety.
  • 40 per cent had sought mental health help.
  • Of those, 50 per cent found the experience of getting help challenging.
  • 42 per cent did not get the help they needed or are still waiting.

Parents are also impacted when their child has to wait as long as 18 months for mental health care, said Kimberly Moran, CEO of CMHO, the association that represents Ontario’s publicly funded Mental Health Centres and advocates for government policies and programs.

“Parents miss work and certainly myself as a parent, I have to take time to look after my daughter,” Moran said.

The Ministry of Health and Long-Term Care and Ministry of Children and Youth Services did not respond to requests from the Star for comment, with Monday being a holiday.

The study, conducted by research firm Ipsos, surveyed 806 people in October and suggests that a quarter of parents have had to miss work to care for their child due to issues related to anxiety.

When her 11-year-old daughter tried to die by suicide while on a year-long wait list for mental health care, Moran took a four-month leave of absence and then worked part-time. Six years later, she still takes about 10 per cent of the year off to help her daughter.

Half of the parents surveyed found getting their child mental health help was challenging because wait times are long, they don’t know where to go, or service providers don’t offer what their child needs, don’t exist in their community, are too far away or aren’t available at convenient times.

Anxiety is one of the “big front-runners” when it comes to mental illness in youth, said Lydia Sai-Chew, CEO of Skylark Children, Youth and Families, which offers free counselling and mental health services in Toronto. Wait times at Skylark for in-patient programs can be up to six months.

“The difficulty with wait times is that the youth gets more stressed, but so does the family,” Sai-Chew said. “Anxieties build up. They don’t have the strategies and it just gets worse.”

For 13 years, Michele Sparling of Oakville has juggled owning a business and taking care of her son who was diagnosed with anxiety and depression when he was 10 years old.

“If your child is home from school, you’re not leaving them alone,” Sparling said. “You’re worried when you have to step out for a moment. When a fire truck goes through your neighbourhood, you think ‘not my kid, not my kid.’

“That worry is constant.”

She said her family struggled to get her son the help he needed. In between driving him to and from appointments in Toronto, she got used to telling clients she might have to end a meeting at a moment’s notice if a crisis occurred. She watched as her son had to miss school, and continues to care for him now as he struggles with mental illness in university.

“This is not just about this one person, it’s about the bigger picture, the lost potential,” Sparling said. “I think we’re doing young people such a disservice.”

CMHO is asking the province to invest $125 million in community-based mental health centres, staffing and services for children and youth.

Reposted from:

Sick Not Weak.

What an inspiring and fierce campaign that was launched by the SickKids Foundation. It’s empowering in a sense, in that there’s been a shift from sickness being seen as a weakness to battling sickness being seen as fierce.  Wonderful to see both patients and the staff who provide the necessary and often life-saving care presented in such a brave manner.

From the traditional heart-string provoking videos using song’s like Fix You by Coldplay to draw more sympathetic emotions from viewers, it’s a bold move in my opinion to set the background music to the rap song “Undeniable” by Donnie Daydream. It’s awesome seeing such an innovative organization taking strides away from traditional campaigns in gaining support for their fight and still tugging on the emotions of viewers. It’s touching to know that each of the kids featured in the video all have a story with their own illness and being a showcase of the amazing work SickKids has been able to accomplish in making a significant difference in not only their lives, but the lives of their families.

Only makes me more excited to enter a profession in which I can help be apart of a team that empowers patients into believing they are more than just their illness. Modern medicine has made so many advancements in healthcare technology, medicine, and in patient care, but the video is a great reminder in bringing forth the reality that the fight is not over.

What an inspiring campaign from a phenomenal organization. Just to put things in perspective at SickKids, more than 80 per cent of patients battling cancer survive, about 98.5 per cent of heart surgeries performed are successful, and the mortality rate from liver failure for intestinal diseases has dropped to less than 1 per cent, from what was about 22 per cent in 2000. Within 16 years, that’s a 21% drop!

I really encourage everyone to check out the relatively short video. Be inspired and in awe of the battle patients, researchers, and  their healthcare providers fight everyday. Without the funds that are raised through these campaigns the fight would not be possible.

Are there any moral principles a health care professional should never violate?

On a regular basis, healthcare professionals are confronted with ethical dilemmas in their practice. Hence, ethical problem solving requires the application of a variety of ethical rules and principles in specific situations[1]. Although ethical theories largely differ from one another, certain ethical principles appear consistently in the realm of bioethics. Thereby, respect for individual autonomy has quickly become a dominant principle in modern medical ethics.[2]

Autonomy in this essay shall be defined as individuals being independent and competent agents who are capable of making (a) rational and (b) unconstrained decisions. ‘Rational’ shall apply when an agent is able to ‘reason well’ and choose appropriate ends. ‘Unconstrained’ applies if all necessary elements for the individual to freely make an informed decision are present. Hence, individuals who fail to meet these criteria include patients in a comatose state, individuals suffering from forms of mental impairment or brain damage, and those in a drug induced state.

In this paper, the proposition that the principle of autonomy is the most fundamental principle in allowing patients to express their own free will shall be contended. Therefore, the purpose of this essay sets out to define the concept of autonomy and its importance. It is important to acknowledge that in some circumstances autonomy may need to be violated in order to protect individuals from exercising an irrational decision, particularly in cases where there are limited resources or other limiting factors which will comprise the final section of this essay.


Concept of Autonomy:

Autonomy has been defined as ‘at a minimum, self-rule that is free from both controlling interference by others and from limitations, such as inadequate understanding that prevent meaningful choice’.[3] In this regard, the principle of autonomy gives ultimate control for a moral action to the individual (or agent) in making a decision to perform an action according to his or her desires and values.[4] Autonomy of an individual can be violated through the use of manipulation, trickery, and deceit.[5] A physician who deliberately misguides their patient into believing they have cancer, in order to justify prescribing unnecessary chemotherapy and partake in expensive billing practices, is seen as a violation of patient autonomy.

Importance of Autonomy:

Autonomy recognizes the rights of individuals and their ability to self-determine what can be done in regards to their bodies. Kantian ethics have contributed to the notion of respecting patient autonomy and the related aspect of treating patients as ends in themselves.[6]  Kant’s central argument in his moral theory purports that ‘rational human wills are autonomous’.[7] Hence, choice is an expression of autonomy and what separates human beings from other beings rests on the idea of rationality.[8] In supporting Kant’s view on the principle of autonomy,  philosopher John Stuart Mill claimed  that the right to independence is absolute when it pertains to the individual and doesn’t infringe on the autonomy of others.[9]

Alan Gewrith argues that ‘rights are necessary for humans to be able to function as moral agents, displaying autonomy in the exercise of choice’[10], thus highlighting the need to defend autonomy as a right. The fundamental nature of autonomy was recognized as far back as 1914 when Cardozo J dictated in Schloendorff v New York Hospital: ‘every human being of adult years and sound mind has a right to determine what shall be done with his own body’.[11] This reasoning supports the idea that autonomous persons are likely to be in the best position to determine whether a decision would benefit them, hence why autonomy is of instrumental value in patient care.

Furthermore,  bioethicists such as Glover argue that patients should be permitted to make choices about their own treatment even if it is clear that ‘others would be in a better position to make choices that would serve the patients’ wellbeing’.[12] Glover argues that by giving up central decision making powers we ‘lose the sense of living our own lives’, and would rather ‘forgo a great deal of happiness, or risk a fair amount of disaster, to losing control of our lives in this way’.[13]  By removing patient autonomy, the patients’ dignity and independence is challenged.



Challenges to View of Autonomy:

 Autonomy is a principle of moral empowerment, where the responsibility for the consequences of an action are placed on moral agents themselves.[14] An individual that acts on this principle cannot legitimately blame another for the adverse consequences that occurred as a result of their decision. As stated by Mill, the perceptions of others are not a sufficient reason to warrant a stop to an individuals’ autonomous action. Mill argues that ‘person of individuality and character’ (now accepted as personal autonomy) can only flourish if protected from the ‘tyranny of the majority or society’.[15] In On liberty he argues that ‘power’ can only be exercised upon an individual if it prevents harm to others. Hence, an individual’s own good is not a sufficient reason to compel them ‘to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others, to do so would be wise, or even right’[16] In this view, Mill would oppose the act of paternalism on the grounds that it prevents individuals from developing independent character. Provided that a patient satisfies the rational and unconstrained criteria, the individual themselves should solely determine the value of their life. It would be unjustly paternalistic for another individual to interfere with the patients’ views on their life and impose treatment against their will.[17]

Discussion surrounding the principle of autonomy arises in the context of the ‘right of a patient to refuse life saving treatment’ and the balance for physicians to adhere to their beneficent duty.[18] Beauchamp and Childress recognize that in theory, physician obligations are to act for the patient’s medical benefit, and not to promote autonomous decision-making.[19]  Beneficence refers to the duty to do what is ‘believed’ to be in the patient’s best interests, such as cases where patients diagnosed with lung cancer want to continue to smoke. As such, the autonomous choice of the patient conflicts with the physicians’ duty to look out for the patient’s best interests. Following the path of beneficence or autonomy would lead the physician to take different actions. Personal autonomy, or self-determination, ‘requires a respect for the choice and wishes of people who possess decisional capacity, along with protecting those lacking capacity’. [20] Permitted the patient meets the criteria to make an autonomous decision, physicians should respect their wishes.

Self-determination was evidenced in Re C., in which an elderly man (C) suffering from paranoid schizophrenia developed gangrene in his foot and refused a life-saving amputation.[21] Although his general capacity to make decisions was impaired by schizophrenia, there was evidence that he understood and retained the relevant information and arrived at a clear choice. The reasons for respecting C’s wishes are two-fold. Firstly, non-consensual intervention where the individual is able to make a decision, regardless of the fact that they may not be able to make all decisions, violates their integrity. Secondly, unless there is reason to rebut their capacity,  competent persons are considered the best judges of their own welfare and interests. Only the individual can weigh the burdens, benefits, and harms of the proposed treatment in view of their wishes and values. If patients such as C refuse treatment on the basis that the treatment is not valued in their life then the refusal ought to be respected, regardless of the consequence of their decision.

Principally, competent patient’s decisions are generally respected in regards to healthcare. However, patient groups such as the elderly or young children often raise concerns about whether age or the onset of various physical and mental illnesses erodes the principle of autonomy. There is much debate over whether patients suffering from conditions such as “dementia”, or young children who are deemed competent, are truly able to make competent and rational decisions.[22]

The case of Makayla Sault, an 11-year old child suffering from acute lymphoblastic leukemia sparked debate into both the validity of indigenous medicine and the rights of children to pursue their own treatment[23]. Makayla was given a 75% chance of survival and in accordance underwent 11 weeks of chemotherapy and experiencing severe side effects. While in remission, Makayla wrote a letter to her medical team indicating that the chemo was killing her body, therefore electing to leave treatment and pursue alternative medicine.[24]  The courts decision to not intervene cited that she was not in need of protection because of her familial bond, as well as the use of traditional medicine which was within their right.[25] Listening to patients is crucial in promoting ethical health care, as well as respecting the patient’s right to determine choices for themselves, particularly in refusing treatment. By overriding Makayla’s decision, even if done in the name of her best interests, physicians would be disrespecting her personal autonomy, thereby amounting to an unjustifiably paternalistic attitude infringing on her personal integrity.

While the refusal of treatment is seen as an absolute right pertaining to adults, a ‘well considered refusal of treatment ought to be respected’ in the cases of young children, particularly if there is cultural relevance.[26] Opponents would question what is meant by a ‘well considered refusal of treatment’, and argue that refusing treatment would be deemed ‘ill-considered’ because it goes against medical advice. In this view, refusal of treatment should carry a greater ‘tariff’ then if a patient were to consent because of the fact it runs contrary to medical opinion. However, that argument is different from a refusal never being able to be ‘well-considered’, regardless if it’s contrary to medical opinion.[27]

True respect for autonomy hinges on the individual being autonomous, and therefore it would appear respectful of the principle to allow patients to refuse treatment, even if on irrational grounds. A key component of the principle of autonomy hinges on the fact that the patient is capable of making a specific decision pertaining to their care, as seen in Re C. Evidently, that does not mean that physicians cannot try to convince patients otherwise, as that would fail to acknowledge the premise of the duty to beneficence. As long as patients remain conscious of the consequences of their actions, respect for autonomy should outweigh the physicians’ duty to beneficence, particularly once the physician has exercised the presentation of all treatment options and their risks and benefits.[28]

Where patients are shown to lack capacity it can be argued that they are not autonomous and therefore the use of ‘best interests’ would apply. [29] Violating autonomy in the case of a patient suffering from a mental disorder being compulsorily confined and treated without their consent or a patient in a vegetative state is still consistent with the principle of autonomy because the act seeks to restore their autonomy and enable them to make decisions regarding their future care.[30] Hence, the best interests approach involves taking into account salient medical evidence, the patient’s wider personal interests, and  what the patient would have wanted before becoming incapacitous or currently wants (regardless of incompetence).[31] While this approach protects the self-determination of a patient, Bailey points out that ‘it is possible that decisions based on what somebody else views as the patient’s best interests will be made covertly under the guise of a substituted judgment’. [32]

                          Another concept to the challenge of autonomy surrounds the principle of the sanctity of life. With strong underpinnings in religion, the duty to respect life views human life as holy and inviolable.[33] This principle often appears in debates surrounding abortion and end of life decisions, in which physicians are to refrain from destroying life and instead seek to preserve it due to the belief that life holds intrinsic value. The thought of an individual being in a “incapacitous state” and subservient to other’s ‘best interests’ has been a particularly controversial issue, with many cases going before the courts to decide upon whether the ‘sanctity of life’ can violate the principle of patient autonomy.[34]  Preserving life is often seen as the highest duty of a physician, and those who support the practices of abortion and euthanasia are often confronted with arguments surrounding the sanctity of life.

According to the deontological school of thought, the sanctity of life approach emphasizes the need to protect life, where every individual has a right to life.[35]  This position can be attributed to the autonomy approach, in which a physician may be duty bound to respect the patient’s autonomous decision which may result in an earlier death. Having noted the discourse between the sanctity of life and autonomy, Hoffmann LJ in Bland observes the compatibility between these two concepts by pointing out that patients who refuse life-saving medical treatment are exercising their right to self-determination.[36] Allowing patients, in effect, to choose to die offends the principle of the sanctity of life.[37] Hence, a conflict between the two principles requires a painful compromise to be made and one having to be sacrificed. In this manner, a paternalist view would have autonomy denied in such an extreme case, and the principle of sanctity of life would be upheld.[38] Going down this route would have disturbing implications in clinical practice, particularly cases involving incompetent patients. To presume that the incompetent patient shall be subjected to treatment that a rational person would decline would ‘downgrade the status of the incompetent person’ and thereby lessen the value of his ‘intrinsic human worth and vitality’.[39] 

Problems with the View of Autonomy

While the principle of autonomy is an ideal worth protecting, it is evident that there are some justifications in violating for the principle.  While Mill set claimed  the non-interference of people’s actions and decisions as a necessary condition to autonomy, it is apparent that this rationale is not a sufficient condition.[40] In this respect, a homeless individual who requests to have his leg amputated because it would benefit his prospects on the street should have his autonomy violated. There is an inherent flaw if applying these straightforward claims about autonomy, in that as long as the decision was rational and unconstrained, then this individual should have his request honored. It is apparent that the right to autonomy does not entitle patients to request or demand all treatment, such as amputation of a healthy limb. As fundamental as autonomy is there must be some limits , as supported by Kant, who believed that autonomy is tied to our rational nature.[41] According to Kant:

‘There are compelling independent ethical arguments to suggest that the exercise of full autonomy requires some element of rationality … not [a] mere choice but an evaluative choice of which of the available courses of actions is better or best.’[42]

Kant’s view acknowledges that an autonomous decision cannot merely be a wish, but a decision that takes into account rational consideration and appropriate information. Savulescu argues that the decision should not be dependent on whether it is or is not prudent, but whether the imprudent decision was made on a rational or irrational basis.  As Savulescu explains, ‘rational imprudence is imprudence based on a proper and rational appreciation of all the relevant information and reasonable normative deliberation.’[43] This rationality explains why it is permissible to respect someone’s autonomy in cases where a patient with strong religious convictions, such as a Jehovah’s Witness, refuses a life-saving treatment. In this case while the decision itself can be considered imprudent, it becomes rational when religion is considered because their beliefs over spiritual well-being takes precedence over life itself. Irrational imprudence occurs when ‘there are no good overall reasons’ to engage in such act, as the individual ‘is not thinking clearly about information at hand or holds mistaken values or wildly inaccurate estimates of risk’.[44] Where a patient requests to remove his healthy limb, violation of autonomy can be acceptable because their request serves no medical purpose. The physician’s appropriate response should be to dissuade the patient from pursuing their irrationally imprudent decision because such desire is not autonomous and would produce more harm than benefit. Exercising a completely autonomous choice centers on the fact that the decision being rational, but realistically autonomous decisions ‘often turn on the reasons an individual has in a particular situation’.[45] Controversially, Bayne and Levy use the healthy limb example arguing that the request for amputation of a limb may represent Body Integrity Identity Disorder, a poorly understudied condition. Individuals are often driven to dangerously remove limbs themselves as alternative treatments are generally ineffective.[46]. Surgeons would be permitted to remove their healthy limb provided alternative options have been exercised.[47] Normative deliberation in cases of health limb removal is not sufficient in itself to make the action rationally defensible in all cases.


Respect for autonomy as a principle of bioethics assumes a certain level of respect for persons and their corresponding ability to make decisions that affect their health and wellbeing. As pointed out earlier in this essay, personal autonomy is synonymous with the right of self-determination, and hence has become one of the foremost and fundamental guiding principles in allowing individuals to express their own free will. It is evident that while both autonomy and beneficence are to be practiced by health care professionals, in most cases autonomy will outweigh the latter so long as the patient is able to make a rational and unconstrained decision, regardless of the fact that the treatment would run against the patient’s best interests.

Whether someone should live or die is generally not a decision that can be decided upon without an objectionable denial of the competent individual’s autonomy. However, that does not mean that healthcare professionals are obligated to honor all requests, particularly if the patient fails to understand the nature, purpose, and proposed effects of their medical treatment. Arguably, removing a healthy limb may be permissible if all the less invasive treatments have been exhausted and if the final procedure produces greater benefit than harm. Hence, in rare situations this may be the desirable option. As such, the principle of autonomy should not be violated in cases where the request or decision is rational, but limits should be applied in cases where the decision is imprudent and irrational, as that is not what autonomy demands.





Works Cited


Airedale N.H.S. Trust v Bland [1993] 2 WLR (HL).


Almond, B. (1993) ‘Rights’, in Peter Singer (ed), A Companion to Ethics, Blackwell 1993)


Piper, M., ‘Autonomy: Normative’ (James Madison University, n.d.)

<> accessed 2 December 2015


Bayne, T. & Levy, N. (2005) Amputees by choice: body integrity disorder and the ethics of amputation, Journal of Applied Philosophy, 22(1): 75-86


Brennan, T. ‘Ethics of Disclosure Following a Medical Injury’, in Rosamond Rhodes, Leslie Francis & Anita Silver (edn), The Blackwell Guide to Medical Ethics (Blackwell 2007)


Beauchamp, T. & Childress, J., Principles of Biomedical Ethics (6th edition, OUP 2008)


Davies, E., ‘Is old age an ethical problem?’ (GM, 2013)

<> accessed 29 November 2015


Donna Dickenson, D., Huxtable,R. & Parker, M., The Cambridge Medical Ethics Workbook (2nd edition, CUP 2010)


Foster, C. (2011) ‘Human Dignity in Bioethics and Law’, Bloomsbury


‘Geriatrics: Decision-Making, Autonomy, Valid Consent and Guardianship’ (University of Miami, n.d.) <> accessed 15 November 2015


Gillon, R., ‘The Sanctity of Life Law Has Gone Too Far’ (Gresham College, 2014) <>


Glover, J. (1977) ‘Causing Death and Saving Lives’, Penguin.


Hamilton Health Sciences Corp. v. D.H., 2014 ONCJ 603.


Harris, J., (1985), The Value of Life, New York: Routledge and Kegan Paul


Kant’s Moral Philosopy’ (Stanford Encyclopedia of Philosophy 2008) <> accessed 10 November 2015


Michel, J.P., ‘When the Sanctity of Life Includes the Right to Choose Death’ (The Gospel Coalition, 2015) <> accessed 15 November 2015


Mill, J.S., On Liberty, in John Gray (ed), John Stuart Mill: On Liberty and Other Essays (OUP 1991)


Pantilat, S., ‘Autonomy vs. Beneficence’ (University of California, 2008) <>


Re C (Adult: Refusal of Treatment) [1994] 1 WLR 290 (FD)


Savulescu, J, ‘Autonomy, the good life and Controversial Choices’, in Rosamond Rhodes, Leslie Francis & Anita Silver (edn), The Blackwell Guide to Medical Ethics (Blackwell 2007) 27


Schloendorff v New York Hospital [1914] 105 N.E. 92 (CA)


Suber, P., ‘Against the Sanctity of Life’ (Earlham College, 1985)

<> accessed on 2 December 2015


Superintendent of Belchertown State School v Saikewicz [1977] 370 N.E. 2d. 417, 428


Ulrich, L., ‘Ethical Principles in Healthcare Ethics’ (University of Daytona, n.d) <> accessed 12 November 2015


Varelius, J, ‘The value of autonomy in medical ethics’ (2006) 9(3) MHCP <> accessed 12 November 2015


Vevaina, JR, Nora, LM & Bone, RC, ‘Issues in Biomedical Ethics’, (1993) 39(12) DM <> accessed 10 November 2015


Walker, C., ‘Makayla Sault, girl who refused chemo for leukemia, dies’ CBC News, (January 19, 2015) <> accessed 10 November 2015


Walker, C., ‘Makayla Sault will not be apprehended by Children’s Aid’ CBC News, (May 20, 2014) <> accessed 10 November 2015


Walsh, P. Autonomy- Handout (King’s College London, 2015)



[1] JR Vevaina, LM Nora & RC Bone, ‘Issues in Biomedical Ethics’, (1993) 39(12) DM <> accessed 10 November 2015

[2] Elizabeth Davies, ‘Is old age an ethical problem?’ (GM, 2013)

<> accessed 29 November 2015

[3]Tom Beauchamp & Jeff Childress, Principles of Biomedical Ethics (6th edition, OUP 2008) 58

[4] Lawrence Ulrich ‘Ethical Principles in Healthcare Ethics’ (University of Daytona, n.d) <> accessed 12 November 2015

[5] ibid.

[6] Troyen Brennan, ‘Ethics of Disclosure Following a Medical Injury’, in Rosamond Rhodes, Leslie Francis & Anita Silver (edn), The Blackwell Guide to Medical Ethics (Blackwell 2007) 394

[7]‘ Kant’s Moral Philosopy’ (Stanford Encyclopedia of Philosophy 2008) <> accessed 10 November 2015

[8] Julian Savulescu, ‘Autonomy, the good life and Controversial Choices’, in Rosamond Rhodes, Leslie Francis & Anita Silver (ed), The Blackwell Guide to Medical Ethics (Blackwell 2007) 27

[9] J.S. Mill, On Liberty, in John Gray (ed), John Stuart Mill: On Liberty and Other Essays (OUP 1991).

[10] Brenda Almond, ‘Rights’, in Peter Singer (ed), A Companion to Ethics (Blackwell 1993)

[11] [1914] 105 N.E. 92 (CA)

[12] Jukka Varelius, ‘The value of autonomy in medical ethics’ (2006) 9(3) MHCP <> accessed 12 November 2015

[13] Jonathan Glover, ‘Causing Death and Saving Lives’ (Penguin, 1977) 81.

[14] Ulrich ibid (n 4)

[15] Mill ibid (n 9)

[16] ibid.

[17] Donna Dickenson, Richard Huxtable, & Michael Parker, The Cambridge Medical Ethics Workbook (2nd edition, CUP 2010) 3

[18] Steve Pantilat, ‘Autonomy vs. Beneficence’ (University of California, 2008) <>

[19] Beauchamp ibid (n 3) 272

[20] Davies (n 2)

[21] Re C (Adult: Refusal of Treatment) [1994] 1 WLR 290 (FD)

[22] ‘Geriatrics: Decision-Making, Autonomy, Valid Consent and Guardianship’ (University of Miami, n.d.) <> accessed 15 November 2015

[23] Connie Walker, ‘Makayla Sault, girl who refused chemo for leukemia, dies’ CBC News, (January 19, 2015) <> accessed 10 November 2015

[24] Case precedence in J.J: Hamilton Health Sciences Corp. v. D.H., 2014 ONCJ 603

[25] Connie Walker, ‘Makayla Sault will not be apprehended by Children’s Aid’ CBC News, (May 20, 2014) <> accessed 10 November 2015

[26] Dickenson (n 17) 11.

[27] ibid.

[28] Steve Pantilat, ‘Autonomy vs. Beneficence’ (University of California, 2008) <>

[29] M Stauch & K Wheat, ‘Text, Cases, and Material on Medical Law and Ethics’,  (Routledge 2015) 31

[30] ibid 33.

[31] Dickenson (n 17) 8.

[32] ibid 16.

[33] Raanan Gillon, ‘The Sanctity of Life Law Has Gone Too Far’ (Gresham College, 2014) <>

[34] ibid.

[35] Dickenson (n 17) 8.

[36] Airedale N.H.S. Trust v Bland [1993] 2 WLR (HL)

[37] ibid 351.

[38] Bland (n 36) 352.

[39] Superintendent of Belchertown State School v Saikewicz [1977] 370 N.E. 2d. 417, 428

[40] Pat Walsh, Autonomy- Handout (King’s College London, 2015)

[41] Savulescu (n 8) 28

[42] J., Harris (1985), The Value of Life, New York: Routledge and Kegan Paul

[43] Savulescu (n 41) 27

[44] ibid.

[45] Savulescu (n 8) 28

[46] Bayne, T. & Levy, N. (2005) Amputees by choice: body integrity disorder and the ethics of amputation, Journal of Applied Philosophy, 22(1): 75-86

[47] ibid.

Step Forward.

I came across this story today while on my normal internet grind. The story of 13-year old Daniel Fitzpatrick , a young boy who took his own life because of being bullied. This story makes me sick, another young child helpless to the people who are supposed to be there to support him and protect him from this type of behaviour. The whole “it’s part of growing up” mentality is bullshit. The world is tough, no one said things are meant to always be peaches and roses, but let’s be honest here NO ONE should ever have to live a life where they a) fear for their safety b) wake up sad to be alive c) made to feel excluded. It’s time people take responsibility for the actions of their children and it’s time administrators step up to curb the problem.

We are in a whole new generation here, the speed at which things can spread has grown enormously with the invention of social media and the internet. As a society we need to be more proactive in educating and protecting our children from these behaviours. Administrators need to do more to get involved when a child comes forward. I’m sure many of us have been bullied at some point, that seemingly “harmless” joke or shove growing up. I know i’ve been there and it sucks, but I know I never had it as bad as many people out there. There’s a difference between “having fun” and being “tormented” and I feel like many people are quick to judge. This child is not weak, how can you expect ANYONE to tolerate what he likely did on a daily basis. A human is only made to take so much, growing up shouldn’t be this difficult and it’s sad to see even when he did reach out, people still failed him. How many other children do we as a society fail on a daily basis? How many children do we need to lose before people take proactive steps?

Kids can be cruel and heartless, do we blame the parents of these kids? I wouldn’t go so far to do that, but how we are raised does play a part in how we act and interact with others. There’s likely so many factors that go into this, take into consideration the social dynamics of families for example.  It’s sad to know that there are two young children out there who have the blood of this boys’ life on their hands. Is that what it takes to change people’s behaviours these days? I hope these children learned a lesson, it’s sad to think they will have to live with their actions for the rest of their lives.

13 is so young. As someone who has struggled deeply with depression and thoughts of suicide, I can understand where this young boy is coming from. But it’s important children realize there are alternatives out there to such a drastic and permanent act. We need to do more to advocate for youth support. No child should have to go through this alone, and no parent should feel helpless at the mercy of a school and fight their battles alone.

My heart goes out to his loved ones during this difficult time. No parent should ever have to bury their child, especially from something that was so preventable. One person stepping forward to protect this child could have gone a long way to saving his life. This child had the potential for a full life ahead of him and now it’s gone.

– M

Disney Influence on Gender Types and Race

Since its establishment in 1920, the Disney Corporation has since become a household name for wholesome family entertainment. Disney is often associated with promoting pure and innocent fantasies, oftentimes through the use of fairytales. As technology’s role in the lives of children increases, it has become evident that accumulated media experiences, including television and film, have increasing and lasting effects on children’s beliefs and values. Therefore, it is critical to understand how Disney’s ideology of gender types and race, through the use of film, consequently shape children’s values and lead to the formation and reinforcement of stereotypes.

Increasing research on the gender typing messages promoted through Disney films has shown various recurring themes for both male and female characters. Males in Disney films were generally portrayed as: independent, unemotional, brave, physically attractive, and performed non-domestic jobs (England, Descartes & Collier-Meek, 2011). However, females were portrayed as being a victim, physically weak, submissive, sensitive, and valued more for their beauty than intellect (England, Descartes & Collier-Meek, 2011).  In a study conducted by Blaise (2005), female kindergarteners understood that make-up could be used as a powerful tool to determine and express femininity. One young girl chose to wear red lipstick and grow long hair to attract her “prince”, just like she had seen Princess Ariel do in the Disney movie ‘The Little Mermaid’.  It becomes apparent that Disney’ s portrayal of gender roles leads to learned associations of gender typing that can lead to and shape stereotypical views of gendered activities, values, and roles.

Disney films largely impact the images children are exposed to shaping their attitudes towards racial prejudice. Although children can be influenced by a variety of sources, media is often most influential. In an analysis on race and culture in Disney movies, Towbin, Haddock, Zimmerman, Lund and Tanner (2003) noted three recurring themes; negative representation of non-dominant cultures, exaggerated class stereotypes, and characters with shared values are grouped together. Other research on race and culture in Disney films also note that characters of color are generally seen as villainous, therefore leading to racially stereotypic images of marginalized groups. One movie that evidences this includes Aladdin, where the hero, Aladdin, is depicted as having European features, with no accent, as to the villains whom all have Middle Eastern characteristics such as beards, and foreign accents (Anderson & Cavallaro, 2002). In addition, Disney movies have been predominately depicted to relay Western cultural norms, therefore disseminating American cultural messages to children in other cultures, leading to the “Americanization” of cultural norms (Lee, 2010).

Consequently, Disney is able to shape childrens values on gender typing and race by scripting aspects of childhood and society. One example includes the Disney adaptation of Pocahontas, which portrays themes of gender typing and race. As Giroux (1997) points out, Pocahontas was portrayed as a “brown-skinned, Barbie like supermodel with an hourglass figure”, which is an unrealistic representation of a Native American woman, let alone an average female.  As Giroux (1997) points out, many young children fail to recognize the objectification of the female bodies in Disney movies. Additionally, conflicting messages about gender typing included her initial portrayal as a strong woman, only to end with her choosing to remain at home out of a sense of duty to her community rather than for herself (Towbin et al., 2008). Pocahontas was portrayed as being constrained to a certain role, thereby reinforcing stereotypes of gender typing and race.

Although children can be influenced by a variety of sources, media often serves as a powerful learning tool that helps to convey messages about race and gender roles. As Lee (2010) point out, the messages that are conveyed through Disney films have become important socializing agents that help formulate children’s identities. Although, children may not emulate exactly what they see from the films, they may see possibilities in emulating that person. Ultimately, It is imperative that children understand that gender roles are not rigid, and that race and gender do not define roles and values. Parents and educators have the power to counter these unrealistic images by displaying realistic and accurate representations of people and by exposing them to a variety of role models.



Works Cited

Anderson, K. J., & Cavallaro, D. (2002). Parents or pop culture? Children’s heroes and role models. Childhood Education, 78(3), 161-168.

Blaise, M. (2005). A feminist poststructuralist study of children ‚”doing” gender in an urban kindergarten classroom. Early Childhood Research Quarterly, 20(1), 85-108.

England, D., Descartes, L., & Collier-Meek, M. (2011). Gender role portrayal and the Disney princesses. Sex Roles, 64(7-8), 555-567. doi: 10.1007/s11199-011-9930-7

Giroux, H. A. (1997). Are Disney movies good for your kids?. Kinder-Culture: The Corporate Construction of Childhood (pp. 187-195). Boulder, CO: Westview Press.

Lee, L. (2010). Disney in Korea: A socio-cultural context of children’s popular culture. Red Feather Journal: An International Journal of Children’s Visual Culture, 1(2), 41-45. Retrieved from

Li-Vollmer, M., & LaPointe, M. E. (2003). Gender transgression and villainy in animated film. Popular Communication: The International Journal of Media and Culture, 1(2), 89-109.

Towbin, M. A., Haddock, S. A., Zimmerman, T. S., Lund, L. K., & Tanner, L. R. (2004). Images of gender, race, age, and sexual orientation in Disney feature-length animated films. Journal of Feminist Family Therapy, 15(4), 19-44.

Making a Difference in the World of Children's Mental Health.

Love that today The Duchess of Cambridge (or also known as Princess Kate) was highlighted as the guest editor for the UK edition of the Huffington Post. She was enlisted to bring attention to the #YoungLivesMatter edition of the website highlighting the issue of children’s mental health, an often neglected area of health care and education systems around the world. This new initiative seeks to encourage individuals of all walks of life to join in on the conversation surrounding mental health, particularly young individuals in ensuring that they are able to feel loved, secure, valued, and understood. Articles in this section will seek to help combat the stigma that is often associated with mental health issues (particularly in children) and discuss the causes and potential solutions that could be used to fight this health crisis.

Research has shown that mental health issues often start early.  In the United Kingdom, one young person in 10 is estimated to experience some form of emotional or mental health problem each year. These problems become significantly worse as the age demographics move up towards post-secondary education, with approximately 1 in 5 (in Canada) reporting some form of mental health issue (ex anxiety, depression, etc). Furthermore, half of young adults with mental health disorders first experience difficulties before they are 15.

As pointed out my the Duchess in her blog post today:

“What I did not expect was to see that time and time again, the issues that led people to addiction and destructive decision making seemed to almost always stem from unresolved childhood challenges……children – even those younger than five – have to deal with complex problems without the emotional resilience, language or confidence to ask for help. And it was also clear that with mental health problems still being such a taboo, many adults are often too afraid to ask for help for the children in their care. ”

Why are our systems reacting so slow to addressing these problems? Children are supposedly “our hope for the future”, yet we are failing many of the children in giving them a successful head start in developing healthy coping mechanisms.

Although not all forms of mental illness have specific cures, preventative efforts are crucial to giving people the support they need to live functional and fulfilling lives. We are all well aware the economic impact that mental illness has, yet for many who choose to seek help it if often mission impossible to even get on the waiting list for help. In Canada and the United States there is emerging concern about a shortage of child psychiatrists that is predicted to get worse. Even more alarming, a 1999 study indicated that there were 6,148 children with mental health needs per child psychologist in Ontario. Keeping in mind, there are only approximately 2,000 psychologists in ALL of Ontario. Even worse, in all of rural Ontario (a MASSIVE plot of land) there were only 21 practicing psychiatrists serving rural Ontario (Bazana, 1999). HUH??? I am well aware of the dilemmas of trying to recruit physicians to remote and rural areas, but we need to find ways to encourage more people to serve these populations. Mandatory rural/remote medical placements should be encouraged, possibly even another Northern medical school with a mandatory placement time up north should be encouraged. For many these are not ideal places to live, but as someone serving the medical community these people are in need of care and for many living on the reserves there is a dire need for more medical professionals and psychologists to address these long-standing problems.

We as a society need to do more to train a variety of individuals with how to identify and help those who may be struggling to navigate our often complex and fragmented system.  In the UK alone, more than 15,000 people working in a variety of schools have been trained as mental health first aiders. An excellent program to help spot potential warning signs and a method to provide children with access to an initial support system and guide in obtaining the resources needed to help them.

As Michelle Obama put it in her comission blog post for the Young Minds Matter edition:

“Sadly, too often, the stigma around mental health prevents people who need help from seeking it. But that simply doesn’t make any sense. Whether an illness affects your heart, your arm or your brain, it’s still an illness, and there shouldn’t be any distinction. We would never tell someone with a broken leg that they should stop wallowing and get it together…..We shouldn’t treat mental health conditions any differently. Instead, we should make it clear that getting help isn’t a sign of weakness – it’s a sign of strength – and we should ensure that people can get the treatment they need.”

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Articles cited:


This paragraph from the article below is such a common theme with many young people that have opened up to loved ones:

“I remember sitting at the kitchen table speaking with my parents about how I felt really depressed. I was in my early twenties and they clearly just didn’t understand. I know that it’s not that they didn’t care, but their response was something like, “Renee, you have a great life…nothing to be depressed about.” Perhaps they were under the false impression that depression could just be turned on and off or that people used the idea of depression as an excuse or a crutch.”

It’s important to be aware that it’s all about education, we need to educate people to become aware of the symptoms of mental illness. We need to educate people to be better equipped to help those with mental illness. But most of all we as a collective group need to erase the stigma associated with those battling from mental illness, so they never have to feel ashamed or misunderstood by those they are reaching out to.

Remember, nobody should ever feel like they are alone and feel that the only option to get out of their misery is to end their life. For those of you on twitter, from December 1-25, follow the hashtag “#NotAlone”, and retweet in hopes that it will save a few lives.

– M


As news broke that the missing Ohio State football player’s body had been found, I was coincidentally working on writing this article on depression and suicide prevention.

A few months ago, my dear friend Sam had the terrible misfortune of losing his son to suicide.

I originally met Sam  on Twitter through a hashtag  where people shared content related to everything social media, but our families quickly became friends in real life too.  A few of my digital friends were trying to come up with something special we could do for Sam (and his family) when we realized that if we used our collective social media influence, we could do something really meaningful for not only Sam, but for other families managing similar loss. We decided to curate content from December 1-25 on depression and suicide awareness. We are using the hashtag #NotAlone, Please watch and share my tweets and our posts as it’s our hope that through our efforts we might be able to save a few lives.

“It is estimated that about 10 to 15 percent of children/teens are depressed at any given time. Research indicates that one of every four adolescents will have an episode of major depression during high school with the average age of onset being 14 years!” -PsycheCentral

Kosta Karageorge, the Ohio State football player, was found near campus, with an apparent self-inflicted gunshot wound. According to the online reports, his mother mentioned that Kosta had suffered from several concussion and had been extremely confused. She received a text from him that read, “I am sorry if I am an embarrassment.”

According to the website, researchers found that there is a very string association existed between concussions and clinical depression. “The findings significantly underscore the importance of understanding and evaluating the potential neurological consequences of recurrent mild traumatic brain injuries,” said co-author Dr. Bailes. “Not only do concussions and other head injuries in early adulthood significantly raise the risk of depression decades later, but concussions are reported to have a permanent effect on thinking and memory skills later in life.”

As parents, it’s impossible to have answers to everything and we can’t blame ourselves when we don’t see signs we didn’t know we should be looking for. According to the American Foundation for Suicide Prevention, there may be an increase in suicides, in 2012 (the last time the study was done) 40,600 suicides were reported, making suicide the 10th leading cause of death for Americans. In the past, suicide was considered a taboo as an act against God, people were embarrassed to discuss let alone try to understand why.

Depression – not in my family…

As a child, I grew up having a relative (my father’s sister) who suffered from mental illness. She was diagnosed paranoid schizophrenic / manic-depressive and has always struggled to live outside of institutions. There is still so little that we truly know about mental illness, which is likely why the stigma of depression continues.

I remember sitting at the kitchen table speaking with my parents about how I felt really depressed. I was in my early twenties and they clearly just didn’t understand. I know that it’s not that they didn’t care, but their response was something like, “Renee, you have a great life…nothing to be depressed about.” Perhaps they were under the false impression that depression could just be turned on and off or that people used the idea of depression as an excuse or a crutch. I remember my father saying, “what are you, like Aunt Roseanne?” that comment stung for a long time. For them, the idea of having a child who was depressed was embarrassing. They didn’t know what we know…it’s about education.

What can we do?

If you’ve never felt depressed then it’s hard to imagine the blanket of sadness that envelopes you when you suffer from depression. It can be a sunny, beautiful day but depression does not discriminate; it just happens and it’s awful. It’s like a heavy weight of sadness, a dark glaze overshadowing even the brightest moments. What we need to do is work on being aware by recognizing the signs and how to help. We need to accept that nobody’s perfect,  embrace the people we love when they need us…and not pass judgement. Be honest and open.

Be aware of the signs of depression in teens (from

  • Madness or hopelessness
  • Irritability, anger, or hostility
  • Tearfulness or frequent crying
  • Withdrawal from friends and family
  • Loss of interest in activities
  • Changes in eating and sleeping habits
  • Restlessness and agitation
  • Feelings of worthlessness and guilt
  • Lack of enthusiasm and motivation
  • Fatigue or lack of energy
  • Difficulty concentrating
  • Thoughts of death or suicide