Players from NHL, junior leagues seeking brain scans without team involvement.

More than 200 current and retired National Hockey League players have taken concerns about existing or potential brain injuries into their own hands by visiting a neurosurgeon in Kingston, Ont., for MRI brain scan procedures.

Dr. Douglas James Cook says at least 120 former and some 80 active NHL players have undergone the scans over the past two years. He said that about 50 active players combined from the Ontario Hockey League and Western Hockey League have also been tested at Queen’s University over the same time frame.

The tests have not been done with the oversight or formal participation of any of the active players’ teams, Dr. Cook said in a series of interviews with TSN.

“Some guys come because teammates tell them about it,” Dr. Cook said. “Some players bring a teammate with them and then when they come for a follow-up say, ‘Can I bring these other two players with me? I think they might be interested.’”

TSN could not independently corroborate the number of NHL players who have had the tests completed.

Dr. Cook, who operated twice on Tragically Hip lead singer Gord Downie after his brain cancer diagnosis, said the technology used to measure the flow of blood through the brain’s millions of blood vessels is new and that his methodology for analyzing the data collected is unique.

Following a brain injury, Dr. Cook said, the flow of blood can accelerate through damaged or stressed parts of the brain as the brain directs oxygen-rich blood to the affected areas. In other nearby parts of the brain, blood flow can slow if it is redirected to injured areas in need of repair.

“We simplify it for players,” Dr. Cook said. “We explain that there are areas of stress in the brain after an injury and that there are changes in blood flow that we can monitor in those areas of stress.”

Dr. Cook said he’s discovered blood flow abnormalities in the brains of about one-quarter of the roughly 80 active NHL players he has examined.

“Unfortunately there are a number of them,” he said. “They just are not comfortable telling anyone about it.”

Dr. Cook said he’s talked about his testing with some NHL team owners and is hoping to meet with the NHL Players’ Association to discuss the testing. The NHL Alumni Association has also been involved in helping to build awareness of the tests, he said.

NHL Alumni Association president Glenn Healy declined to comment.

“We think this is exciting but it’s also controversial,” Dr. Cook said. “From the players’ perspective, some are concerned about what we might find out, what we might see. Some people don’t even want to know what’s going on in there. They know that they have accumulated damage and don’t necessarily want to face it. And obviously there are always concerns from the owners’ side. …  We worry the [NHL] perspective and perhaps the owners’ perspective is that this … is potentially damaging for the reputation of the league.”

The active players who have been tested include some of the NHL’s top young stars, a source told TSN. Their identities have not been made public and Dr. Cook declined to identify any players involved in the tests, citing privacy rights.

Toronto neurologist Dr. Charles Tator once taught Dr. Cook when he was in medical school at the University of Toronto and calls the 39-year-old Cook a rising star in the field of neurology.

“He was very inventive when he was working in my lab. He’s smart and well trained and he’s an expert on blood flow. … He told me about this project at least a year ago. … He’s a clever guy and has attracted their [NHL players’] interest. There is word of mouth and players encouraging their colleagues to go. That’s the way it happens.”

Dr. Tator said he has also examined NHL players in his Toronto office, but said he’s worked with far fewer players than Dr. Cook.

“Many players are capable of independent thought and they are concerned and sometimes they are pushed into seeking other opinions from their families if their families detect some alteration in behaviour,” Dr. Tator said. “Despite the best efforts of the NHL officials to play down concerns, there is concern among players’ families. They are thinking more about it. And this is escalating as time goes on.”

After finishing his residency and PhD in Toronto, Dr. Cook moved to California and worked at Stanford University, establishing himself as an expert in cerebral blood flow. In 2013 he returned to Canada and began working at Kingston General Hospital.

Using the nearby Queen’s University MRI machine costs about $600 an hour, Dr. Cook said. Players are not charged for the exams. The costs are covered with funding from Queen’s and from a family foundation whose administrators want to remain anonymous.

In Kingston, Dr. Cook said that the brain scans take about 45 minutes. Patients lie down inside the MRI machine and put on a facemask known as a rebreathing machine, which controls the amount of inhaled oxygen and carbon dioxide.

Dr. Cook said the MRI is then able to identify areas of the brain that have been damaged.

“We’re looking at the brain’s vascular physiology following injury,” Dr. Cook said. “There are patterns of impairment that are recoverable and there are patterns of impairment that set in and become more permanent. So we are using this as a technique as a way to detect concussion and also to identify the chronic syndrome that we see in older athletes as they age – issues like sclerosis, scar tissue, impaired vessel function and flow. It’s an exciting technology in a lot of ways.”

Dr. Cook said he began examining patients with suspected brain injuries four years ago and has received about $1.5 million in funding so far. After researching military personnel with a grant from the Canadian Institute for Military and Veteran Health Research, the Canadian Institutes of Health Research and the Natural Sciences and Engineering Research Council offered funding for a study of varsity football players at Queen’s.

Brain injuries and concussions are perhaps the most polarizing issue facing the NHL. On one hand, the NHL’s critics, who include nearly 200 former players who are suing the NHL, say the league has not done enough to educate and protect players from the long-term consequences of repeated head trauma. They point to NHL internal emails that show senior league officials have scorned independent medical experts who scrutinize or critique the NHL’s medical decision making.

For its part, the NHL has argued that any interested players could seek out medical journals and do their own research about the impact of brain injuries. Moreover, its officials point out that the NHL was the first pro sports league in North America to introduce baseline neurological testing for its players.

Reposted from:

Biological Changes Could Be Underlying Factor For Higher Rates of Psychosis in Immigrants.

A new study could explain how migrating to another country increases a person’s risk of developing schizophrenia, by altering brain chemistry.

Immigrants had higher levels of the brain chemical dopamine than non-immigrants in the study, conducted by the Centre for Addiction and Mental Health (CAMH) in Toronto and the Institute of Psychiatry, Psychology and Neuroscience, King’s College, London. Abnormal dopamine levels are linked to symptoms of schizophrenia. Dopamine is also connected to the body’s stress response.

The study was published in the January issue of Schizophrenia Bulletin.

“Schizophrenia is still a rare diagnosis,” says Dr. Romina Mizrahi, a senior author and Clinician Scientist in the Campbell Family Mental Health Research Institute at CAMH. “But if we can understand the factors that increase the risk of this serious illness among immigrants, we can develop strategies such as social supports to mitigate this risk.”

As Canada’s population and workforce will decline without migration, a set number of immigrants are accepted into the country each year. While it’s not feasible to offer stress supports to all newcomers, the approach of identifying those at highest risk and offering evidence-based interventions to prevent schizophrenia is one that Dr. Mizrahi applies to her work with youth, as Head of the Youth Psychosis Prevention Clinic and Research Program.

The current study involved a type of brain imaging called positron emission tomography (PET), and applied two different approaches to examining dopamine levels.

In Toronto, 56 study participants were given a mild stress test to see its effect on dopamine release. People with schizophrenia, and those at high risk, release more dopamine with this test when compared to a matched healthy group of participants. Among the 25 immigrants in the study, dopamine release was higher than 31 non-immigrant participants. This increase was related to participants’ experiences of social stress, such as work overload, social pressures or social isolation.

The London researchers showed that the synthesis of dopamine was higher in immigrants. This increase was related to the severity of symptoms among those considered at high risk of developing schizophrenia, and did not occur among non-immigrants at high risk. In total, 32 immigrants and 44 non-immigrants were involved in this part of the study.

Dr. Mizrahi emphasizes that not everyone with high dopamine levels will develop schizophrenia, nor will the vast majority of migrants.

Yet it is well-established through population studies in Canada, the U.K. and Western Europe that the risk of developing schizophrenia is higher in immigrants and their children than non-immigrants. Stress – particularly related to perceived discrimination, social isolation and urban living – is believed to increase this risk. The role of stress also appears to be supported by the current findings on brain dopamine levels.

“This is a first step in integrating social science and biological research,” says Dr. Mizrahi. “A next step would be to help regulate stress among higher risk immigrants through social support programs, and see if this reduces dopamine in the brain and prevents psychosis.”

Reposted from:

Delirium, Dementia, and Depression in Older Adults: Assessment and Care

One of the things I am most proud of in being a McMaster student is being taught in an evidence based manner. All the course work we are given, lectures, and clinical case studies are all based off of current evidence. Therefore, one of the new goals I have in advocating for mental health issues is to share some of the evidence based research I have come across. Working in my Problem Based Learning class I have come across a vast amount of literature pertaining to mental illness.

I have decided to share some of the resources I have accessed in order to help allow people who may not be familiar with searching textbooks, databases, and best practice guidelines,  in hopes that it will make the information a lot more accessible.  The first source of evidence I chose to share is from the Registered Nurses’ Association of Ontario and an update to their Depression guidelines.

As the RNAO points out this guideline “is to be used by nurses and other members of the interprofessional health-care team to enhance the quality of their practice pertaining to delirium, dementia, and depression in older adults, ultimately optimizing clinical outcomes through the use of evidence-based practices.”




Testosterone and Its Effects on Aggressive Behaviour in Adolescents

Aggression has been defined as any form of behaviour that is intended to harm another person (Passer, Smith, Atkinson, Mitchell and Muir, 2011). Over the years psychologists and other researchers have been able to study this form of behaviour by analyzing the factors that may contribute to aggression. These factors have been thought to include biological, environmental and psychological levels, which may work individually or all together in contributing to aggressive behaviours. Aggression can take place in various forms including physical aggression where the aggressor exhibits pushing, slapping and shooting other people or verbal aggression, in this form the aggressor may intimidate or engage in taunting and name-calling. The last form of aggression takes place indirectly and involves the aggressor taking part in behaviours such as gossiping, spreading rumors and encouraging others to exclude someone (Facts for teens: aggression, 2002). A wide variety of research has been done on aggressive behaviour in adolescents and it is still an ongoing process into understanding why some children are more predisposed to certain behaviours than others. Research that has been undertaken has discovered that children are more likely to engage in aggressive behaviour if they are exposed to the following risk factors: individual characteristics, home environment, relationships with peers, media violence, social failure, community factors and genetics (Facts for teens: aggression, 2002). Therefore, more research needs to be conducted in order to help understand why some children are more aggressive and to reduce or prevent the behaviour. Studies in the last few decades on aggression have particularly focused on the effects of the androgen hormones; testosterone and cortisol. Much of the research supports the idea that these two hormones do play a role in the expression of aggressive behaviour in young adolescents.

Yi-Zhen Yu and Jun-Xia Shi examined the effects of testosterone and cortisol hormone levels in saliva to examine whether the endocrinal factors contribute to the aggressive behaviour in adolescents.  Their study included the participation of 20 aggressive youth, which was made up of 10 males and 10 females, as well as 20 non- aggressive students. The 40 participants were selected from a population of 1051 students all of whom were between the ages of 11- 16 years of age and from the province of Hubei in China. The groups were then further divided by age, gender, stage of pubertal development and economic status of their families. Once selected Yu and Shi evaluated aggressive behaviours using child behaviour check list (CBCL), along with a parent questionnaire. The use of the CBCL allowed the researchers to adhere to a standardized evaluation technique, consisting of the evaluation of behavioral problems and social competencies based on the reports from people who know the child well. The checklist allowed the researchers to examine a broad range of emotional and behavioral problems and identify two major groups of problem children- those that internalize problems (inhibited behaviour) and those that externalize problems (aggressive behaviour) (Yu & Shi, 2009). Using the questionnaire taken by the child’s guardian along with the rest of the CBCL, Yu and Shi were able to calculate a score for aggression. An aggressive child in this study was defined as having a score that was above or equal to China’s norms. In this case, for male an aggressive student was considered aggressive if their score was above 18, while for females the score had to be 17 or above. Yu and Shi also collected saliva samples from each individual, all at the same point during the day. The collected sample from each participant was examined and tested for the cortisol (CORT), testosterone (T) and growth hormones (GH) using radioimmunoassay, which measures the levels of each hormone. After testing was complete, Yu and Shi were able to compare the results from both groups to determine whether increased levels of the hormones were a contributing factor towards displays of aggressive behaviour.

Richard Tremblay and his colleagues focused on identifying the associations between testosterone level, physical development and a concurrent assessment of antisocial behaviour (Tremblay, Schaal, Boulerice, Arseneault, Soussignan, and Paquette, 1998). The subjects involved were made up of 1161 caucasian males with the mean age sitting at around 6.12 years. All the subjects chosen were from low socioeconomic areas in Montreal. For 57 of the boys who were between the ages of 12 and 13, data on testosterone, physical aggression and social dominance was available to use (Tremblay et. al., 1998).  For behavioral measures, behaviour assessments were obtained from the children’s teachers at the ages of 6,10,11 and 12 years, from peers at 10,11 and 12 and from the boys themselves at 10, 11, 12, and 13 years of age. The teacher’s ratings were obtained using a Social Behaviour Questionnaire (SBQ) and scored on a three level scale consisting of “does not apply”, “applies sometimes” and “frequently applies” (Tremblay et. al., 1998).  Two types of aggression- physical and opposition scores were derived from items such as “blames others”, “disobedient” and “fights”. The range of the scores for physical aggression was from 0-6 and for opposition aggression it was from 0-10. This testing was done at the end of every school year for the ages of 6,10,11 and 12 years of age. For peer ratings, Tremblay and his colleagues used the Pupil Evaluation Inventory that was used at ages 10,11 and 12. The evaluation involved each child in a class to nominate four students who fit the criteria for each item described on the questionnaire. From the questionnaire a score was derived that represented physical aggression. This score was generated from two criterions out of the thirty-five that were “those who start a fight over nothing” and “those that say they can beat everybody” (Tremblay et. al., 1998). For the self-assessments the boys answered a 27-item delinquency questionnaire at the ages of 10, 11, 12 and 13 years of age (Tremblay et. al., 1998).  The questionnaire was made up of a four point rating scale (never, once, twice or often). Questions that were asked included  “steals objects worth more than $10 in school”, “get drunk”, “set a fire”, “carries a weapon” and “takes money from home” (Tremblay et. al., 1998).  The score from the 27 questions were used to obtain a self-reported physical aggression score. Hormonal measures were also obtained for the boys at the ages of 11,12, and 13 years of age. Saliva samples taken at three consistent times (8:30, 10 and 13:00 o’clock) were used to measure testosterone levels. The samples were then subjected to radioimmunoassay testing to obtain the testosterone levels of the boys. The testosterone levels in boys who were 11 years of age did not have a high enough detection limit and therefore their saliva sample was excluded in later statistical analyses.  Physical measures included in the study involved height, wrist, weight and head circumferences for boys between the ages of 12 and 13.

The two studies are similar in the sense that they both focused on whether increased levels of testosterone were found in the more aggressive groups. However, both studies differed in how they were conducted. Yu and Shi focused more on the hormones that are present in aggressive adolescents with the use of testing hormone levels using saliva and the CBCL. The study conducted by Yu and Shi concluded that the cortisol (CORT) and testosterone (T) hormones are associated with adolescent aggressive behaviours. They also stressed that the endocrine factors do play a certain role in the display of aggressive behaviours. However, the study was not able to explain the mechanism, which underlies the occurrence due to external factors such as personality playing a certain role in aggressive behaviours. In the study done by Tremblay and his colleagues, their results concluded that testosterone levels and the individuals body mass were highly correlated with an individual displaying physical aggression. Other differences between the studies focused on different aspects of adolescence, with Tremblay and his colleagues choosing to use only male subjects to test aggression, while Yu and Shi chose to involve both males and females. Overall, Tremblay’s study concluded that boys with the largest body mass tended to be the most physically aggressive. The study also was able to show the link between testosterone and aggression, suggesting that the more testosterone that was present in the boy led to more physical aggression. However, Tremblay and his colleagues stressed that the positive association may be due to other factors, such as social dominance. The boys who had the greater need to dominate would be more likely to express physical aggressive behaviors and often times display them more frequently due to higher levels of testosterone.

Overall, both studies generally agreed that testosterone levels were higher among adolescents with aggressive behaviour. Thus, experiments done on aggression in adolescents may help lead to understanding how to predict aggressive behaviours early on in adolescents. This can therefore help to allow individuals and their families to create an environment where factors that lead to aggression can be lessened since individuals with higher testosterone levels are more at risk to display aggressive behaviours. In conclusion, more research is needed to help continue to support the idea that increased testosterone levels do lead to greater levels of aggression. Although both studies do support the idea that higher testosterone levels and higher body mass lead to more aggressive behaviours, the results are only correlational and more research would be needed to confirm these results.  Research will need to create an understanding of why these individuals have an increased level of testosterone and ways to minimize the factors that can lead to these aggressive behaviours.

– M

Works Cited

Facts for teens: aggression. (n.d.). National Youth Violence Prevention Center. Retrieved March 24, 2012, from

Passer, M. W., Smith, R. E., Atkinson, M. L., Mitchell, J. B., & Muir, D. W. (2011).  Memory.
Psychology: frontiers and applications (Fourth Canadian Edition ed., p.  300). United States
of America: McGraw- Hill Ryerson.

Tremblay, R. E., Schaal, B., Boulerice, B., Arseneault, L., Soussignan, R. G., Paquette, D., et al. (1998). Testosterone, physical aggression, dominance, and physical development in early adolescence. International Journal of Behavioral Development, 22(4), 753-777. Retrieved March 21, 2012, from the Sage Publisher database.

Yu, Y., & Shi, J. (2009). Relationship between levels of testosterone and cortisol in saliva and aggressive behaviours of adolescents. Biomedical and Environmental Sciences, 22, 44-49. Retrieved March 20, 2012, from

Why do I want to be a nurse.

I’ve postponed writing this post for weeks, so much has happened and it’s taken me awhile to really sit down and focus. It’s taken me a while to compose my thoughts and orchestrate them into a post. I’ve honestly felt really lost the past few weeks with everything that’s been going on and it’s taken me a bit of time to feel grounded and motivated again.

I wanted to write this in my first year of nursing to see how my views and attitude will change over the next three years and even after I enter the profession.

I chose this path for a reason, I wanted to be part of profession that is well respected and hands-on.  Something that I had a ton of space to grow, whether one day I move into bioethics, policy, or even business management. A job where I would constantly be on my feet and challenged physically, emotionally, mentally, and ethically. I wanted to be part of a profession that sought to make a difference in the lives of people, whether on a small scale (ex. hospital care) or on a large scale (ex. public health or health policy). A job where I would be on my feet, constantly challenged to learn new things and adapt to a constantly changing landscape.

I recognize that nurses are often underrated compared to the prestige of a physician, dentist, or even eye doctor. People always questioned me as to why I chose nursing rather than having to try for medical school. To be honest, I wanted to play a large role in the live’s of my patients. When you listen to the narratives of either the patient or their loved ones, you often hear stories of how the nurse made a difference in caring for their child, parent, grandparent, or friend. How it was the nurse who knew that the patient hates the sight of needles or needs to have their teddy bear whenever a treatment is administered. It’s the nurse that has the time to get to know their patients, to hold their hand when they are alone at night or have no visitors, its the nurse that is at your bedside when you are uncomfortable, and its the nurse who is there to try to boost your spirits when you’re feeling down.

The stories I have heard of coworkers, family, and friends talking about how the nurse made such a difference for them that they developed long-standing relationships with them. Stories of inviting nurses to the wedding of their children whom they cared for during their illness or surgeries. How they still make every effort to keep in touch with the nurse they felt cared so much about them and their loved one that it still positively impacts their lives years later. Seeing how grateful they are for the care and compassion their nurses showed during the long stays in the hospital, often during crucial times, really opened not only my eyes but also my heart. You don’t realize how important having a compassionate and knowledgeable healthcare practitioner is until you need them the most.

We’re there for all the tiny questions people may have. We’re there during the outbreaks of the flu and other infectious disease. We put your lives in front of our own at times because that’s just the type of people we are. We are here for you and will be there for you when you need us even if sometimes it goes beyond what is expected of us.

I realize not every shift is going to be a good shift. There are going to be days when I am so exhausted with my own troubles that I have to put on my best self to care for my patients. That I have to put the needs of my patients above my own even after 3 days of doing 12 hour shifts. But wait, many nights it won’t be the set hours I’m given, I will be there beyond my call because that is what is expected of me and what my patients require from me. There are going to be days when I will breakdown from stress, when I will cry my heart out because I lost a patient who should have lived, someone who was a child or a parent or even a sibling. Days when I feel overwhelmed with everything I have to do, whether it be patients requesting my help, or having to skip my lunch or break to continue charting, or even being there to support a patient who is too scared to go through treatment alone and wanted someone there for them.

There will be times when I have to be the strong one for the patients loved ones as they grieve for their loss or recognize the situation is going downhill. Times when I will have to show the patients loved ones, that I am human too and I grieve with them during these darks times. I am going to have days when I sing to the Lord that a patient miraculously lived, that the patient can walk again, or even for the first time in a long time the patient opened their eyes. How heartwarming it will be to see the patient and their family walk out of the hospital feeling hopeful and on the way to recovery. Or even more exciting seeing a patient walk back into the hospital when at the time it looked like there was no hope for them or even seeing a patient years after they have left my watch. How emotional I will be the first time a patient thanks me for not only being their nurse and helping them get better, but that because of the actions of my team and I, they have renewed faith in our healthcare system.  Times when I will feel angry that my voice was not heard, or that I couldn’t give it my all, or even angry at the patient for choosing a path that went against my own views. How ethically I will be challenged on a continual basis (ex. should a 14 year old get an abortion without their parents knowing? Does this 50 year old chronically and severely depressed patient really want to be euthanized?). There will be days when I feel incompetent at not being able to figure something out and wonder why its not working. How I will spend hours trying to figure out the best practice to help my patients feel better, even though I’m not being paid extra to do so.

Most of all I want every shift that I do to be one where I go out of my way to make my patients feel safe, happy, and comfortable. I want to go home knowing that I did my best, even if sometimes it may not feel like it.

I’m excited to look back and see how my views will constantly change. I know right now I am most interested in maternity nursing, but it will be interesting to see where I end up. Will my path change in that I choose to work internationally? Will I choose emergency medicine, orthotics, community nursing, or geriatrics?

Who knows at this point. What is known is that I am excited to enter this profession and soak up every bit of learning I can in order to make a difference in the lives of my patients and the communities they live in. Let’s see what the next four years bring.


Drummond Report Chapter 5 Review (Part 2)

The Drummond Report was commissioned for the purpose of addressing the rising costs of health care in the provincial budget and gave a series of recommendations in a variety of areas related to the health care system. One such area under review was hospitals, which the report argued was not being incentivized to increase efficiency due to a funding model based on average costs across the province. The report goes on to state that there is little understanding of the true costs of procedures and that in order to ensure Ontario is getting the best value for its money, the costs incurred by hospital procedures needs to be examined from region to region and hospital to hospital (Ministry of Finance, 2012). The Drummond Report makes six recommendations in this area related to changing how hospitals are funded, operated, and administrated. Almost 3 years after the release of the report it is clear that Ontario has made great strides towards achieving many of the recommendations outlined in the report pertaining to hospitals.

Recommendation 5-50 proposes the use of the Health-Based Allocation Model (HBAM) system to set appropriate compensation for procedures (Ministry of Finance, 2012). This proposed change would represent a shift from the use of the prevailing global funding model, in which every hospital received lump-sum funding, to HBAM which estimates expected health care expenses based on demographics and clinical data on complexity of care and type of care (Ministry of Health and Long-Term Care, 2012). This recommendation has been realized to some extent in Ontario through the introduction of the Health System Funding Reform (HSFR). By 2015/2016 the HSFR will represent 70% of the funding envelope provided to hospitals, while global funding will represent the remaining 30% (Ministry of Health and Long-Term Care, 2015). The organizational-level funding component representing 40% of the HSFR allocation will be determined using the Health Based Allocation Model, while the quality-based procedures component will see specific procedures funded based on a “price x volume approach” meant to incentivize providers for delivering high-quality care.

Recommendation 5-51 was aimed at creating a blend of activity-based funding and base funding managed through accountability agreements. Ontario has begun the shift towards activity-based funding also known as patient-based funding, by categorizing hip replacement, knee replacement, dialysis and other treatments for chronic kidney disease and cataract surgery as quality-based procedures in which outcome is used to help determine payment (MOHLTC, 2012). The province plans to add to the list of procedures classified as quality-based procedures in the coming years in the hopes that it will maximize efficiency and incentivize providers to increase the quality of care they deliver to patients receiving these procedures.

The introduction of the HSFR in the funding model can also be seen as helping to facilitate recommendation 5-53 of the Drummond Report, which pushed for a new funding model that would incentivize hospitals to specialize so that not all were trying to provide all services regardless of comparative advantage (Ministry of Finance, 2012). By tying the performance outcomes of procedures to payment, it encourages hospitals to specialize in procedures for which they can deliver high-quality outcomes in order to maximize the level of funding they receive. This change to the funding model follows the logic proposed by the Drummond report, which believed that the way to encourage hospitals to cut costs and provide better quality care was to incentivize them to specialize (Ministry of Finance, 2012). Specifically the report stated that if a certain reimbursement rate were set for an activity, hospitals that could not provide the service within that rate would gravitate away from it. The quality-based procedures component of the HSFR model is meant to achieve the goal of better quality and system efficiencies by basing payment on outcome. Ontario has decided to continue down this route with the planned addition of other procedures in coming years (MOHLTC, 2012).  In 2013, six other procedures were added as quality-based procedures which included: chronic obstructive pulmonary disease, congestive heart failure, vascular, stroke, chemotherapy, and endoscopy (South West LHIN, 2014).

Recommendation 5-52 encouraged the creation of policies to move people away from inpatient acute care settings by shifting access from emergency rooms and toward community care, home-care, and long-term care (Ministry of Finance, 2012). Currently in Ontario over 184 family health teams have been operationalized with the purpose of expanding access to comprehensive family health services across Ontario by ensuring teams are set-up based on local health and community needs (MOHLTC, 2014). Family Health Teams in the province are community-centered and have been established in traditionally underserved rural and northern communities with unique populations and specialized health needs. By virtue of the many different types of health care professionals that comprise a Family Health Team including family physicians, nurses, social workers, and dieticians, Family Health Teams are meant to facilitate a more comprehensive and coordinated level of care for patients. The broad range of services they can provide are expected to help decrease reliance on the more costly and overburdened emergency departments in part by helping to prevent and treat chronic disease.

Recommendation 5-55 highlights a huge problem that has plagued the Ontario health care system, which is the lack of coordination between the different health care professionals including hospitals, Family Health Teams, and long-term cares facilities. In order to facilitate the discharge of patients and reduce costs there needs to be coordination with other health care professionals to optimize patient outcomes. Recommendation 5-55 proposed the use of hospitalist physicians to co-ordinate inpatient care from admission to discharge and follow a patient as they move through the health care continuum (Ministry of Finance, 2012). Increasing health care costs and chronic illness have led to a need for better coordination of care and the creation of hospitalists, the fastest growing medical specialty in North America with more than 300 practitioners and 62 programs operating in Ontario hospitals today., who are defined as physicians who spend the majority of their professional time providing general medical care to hospitalized patients (White, 2011). However, there are concerns as to the financial sustainability of hospitalist programs, satisfaction amongst patients and providers and perhaps most importantly, whether patient outcomes are adversely affected by the transfer of responsibility between providers.

The province of Ontario has restructured the funding model for hospitals in recent years from the traditional global health model towards the Health-Based Allocation Model and activity-based funding in the hopes of cutting costs and increasing efficiency and quality of care. This restructuring addressed many of the concerns in the Drummond Report about the way hospitals are funded, in particular the lack of incentives the old model contained for to specialize based on comparative advantages. The province continues to head in the direction proposed by the report by decreasing the portion of the payment that is under the Global Health Model and is expected to continue to do so in the upcoming years. The province also continues to employ hospitalists with the hopes of increasing coordination of care to ensure better health outcomes and cutting costs. The controversy surrounding the profession of hospitalists indicates more research should be done into the cost effectiveness, financial sustainability, and impact on patient outcomes to determine whether the profession is attaining the goals it set out to. This also highlights the importance of remaining critical of the recommendations in the report as they are implemented, and the need to ensure that there are not unintended consequences stemming from these changes to the system.

Works Cited

Ministry of Finance. (2012). The commission on ontario’s public services. Retrieved from  

Ministry of Health and Long-Term Care (2015). Health system funding reform (HSFR). Retrieved from

Ministry of Health and Long-Term Care (2014). Family health teams. Retrieved from

Ministry of Health and Long-Term Care (2012). Patient-based funding overview. Retrieved from

South West LHIN (2014). Health system funding reform update. Retrieved from

White, Heather L. (2011). Assessing the prevalence, penetration and performance of hospitalist physicians in Ontario: implications for the quality and efficiency of inpatient care. Retrieved from


Ethical Proponents of Patient End-of-Life Decision Making Using Functional Magnetic Resonance Imaging Techniques

Major medical advancements have revolutionized the field of medicine in recent years, including procedures such as the one undertaken by Dr. Adrian Owen and his research team regarding the use of functional magnetic resonance imaging (fMRI) to detect levels of consciousness in permanently vegetative state (PVS) patients. Similar to other medical interventions, this technique has led to ethical dilemmas amongst members of the medical community, regarding the ability of PVS patients and their families to make decisions regarding the withdrawal of life-sustaining interventions.  Prior to this discovery, little exchanges of information had been done with patients who have been diagnosed as being in a PVS.  Furthermore, initial findings from the research that has been undertaken may help support the notion that this technique should play a role in allowing patients and their families to make choices in regards to end of life decisions, despite their physical and mental state. Initial findings have led to two distinct arguments within the ethical realm surrounding the idea of asking these patients questions regarding end-of- life decisions and what can and should be done to improve their quality of life. The context of this paper will be supported by the ideas behind individuals right to life supporting the direction of health care moving patient autonomy. Thus, I believe that patients that have successfully undergone Dr.Owen’s technique should have the right to make their own choices regarding end of life decisions as supported by the principles of liberalism due to their conscious awareness of their surroundings.


Within the past few months, a breakthrough has been seen in regards to patients who have experienced traumatic brain injuries leaving them in vegetative states. This breakthrough method involves monitoring real-time brain activity with the use of an fMRI- by visualizing the flow of oxygenated blood through the brain as the patient answers specific questions (Mole, 2012). Patients are therefore trained and instructed to imagine doing tasks such as playing tennis to simulate the answer no, and to visualize walking through their homes as yes (Blackwell, 2013). Thus, when being asked questions the thoughts from the patient cause different regions of the brain to light up and is then captured on fMRI scans which captures brain activity over time (Blackwell, 2013).  This method is the first technique that has shown clinically vegetative patients answering questions pertaining to their condition (Mole, 2012).

Prior to the discovery of this technique, it was noted that PVS patients were seen to be unable to respond to stimuli from the outside world. Patients in permanently vegetative states (PVS) have been characterized as being “awake”; mainly due to the fact that their eyes are open (Blackwell, 2013).  However, they were thought to be incapable of responding to any form of stimuli or possessing any form of thinking capabilities (Blackwell, 2013). It has been noted that some PVS patients may emerge to higher levels of consciousness, however many others remain unchanged for years in a vegetative state (Blackwell, 2013).  Thus, Dr. Owen’s findings help to support the idea that if these patients are indeed conscious, then PVS patients in these should have authority to make their own decisions regarding the removal of life support.

            Similar to other medical interventions and techniques, these recent findings have raised several ethical questions. One question relates to Owen’s technique of testing consciousness itself. Dr. Owen’s findings have been contested on the findings that these individuals are not conscious and that the findings should have no bearing on end-of-life decisions. I will not deny that the technique does require improvement, however, I feel that it does offer some insight into initial stages of testing the levels of consciousness in PVS patients. Generally, it is agreed that this technique relays an opportunity for these patients to provide important information pertaining to things such as pain and discomfort (Cyranoski, 2012).

What has generally not been agreed upon is the idea surrounding whether these patients should be able to choose death rather than remaining in a PVS. John Stuart Mill’s principle of liberty helps to rebut the presumption that if found to be conscious, patients should be able to come to a decision that reflects their own values and beliefs. Mill’s principle also promotes the notion that “a person is sovereign over his or her own body and mind” (Glannon, 2005). If this technology proves to be effective, it would allow medical practitioners and the patient’s family to explore the individuals’ thoughts to make an informed decision. Individuals could therefore decide on treatment plans that reflect their own values, rather than decisions that solely reflect the interests of practitioners and their families. Critics have also expressed concern in regards to the premise of answering yes or no questions as reflecting the idea that a patient therefore has some level of consciousness and therefore does not completely understand their mental state or cognitive abilities (Cyranoski, 2012).  However, Owen’s has stated that the task is no easy feat, as it requires patients to focus on the task for 30 seconds and then rest for another 30 seconds (Cyranoski, 2012). The treatment has been proven to work in all patients, with only one in five responding to the technique. However, we should not limit this treatment to help in end-of-life decision making for the small proportion of PVS patients when it may lead to a better understanding of consciousness and the condition, which will benefit future PVS patients and society. Individual freedom should only be restricted if the treatment proves futile or would harm others. Other implications revolve around the idea that even if patients are able to make a full recovery (seen in some patients with serious brain injuries), many patients remain incompetent and unable to care for themselves (Blackwell, 2013).

Critical Discussion:

Liberalism is an ethical theory that focuses on “the rights, interests, and reasoning of individual moral agents” (Glannon, 2005). The theory states that individuals should have the right to a good life, provided it does not have any interference on other individuals to do the same (Glannon, 2005). In the case of Dr. Owens’ fMRI technique, I believe that this would not impact the ability of others to have a good life, considering these individuals may be fully conscious. The first distinction liberalism states is that there should not be one conception of an overarching moral value that all individuals should live and abide by (Glannon, 2005). The second distinction points to the idea that “the interests of individuals should not be sacrificed for the interests of the larger society” (Glannon, 2005).

Taking patients off life support would impede on the individuals ability to enjoy life. One interpretation of the neuroimaging evidence surrounds the idea that “patients who are able to obey instructions and demonstrate patterns of activation of functional imaging may be completely aware of their surroundings” (Wilkinson, Kahane, Horne, & Savulescu, 2009). This procedure has led to reconsideration of the patient’s prognosis, since doctors have a clearer understanding of the patient’s needs and mental functioning. Consciousness may also become an important factor in the treatment of patients who show signs of consciousness. This consciousness may indicate that the patients in PVS are aware of their surroundings including family and friends, and therefore might be able to take pleasure from those things (Wilkinson, Kahane, Horne, & Savulescu, 2009).  This idea helps to reinforce the second distinction of liberalism that was previously mentioned. If these patients are conscious and aware of their surroundings, it helps support the idea that they can still experience pleasure. Morally, it would be wrong to assume that since an individual is not awake and moving around that their life is not as “good” as others. I agree with the argument Glannon (2005) sets out in stating that it is wrong to set out a conception of what constitutes a good life for everyone to adopt. All individuals have the right to embrace their own values and beliefs and if the advancement technology supports the notion that the patients are indeed conscious, then they are entitled to make their own decisions.

The removal of life-sustaining interventions has been noted to go as far as violating the ethical principle patient autonomy. This deontological principle is concerned with things such as “a patient’s rights, dignity, and values, as well as the doctor’s corresponding duty to respect them” (Glannon, 2005). A counter argument to this ethical principle may include the notion of informed consent and how patients are not entitled to all treatments they request. Informed consent has been noted to be a practical application of respect for personal autonomy (Glannon, 2005). Glannon (2005) points out that in most cases doctors are required to provide treatment, and patients have the right to access it if it entails therapeutic benefit. Some may say that keeping patients on life support has no therapeutic benefits since the PVS patient will most likely not return to normal functioning. Families of PVS patients may argue that the issue here is more about the quality of life, and that keeping him on life support may undermine his dignity. However, I believe that the real issue here is the sanctity of life. Prior to this technique it was thought these patients were unaware of their surroundings, the fact that Owen’s findings support the signs of consciousness indicates that the person “still exists”. Since these patients were taught to answer questions, it could be said that future technological advancements may help them to lead a more meaningful life with the ability to communicate their thoughts to the outside world and allow them to further expand on their wishes and beliefs in regards to their future treatment. Glannon (2005) points out that physicians should not coerce patients or family into withdrawing treatment. If found conscious, patients should be allowed to understand their own condition, the benefits and costs of continued interventions in order to formulate their own opinions reflecting their own values and beliefs.
PVS patients should have the right to access those treatments if they choose to do so since it does involve their interests and well-being. Many people have thought for years that these patients had no sense of consciousness or awareness, with this recent advancement it offers some indication that the medical community can work to improve the lives of these patients (Panksepp, Fuchs, Garcia, & Lisiak,, 2007). Future technological advancements seek to understand and allow patients to communicate their thoughts, which may allow them to lead meaningful lives. Other findings have also found that some patients are able to retain consciousness after their brain injuries, noting that patients studied earlier, who showed a higher level of associative cortices, were more likely to improve clinically (Wilkinson, Kahane, Horne, & Savulescu, 2009).  If the preliminary findings are true, it would be immoral for doctors and the patient’s families to remove patients from life support, since neuroimaging might be able to detect patients who are more likely to experience full recoveries. Removing life support of a PVS patient is inhumane in the sense that because they are seen as being physically responsive to outside stimuli they are not leading a “good life”.
It is important to note that we do not want autonomy to be the sole focus of medical treatment; we want physicians to be compassionate in helping to make decisions. PVS patients should have the opportunity to be able to communicate to the outside world and be able to decide whether they want to continue treatment or end it. However, sometimes physicians are stuck in an ethical dilemma revolving issues surrounding justification of allocating scarce medical resources in allowing patients to access this technique. One objection to the idea of liberal ideals includes the burden that these patients place on the health care system in terms of both access to treatment and the cost of life support. Based on the idea PVS patients are not making contributions to society, society may see these patients as being a burden to support. However, just because they are not “contributing members” that does not mean PVS patients should not have the opportunity to choose their own “fate”. If they have some form of conscious awareness then they should be entitled to the same rights as everyone else. It is not justifiable to remove a patients feeding tube if they are found to be aware of their surroundings, just because they are not responsive to outside stimuli.

There is no solid definition of what constitutes as a life, some argue that it involves being able to sustain your own biological functions, others see it as having the ability to reason and understand things such as questions. To support my argument, I look to the Charter of Rights and Freedoms, which helps to formalize basic ethical and moral principles that are practiced in Canadian society. Section 7 helps to encompass principle such as autonomy, and states “everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice” (Canadian Charter of Rights and Freedoms, 1982). Since it is so broadly worded I feel that this supports and protects the ability for the patient to make his or her own decision regarding their right to life. In this context, liberty would particularly support the notion that patients should have the right to make their own decisions in regards to sustaining life support. By using this as a protection measure we as a society allow people to realize their full potential. The Charter helps to support this notion of allowing people to uniquely define their own definitions of what is good and formulate their own context of autonomous choice, including the ability to define happiness and values. Society’s role is to embrace the diversity of the individual, regardless of things such as origin or their physical or mental status. One cannot deny the issue here is that this right occurs in exchange with the individual acknowledging responsibility for their own fortunes and that of the community (Glannon, 2005). Positivist liberals may argue that having an absolute right to do something is useless if the individual does not have the capacity to do so. However, I think that prior to the discovery of Owen’s technique, this would have been a valid argument but,I would now argue that the initial findings suggest that some PVS patients’ do have some form of mental consciousness to support their ability to at least contribute on some level their own decision.

The fMRI technique is not effective for all PVS patients; current research has shown that roughly only one in five patients have been able to communicate with the outside world (CBC, 2013). It is important to note that the technique itself uses limited resources, one being the fMRI machine itself. However, all patients and their families should at least have the opportunity to access this limited technology to help them in the decision making process, particularly due to their vulnerable state. This begs the question of where do we draw the line of allocating these resources for families and patients to communicate with the outside world. It is justifiable as seen in cases from Alberta that life support should be terminated if this technique unanimously proves that the patient is without any form of awareness or hope of being able to recover and other treatments have been proved futile (Blais, 2012). I would argue that PVS patients’ that have undergone the fMRI scan unsuccessfully could morally be taken off life support, since future treatment is futile and not beneficial. However, in the case of successful patients, they should have the right to express their own individual decision, since they do have the opportunity to have their values and beliefs reflected in their choice.

         Overall, initial findings support the notion that PVS patients are indeed somewhat conscious and aware of their surroundings on some level. Dr. Owen’s findings should therefore have an impact on end-of-life decisions made by both the family and the patient themselves. Following the principles of liberalism “the good life is necessarily a freely chosen one in which a person develops unique capacities as part of a plan of life” (Stanford, 2010.). Living in a society where individual autonomy is promoted, we should take effort to protect vulnerable populations such as those in PVS in upholding the basic principles of justice such as the right to life and liberty. Although initial findings have been supportive of the idea of PVS patients being somewhat conscious, more conclusive research and technology is needed, particularly in regards to decoding the patients’ thoughts and needs before this technology can fully be integrated into the context of end of life decision-making processes. Solely based on the current information and research that is provided, my position stands in saying that this treatment should play a pivotal role in allowing PVS patients and their families to make end-of-life decisions.



Blackwell, T. (2012, November 18). Trapped in a motionless body? Scientific advances raise new questions about the ‘vegetative’ state. National Post. Retrieved March 5, 2013, from

Blais, T. (2012, September 14). Decision stayed to take girl, 2, off life-support. Owen Sound Sun Times. Retrieved March 15, 2013, from

News. (2012, September 13). Canadian in ‘vegetative state’ communicates to scientists. Retrieved March 15, 2013, from

Canadian Charter of Rights and Freedoms, s 2, Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11.

Cyranoski, D. (2012, June 13). Neuroscience: The mind reader. Nature Publishing Group. Retrieved March 15, 2013, from

Glannon, W. (2005). Biomedical ethics. New York: Oxford University Press.

Liberalism (Stanford encyclopedia of philosophy). (2010, September 16). Stanford Encyclopedia of Philosophy. Retrieved March 2, 2013, from

Mole, B. M. (2012, November 14). An unconscious man talks. The Scientist Magazine. Retrieved March 15, 2013, from–Unconscious–Man-Talks/

Panksepp, J., Fuchs, T., Garcia, V. A., & Lisiak, A. (2007). Does any aspect of mind survive brain damage that typically leads to a persistent vegetative state? Ethical considerations. Philosophy, Ethics, and Humanities in Medicine, 2(32), 1-11. Retrieved March 10, 2013, from

Wilkinson, D. J., Kahane, G., Horne, M., & Savulescu, J. (2009). Functional neuroimaging and withdrawal of life sustaining treatment from vegetative patients. Journal of Medical Ethics, 35, 508-511. Retrieved February 27, 2013, from

Why Cannabis Should Not be Legal in Canada

Cannabis sativa, a species of Cannabis, is a flowering plant that is used in the creation of marijuana (United States Department of Agriculture, 2011). Although its use has been illegal in Canada since 1923, cannabis is the most widely used illicit drug in Canada, and the country has the third highest prevalence rate of marijuana usage in the world (Haines-Saah et al., 2014). Cannabis is often referred to as pot, dope, marijuana, ganja, and hemp and has been classified as a pychotropic drug which acts as a modulator of the central nervous system (Nolin & Kenny, 2002). In Canada, it has been labelled a Schedule II controlled substance, a drug that has a higher than average potential for addiction and abuse (The Canadian Consortium for the Investigation of Cannabinoids, 2014).  The illegality of cannabis is a highly debated and controversial subject with many calling for its decriminalization and others suggesting a public health approach to minimize the consequences that follow its use (Haines-Saah et al., 2014).  Decriminalization would involve the removal of a behaviour or activity, in this case cannabis, from the scope of the criminal justice system in which an administrative decision is made to not prosecute acts that nonetheless remain against the law. On the other hand, legalization would involve legislating under a regulatory system the culture, production, marketing, sale and use of a substance (Nolin & Kenny, 2002). The use of cannabis-containing products has been linked to increased respiratory and reproductive health concerns, increased likelihood of psychosis including schizophrenia when used in adolescence. A lack of scientific consensus and knowledge on the long-term health impacts of cannabis would make it difficult to predict what outcomes the legalization of marijuana would have. The decision on whether or not to legalize cannabis should be made solely on the basis of scientific knowledge and not based on public desire, and current research is insufficient to support legalization. The arguments for legalization including lessening the burden on the criminal justice system and lessening exposure to other illegal substances if marijuana was regulated in a similar way to alcohol, are not sufficient to override the health concerns that have been raised. At this time, the benefits shown for patients with chronic conditions including reduced pain and symptoms are enough to support the continued legality of medicinal marijuana if prescribed by a physician and stringent regulations are in place to prevent misuse or abuse. I contend that current scientific evidence supports the continued illegality of cannabis in Canada, but medical marijuana should continue to be available for individuals when prescribed by a health care professional.

Tetrahydrocannabinol, also known as THC is the active ingredient in marijuana and is thought to produce feelings of relaxation, enhanced sociability, a diminished ability to focus, distorted time and depth perception, and physiological side effects including an increased heart rate, increased appetite, and reddened eyes (Canadian Public Health Association, 2003). While intoxicated It may also result in impairment to short-term memory and attention span, motor skills, skilled activity and reaction time, and anxiety and panic reactions (Hall & Solowij, 1998). Heavy marijuana usage is associated with chronic bronchitis symptoms, development of chronic obstructive pulmonary disease, and is a possible risk factor for the development of lung cancer (Joshi, M., Joshi, A., & Bartter, T 2014).  The dosage of marijuana needed to produce these lung diseases is not yet known and must be further studied. The research on the reproductive effects of cannabis smoking is inconsistent, however, low birth weight babies, impaired sperm production and viability, and behavioural and developmental effects on infants exposed in utero have been suggested as potential consequences of cannabis use (Hall & Solowij, 1998). Long-term use of cannabis can also lead to psychological or physical dependence and withdrawal symptoms when the user is unable to use cannabis (Centre for Addiction and Mental Health, 2010).

The long-term effects of cannabis on the health of the user are not well understood and are widely debated due to the lack of epidemiological evidence and different interpretations of existing studies (Hall & Solowij, 1998). It is for this reason in particular, that I do not believe that cannabis should be made legal in Canada. The National Institute on Drug Abuse has determined based on the limited evidence available, that marijuana is harmful to the developing brain and has suggested that more research must be conducted in this area (Alcoholism & Drug Abuse Weekly, 2014). However, research on the effects of cannabis on the health of individuals is difficult to conduct because it is hard to collect data from individuals who regularly consume cannabis while controlling for other factors due to ethical implications. The existing gaps in research would make the legalization of cannabis dangerous because of the unforeseen impacts on health that could potentially occur should drugs containing cannabis be made more widely available.

Much of the emerging research on the effects of acute and chronic cannabis use is focused on adolescents and the connection between marijuana usage and psychosis suffered in adulthood. A revolutionary study conducted in Sweden was one of the first to show a six-fold increase in the occurrence of schizophrenia in individuals who used cannabis heavily at age 18 (Andréasson, Allebeck, Engström & Rydberg, 1987). However, it must be said that the study is limited in the sense that its findings are only correlational and cannot be used to determine causality. The study was unable to draw a conclusion as to whether schizophrenia was caused by the use of cannabis, or whether pre-existing symptoms of schizophrenia led to the use of marijuana (Arseneault, Cannon, Poulton, Murray, Caspi & Moffitt, 2002). Further studies have been conducted examining this relationship. The exact neurobiological process that leads to potential psychosis is unknown because a cause-effect relationship has not yet been established, but current research is focusing on the identifying the factors that contribute to the developmental pathway of psychosis (Shrivastava, Johnston, Terpstra, Bureau, 2014).  A study conducted on college students found that heavy marijuana usage, defined as smoking marijuana 29 out of 30 of the previous days, resulted in impaired executive functioning even after controlling for confounding factors (Pope Jr & Yurgelun-Todd, 1996). This study was unable to determine whether impairment is due to a residue of drug in the brain, a withdrawal effect from the drug, or a neurotoxic effect of the drug. Another study reached the same conclusion as the Swedish study, adding that rates of schizophrenia increased after cannabis use even after controlling for psychotic symptoms preceding cannabis use, early use (by age 15) conferred greater risk than later use (by age 18), and risk was specific to cannabis use as opposed to other drugs (Arseneault, et al., 2002). A tenth of the individuals in this study who used cannabis before age 15 developed schizophrenia by the age of 26. The effects of cannabis on the developing brain are not fully known yet but current research suggests that some adolescents may be psychologically vulnerable and thus legalizing marijuana, thereby making it more widely available, could potentially have long-term detrimental effects on the mental health of these individuals.

Many proponents for the legalization of the drug have argued that the illegality of the substance has not prevented it from becoming one of the most widely used drugs in the developed world, and that the government should regulate the substance much in the same way it regulates alcohol or other medications. This claim is made with the belief that the regulation of cannabis would reduce the number of adolescents selling marijuana and their access to other illegal drugs, and would reduce the cost of prosecuting offences related to the use of cannabis. In response to suggestions that the legalization of cannabis would reduce costs to the judicial system, opponents of legalization have proposed decriminalizing marijuana and instead imposing civil penalties for possession including small fines (Alcoholism & Drug Abuse Weekly, 2014). The health of individuals should be the first and foremost priority of health and government officials and the substance should not be made legal simply to reduce the strain on the judicial system, or as a means to prevent the usage of other more harmful and addictive substances. Although many of the findings about the physical, and psychological health effects of cannabis usage are limited or are correlational instead of demonstrating causality, this should not serve as a basis to decriminalize cannabis. In Canada, any potential new drug must go through a rigorous screening process including clinical studies that are then reviewed by the Therapeutic Products Directorate of Health Canada and the findings are then assessed for the safety, efficacy, and quality of the drug (Health Canada, 2001). The potential benefits and adverse effects of cannabis have not been rigorously studied to the extent that other drugs have had to undergo when going through the drug review process (Sullivan, 2012). Health Canada states that its first and foremost concern is ensuring the safety and well-being of Canadians, and the current research and findings on long-term cannabis usage must be addressed before any discussion of legalization could take place (Health Canada, 2001). More scientific research is needed for this purpose. There are also a host of other concerns which would emerge if legalization were to happen including whether or not it would increase the number of individuals who become addicted to marijuana, whether accident rates would increase due to cannabis usage particularly in the teenage demographic, and what impacts on health this would have in the long-term.

Cannabis products for medicinal purposes are a widely debated topic in Canada. In 2001, the Supreme Court of Canada ruled that there must be reasonable access to a legal source of marijuana when authorized by a physician, which resulted in the creation of Health Canada’s Marijuana Medical Access Program (Health Canada, 2001). A report published in 1999 by the Institute of Medicine found that marijuana functioned to treat chronic pain and physical symptoms and produced anti-anxiety and sedative effects (Rubens, 2014). Medical marijuana has been shown to benefit patients suffering from chronic pain due to diabetes, multiple sclerosis, and hepatitis, relieves eye pressure caused by glaucoma, increases appetites in patients with AIDS and cancer, and relieves acute anxiety, insomnia and other sleep disorders (Friedman, 2013). The stance of the Government of Canada is that it does not condone the use of marijuana and it has announced that the Marijuana Medical Access Program will end on March 31, 2014 at which point the only legal access to marijuana for medical purposes will be through licensed producers even if you have an authorization to possess or a license to produce the drug (Health Canada, 2013). Many individuals argue that these new laws are unconstitutional because they interfere with the rights of patients to access medication. The Government of Canada has responded that these new laws must be put into place in order to protect public safety, while making sure patients still have access to what they need to treat serious illness (Health Canada, 2013). My belief is that based on current evidence medical marijuana has been shown to effectively treat many health issues and alleviate chronic pain. Medical marijuana should remain legal because of the strict regulations that are in place to prevent misuse and abuse of the system. Government regulations require that a physician prescribe medical marijuana and the new laws will limit the distribution of medical marijuana to licensed facilities only. I believe that the benefits to patients in this case supersede the potential consequences, as those who would qualify would already have chronic and debilitating health issues, and their quality of life would be dramatically improved through the use of medical marijuana. I believe the new restrictions concerning which facilities can distribute medical marijuana will ultimately be beneficial, as the facilities will be regulated by government legislation, and it will ensure that only those who have been prescribed medical marijuana are serviced at these facilities. The Special Committee on Illegal Drugs stated in its report that public policy concerns should not be considered by a physician when making a professional decision on the extent to which and in what circumstances marijuana serves a therapeutic purpose for the patient (Nolin & Kenny, 2002). The legal status of medical marijuana should be continually reviewed and reconsidered based on the most current and up to date evidence on the health impacts of marijuana. The therapeutic value of medical marijuana must always outweigh any potential health impacts for patients suffering from chronic health conditions. One line of research that should be conducted is on the psychological effects of cannabinoids which could lead to undesirable effects for certain patients and could negate any potential medical benefit from its usage (Joy, Watson, Benson, 1999).

In conclusion, my contention is that current research supports the continued illegality of cannabis in Canada. The legalization of cannabis should not occur because of public demand, or as a new source of revenue for the government of Canada, but should only be done on the basis of science. Currently, scientific research has shown many potential adverse effects from the use of cannabis and thus does not support the notion that legalization should take place. To allow legalization to occur at this point would go against the objectives of Health Canada and could potentially jeopardize the health of Canadians and lead to many other unforeseen outcomes. More research must be conducted in this area in order for researchers and policy makers to make an informed decision about whether the legalization of cannabis should take place. Some researchers predict that rates of marijuana usage could double or triple if legalization were to occur, thus it is important to understand what implications this will have on the health of individuals and society as a whole before legalization can occur (Alcoholism and Drug Abuse Weekly, 2014). The lack of scientific consensus on the health impacts of cannabis usage and studies showing correlations of cannabis usage and adverse outcomes have led me to draw the conclusion that cannabis should not be legalized at this time. However, I do believe that an exception for medical marijuana should be made as it has been shown to alleviate chronic pain and benefit patients with certain medical conditions. Unless more research is conducted which shows adverse effects to human health that outweigh the benefits to patients who use medical marijuana to treat their symptoms, the removal of medical marijuana would serve to do more harm than good and would infringe on their constitutional right to life, liberty and security of person. There should be controlled access in this case, regulated by the Government of Canada which bears the responsibility of creating and upholding regulations for medical marijuana production and distribution to ensure access to medical marijuana, while continuing to ensure the safety of the Canadian population as a whole.  It is important to note that my position is based off of current scientific literature, which has not yet drawn conclusions as to the long-term health impacts of cannabis usage and the impacts it will have on society in other aspects. The interest and controversy in the debate on the legal status of cannabis products has not diminished and the next few years may prove critical for reaching both scientific and political consensus on the health impacts of cannabis and what the legal status should be respectively.  In 2013, Uruguay became the first nation to legalize the growing, sale, and smoking of marijuana (Castaldi & Llambias, 2013). There are also other nations and cities known for openly selling marijuana to locals and tourists, including Jamaica and certain “coffee shops” in the Netherlands. In my opinion a lack of aversive consequences in these countries does not help to strengthen the argument that cannabis should be legalized in Canada, as the findings are non-generalizable because of the vast difference in culture, history, society, and other confounding factors. Colorado and Washington are now in the process of legalizing marijuana and are serving as experimental labs for the rest of the United States (Rocky Mountain HIDTA, 2014). The impact of legalization will be heavily studied in the upcoming months and potentially years. This may serve as an unprecedented opportunity for scientists to study the usage of marijuana and cannabis products in cities that more closely resemble Canadian cities and may prove to be key in ascertaining the scientific data needed to make a more informed decision on whether cannabis should continue to remain illegal in the future, or whether we should proceed with decriminalization or legalization.







Works Cited

Alcoholism & Drug Abuse Weekly. (2014). Marijuana: The new alcohol? voices from the ……legalization debate. Wiley Periodical, 26(2), Retrieved from …………cqs&s=28d18dfd2fe9d5b22d8c9b51e5cd17f60f404b55&systemMessage=Wiley Online ……Library will be disrupted Saturday, 15 March from 10:00-12:00 GMT (06:00-08:00 EDT) ……for essential maintenance

Andréasson, S., Engström, A., Allebeck, P., & Rydberg, U. (1987). Cannabis and schizophrenia ……a longitudinal study of Swedish conscripts. The Lancet, 330(8574), 1483-1486. Retrieved ……from

Arseneault, L., Cannon, M., Poulton, R., Murray, R., Caspi, A., & Moffitt, T. (2002). Cannabis ……use in adolescence and risk for adult psychosis: longitudinal prospective study. British ……Medical Journal, 325(7374), Retrieved from

The Canadian Consortium for the Investigation of Cannabinoids. (2014). FAQs. Retrieved from ……,0,0,1,0,0

Canadian Public Health Association. (2003). Marijuana, is it safe? – part 1. Retrieved from    ……

Castaldi, M., & Llambias, F. (2013, December 10). Uruguay becomes first country to ……legalize marijuana trade. Retrieved from……uruguay-marijuana-vote-idUSBRE9BA01520131211

Centre for Addiction and Mental Health (2010). Do you know.. cannabis. Retrieved from …………rmation/marijuana/Pages/cannabis_dyk.aspx

Friedman, J. (2013). Should you establish a medical marijuana dispensary?. Drug Topics, ……157(12), Retrieved from

Haines-Saah, R., Johnson, J., Repta, R., Ostry, A., Young, M., Shoveller, J., Sawatzky, R., ……Greaves, L., & Ratner, P. (2014). The privileged normalization of marijuana use – an ……analysis of Canadian newspaper reporting 1997-2007. Critical Public Health, 24(1), ……Retrieved from …………=en

Hall, W., & Solowij, N. (1998). Adverse effects of cannabis. The Lancet, 352, Retrieved from ……

Health Canada. (2001, August 01). How drugs are reviewed in Canada. Retrieved from ……

Health Canada. (2013, June 10). Harper government announces new medical marihuana ……regulations. Retrieved from……eng.php

Joshi, M., Joshi, A. & Bartter, T. (2014, March). Marijuana and lung disease. Current Opinion in Pulmonary medicin, 20(2), 173-179. Retrieved from……3.11.0a/ovidweb.cgi?QS2=434f4e1a73d37e8c1e91ed18c2a77ef2f9d0011e75af760b9eae9e3……e5d4b2aff3bb7705ed9ca5914c10582ecaf1399cc06c152fa0f45846a0b42f5424d6a30292235……1c15c3cc2d2b44fa4c68d7a6c37a2490ba21dd245f39ed6769d920d95d878fc183022a69a651……838928391de32811f70f6bbb180ddb45543a6d6b5b3b476d942fde522c347670525fa4545f7f……dc2da1133cf1a3d595476f76eb65e3a49f130df693b776ff89f848d3d6422c12492a556f13c4fc……c36dd15b41ec22d16e366a09948d77680af9d03d98519d75a4d3b2e34d3a39553472b70de70……c4af143f4e2cfef8ed550cebcd971030c6de2915f0d58c1064321ab8d82a3f255d27939c0baade……9e8311213b08bcfb12a68b42e7f8d2f62b2863240eaa77664c4a283b22b42a005b12e0606c78……c867a32f943ff618986777e0ceaa6c1fce7c3ab5a43f0b5f02097c985f5b05676912f0599597d8……98078ada245cabe79ddd7425dbb838f6aa0c3e228bd5ddbece8ce86a394bec892da5aa8e81e0……2e6d1cf993a5e8fbebb2e4a233181514b7310409677c72ed689c0e4f38a31df342dd671d69f17……4113ac484d60fc311f2ebcbf19c64f6fc824ba9100ae4792bf620dffa83cdc90361b96b4ea36ca……7ec3dbfc009285c6f133dd917cba76913a5a49b5c3622b294d653d78b9e2048d3865314b262f……5afe4e3d720c9623bf1afc672e36f917c7f8dd5e788a5e696d3387b3bcc8fbae

Joy, J., Watson Jr, S., & Benson, J. (1999). Marijuana and medicine assessing the science base. ……Institute of Medicine, Retrieved from ……

Nolin, C., & Kenny, C. Senate Special Committee on Illegal Drugs, (2002). Cannabis: Our ……position for a Canadian public policy. Retrieved from Parliament of Canada website: ……

Pope Jr, H., & Yurgelun-Todd, D. (1996). The residual cognitive effects of heavy marijuana use ……in college students. The Journal of the American Medical Association, 275(7), 521-527. ……Retrieved from

Rocky Mountain HIDTA. (2014). The legalization of marijuana in colorado. Retrieved from …… Legalization of MJ in Colorado The Impact.pdf

Rubens, M. (2014). Political and medical views on medical marijuana and its future. Social ……Work in Public Health, 29(2), Retrieved from ……

Shrivastava, A., Johnston, M., Terpstra, K., & Bureau, Y. (2014). Cannabis and psychosis: ……Neurobiology. Indian Journal of Psychiatry, 56(1), 8-16. Retrieved from http://www-ncbi-……

Sullivan, P. (2012). Cma decries new medical marijuana rules. Canadian Medical Association, ……Retrieved from

United States Department of Agriculture. (2011, May 09). Taxon: Cannabis sativa. Retrieved ……from