Anthony Bourdain, suicide, and lifelines

For the CBC on June 12, 2018

Many of us experience a heaviness in the early morning hours; a feeling that the Swedish word vargtimmen perfectly encapsulates.

Robert Macfarlane, author of The Lost Words, writes that this term translates to “wolf-time; the menacing transitional hours of night into dawn.” How fitting that during these dark, foreboding hours last Friday, the world learned that Anthony Bourdain, age 61, had taken his life.

Like so many others, I was drawn to the authenticity of Bourdain’s work. His inexhaustible curiosity about the world, his ability to weave together stories of people and cultures, enabled viewers to experience foreign destinations in a uniquely engaging manner.

‘Your realest friend’

As New Yorker correspondent Helen Rosner put it, Bourdain cultivated an intimacy with his audience in such a way that he felt like “your realest, smartest friend, who wandered outside after beers at the local one night and ended up in front of some TV cameras and decided to stay there.”

How a man who appeared so full of life — whose drive to work and travel and explore seemed so insatiable — could have possibly taken his own is, on its surface, incomprehensible. So too is the question of how someone so demonstrably successful, respected and admired could have felt so powerless, lost and alone, that such a disproportionate, permanent solution seemed the necessary choice.

Suicide is often (though not always) an impulsive act, where one moment’s unbearable despair eclipses a lifetime of reason. Nihilism supersedes all rational thought.

In his 1972 book The Savage God, English poet, novelist and essayist Alfred Alvarez described suicide as “a closed world with its own irresistible logic” akin to “the unanswerable logic of a nightmare … Once a man decides to take his own life he enters a shut-off, impregnable but wholly convincing world where every detail fits and each incident reinforces his decision.”

Because depression is an all-consuming beast, one that incrementally siphons life of meaning, the way the mind works to rationalize suicidal ideation over time can create a self-fulfilling prophesy.

Though Bourdain spoke of his depression and of the despondency he’d sometimes feel, there were hints of something deeper, a vacuum he left unexplored.

While paying tribute to his CNN colleague, Jake Tapper spoke of insecurities Bourdain seemed to mask with bravado, hinting of an emptiness — some sort of persistent wanting that plagued Bourdain — which could never quite be satisfied. Friends spoke of Bourdain’s self-imposed gruelling work schedule, which fed the isolation and loneliness he’d accepted as a tradeoff for his lifestyle. One colleague mentioned Bourdain’s worry of where he might find himself should he ever ease off the workload.

Recently, however, there seemed a calm; a sense of completeness.

“The last I knew, he was in love,” Bourdain’s friend Michael Ruhlman told CNN’s Anderson Cooper Friday night. “He was happy, he said, ‘love abounds,’ some of the last words he said to me.”

Andrew Zimmern, another close associate, echoed that belief, saying he’d “never seen (Bourdain) as happy. He told me that in his relationship, not only had he never been happier, but that he never liked himself more, those were his words.”

So, what could possibly have happened? What changed so drastically that Bourdain, who’d overcome addiction and hardship in the past, felt he couldn’t possibly cope with the present?

His friends say he wasn’t showing cracks; he wasn’t letting people in. Only Bourdain knows why he maintained that barrier, even among the people closest to him. For all his candour about his past, he was guarded in his final moments.

It’s possible that, no matter how long he’d known these peers, there lacked a specific trust that would have made this conversation a safe one to have, particularly among fellow men.

When confiding in someone, there’s a difference between being listened to and being heard, between being heard and being understood. When there’s trust that no matter what is said, there will be understanding — meaning no risk of judgment or loss of respect, no worry of awkwardness later on — one will often reach out without hesitation.

Acting as lifelines

In times of crisis, when anxieties are heightened, that trust is vital. It’s something that is built over time, cultivated through regular, forthright conversations. One would assume Bourdain, a man who so seamlessly connected with others and could converse with such ease, had these sort of bonds. That indications are he didn’t, arguably deepens the sadness of this entire situation.

It’s easy for those who have these friendships to take them for granted, assuming everyone else is as privileged to have secured this most precious thing. While there are no easy answers to what’s become an epidemic of suicide, there are ways one can serve as a potential lifeline for another, should the need arise. And that begins by developing trust.

It’s not enough to ask someone to be vulnerable, the candour must work both ways. There must be a demonstration of understanding, or at least, of sincere empathy. There must be something that will override the lies one’s mind will tell at the thought of opening up. Words alone are inadequate.

In a 2014 episode of Parts Unknown, Bourdain traveled to Massachusetts where he retraced his heroin addiction through Provincetown.

“You know, I didn’t have anyone else who could have talked me out of what I was doing,” he told a group of recovering addicts. “The first time I shot up, I looked at myself in the mirror with a big grin … intervention wouldn’t have worked.” One day, however, he “saw somebody worth saving” in his reflection.

If only he knew how desperately people wish they could have talked him down now. If only he caught that glimpse of worth one more time.

On loneliness​ and the winter low

For Maclean’s on December 24, 2017

“Lonely people have a natural affinity for the internet,” wrote the late film critic Roger Ebert in a 2010 entry on his online journal. “It’s always there waiting, patient, flexible, suitable for every mood. But there are times when the net reminds me of the definition of a bore by Meyer the hairy economist, best friend of Travis McGee: ‘You know what a bore is, Travis. Someone who deprives you of solitude without providing you with companionship.’

“What do lonely people desire? Companionship. Love. Recognition. Entertainment. Camaraderie. Distraction. Encouragement. Change. Feedback … what all lonely people share is a desire not to be—or at least not to feel—alone.”

Embedded in the post was a poignant cartoon of a simple figure, looking downward with a pink heart on its chest, showered by an unforgiving rain from a cloud hovering above. Beside this image, there were these words: “Sometimes I take a carton of eggs out of the fridge and look at it and think that maybe one day I’ll crack an egg and a little baby chicken will fall out, and I’ll wash him off and raise him indoors and then… then I’ll have a friend.”

For many, the winter brings an increasing darkness beyond the shortened daylight—a shadow which stubbornly hovers like the cloud haunting the figure in the cartoon—a cycle best captured by an Icelandic term: “Skammdegisskuggar.” The meaning, as noted by author Robert Macfarlane, is “literally, ‘shadows of the short days’; metaphorically, the darkness that can be cast into both land and spirit by deep winter.”

Winter depression, and the loneliness it invites, can make the year’s final months seem, at times, unbearable. The holidays can prove to be a particular challenge, as the reluctance on one end to reach out for support, combined with uncertainty on the other of when and how to extend a hand amid overwhelming cheer, intensifies the aching sort of isolation, which then begets further loneliness.

Why, with all the campaigns dedicated to understanding mental illness and promoting emotional well-being, does there remain a reluctance to seek support for social isolation? Loneliness hasn’t been granted the same sort of legitimacy as, say, depression. It’s largely subjective, deeply personal, and remains so stigmatized, people are deeply reluctant to discuss—or even admit to—this honest emotion. There’s a profound vulnerability in doing so, as if loneliness itself indicates or reveals some fundamental failing or flaw of character.

Some won’t acknowledge their own lingering sadness because they imagine loneliness only affects those who are, quite literally, all alone. But the fact is, you can be married, have children, enjoy a stable, successful career, be surrounded by like-minded colleagues, and still, at the end of the day, feel lonely. You can still lie awake with an emptiness, yearning for some specific, meaningful connection to something or someone that would satisfy some persistent void.

“Human connection lies at the heart of human well-being,” wrote Dr. Dhruv Khullar in his December 2016 column in the New York Times outlining the “dire physical, mental and emotional consequences” of social isolation. Though we’re more connected online than ever, those ties are increasingly superficial. Not only have deep, meaningful bonds become scarce for many, modern demands of life and work have made it more difficult to maintain and nurture—or at least, far too easy to neglect—those important few that are still held.

Whether you’re married, single, an extrovert or generally shy, close, meaningful friendships matter. It’s not the number of connections or the proximity, but the quality of them.

Despite the evolutionary role of interdependence for well-being and survival, rugged individualism is too often romanticized. As recent research on the medical, as opposed to the psychological, fallout of loneliness has shown, the biological and physiological consequences of the prolonged stress from loneliness can be, quite literally, lethal.

According to Khullar, “analysis that pooled data from 70 studies and 3.4 million people found that socially isolated individuals had a 30 per cent higher risk of dying in the next seven years, and that this effect was largest in middle age. Loneliness can accelerate cognitive decline in older adults, and isolated individuals are twice as likely to die prematurely as those with more robust social interactions.”

What’s more, the fallout begins early. “Socially isolated children have significantly poorer health 20 years later, even after controlling for other factors.”

“It’s up to all of us,” concludes Khullar, “to maintain bonds where they’re fading, and create ones where they haven’t existed.”

If you find yourself, to use Ebert’s words, among “the lonely people” as the year draws to a close, it’s important to understand that, no matter the reason, you’re not alone in that feeling. If you reach out to someone—whether a close friend or a mere acquaintance; a family member or a crisis line—you’ll be met with far more empathy and understanding than you might expect, because everyone, at some point, to some extent, has been there too.

Rekindle ties with those you value and with whom you may have fallen out of touch. Write a letter or an email, or give them a call. Do something tangible, even if it feels forced at first, to begin to reconnect and rebuild the relationships which remain, in some way, important to you.

If you’re someone who will be surrounded by family and friends over the holidays, consider taking a moment, or finding meaningful time, for a person you suspect might not be as fortunate. It could be an elderly neighbour who lives alone, or perhaps a colleague you’ve noticed withdraw in recent months. You never know when the simple act of checking in—sending a simple text or e-mail, calling to chat, leaving a message, or dropping by—will change, or even save, a life.

Helping others through a difficult stretch doesn’t require special training or knowledge, just a moment of patience and an empathetic ear.

Never underestimate the value of time. Whether seeking it from another, or offering some of your own, it can prove to be the most cherished gift exchanged through the holidays. These connections have a way of growing into deep, lasting friendships—the kind that are the ultimate antidote to loneliness, even after the winter low has lifted.

 

On Charlie Gard, medical harm, and fate

For Maclean’s on July 18, 2017

It’s the most commonly cited phrase from the Hippocratic Oath, the binding document—one of the oldest in history—upon which physicians swear: “First, do no harm.” However, that four-word axiom doesn’t itself appear in the classical text of the pledge. Instead, there’s a promise to “apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.” That distinction is important: In medicine, harm can be mitigated, but it cannot be avoided. Every procedure carries risk, and the value of beginning or continuing treatment is weighed against the merits of withholding, suspending, or abandoning it. No course of action—or inaction—is free of trade-off. While harm cannot be the intent, it’s inevitable that harm, to some degree, will be done as a result.

And so physicians and surgeons, knowing the limits of their capacity as doctors and that of medicine itself, strive to achieve the best possible outcome while doing as little damage in the process. This includes situations where the “best possible outcome” means sparing a patient prolonged suffering, protecting against futile interventions sought out of desperation, and allowing death to occur as gently as possible. The modern interpretation of the oath includes a vow to “apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”

This commitment to hold the patient’s best interest above all else, to practise with tenacity and skepticism in equal measure, is of particular importance when patients cannot speak for themselves—even more so when the patient is a child, and there’s denial or defiance from caregivers regarding a diagnosis, prognosis, or proposed treatment.

Which brings us to the wrenching saga of Charlie Gard, the terminally-ill British child at the centre of what’s become an international, ideological brawl over parental rights and the boundaries of intervention when caregivers and medical experts are at odds; a case which demonstrates the delicate balance between optimism and realism in both treating and coping with disease. It raises questions regarding the ethics of medical professionals who provide false hope—a practice known to be predatory and harmful—exposes the moral bankruptcy of those who so often position themselves as defenders of morality, and reveals the callous politicization of a dying child for selfish, partisan purposes.

Taken together, the push to assign blame and assume control over what’s ultimately a genetic tragedy speaks to a broad misunderstanding of disease and how it’s treated—and our stubborn reluctance to concede to the cruelty of fate.

Born Aug. 4, 2016, Charlie has lived all but the first nine weeks of his life in London’s Great Ormond Street Hospital. He inherited a rare, genetic defect which hinders the mitochondria—the powerhouse of the cell—from producing energy. Charlie’s diagnosis of infantile onset encephalomyopathic mitochondrial DNA depletion syndrome (MDDS) is incurable, untreatable, and fatal.

Though his parents, Chris Gard and Connie Yates, insist Charlie remains responsive, his MDDS has reached the terminal phase—his body is dying—and the life support that’s artificially sustaining his existence cannot halt the natural progression of the disease. What it can do, however, is temporarily prolong the agony of Charlie’s life: MDDS starves Charlie’s muscles, kidneys, and brain of the energy needed to function, and because of his epileptic encephalopathy, Charlie also suffers from frequent seizures and has extensive, irreversible brain damage at both the structural and cellular level.

Charlie can’t communicate the extent of his discomfort. But in Britain, courts intervene when there’s a dispute between doctors and families over a proposed course of treatment, and judges help determine what’s in the best interest of the patient. And in siding with the doctors selflessly dedicated to the child’s care—ruling against his parents’ desperate appeal to the right-to-try—the U.K. Supreme Court established that Charlie “is suffering [pain] and at more than a low level … it was in his best interests for the clinicians treating him to withdraw [all life-sustaining support] and to provide him only with palliative care.” That ruling upheld decisions from the British Court of Appeal and the Family Division of the High Court of Justice, which had granted the hospital permission to “withdraw all treatment, save for palliative care, to permit Charlie to die with dignity.” The European Court of Human Rights in Strasbourg then declined to intervene.

But Yates and Gard found an American neurologist willing to subject their son to a costly, experimental therapy, and they have been fighting in court since April for the right to take Charlie to America and treat him as they see fit. The couple launched a GoFundMe campaign to finance the therapy—an effort which has raised more than £1.3 million to date—with Yates writing that Charlie “literally has nothing to lose but potentially a healthier, happier life to gain.” Problem is, when Charlie’s medical team asked for evidence of the proposed treatment’s efficacy, the American neurologist—known only as Dr. I through court documents—admitted that “there is no direct evidence, but there is a theoretical scientific basis for saying it could [help].” After learning the full extent of Charlie’s “catastrophic and irreversible brain damage,” Dr. I conceded it was “very unlikely” the experimental therapy would benefit the child in any meaningful way, which aligns with the London hospital that has always maintained the desired nucleoside therapy “would be futile and would prolong Charlie’s suffering.”

Heading into July, their legal options exhausted, it seemed Yates and Gard were finally ready to let Charlie go. “We’re making precious memories that we can treasure forever with very heavy hearts. Please respect our privacy while we prepare to say the final goodbye to our son Charlie,” Yates said on June 30, the day Charlie’s ventilator was set to be disabled. The hospital granted an extended window for goodbyes.

Enter the Pope and the Vatican, the President of the United States, and a range of conservative activists, from notorious right-to-life warriors to fervent champions of free-market health care, some referring to “death panels” blocking Charlie from accessing care in America. One week later, Charlie’s parents were again in denial, and poised to fight on; Yates credited the international attention brought by the Pope and Trump as the “single biggest factor” for Charlie’s life support remaining in place.

On July 13, Yates and Gard were back in court, again pleading their case to Judge Francis, a hearing requested after the hospital—amid intense international pressure—agreed to hear the “new evidence” the parents claimed to have. There remains no resolution, though lawyers from both sides have agreed to arrange for a meeting in Britain between Charlie’s doctors and the American neurologist, who has not yet examined the child, yet remains willing to cede to the parents’ demand for hypothetical cause to hope.

But all these intervenors continue to miss the point. The fate of the child is not open to ruling; Charlie’s genetic disorder remains his death sentence. There is no question of whether or not to discontinue the infant’s life support—that will and must be done—nor is this a matter of medical resources or “death panels.” In fact, it’s the remarkable care of Britain’s socialized health care system that has enabled Charlie’s survival to this point, and at no cost to his parents. Spending millions on private, experimental therapy will neither slow nor reverse this painfully terminal situation.

This is the fundamental, brutal truth at the heart of this case. And while Charlie’s parents believe themselves sincere in their claims—“We’re not doing this for us. He’s our son. We want what’s best for him. If he is still fighting, we are still fighting”—the fact remains that they’re not actually fighting in the child’s interest. The pain of losing their son is being prioritized over Charlie’s own sustained agony. Further, Charlie isn’t “fighting”: He’s dying. He’s not engaged in this battle. For most observers, these are difficult notions to consider; for those intimately involved, they’re impossible to admit to.

By and large, society’s grasp of death and understanding of illness is selective and flawed. Disease is presented as something to be valiantly fought against as opposed to professionally treated; when people die, they’re said to have “lost the battle,” suggesting failure on the part of the individual for circumstances well beyond their ability to influence. Medicine and doctors treat disease as best they can, but not every illness can be remedied or managed—that’s not failure, that’s nature. The need to believe one can assume control and triumph over adversity, no matter the circumstance, stems from an unwillingness to accept that, more often than not, stories of medical hardship don’t conclude in straightforward, tidy, or even satisfactory fashion. The widespread, fierce denial of the inevitable outcome for Charlie is the social issue worthy of attention in the Gard case.

Medical misfortune and dying—and the hard truths of their realities—are realities I know well. There have been two distinct periods of my own life where I endured a sustained, tortuous march toward death. The first, caused by a should-have-been manageable, inherited disease which went undiagnosed and untreated, resulting in the widespread damage and complete shutdown of a major life-sustaining organ, the intestine; the second, after proper diagnosis and years of intensive treatments and surgeries, a rare post-operative complication resulted in catastrophic, multi-organ failure, and further damage to what remained of the intestine.

It’s the second period of being alert and aware in an imminently dying body that was most physically excruciating and emotionally traumatic. There’s the “air hunger,” or chronic sensation of suffocation, which compounds the already intense state of anxiety and what’s known as terminal agitation; in addition to frightening hallucinations and intense nightmares, this second experience was also intolerably, relentlessly painful.

Every day during this period, I’d ask my doctors if I was going to die, and each horrified query was met with some form of this honest, if unsatisfactory answer: “We’re taking good care of you.” Though lacking certainty themselves, my family quietly prepared for the worst. They chose to control what they could while maintaining hope, but granted that—like before—they ultimately had no sway over my fate. There were no end-of-life discussions directly with me because everyone knew clearly that I did not want to die, and at the time, I was unable to cope with the prospect enough to properly discuss it.

I can’t say why I’ve survived impending death—twice—but I do know I cannot take credit. It remains my own medical team, and chance, that saw me though. Were my diagnosis undeniably terminal and prognosis clear, palliative care would have been the route to follow. Though I’d have been devastated, that certainty would have forced my hand on many things—including facing my mortality. Rather than cowering in death’s shadow, perhaps I’d have danced in it.

There is undeniable—though unavoidable—harm in learning that a prognosis is fatal and nothing more can be done. But that finality, however devastating in the near term, offers both patient and family some degree of control over the remaining days. It provides a meaningful window for final goodbyes or final adventures, and allows for an uninterrupted focus on quality time. These moments, down the road, are what help those bereaved find their way through the sorrow.

This long-term benefit is lost on those who, desperate to bypass immediate grief, are seduced by false hope and empty promise. In chasing what they believe to be a miracle cure, patients are robbed of time as their families are robbed financially. Those who suggest there is “nothing to lose” in seeking “alternative” treatments are not allowing themselves to see the intangible, irreplaceable things that remain, all of which they forfeit to follow a mirage. Yates and Gard are both victims of this dreadful, depressingly common, trap.

Of all those claiming to be fighting on Charlie’s behalf, it’s those who’ve been demonized—his medical caregivers, and the British courts—who’ve offered the selfless, ethical, unwavering commitment to the child. The medical fight for Charlie’s right to die is an extension of the life-sustaining treatment provided to this point.

End-of-life support is an under-appreciated element of health care; to know the excruciating experience of dying-of-illness firsthand is to appreciate the importance of preventing that sort of drawn-out agony whenever possible.

 

On assisted death and psychological suffering

For Maclean’s on March 28, 2017

In 2015, a landmark ruling by the Supreme Court of Canada struck down the federal ban on physician-assisted suicide, solidifying the charter right of competent, consenting adults who are “suffering intolerably as a result of a grievous and irremediable medical condition” the right to die on their own terms with medical assistance.

Criminal prohibition on assisted-death, the unanimous Carter v. Canada decision noted, condemned the “grievously and irremediably ill … to a life of severe and intolerable suffering. A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.”

That callous dilemma was rectified only in part by the assisted-dying legislation put out by the federal government in June, which restricts physician-assisted death to “grievous and irremediable” illness where natural death is “reasonably foreseeable.” In effect, the law prohibits assisted-death beyond the end stages of terminal disease, a limit that defies the underpinnings of the Carter ruling and fails to provide medical professionals with straightforward criteria or substantive guidance on this delicate matter.

The instinct to prioritize extreme physical suffering above all else is a deeply human tendency. Even without first-hand experience, people can relate to tangible pain. Compassion is natural. But abstract torment—the sort of ongoing suffering caused by an unquiet mind—garners far less empathy and even scarcer latitude. However unsettling it is to discuss, it is time for honest, open dialogue to begin on the matter of physician-assisted death for psychological disease.

Where the government’s narrow approach to assisted-dying has sown confusion and doubt around patient eligibility and physician liability, the distinct exclusion of psychological suffering further compounds uncertainty, as it inadvertently establishes an hierarchy of disease and opens the extent and validity of another’s suffering to broad debate. When the legitimacy of an illness can be arbitrarily called into question, people living with proven-irremediable torment will be denied their charter right to die simply because their anguish stems from a disrespected diagnosis.

The government will at some point, by choice or by force, amend its assisted-dying legislation which, in its current form, has been deemed unconstitutional by Peter Hogg, Canada’s foremost authority on constitutional law. When the required independent review regarding the scope of eligibility reports back in 2018, a comprehensive understanding of mental illness will prove crucial to making the law right.

Though significant gains have been made in demystifying mental illness and eroding the stigma attached to various diagnoses, there remains a reluctance to candidly discuss, or even admit to, an uncomfortable reality: As is the case for any severe or chronic health condition, for some, recovery from mental illness simply will not happen—not for lack of effort or will, mind you, but because the brain cannot right itself. Be it unrelenting depression or ruthless OCD, psychiatric disorders which prove not-responsive-to-treatment can, like a terminal cancer, slowly destroy the individual without mercy and without reprieve.

A point will be reached where there is little, if any, quality of life, and deterioration will only continue. It will not get better because in those specific, extreme cases, it cannot get better. Though painful to confront, this truth cannot be ignored. It’s key to understanding the true nature of mental disease.

To date, medical conversations around aid in dying have largely omitted this component of psychological illness. In arguing against assisted-death for psychiatric suffering, Euthanasia Prevention Coalition (EPC) president Jean Echlin insists: “If somebody loses their life now, they’re put to death, and two weeks from now there’s a breakthrough, they’ve lost their life when they could have had quality.”

But that’s a false premise. In making that argument, the EPC and similar organizations appeal to a misplaced faith in some imminent, miraculous recovery. They endlessly debate what if scenarios because they refuse to acknowledge the distressing reality of what is.

Forcing someone to exist for decades in what amounts to an excruciating purgatory is no morally or ethically superior than granting those living a ceaseless hell some control over their circumstance by allowing the option of a merciful end should they, at some point, choose.

Because, to be clear, these individuals will end the pain. Bioethicist Udo Schuklenk, who chaired the Royal Society of Canada’s 2011 panel on end-of-life decision-making, confirms “a large number” of those suffering from intractable mental disease will “at one point or another commit suicide, and it often happens in terrible circumstances”; these methods often further traumatize those left behind. Physician-assisted death offers “a better way for them to end their lives,” and provides a peaceful, controlled conclusion, where no loose ends remain to painfully fray. In this sense, state-facilitated “suicide” is a form of harm-reduction.

There’s understandable apprehension about “normalizing” suicide or being seen as encouraging—or worse, glorifying—death over treatment and recovery for psychiatric suffering. But suicide and assisted-death are two entirely different phenomena and should not be confused.

As the Centre for Suicide Prevention notes, suicidal urges are temporary and the act itself is one of desperation. At their point of crisis, a suicidal person “cannot see alternatives to their situation beyond death.” They do not want to die, but they lack the means to help them live. “Given help,” the CSP says, “they will choose help”; with proper intervention, recovery is not only possible, it can be expected.

Those qualifying for assisted-death explicitly want to die. They have sought and exhausted all available medical resources, and further treatment would not yield results. With no prospect of recovery or further improvement, their decision to die would be neither rash nor ill-considered, but carefully planned and, if carried out, done so mindfully.

A proper framework for assisted-death in cases of physiological suffering would see final approval granted to those who undoubtedly qualify while safeguarding the most vulnerable. Stipulating alternative pathways be encouraged throughout the screening process and mandating meetings with medical and psychiatric professionals who would offer the proper course of treatment to those who perhaps, to that point, had gone without or were unable to access it could, over time, save lives.

The right to assisted-death needn’t supplant or replace proper mental health funding and treatment, either. Where already available, in cases of terminal disease, aid in dying doesn’t replace or supersede comprehensive palliative care, but serves as an option in addition to it.

An excruciating life voluntarily cut short is undeniably tragic. So too is condemning others to an unending misery because the distress of those uninvolved—over the mere notion of an alternative—is deemed the greater bother.

 

Carleton’s unbalanced approach to wellness

For the Ottawa Citizen on March 14, 2017.

It’s hard to overstate the naïveté at the heart of Carleton University’s initial decision to remove the scale from its fitness room at the athletic centre.

The move, ostensibly “keeping with current fitness and social trends,” sought to promote a “more holistic” approach to fitness, body image and overall wellness by discouraging focus on weight. (In an email update Tuesday, however, Carleton said scales have now been put in the change rooms.)

Contrary to some reports over the heated debate sparked by the university’s decision, the scale’s initial removal wasn’t prompted by any specific request or complaint, but was an independent choice of the recreation and athletics department.

“We don’t believe being fixated on weight has any positive effect on your health and well-being,” Bruce Marshall, manager of health and wellness, told Carleton’s student-run paper, The Charlatan. “It takes weeks, even months to make a permanent change in your weight. So why obsess about it?”

Marshall, without a hint of irony, offered other numbers on which anxious gym-goers should fixate: “You can start by recording measurements in multiple areas, for example your torso, hips, chest, legs and arms. You would then revisit these measurements after a few weeks to keep tabs on your progress.”

He also suggested “the best indicator” in measuring success “is how well you feel in your body.”

Setting aside the comparative limits in tracking girth versus tracking weight – neither can provide any significant gauge of fitness, as neither separates the lean body mass from fat mass in those numbers – to advise success be measured in terms of self-perception speaks to lack of thought behind the attempted culture shift.

Recent years have seen a rise in this “body positive” approach, where emphasis is placed on learning to love your body and all its imperfections. This is not, at its heart, a bad thing. It offers permission to be flawed, and provides comfort in being human.

However, determining fitness-related progress by “how well you feel in your body” is a terrible strategy. Being remarkably lean and muscular, having a body others might envy, for instance, doesn’t magically translate to confidence, self-worth, or any real sense of accomplishment. Relying on “feeling” as a marker of success in the gym can be a route to self-destruction, and no less so than obsessing over numbers on a scale.

Tangible, reliable methods of tracking success in health and fitness are essential to sustained progress and maintained well-being, both inside the gym and out. While an imperfect tool, the scale serves as an easy, reliable motivator and monitor.

And while most associate the scale with the quest for weight loss, it’s essential for those whose goals in the gym include gradual, sustained weight gain.

It’s entirely normal to approach a scale with some hesitation. Having an unhealthy relationship with the numbers that appear, however, to a point where it interferes with daily life – where it consumes all one’s attention, drives irrational dietary habits, causes relentless anxiety – is a problem, and not one that is solved by the scale’s disappearance.

If there’s genuine concern over those struggling with body image or eating disorders in relation to the scale, then provide a list of resources, such as psychological and nutritional counselling, support networks and peer groups, one-on-one consultation on making goals and tracking progress, next to the scale, rather than removing it altogether.

There are far better ways to cultivate a more welcoming, well-rounded atmosphere for gym-goers than the athletics department initially chose.

And the increasingly hostile sniping between sides over the merits of the scale suggest the university has only served to create an even more unsympathetic environment for those already unsure of taking part.

 

Expanded thoughts, if interested: Learning to live with the body you’re in 

On Homeopathy, Health Canada Must End The Double Standard

For the CBC on December 11, 2016.

Until recently, homeopathic remedies sold in the United States enjoyed many of the same privileges — including the freedom to claim they could treat or cure specific ailments or diseases — as real, science-based medicine. The difference? Peddlers of homeopathy weren’t required to provide the Food and Drug Administration (FDA) with any evidence whatsoever to substantiate the miraculous therapeutic claims their products made. The same has largely been the case in Canada.

It was an abhorrent oversight by agencies tasked to protect consumers’ well-being, and one that only now being addressed by the Federal Trade Commission (FTC). In a statement issued last month, the FTC announced that homeopathic remedies, like all medications sold, must provide “competent and reliable scientific evidence” for all health-related claims, including, most importantly, “claims that a product can treat specific conditions.”

New labels

Absent that, in the U.S., homeopathic drugs will have to wear a label indicating that: “1) there is no scientific evidence that the product works; and 2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.”

Homeopathy is, as Steven Novella, academic clinical neurologist at the Yale University School of Medicine, unambiguously describes it, an “unadulterated pseudoscience … a prescientific medical philosophy.”

Its underpinning theory is that “like cures like.” Homeopathic drugs are made using trace elements of substances that cause symptoms in healthy people. Those elements are then diluted entirely out of existence, priced at a premium and sold as inert “remedies.” Infinite dilutions of poison ivy would be sold as the treatment for a persistent itch or chronic rash, for instance.

The idea is that water carries a “memory” of substances it has come into contact with — a theory that defies the basic principles of biology, physics, and chemistry. To find a single molecule of active substance in a 30C homeopathic solution (the dilution level of many over-the-counter homeopathic treatments), for instance, American physicist Robert L. Park notes you’d require a container of water greater than 30,000,000,000 times the size of the Earth.

Homeopathy is a lucrative business: we’re talking one where American consumers spend in excess of $3 billion per year. Yet the most comprehensive evaluation of homeopathy to date — a review of evidence from 225 studies, which met the required rigour of some 1800 published papers — concluded “there is no reliable evidence that homeopathy is effective for treating health conditions.”

The ‘natural’ choice

No amount of evidence will be sufficient to sway those hopelessly indoctrinated into pseudoscience, but many who turn to alternative medicine are driven by honest misunderstanding of how the body functions and how medicine works. Some are also driven by the appeal to nature — a seductive fallacy which argues that “natural” is inherently good, therapeutic, and pure — based on the notion that homeopathy is a natural choice.

Yet “natural” versus “synthetic” is a fundamentally false, meaningless comparison. Raspberry ketone, for instance, a purported natural “miracle fat-burner,” is a chemical extracted from various fruits and berries. It can also be synthetically made, then known as p-Hydroxybenzyl acetone. But whether “naturally sourced” or synthetically derived, it’s still C10H12O2 — a single chemical, with a set arrangement of atoms that behave in the same, identical manner. Not one, mind you, that involves “miracle fat-burning.”

That’s likely too esoteric for the average consumer, but clear labels indicating a lack of scientific backing surely is not. Canada, however, has only gone so far as to require labels for nosode products (which are touted as vaccines) and homeopathic remedies for cough, cold and flu marketed to children 12 and under. Everything else can stand on pharmacy shelves, right next to legitimate medicine, and sold as fanciful medicinal alternatives. Fortunately, Health Canada has just recently signalled that it’s ready to start cracking down on claims that have not be scientifically proven.

Health professionals have been in the trenches of this dystopia for some time — their fight for reason made increasingly difficult by governments’ own normalizing of pseudoscience. Timothy Caulfield, Canada Research Chair in Health Law and Policy at the University of Alberta, has rightly called for Health Canada to follow the FTC’s lead in requiring proper labelling to “ensure the Canadian public gets scientifically accurate information about the health care products and services they are buying.”

This isn’t complicated. Holding practitioners of alternative medicine — and the products they sell — to the same rigorous standards we apply to physicians, pharmacists and all other certified healthcare professionals is certainly not asking too much. If the U.S. can do it, why can’t we?

 

Re: Death By Pseudoscience – The Misinformation Campaign

First, a quick review of the facts:

David and Collet Stephan are on trial for failing to provide the necessaries of life — for failing to seek medical care for their son in a reasonably prudent time/manner. They are NOT on trial for murder or manslaughter.

Ezekiel Stephan died from bacterial meningitis, the kind which is vaccine-preventable and when promptly and properly treated, can be fully recovered from.

The child did NOT have viral meningitis

.

The bacterial meningitis was at such an advanced state by the time Ezekiel finally reached hospital, he was clinically brain dead and sepsis was coursing through his bloodstream; the post-mortem revealed pus on his brain, in his spinal fluid, and on his right lung.

These facts are 100% knowable, and known, and irrefutable. People lie, autopsies and medical reports do not.

The child’s health deteriorated for weeks: he was displaying neurological abnormalities (likely small seizures) and was neither eating nor drinking, but sustained through an eyedropper, as the parents stuck to the “game plan” they’d drafted to “use as many natural things” as possible before resorting to proper medical intervention.

As Ezekiel lay dying in hospital, his parents were defending the efficacy of their plan.

The CBC reports:

Asked by the officer whether he considered himself an expert in naturopathic remedies, Stephan said no.

“Do we have a formal education? No. Are we educated in it? Absolutely,” he said. “Has it worked for us in every single scenario in the past before this? Yes.”

Ezekiel was regularly given vitamin and mineral supplements, said his father, who is a vice-president of Truehope Nutritional Support Inc., a natural remedies company founded by his father, Anthony Stephan.

“And then when he was sick there, we were giving him, above and beyond that, the olive root extract, which is an antifungal, antiviral, it’s a very powerful one.”

The mother told investigators that the nurse-friend she called to check on Ezekiel advised he was showing symptoms of meningitis, and yet she ignored the friend’s advice to take the child to see a medical doctor. 

Instead, Collet “went online and researched meningitis … and it looked like he had about 95 per cent of those, the symptoms of a viral meningitis.”

Again from the CBC:



The mother told the officer she immediately started giving Ezekiel natural antibiotics and anti-inflammatories, along with a product called Total Reload, “which is filled with electrolytes, vitamins … and amino acids that are already a broke-down form of protein,” she said.

“And so we started getting that into him immediately and he started to improve very quickly.”

Total Reload is one of several natural supplement products sold by Truehope Nutritional Support Inc.

That “improvement” included his body being visibly contorted and too stiff to sit in his car seat when they sought out the Naturopath and purchased an Echinacea mixture to administer to the child.

Ezekiel was given another Truehope product called Empowerplus which, according to the father, “had obviously a profound effect on him, and he was doing great, he ended up going right to sleep and it was a completely relaxed sleep, he was no longer arching his back.”

No longer arching his back, and soon, no longer breathing.

The Stephans called 911 twice — with a 23 minute gap in-between. For a full 23 minutes after Ezekiel first exhibited signs of respiratory distress – the father counted 5- and 6-second gaps between breaths – the Stephans opted to ‘wait and see’ as Ezekiel struggled to breathe for nearly a half-hour.

Ezekiel did not die from lack of oxygen, nor was his brain affected by time in Ambulance without a properly fitting face-mask. The child was being worked on by paramedics the entire time.

Brain death from oxygen is markedly different from brain death from meningitis, and both the CT scan in hospital and autopsy conformed there were NO signs of brain damage or death from oxygen deprivation.

The child died from “a cardiac arrest secondary to what was likely a hypoxic event because of his overwhelming bacterial meningitis.”

Further to Ezekiel’s diagnosis and likely state of health, a paediatrician explains:

Dr. Adeagbo concluded that Ezekiel died from both bacterial meningitis as well as pneumonia with an accompanying empyema. Empyema is typically diagnosed in the setting of a bacterial pneumonia when pus collects within the lining of the lung.
So what does this mean? It certainly makes sense from a clinical perspective. Ezekiel likely developed bacterial pneumonia caused by infection by either S. pneumo or HiB, which went untreated and developed into an empyema. At this point surgical drainage is usually necessary for recovery in addition to appropriate antibiotic treatment. His bloodstream was repeatedly showered with the pathogenic bacteria, which eventually made its way to the child’s brain.

This new information adds to my suspicion that Ezekiel was much more ill-appearing than described by his parents and the nurse who visited the family’s home. Although there may have been some degree of waxing and waning of his symptoms, particularly with the fever he almost certainly developed during the course of his illness, I am very skeptical of claims that he had any significant recovery just prior to his arrest. This also makes it more likely that he suffered a great deal prior to his death.

Those who’ve been following this case will be familiar with the aggressive misinformation campaign mounted by the Stephans and their apologists/supporters.

A few to note:

Karen Selick, who I’ve touched on before.

Selick is acting as part of the Stephan’s PR campaign, and her connections to Anthony Stephan and Truehope go back to 2004 (more of her beliefs in dubious alternative health treatments are detailed here as well.)

She has a long history of working along side a man named Shawn Buckley — president of the Natural Health Products Protection Association (NHPPA – an alt-med/health lobby) and defence lawyer for David and Collet Stephan.

He previously represented Truehope/Anthony Stephan in the fight with Health Canada.

Buckley was supposed to be at a recent Total Health Show in Toronto, but couldn’t attend due to the trial. 

Selick was there, though, and distributing photocopies of her (now pulled) op-ed for the Lethbridge Herald (a nearly identical version still appears on Huffington Post Canada) where she lies about my column for the National Post and about the case itself.

Danielle Smith had Selick on her radio program to repeat a number of untruths about the case, completely unchallenged.

Smith later hosted a man named Ian Stewart to present the “other side” of the story.

Stewart is Vice-President of the NHPPA and Director of Regulatory Affairs for Truehope.
He is also the one behind the Stephan’s Stand 4 Truth blog where he offers a skewed interpretation of events from the trial.

Stewart was on Smith’s show – again completely without question – to misinform about the case and push the defence’s big ‘bombshell.’
Both Stewart and Selick (with many thanks to Danielle Smith) were instrumental in pushing the, as described by another member of the Stephan family:

Massive massive system shaking scandal coming out in court tomorrow as Albertas Recently retired Chief Medical Examiner testifies AGAINST the crowns star witness and the Provinicial Government specifically regarding this case!!!!!!!!!! Massive cover up!!!!!!

Here’s what you need to know about Dr. Anny Sauvageau:

Her qualifications and credentials have come under scrutiny before. She is not board-certified or trained in forensic pathology, nor does she have license to practice medicine in Alberta.

She did not, at any point, examine the child and her nonsensical testimony and blatant misreading of the autopsy would have medical professionals calling for her to be stripped of her medical license — but she doesn’t have one.

There’s much, much more to write about the many players involved in this case, the multitude of conspiracy theories they’ve concocted regarding the trial and the case itself, and the trail of lies from all involved which, thanks to testimony from medical professionals and recorded police interviews, have been exposed as such.

For now, however, just be aware of what you’re being sold when you’re presented with other versions of this tragic story, and by whom.