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MacDonald Laurier Institute

Barriers to care persist but access to MAiD keeps expanding

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From the Macdonald Laurier Institute

By Ramona Coelho

Our government has allowed the incredible power of certain lobby groups to control the public discourse and policies around MAiD and its expansion, prioritizing access to MAiD over the safety of Canadians.

My family medicine practice serves predominantly low-income and marginalized patients, including refugees, those who have been in our prison system or are facing charges, and many with disabilities and mental health issues. My patients experience high barriers to care and support and face social isolation and all kinds of discrimination. Observing the impacts of this has left me deeply concerned about our government’s priorities.

When the federal government introduced MAiD (a medical procedure that causes death) to those not at imminent risk of dying, I was appalled to learn that my patients, who are frequently blocked from care as a result of hurdles created by our government and systems, could potentially be offered an expedient death provided by the government.

In 2016, assisted suicide and euthanasia were first legalized in Canada and the term medical assistance in dying (MAiD) was created. Originally MAiD was presented as an exceptional lethal procedure for ending the lives of consenting adults who were experiencing intolerable suffering and were near death. The legislation required that patients meet certain criteria, including having a “grievous and irremediable” medical condition, such as organ failure or cancer, and a “reasonably foreseeable natural death.”

But the Canadian discourse around MAiD rapidly shifted to facilitating access and there has been a broadening of the number and criteria of those who qualify for MAiD. In 2021, Bill C-7 came into effect and removed some of the safeguards within the original pathway, now called Track 1, and created a new, second track, Track 2, for adults with physical disabilities[1] who are not  dying. Furthermore, there is a planned expansion, though the timing is currently being debated in Parliament, for patients whose only medical condition is mental illness. Parliamentary recommendations in 2023 included future expansion to children and to incapable adults who signed advance directives for euthanasia.

Currently, those in Track 1 with a “reasonably foreseeable natural death” can potentially have their life ended the same day as the initial request if all the criteria are met and practitioners are available.

For those in Track 2, those not dying, death by lethal injection is set at a minimum of 90 days after the completion of the first MAiD assessment. To qualify for this track, a patient must also have a “grievous and irremediable” condition and experience intolerable psychological or physical suffering. Suffering is treated as purely subjective with no requirement for further validation. There is also no legal requirement for standard treatment options to be accessible or tried, only that a patient be informed that they exist. This means that a patient who says they are suffering intolerably could access MAiD having declined treatments that would remediate their condition. This could be because the treatment is inaccessible, or unaffordable, or if the patient declines therapy.

The Canadian Association of MAiD Assessors and Providers (CAMAP) has received 3.3 million dollars in funding from Health Canada to educate clinicians assessing and providing for those who have requested the service. So although the existing Track 1 and Track 2 pathways have different safeguards, in aiming to allow those near death to have access to MAiD quickly and with no barriers, CAMAP has created a guidance document that suggests clinicians can be flexible as to whether someone fits Track 1’s reasonably foreseeable natural death, since the law does not require that the person be terminally ill or likely to die within 6 or 12 months. It also states that a person may meet the reasonably foreseeable criterion if they’ve demonstrated a clear and serious intent to take steps to “make their natural death happen soon, or to cause their death to be predictable.” This could come about from a refusal to take antibiotics for an infection, stopping oxygen therapy, or refusing to eat and drink.

This means that people with disabilities can state their intention to or make themselves sick enough to qualify as having a reasonably foreseeable natural death, as is currently happening with adults who are not dying and yet are having their lives ended within days of their first MAiD assessment. In one case, a man had a mild stroke and received MAiD shortly after, even though he wasn’t terminally ill. The reason? He was approved for track 1 as he was temporarily eating less. This was due to following a cautious meal plan ordered by the treating team which was intended to prevent choking and aspiration risks.

Currently, some places in Canada have MAiD rates that are the highest in the world. By the end of 2022, there had been almost 45,000 MAiD deaths across Canada since legalization—more than 13,000 of which took place in 2022 with 463 of those individuals accessing MAiD through Track 2. Estimates based on provincial reporting approximate 16,000 deaths in 2023. Health Canada and MAiD expansionists have tried to reassure the public that the overwhelming number of MAiD deaths have been mostly Track 1 deaths (implying they were dying anyway) but we do not know how many of those persons were “fast-tracked” and may have had many decades of life left to live and the potential to recover with time and care.

The CAMAP guidance document that seems to circumvent Track 2 safeguards is just the beginning of many serious problems with MAiD legislation and practice in Canada.

Patient safeguards for MAiD are lacking

Other jurisdictions in the world where MAiD practices are legalized, such as New Zealand and Victoria, Australia, frown on or prohibit raising death as a treatment option. This is due to the power imbalance that exists between physician and patient, coupled with the patients’ assumption that the provider will only suggest the best options for their health. Raising  MAiD unsolicited could cause undue pressure to choose death.  Yet Health Canada’s 2023 Model Practice Standard for Medical Assistance in Dying recommends that MAiD should be raised to all who might qualify if the practitioner suspects it aligns with a patient’s values and preferences.

The model practice standard’s approach to “conscientious objection” is equally troubling. Health care providers who object to providing MAiD, even in specific cases, are considered conscientious objectors. A physician who is concerned that MAiD is not a patient’s best option is supposed to ignore their conscience or professional opinion and simply refer the patient on so they can seek access to a MAiD death.

This is further echoed in a CAMAP video training session where experts explain that patients might be driven to MAiD by unmet psycho-social needs. The expert leading the session responds to a trainee’s concerns: “If withdrawing is about protecting your conscience, you have [an] absolute right to do so.” But he adds: “You’ll then have to refer the person on to somebody else, who may hopefully fulfill the request in the end.” This demonstrates precisely how effective referrals can funnel patients toward death despite legitimate professional concerns and obligations that should have instead led to the process being stopped or paused.

In response to this legislation, many from the disability community have advocated for safe spaces where MAiD can’t pose a risk to their lives. The Disability Filibuster, a national grassroots disability community, stated in an open letter that its members have raised fears about seeking health care where death could be offered to them and if at their lowest, they might agree.

The disability community is not being alarmist in this concern. Health care providers often rate the quality of life of those with disabilities as poor despite those patients rating their own quality of life as the same as aged-matched healthy individuals. Put differently, many physicians might consider that patients with disabilities are better off dead, consciously or unconsciously, which might lead them to suggest MAiD.

Besides the problems of mandatory referral and raising MAiD unsolicited, there is another important factor to consider. Persons with physical disabilities systemically lack much of the essential care they need to live and consequently suffer higher rates of isolation, poverty, and marginalization, all of which can make death their most accessible option. The Canadian government commissioned a University of Guelph study, published in 2021, in which the researchers noted that some persons with disabilities were encouraged to explore the MAiD option—even though they had not been contemplating doing so—because of a lack of resources that would enable them to live. Those with disabilities can be approved for MAiD based on their disability, but it is their psycho-social suffering that can drive their requests.

The United Nations Special Rapporteur on the rights of persons with disabilities, the Independent Expert on the enjoyment of all human rights by older persons, and the Special Rapporteur on extreme poverty and human rights have all warned the Canadian government that the current MAiD framework could lead to human rights violations. Their concerns are validated by the numerous fact-checked stories about MAiD abuses that are emerging in Canada. These should give us pause. For example, Sathya Dhara Kovac, 44, ended her life through the MAiD program. She lived with a degenerative disease and her condition was worsening, but she wanted to live but lacked the home care resources to do so. “Ultimately it was not a genetic disease that took me out, it was a system,” Kovac wrote in an obituary to loved ones. All Canadians have a right to humane living conditions, to be treated with respect and dignity, and to receive appropriate timely medical care. Considering the living conditions and lack of care that as a society we allow persons with disabilities to have, choices to die might be understandable for those like Sathya. But we should ask ourselves if choices, made under inhumane conditions, are made freely if driven by structural coercion.

Disturbingly, there are MAiD assessors and providers who seem to be ok with proving MAiD under such inhumane conditions. One such provider testified at a parliamentary committee on MAiD that if someone had to wait a long time for a service that would remediate their suffering, she would still consider that waiting to be irremediable suffering and grant them MAiD in the interim. Therefore, it is not surprising that patients with unaddressed psycho-social suffering are being given MAiD by assessors like her.

When it was considering Bill C-7, the federal government asked the Parliamentary Budget Officer to estimate cost savings to our health care system of the legalization of MAiD. The office did this by looking at the comparative cost savings of MAiD versus palliative care at the end of life. Through this impoverished lens of valuation, it is clear that the cost savings will be even greater when, by many years, we prematurely end the lives of people who have higher care needs, especially when we factor in social services, disability benefits, equipment, and other costs on top of the direct savings to health care budgets. But this is not how we should create budgets or measure outcomes. Our socialized health care system is meant to serve those with disabilities, not consider them a cost to the system.

The Canadian government is currently deciding on the timing for its further roll-out of MAiD, this time for mental illness and with no legislative changes to the current safeguards. This expansion is alarming given what we know is happening already to disabled Canadians under the existing MAiD regime. The Canadian Association of Chairs of Psychiatry wrote a letter in 2022—and some testified more recently in Parliament—that we are not ready for this development. They have warned that there is no evidence to guide decisions about who with mental illness would not get better. The evidence suggests that for every 5 people whose lives would be ended based on the sole medical condition of mental illness, 2 or 3 would have recovered. We expect to have much higher numbers qualifying for MAiD on the grounds of mental illness in Canada than in other jurisdictions that allow assisted death for this reason, since barriers to care and unmitigated psycho-social suffering do not have to be rectified in this country (as they do elsewhere) before being granted MAiD.

Our government has allowed the incredible power and influence of certain lobby groups and their members to control the public discourse and policies around MAiD and its expansion, prioritizing access to MAiD over the safety of Canadians. Besides the current discussion about when to legalize MAiD for mental illness, the parliamentary committee has also recommended expansion to children and MAiD by advance directives. With eligibility for MAiD continuing to broaden, we are not giving priority to serving those most in need, but instead seem intent on rapidly expanding a path to end their lives.

[1] Disabilities is an umbrella term that includes impairment, chronic illness and/or other conditions.

Dr. Ramona Coelho is a family physician in London, Ontario. Her practice largely serves marginalized patients.

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MacDonald Laurier Institute

The Governor General deserves better, but we deserve impartiality

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From the Macdonald Laurier Institute

By Philippe Lagassé

Mary Simon’s impartiality was undermined by hosting a symposium tied to controversial government legislation.

Mary Simon has been a guarded Governor General. She’s adopted a low profile since her appointment, performing her vice-regal responsibilities without much notice. When she has been in the news, it’s usually because of her efforts to learn French and costly diplomatic trips, not on account of an initiative she’s launched or a stance she’s taken. Aside from routine public statements and some championing of Indigenous reconciliation, Simon hasn’t tried to make a mark. Until last week, that is.

On April 11, Her Excellency hosted a symposium on online abuse and creating safe digital spaces. Simon has been the target of vitriol on social media, a reality she shares with many public figures, particularly women. She wants to address this problem, stressing that “we deserve better.” As far as causes go, this is a laudable one. Online abuse is a serious issue, one that can excuse and encourage physical violence and attacks. To highlight the severity of the challenge, the Governor General’s symposium featured well-known Canadians who’ve also suffered from online abuse and are determined to fight it.

Unfortunately, the Governor General’s symposium took place while a government bill on online harms is making its way through Parliament. Bill C-63, the Online Harms Act, has been the source of significant controversy, notably around its impact on free expression and the potential life sentences it imposes on certain types of hateful speech. C-63 has been criticized by law professors, civil liberties advocates, and the Conservative Party. While there may be a general consensus that online abuse is a scourge, the solution is contentious, and Bill C-63 has been the subject of serious debate.

As well-intentioned as the Governor General’s symposium was, she should never have hosted it in this context, a conclusion that’s reinforced by the Minister of Justice publicly tying the event to bill C-63. As soon as the government tabled the bill, Her Excellency should have understood that the symposium was no longer appropriate and would present a risk to her office’s impartiality.

The Governor General is the second highest office of the Canadian state, right under the King. As the King’s vice-regal representative, the Governor General performs core constitutional functions. These demand that the Governor General not only act impartially but be perceived to be impartial. This isn’t just good form, it’s a fundamental part of the job.

As part of their constitutional role, Governors General exercise the Crown’s reserve powers. These include the granting of royal assent to legislation on the advice of the houses of Parliament, proroguing and dissolving Parliament on the advice of the Prime Minister, and inviting a party leader to form a new government when the serving Prime Minister resigns. Impartiality helps shield the Governor General from partisan attacks when exercising these powers and maintains public trust in the office.

Now, to be clear, the Governor General has very limited discretion in exercising these reserve powers. As long as the Prime Minister’s party holds the confidence of the House of Commons, the Governor General must almost always accept their advice. Yet, there have been and will be cases where vice-regal representatives exercise their discretion to decide the fates of governments or guard against unconstitutional abuses of power. When these occur, we need the Governor General to be respected as a non-partisan, politically neutral office. Doubts about a Governor General’s impartiality undermine her or his constitutional functions and can weaken trust in the office when it’s most needed.

Turning back to the symposium, it’s important to clarify why it undermined her impartiality, or at least perceptions of it. Defenders of the symposium have argued that the event didn’t feature any members of the government as speakers, hence it wasn’t partisan or meant to endorse the Online Harms Act. Suffice to say, had ministers spoken at the event, we would be dealing with an outright constitutional debacle, not just concerns about vice-regal impartiality. A full-on violation of constitutional norms isn’t the standard here. Instead, we should be asking why the Minister of Justice was even there, and why the Governor General decided to host the symposium, considering how contentious Bill C-63 has been already. Hosting the event allowed Her Excellency to get pulled into the partisan fray, a predictable outcome that she shouldn’t have risked.

Those who participated in the symposium will counter that it was the Minister of Justice who made the connection with Bill C-63, not the Governor General. Her Excellency’s motives, and the importance of the cause addressed by the symposium, shouldn’t be impugned by a careless, partisan tweet. Alas, partisans are going to partisan and politicians are going to politick. This is precisely why vice-regal representatives should avoid wading into politically charged topics. Expecting politicians to show restraint and respect the neutrality of the office of the Governor General is more than a tad naive. Vice-regal representatives should have the wherewithal to avoid situations where their office can be leveraged for partisan purposes.

Defenders of the symposium offer another argument: as the sovereign’s representative, the Governor General should address important social problems that affect Canadians. The vice-regal role shouldn’t be confined to constitutional functions, ceremonies, and commemorations. Not allowing vice-regal representatives to advocate for the public good would be a lost opportunity. This is a fair point, though Governors General need to be careful about what causes they take up. When it comes to vice-regal advocacy, banal benevolence is the way to go. Anything that’s the subject of notable partisan and parliamentary debate, is ideologically fraught, or might be fought over during an election should raise red flags.

Thankfully for the Governor General, the controversy surrounding her symposium hasn’t extended beyond the Ottawa bubble yet. She should keep it that way by abandoning her “We Deserve Better” campaign while partisans battle it out over Bill C-63 and the courts review the Online Harms Act if it becomes law.

This isn’t because the Governor General doesn’t deserve better; she does, as do all those who suffer online abuse. It’s because Canadians deserve impartiality from the Governor General, both real and perceived.

Philippe Lagassé is an associate professor at Carleton University. He’s the co-editor of Canada and the Crown: Essays on Constitutional Monarchy (2014) and The Crown and Parliament(2015).

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Health

Time for an intervention – an urgent call to end “gender-affirming” treatments for children

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From the Macdonald Laurier Institute

By J. Edward Les

Despite the Cass Review’s alarming findings, trans activists and their enablers in the medical professions continue to push kids into having dangerous, life-altering surgeries and hormone-blocking treatments. It needs to stop.

If nothing else, the scathing final report of the Cass Review released this week (but commissioned four years ago to investigate the disturbing practices of the UK’s Gender Identity Service), is a reminder that doctors historically are guilty of many sins.

Take the Tuskegee syphilis study, one of the greatest stains on the medical profession, in which impoverished syphilis-infected black men were knowingly deprived of therapy so that researchers could study the natural history of untreated disease.

Or consider the repugnant New Zealand cervical cancer study in the 1960s and 1970s, which left women untreated for years so that researchers could learn how cervical cancer progressed.  Or the Swedish efforts to solidify the link between sugar and dental decay by feeding copious amounts of sweets to the mentally handicapped.

The doctors behind such scandals undoubtedly felt they were advancing scientific inquiry in pursuit of the greater good; but they clearly stampeded far beyond the boundaries of ethical medical practice.

More common by far, though, are medical “sins” committed unknowingly, such as when doctors prescribe toxic treatments to patients in the mistaken belief that they are beneficial. When physicians in Europe and Canada latched onto thalidomide in the late 1950s and early 1960s, for instance, they thought it was a wonder drug for morning sickness. Only the fine work of Dr. Francis Kelsey, an astute pharmacist at the FDA, prevented the ensuing birth-defects tragedy from being visited upon American women and children.

And when Oxycontin hit the medical marketplace in the 1990s, physicians embraced it as a marvellous — and supposedly non-addictive — solution to their patients’ pain. But the drug was simply another synthetic derivative of opium, and every bit as addictive; its use triggered a massive opioid overdose crisis — still ongoing today — that has killed hundreds of thousands and ruined the lives of countless individuals and their families.

Physicians in the latter instances weren’t driven by malevolence; but rather by a deep-seated desire to help patients. That wish, compounded by extreme busy-ness, repeatedly seduces doctors into unwarranted faith in untested therapies.

And no discipline in medicine, arguably, is more frequently led astray by the siren song of shiny new things than the field of psychiatry. Which is understandable, perhaps, given the nature of psychiatric practice. Categorizations of mental disorders — and the methods used to treat them — are based almost entirely on consensus opinion, rather than on direct measurement.  Contrast that with other domains of medical practice: appendicitis is diagnosed by imaging the infected organ, and then cured by surgically removing the inflamed tissue; diabetes is detected by measuring elevated blood sugar, and then corrected by the administration of insulin; elevated blood pressure is calibrated in millimetres of mercury, and then effectively reduced with antihypertensives; and so on.

But mental disturbances remain largely the stuff of conjecture — learned conjecture, mind you, but conjecture, nonetheless. The Diagnostic and Statistical Manual of Mental Disorders, the “bible” of mental health professionals, is the collective effort of groups of tall foreheads gathered around conference tables opining on the various perturbations of the human mind. Imprecise definitions abound, with heaps of overlap between conditions.

The current version (DSM-5) describes schizophrenia, for example, as occurring on a spectrum of “abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms.” Each of these five domains is open to professional interpretation; and what’s more, the schizophrenia spectrum is further subdivided into ten sub-categories.

That theme runs through the entire manual – and imprecise definitions lead on to imprecise solutions. Given the blurred indications for starting, balancing, and stopping medications, it’s no accident that many mentally unwell patients languish on ever-changing cocktails of mind-altering drugs.

None of which is to downplay the enormous importance of psychiatry, which does much to address human suffering amidst unimaginable complexity; its practitioners are among the brightest and most capable members of the medical profession. But by its very nature the discipline is submerged in — and handicapped by — uncertainty. It’s unsurprising, then, that mental health professionals desperate for effective treatments are susceptible to being misled.

The dark history of frontal lobotomies, seized upon by psychiatrists as a miracle cure but long relegated to the trash heap of medical barbarism, is well known. The procedure (which garnered its inventor the Nobel Prize in Medicine) basically consisted of driving an ice pick through patients’ eye sockets to destroy their frontal lobes; thousands of patients were permanently maimed before saner heads prevailed and the practice was halted. Many of its victims were gay men: “conversion therapy” with a literal, brain-altering “punch.”

Similarly, the fabricated “recovered memories of sexual abuse” saga of the 1980s and early 1990s suckered mental health practitioners into believing it was legitimate. Hundreds of professional careers were built on the “therapy” before it was all exposed as a fraud, leaving many lives ruined, families torn asunder, and scores of innocent men imprisoned or dead from suicide. In a 2005 review, Harvard psychology professor Richard McNally pegged the recovered memory movement as “the worst catastrophe to befall the mental health field since the lobotomy era.”

Until now, that is. That scandal pales in comparison to the “gender transition/gender affirming care” craze that has befogged the medical profession in recent years.

Without a shred of supporting scientific evidence, many doctors — led by psychiatrists, but aided and abetted by endocrinologists, surgeons, pediatricians, and family doctors — have bought into the mystical notion of gender fluidity. What was previously recognized as “gender identity disorder” was rebranded as gender “dysphoria” and recast as part of the normal spectrum of human experience, the basic truth of binary mammalian biology simply discarded in favour of the fiction that it’s possible to convert from one sex to another.

Much suffering has ensued. The enabling of biological males’ invasion of women’s spaces, rape shelters, prisons, and sports is bad enough. But what is being done to children is the stuff of horror movies: doctors are using medications to block physiological puberty as prologue to cross-gender hormones, genital-revising surgery, and a lifetime of infertility and medical misery — and labelling the entire sordid mess as gender-affirming care.

The malignant fad began innocently enough, with a Dutch effort in the late 1980s and early 1990s to improve the lot of transgendered adults troubled by the disconnect between their physical bodies and their gender identity. Those clinicians’ motivations were defensible, perhaps; but their research was riddled with ethical lapses and methodological errors and has since been thoroughly discredited. Yet their methods “escaped the lab”, with the international medical community adopting them as a template for managing gender-confused children, and the World Professional Association for Transgender Health (WPATH) enshrining them as “standard of care.” Then, as American social psychologist Jonathan Haidt is the latest to observe, the rise of social media torqued the trend into a craze by convincing hordes of adolescents they were “trans.” Which is how we ended up where we are today, with science replaced by rabid ideology — and with condemnation heaped upon anyone who dares to challenge it.

An explanation sometimes offered for the massive spike in gender-confused kids seeking “affirmation” in the past fifteen years is that today it’s “safe” for kids to express themselves, as if this phenomenon always existed but that — as with homosexuality — it was “closeted” due to stigma. Yet are we really expected to believe that the giants of empirical research into childhood development —brilliant minds like Jean Piaget, Eric Erikson, Lev Vygotsky, and Lawrence Kohlberg — somehow missed entirely the trait of mutable “gender identity” amongst all the other childhood traits they were studying? That’s nonsense, of course. They didn’t miss it — because it isn’t real.

The fog is beginning to dissipate, thankfully. Multiple jurisdictions around the world, including the UK, Sweden, Norway, Finland, and France have begun to realize the grave harm that has been done, and are pulling back from — or halting altogether — the practice of blocking puberty. And the final Cass Report goes even further, taking square aim at the dangerous practice of social transitioning and concluding that it’s “not a neutral act” but instead presents risk of grave psychological harm.

All of which places Canada in a rather awkward position. Because in December of 2021 parliamentarians gave unanimous consent to Bill C-4, which bans conversion therapy, including “any practice, service or treatment designed to change a person’s gender identity.” It’s since been a crime in Canada, punishable by up to five years in prison, to try to help your child feel comfortable with his or her sex.

As far as I know, no one has been charged, let alone imprisoned, since the bill was passed into law. But it certainly has cast a chill on the willingness of providers to deliver appropriate counselling to gender-confused children: few dare to risk it.

A conversion therapy ban had been in the works for years, triggered by concerns about disturbing and harmful practices targeting gay children. But by the time the bill was presented in its final form to Parliament for a vote it had been hijacked by trans activists, with its content perverted to the degree that there is more language in the legislation speaking to gender identity than to homosexuality.

To be clear, likening homosexuality to pediatric “gender fluidity” is a category error, akin to comparing apples to elephants. The one is an innate sexual orientation, the acceptance of which requires simply leaving people be to live their lives and love whomever they wish; the other is wholly imaginary, the acceptance of which mandates irreversible medical (and often surgical) intervention and the transformation of children into lifelong (and usually infertile) medical patients.

And the real “elephant” in the room is that in a troubling number of cases pediatric trans care is conversion therapy for gay children because for some people, it’s more acceptable to be trans than it is to be gay.

Bill C-4 received unanimous endorsement from all parliamentarians, including from Pierre Poilievre, now the leader of the Conservative Party. No debate. No analysis. Just high-fives all around for the television cameras.

It’s possible that many of the opposition MPs hastening to support the ban did so for fear of being painted as bigots. Yet the primary responsibility of an opposition party in any healthy democracy is to oppose, even when it’s unpopular. In 2015, when NDP Opposition leader Tom Mulcair faced withering criticism for resisting anti-terror legislation tabled by Stephen Harper’s Conservative government, he cited John Diefenbaker’s comments on the role of political opposition:

“The reading of history proves that freedom always dies when criticism ends… The Opposition finds fault; it suggests amendments; it asks questions and elicits information; it arouses, educates, and moulds public opinion by voice and vote… It must scrutinize every action of the government and, in doing so, prevents the shortcuts through democratic procedure that governments like to make.”

In the case of Bill C-4 the Conservatives did none of that. And by abdicating their responsibility they helped drive a metaphorical ice pick into the futures of scores of innocent children, destroying forever their prospects for normal, healthy lives.

We’re long overdue for a “conversion”: a conversion back to the light of reason, a conversion back to evidence-based care of children.

In 1962, when the harms of thalidomide became known, it was withdrawn from the Canadian market. In 2024, now that the serious harms of “gender-affirming care” have been exposed, it remains an open question as to when Canada’s doctors and politicians will finally take the difficult step of admitting that they got it wrong and put a stop to the practice.

Dr. Edward Les is a pediatrician in Calgary who writes on politics, social issues, and other matters.

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