Was football player Terrance Howard really dead? His parents didn’t think so.

The Uniform Determination of Death Act (UDDA) states that there must be an irreversible cessation of all functions of the entire brain for a declaration of brain death. The way doctors currently diagnose brain death does not comply with the law under the UDDA.

North Carolina Central University football player Terrance Howard died recently after a car accident reportedly left him “brain dead.” But his family disputed this diagnosis and requested that their son be transferred to another facility for treatment of his brain injury, leading to conflict with Terrance’s doctors and hospital. According to News One, his parents claimed that Atrium Health Carolinas Medical Center wanted to kill their son for his organs, and accused doctors of snickering and laughing while refusing to help him. His father, Anthony Allen, told News One that the hospital removed Terrance from life support against his family’s wishes and forcibly ejected his family from his room. The family posted videos on social media of apparent police officers entering Terrance’s hospital room, and said that the hospital threatened them with criminal action for trespassing.

If these allegations are true, the Howard family has every right to be outraged at the disrespectful treatment they received at Atrium Health. Especially now, as the legitimacy of brain death is coming under increasing scrutiny, it is outrageous that hospitals and doctors continue being so heavy-handed. The National Catholic Bioethics Center (NCBC), formerly a staunch supporter of “brain death,” released a statement in April 2024, saying:

Events in the last several months have revealed a decisive breakdown in a shared understanding of brain death (death by neurological criteria) which has been critical in shaping the ethical practice of organ transplantation. At stake now is whether clinicians, potential organ donors, and society can agree on what it means to be dead before vital organs are procured.

The NCBC statement was prompted by the newest brain death guideline which explicitly allows people with partial brain function to be declared brain dead. But the Uniform Determination of Death Act (UDDA) states that there must be an irreversible cessation of all functions of the entire brain for a declaration of brain death. The way doctors currently diagnose brain death does not comply with the law under the UDDA.

Terrance Howard’s story is reminiscent of the mistreatment of another Black teenager, Jahi McMath. In 2013, Jahi was a quiet, cautious teenager with sleep apnea who underwent a tonsillectomy and palate reconstruction to improve her airflow while sleeping. An hour after the surgery, she started spitting up blood. Her parents requested repeatedly to see a doctor without success. Her mother, Nailah Winkfield, said, “No one was listening to us, and I can’t prove it, but I really feel in my heart: if Jahi was a little white girl, I feel we would have gotten a little more help and attention.”

Jahi continued to bleed until she had a cardiac arrest just after midnight. She was pulseless for ten minutes during her “code blue” resuscitation. Two days later, her electroencephalogram (EEG) was flatline, and it was clear that Jahi had suffered a severe brain injury which was worsening. But rather than treating these findings aggressively, her doctors proceeded toward a diagnosis of brain death. Three days after her surgery, her parents were informed that their daughter was “dead” and that Jahi could now become an organ donor. The family was stunned. How could Jahi be dead? She was warm, she was moving occasionally, and her heart was still beating. As a Christian, Nailah believed her daughter’s spirit remained in her body as long as her heart continued to beat. While the family sought medical and legal assistance, Children’s Hospital Oakland doubled down, refusing to feed Jahi for three weeks. The hospital finally agreed to release Jahi to the county coroner for a death certificate, following which her family would be responsible for her.

On January 3, 2014, Jahi received a death certificate from California, listing her cause of death as “Pending Investigation.” Why was the hospital so adamant about insisting Jahi was dead, even to the point of issuing a death certificate? Possibly because California’s Medical Injury Compensation Reform Act limits noneconomic damages to $250,000. If Jahi was “dead,” the hospital and its malpractice insurer would only be liable for $250,000. But if Jahi was alive, there would be no limit to the amount her family could claim for her ongoing care.

After Jahi was transferred to New Jersey, the only US state with a religious exemption to a diagnosis of brain death, she began to improve. After noticing that Jahi’s heart rate would decrease at the sound of her mother’s voice, the family began asking her to respond to commands, and videoed her correct responses. Jahi went through puberty and began to menstruate — something not seen in corpses! By August 2014 she was stable enough to move into her mother’s apartment for continuing care. Subsequently Jahi was examined by two neurologists (Dr. Calixto Machado and Dr. D. Alan Shewmon) who found that she had definitely improved: she no longer met the criteria for brain death and was in a minimally conscious state. Jahi continued responding to her family in a meaningful way until her death in June 2018 from complications of liver failure.

How could Jahi McMath, who was declared brain dead by three doctors, who failed three apnea tests, and who had four flatline EEGs and a radioisotope scan showing no intracranial blood flow, go on to recover neurologic function? Very likely, due to a condition called Global Ischemic Penumbra, or GIP. Like every other organ, the brain shuts down its function when its blood flow is reduced in order to conserve energy. At 70 percent of normal blood flow, the brain’s neurological functioning is reduced, and at a 50 percent reduction the EEG becomes flatline. But tissue damage doesn’t begin until blood flow to the brain drops below 20 percent of normal for several hours. GIP is a term doctors use to refer to that interval when the brain’s blood flow is between 20 and 50 percent of normal. During GIP the brain will not respond to neurological testing and has no electrical activity on EEG, but still has enough blood flow to maintain tissue viability — meaning that recovery is still possible. During GIP, a person will appear “brain dead” using the current medical guidelines and testing, but with continuing care they could potentially improve.

This [GIP] is not a hypothesis but a mathematical necessity. The clinically relevant question is therefore not whether GIP occurs but how long it might last. If, in some patients, it could last more than a few hours, then it would be a supreme mimicker of brain death by bedside clinical examination, yet the non-function (or at least some of it) would be in principle reversible.

Dr. Cicero Coimbra first described GIP in 1999, but in the never-ending quest for transplantable organs, his work has been largely ignored. There is absolutely no medical or moral certainty in a brain death diagnosis, and people need to be made aware of this. “Brain dead” people are very ill, and their prognosis may be death, but they deserve to be treated aggressively until they either recover or succumb to natural death. Unfortunately, as the family of Terrance Howard seems to have experienced, doctors are continuing to use a brain death guideline that ignores the reality of GIP and does not comply with brain death law under the UDDA.

Heidi Klessig MD is a retired anesthesiologist and pain management specialist who writes and speaks on the ethics of organ harvesting and transplantation. She is the author of “The Brain Death Fallacy” and her work may be found at respectforhumanlife.com.

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Alberta on right path to better health care

Published on November 19, 2025

Todayville

From the Fraser Institute

By Nadeem Esmail and Mackenzie Moir

Alberta’s health-care system may be set for another positive move away from the failed Canadian model. According to leaked draft legislation by the Smith government, Albertans may soon be able to access physician care in a parallel private sector, with physicians permitted to work in both the public and private systems.

The defenders of the status quo were of course quick to frame the approach as unique in Canada, arguing it would harm our universal system. While this potential change may put Alberta’s policies at odds with those of other provinces, it would more closely align with universal health-care systems everywhere else in the developed world. And most importantly, it will make for better access to health care for all Albertans.

First, it’s important recognize just how unusual Canada’s approach to privately-funded health care is compared to other high-income countries with universal health care.

In every one of the 30 other developed countries with universal health care, patients are free to seek services on their own terms with their own resources when the universal system is unwilling or unable to satisfy their needs. One reason may be to avoid long waiting lists, while others simply want to receive more personalized health-care services, meet a personal health need or access newer medical technologies and procedures.

In the majority of these countries, including those with high-performing systems such as Switzerland, the Netherlands, Germany and Australia, physicians are also permitted to work in both the public and private sectors.

Canada’s deviation, and Alberta’s, from this international norm has not served patients well. Despite having the highest health spending among the provinces in one of the most expensive universal health-care systems in the developed world, Albertans endure some of the worst access to health care and wait in some of the longest queues for treatment.

A central explanation for why Canadians spend more and get much much less is the lack of a private competitive alternative to the universal public system.

Again, a private option gives patients an option to select care the government is unwilling to provide, either in terms of timeliness or in ways that may be personally important to them. Faster access could allow some people to expedite a return to work and support their family, or to re-engage in important activities without needing to leave the province or the country as they currently must.

By moving people willing to pay for services out of the public queues, the government can help reduce the wait times for patients in the public queues. It’s not surprising that Canada has the longest waiting lists in the developed world given we’re the only country that prohibits privately-funded health care.

Arguments that the private sector will starve the public system of resources (including doctors and nurses) misunderstand what’s actually happening in Alberta today.

Currently, surgeons spend a good deal of time waiting for access to operating rooms or hospital beds for patients. Meanwhile, nurses are leaving the profession in large numbers. Canada also has unemployed medical specialists who could be employed if new opportunities arose. Allowing private access to care or previously unavailable medical resources would increase the total volume of services available to Albertans.

Even beyond this, the opportunity to earn more by working extra hours in a private clinic could encourage physicians to use some of their now non-working hours to treat patients privately. In this regard, the focus on allowing physicians to work in both public and private sectors is a well-informed policy choice that makes better use of Alberta’s existing medical workforce.

Finally, a private parallel option creates incentives for better service in the universal system through competition. Shackling patients to a government monopoly with no alternative choices results in a more expensive system and lower standard of care than would be available otherwise. When no one is permitted to deliver timelier patient-focused care, there’s no pressure created to do so anywhere else in the system. The outcome is obvious just from looking at how poorly the public system in Alberta performs despite its world-class price tag.

While this new leaked draft legislation may have the defenders of the status quo frantically racing to defend the current Canadian model, it promises a better health-care system for Albertans. This change will more closely align Alberta’s policies with those of every other universal health-care country in the developed world. More importantly, it will improve access to health care for all Albertans, and provide Albertans currently stuck with poor service an option to choose differently for themselves without a plane ticket.

Nadeem Esmail

Director, Health Policy, Fraser Institute

Mackenzie Moir

Senior Policy Analyst, Fraser Institute

Addictions

Activists Claim Dealers Can Fix Canada’s Drug Problem

Published on November 18, 2025

Todayville

By Adam Zivo

We should learn from misguided experiments with activist-driven drug ideologies.

Some Canadian public-health researchers have argued that the nation’s drug dealers, far from being a public scourge, are central to the cause of “harm reduction,” and that drug criminalization makes it harder for them to provide this much-needed “mutual aid.” Incredibly, these ideas have gained traction among Canada’s policymakers, and some have even been put into practice.

Gillian Kolla, an influential harm-reduction activist and researcher, spearheaded the push to whitewash drug trafficking in Canada. Over the past decade, she has advocated for many of the country’s failed laissez-faire drug policies. In her 2020 doctoral dissertation, she described her hands-on research into Toronto’s “harm reduction satellite sites”—government-funded programs that paid drug users to provide services out of their homes.

The sites Kolla studied were operated by the nonprofit South Riverdale Community Health Centre (SRCHC) in Toronto. Addicts participating in the programs received $250 per month in exchange for distributing naloxone and clean paraphernalia (needles and crack pipes, for example), as well as for reversing overdoses and educating acquaintances on safer consumption practices. At the time of Kolla’s research (2016–2017), the SRCHC was operating nine satellite sites, which reportedly distributed about 1,500 needles and syringes per month.

Canada permits supervised consumption sites—facilities where people can use drugs under staff oversight—to operate so long as they receive an official exemption via the federal Controlled Drugs and Substances Act. As the sites Kolla observed did not receive exemptions, they were certainly illegal. Kolla herself acknowledged this in her dissertation, writing that she, with the approval of the University of Toronto, never recorded real names or locations in her field notes, in case law enforcement subpoenaed her research data.

Even so, the program seems to have enjoyed the blessing of Toronto’s public health officials and police. The satellite sites received local funding from 2010 onward, after a decade of operating on a volunteer basis, apparently with special protection from law enforcement. In her dissertation, Kolla described how SRCHC staff trained police officers to leave their sites alone, and how satellite-site workers received special ID badges and plaques to ward off arrest.

Kolla made it clear that many of these workers were not just addicts but dealers, too, and that tolerance of drug trafficking was a “key feature” of the satellite sites. She even described, in detail, how she observed one of the site workers packaging and selling heroin alongside crackpipes and needles.

In her dissertation, Kolla advocated expanding this permissive approach. She claimed that traffickers practice harm reduction by procuring high-quality drugs for their customers and avoiding selling doses that are too strong.

“Negative framings of drug selling as predatory and inherently lacking in care make it difficult to perceive the wide variety of acts of mutual aid and care that surround drug buying and selling as practices of care,” she wrote.

In truth, dealers routinely sell customers tainted or overly potent drugs. Anyone who works in the addiction field can testify that this is a major reason that overdose deaths are so common.

Ultimately, Kolla argued that “real harm reduction” should involve drug traffickers, and that criminalization creates “tremendous barriers” to this goal.

The same year she published her dissertation, Kolla cowrote a paper in the Harm Reduction Journal with her Ph.D. supervisor at the Dalla Lana School of Public Health. The article affirmed the view that drug traffickers are essential to the harm-reduction movement. Around this time, the SRCHC collaborated with the Toronto-based Parkdale Queen West Community Health Centre— the only other organization running such sites—to produce guidelines on how to replicate and scale up the experiment.

Thankfully, despite its local adoption, this idea did not catch on at the national level. It was among the few areas in the early 2020s where Canada did not fully descend into addiction-enabling madness. Yet, like-minded researchers still echo Kolla’s work.

In 2024, for example, a group of American harm-reduction advocates published a paper in Drug and Alcohol Dependence Reports that concluded, based on just six interviews with drug traffickers in Indianapolis, that dealers are “uniquely positioned” to provide harm-reduction services, partly because they are motivated by “the moral imperative to provide mutual aid.” Among other things, the authors argued that drug criminalization is harmful because it removes dealers from their social networks and prevents them from enacting “community-based practices of ethics and care.”

It’s instructive to review what ultimately happened with the originators of this movement—Kolla and the SRCHC. Having failed to whitewash drug trafficking, Kolla moved on to advocating for “safer supply”—an experimental strategy that provides addicts with free recreational drugs to dissuade use of riskier street substances. The Canadian government funded and expanded safer supply, thanks in large part to Kolla’s academic work. It abandoned the experiment after news broke that addicts resell their safer supply on the black market to buy illicit fentanyl, flooding communities with diverted opioids and fueling addiction.

The SRCHC was similarly discredited after a young mother, Karolina Huebner-Makurat, was shot and killed near the organization’s supervised consumption site in 2023. Subsequent media reports revealed that the organization had effectively ignored community complaints about public safety, and that staff had welcomed, and even supported, drug traffickers. One of the SRCHC’s harm-reduction workers was eventually convicted of helping Huebner-Makurat’s shooter evade capture by hiding him from the police in an Airbnb apartment and lying to the police.

There is no need for policymakers to repeat these mistakes, or to embrace its dysfunctional, activist-driven drug ideologies. Let this be another case study of why harm-reduction policies should be treated with extreme skepticism.

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