Ford and the Media

Ford and the MediaThis article is about the coverage of Toronto mayor Rob Ford, health care and the assisted suicide movement in Canada. In a global sense, media literacy about these issues needs improvement and I’m using the feeding frenzy around Ford to illustrate why. I am not religious, but am a huge fan of Denys Arcand and his films. This article has 2,200 words.

I recently watched Jesus of Montreal again after not seeing it for many years. The 1989 film is a postmodern version of the passion play and its literate narrative — its subtle humour and play within a play — allows viewers to consider Jesus’ life in both extraordinary and ordinary circumstances.

Like a canny aphorism, one scene has left its mark in my memory. It’s when the priest in charge of the shrine, where a controversial version of the play has been staged, lashes out at the actors after they make light of his faith.

Have you ever been here on a Sunday when it’s packed? Have you seen the Haitian cleaning ladies? The Guatemalan refugees? The elderly and forsaken? It’s a gathering of universal misery. They don’t care about the latest archeological findings in the middle east; they want to hear that Jesus loves them and awaits them…

Not everyone can afford psychoanalysis. So they come here, to be told, “Go in peace, your sins are forgiven.” It comforts them, a bit. That’s something. This is where we hit the depths…loneliness, illness, madness.

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The young actors, teasing the shrine’s priest

The exuberant young actors, who minutes earlier had been clowning around, mixing biblical phrases with advertising hyperbole, are momentarily struck silent. It’s moving. In a few sentences, the priest sums up his and his church’s mission: it’s to gently support the dispossessed in their misery. The reference to immigrants is likely what hooked me into the priest’s perspective and made the moment so memorable: my mother is one of that flock he so eloquently defends.

About Ford

Lately I’ve been writing about Rob Ford and about the push to decriminalize assisted suicide. The link between the two can be found in Denys Arcand’s sublime script, in the words uttered by the priest, the ones that speak directly to those in Montreal (and elsewhere) who are on the bottom rungs of society. Ford’s success was entirely predictable, or would have been, if those Torontonians most horrified by his tenure had bothered paying attention to the social climate in their city.

That they were caught off guard is obvious, so the most important question, even more important than the how of the situation, is the why of it. Despite the prodigious output of venom, coming in waves, layers and every colour imaginable, not one social scientist or political pundit, or even an upstanding spokesperson for Toronto-the-Good, has answered this question satisfactorily. While Ford is being blamed for being divisive — for pitting the servers against the served — critics who say so are over-demonizing the man, giving him way too much credit. That divide has been there for decades and Ford, in his disinhibited way, has merely had the gall to say so.

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Robyn Doolittle, author of Crazy Town, with Michael Cooke of the Toronto Star. No more hero narratives, please.

I left Toronto in the early 1990s because with my arts degrees I had no idea how I could support myself with a job I actually wanted. Now when I visit I stay at downtown hotels and wonder how on earth the chambermaids, valets and hotel receptionists, most of whom are immigrants, can afford to live there. My father’s job as a janitor gave me this sensitivity and curiosity. (Those are attributes that would have stood some Torontonians in good stead before the advent of Ford; let’s hope they figure it out in the aftermath.)

The Toronto Media

In the meantime, the media in Toronto has been showing its petticoat and giving us some insight into the parallel workings of egotism at several levels. Like Jesus of Montreal, we are getting narratives within narratives — we are getting the story of Ford’s bad habits — and we are getting the stories about how reporters broke the story. That over-focus on Ford has left some of us wondering if the powerful in Canada are encouraging the dumbing down of our media, if they’re encouraging the “deep” coverage of petty uproars, the kind caused by easy targets like Ford, to distract us and displace other information that might be more pertinent to our lives. Although Ford is accused of being a media ham, everything I’ve seen points at a press aiming to keep us amused instead of informed.

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Ivor Tossell’s essay about Ford reportage appears in the latest edition of The Walrus

The media savvy at Idle No More have figured this out, as have a few of us who are trying to shed light on stories of medical malfeasance in this country. Natives are upset about the lack of police concern and media coverage when it comes to their missing daughters, sisters and wives. People like me, who are concerned about institutional elder abuse, are trying to raise awareness of the issue before assisted suicide is voted into law. We’ve seen enough incompetence and wrongdoing in our health care system to know it is a comprehensively bad idea, but reporters are turning supporters of it into their own media darlings. 

So instead of laughing at how Ford drums up “retail” support via his many visits to Torontonians in need, maybe others in Toronto should step back, look at the larger picture and consider how class divides work in this country.

Our Healthcare System

Let me describe two scenarios. Two Toronto women, Joan and Jane, are diagnosed with similar cancers. Joan has a master’s degree in the arts and has been teaching for 30 years. Jane, whose name is an anglicized version of the one she was given, has been cleaning buildings since she arrived in Canada 30 years ago. She too has an arts degree, but since it wasn’t recognized in Canada and she needed work, she started cleaning even though it was far beneath her abilities. Her English is good, but not perfect, and her children, who could not afford to live in Toronto, live in Montreal and Halifax.

Both women have a form of cancer that causes pain in the early stages and both have been given powerful analgesics while they wait for operations. While Joan shows up with one of her children, who are all well-educated, her treatment pathway proceeds as it should. She sees specialists, meets with a surgeon, has her surgery and chemo afterwards. Jane, on the other hand, has a strong accent, which slightly distances her from the same process and shows up without her children. They haven’t asked for time off work to travel to Toronto because their mother is being vague about her illness. The analgesic, which is powerful, has rendered her muted and indistinct when it comes to answering questions. It’s also interfered in the organizing her treatment: she misses an important appointment because she is too chemically intoxicated to drive or take public transit.

When she is rescheduled for a few weeks later, the physician is very busy, hands her another prescription for pain and tells her it is unfortunate, but she must wait her turn. The powerful drugs muddle her thinking and the physician senses Jane is not someone who will make trouble if she is not treated with urgency — she is deferential and appears intimidated. By contrast, educated patients like Joan, whose children can and will make trouble, are prioritized. The physician doesn’t want the kind of grief her children can cause him.

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Hester Prynne from The Scarlet Letter. Is this where our nation’s media is headed?

So in a healthcare system with more patients than resources, this physician’s path of least resistance means being proactive with his well-educated patients and being less so, to varying degrees, with the rest. Jane is eventually hospitalized two months later, by which time the cancer has progressed to a terminal stage. Her children are told their mother waited too long to be seen and the only option is to provide her with comfort care until she dies. She is sent home with the promise of community caregivers, who show up intermittently. Her daughter takes an unpaid leave from work to help. Joan, in the meantime, has survived and participates yearly in one of the many fundraising walks to raise money for cancer research.

Anyone who doubts the possibility of these scenarios needs to step into my life. Although my mother’s story was slightly different, she is a lot like Jane, and I have no doubt there are many Janes out there. If I had had the option picking up a phone and asking someone like Rob Ford for help, I would have done so in a heartbeat. I would have asked him to advocate for my mother until I had a chance to organize a trip home. And it’s the power of that kind of accessibility that Ford’s enemies are under-estimating and under-estimating to their detriment.

It’s the same with assisted suicide, except that advocates in that case are over-estimating the strength of our healthcare system and aren’t taking the diminished experiences of people like my mother into account. Because people who support assisted suicide are mostly educated, they haven’t experienced inequities in the system — their education gives them the agency and confidence to survive, or at least successfully manage, a serious illness. And so it’s the cleaning ladies, the valets and the cooks, whose unpronounceable names and less-than-perfect English means they will likely be relegated to the medical slow lane, a lane where being treated proactively becomes a hit-or-miss affair.

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The Toronto Sun. Going too far?

That being said, supporters of assisted suicide do know they are advocating for a procedure that is meant for middle-class people just like themselves. And this is obvious because most advocates are using the class card to gather support. The caricature on offer is that only uneducated religious zealots oppose them, so if you don’t want to be lumped in with that herd of lummoxes, you better join us and say yes. Coupled with the requisite descriptions of agonizing deaths, this is neoliberalism at its Sham-Wow best.

The fact that the timing of treatments in Canada, especially in the immediate aftermath of a diagnosis, can differ according to variables like class, ethnicity, age and disability is something supporters of assisted suicide either dismiss or willfully ignore even after they’ve been informed. They pooh-pooh the idea because, of course, it interferes with their goal. 

So it’s disappointing that our media is so in love with itself that we hear stories about how they tell stories — about politicians like Ford — and we don’t hear that in some parts of Canada, it’s dangerous for the elderly (and others in Canada) to go into hospital without help from black belt advocates. Instead we hear about the actions of a garden-variety boozer, Ford, who does the predictable things that boozers are known to do: they lose their tempers, rant about people they may actually care about, and forget about having done so the night before. Anyone with even a rudimentary knowledge of alcohol abuse knows these things and also knows that our media is dining out on Ford’s behaviour in ways that are contributing to the very circus they’re criticizing. 

We don’t need another article or book describing the heroics of reporters who have “broken” the Ford story: believe it or not, most of us have seen heavy drinking people and politicians before. Ralph Klein was known to tie on one and act unreasonably, but the good people of Alberta didn’t lose their minds over it, which, given the current state of affairs in Toronto, makes them seem eminently sensible by comparison.

ford, media
Vince Offer the Sham-Wow guy

What we do need is a media that asks why segments of Toronto are behind Ford, despite his problems. Why aren’t their needs being served and how can service be improved? These questions would be one place to start.

But our media is failing us: they should be taking on the role of asking the tough questions of everyone, not just the Fords or the Ford Nation, and acting as a responsible intermediary between the political machinery of our country and a population that has a right to understand the entire context, and not just the context according to reporters and editors promoting a hero narrative that serves them well and us badly. Ford is not the problem; he’s a symptom and the sooner our media recognizes this, the faster we will return to news that is news and not reportainment. I’m not holding my breath though; the narcissism of our media, like the narcissism of some of our health care professionals, is profound and not likely to change soon.

The Idle No More movement set up a blockade on the rail lines between Montreal and Toronto today. They were protesting the lack of resources our nation’s policing authorities and media outlets put towards the issue of missing native women. Individuals from that movement have read my articles about health care and have commiserated with me: they know what it’s like to be ignored too. Maybe this is a good time to join forces with them and to suggest our media outlets get over their addiction to their own “heroism” — to stop obsessing about their work — and do their jobs properly.

They could start by reporting the news instead of trying to make it. 


Related: Ford and the Media and A Streetcar Named Congestion

irene ogrizek, cheeky canadianIf you like this post, please share it on social media and/or make a comment below. My site is designed to offer an alternative to the mainstream media: adding your voice may help journalists and politicians of all stripes remember what common sense looks like. Feel free to comment anonymously.

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How to die in Canada

“The best defense against democracy is to distract people.”

-Noam Chomsky

In 2013, Sammy Yatim was a young Syrian immigrant living in Toronto. On the evening of July 27th, he was shot and killed on a streetcar by police officer James Forcillo. In the minutes leading up to his death, he had exposed himself and brandished a knife at other riders. In one Toronto Star article, he is described as a “sweet, skinny teenager with striking green eyes….an introvert…and someone who struggled to fit into a new culture.” Yatim’s death raised a furor in Toronto and Officer Forcillo was eventually charged with second-degree murder.

sammy-yatim2There are other photos of Sammy. In them, he is a fit-looking young man, wearing a baseball cap and black tee. Below, he’s holding a bottle of Jack Daniel’s. He looks a lot like the young students I see at work, in the corridors of the college where I teach.

He’s making a fashion statement — he’s a little rebellious, but probably a good kid underneath. According to his friends, that much was true, but they also say that goodness was becoming harder to discern. According to the Star, “his circle of friends expanded and his dress sense changed. He went from 70477SAMMY-YATIM-GANGwearing Euro-style Adidas track suits to snapback caps and graphic tees…he started smoking pot, all in an effort to cultivate a tougher image.”

Below is another image, easily recognizable as the famous crack-video photograph, the one the Toronto Star used in its reportage of Mayor Ford. I’m including all these images to show how our media contributes to the formation of ideas we uptake and store in our collective consciousness.

Apart from the first photo of Sammy, taken with his mother, most of these are of a young man who looks a lot like the young men standing with Ford. The difference, which isn’t immediately apparent, is that Sammy was a young student with hopes for the future; however, he was clearly having difficulty the night he died.

Toronto Mayor Rob Ford and his friends
Toronto Mayor Rob Ford and his friends: I will refer to this image as the “crack photo”

It’s notable that the Toronto Star used the crack photo to augment a very active campaign against the mayor, to visually emphasize how inappropriate his companions were. The question posed by it was “What on earth is the mayor doing with those young men?” That question was based on the implicit assumption the young men were drug-dealing gang members.

Their assumptions may have been correct, but if you’re wondering why the police sometimes shoot young men like Sammy, we should look at how our media portrays others who look and dress like him. For example, the intended purpose of the crack photo was to point to the criminality of all the men in it. Unfortunately, that assumption is part of a larger pattern where the use of visual images in the media is concerned. Images are sometimes manipulated in ways that suggest connections that may not exist, connections that are meant to gain readers’ sympathy or fan their outrage.

An image of Sammy Yatim -- does it look familiar?
An image of Sammy Yatim — does it look familiar?

Why use photos this way? Because they draw in readers. And because of their drawing power, these visual patterns are repeated over and over again by publications like the Toronto Star. 

The problem is that the Sammy Yatims of this world end up paying for that strategy. When we assert that an image equals a fact, it can be dangerous. He was a young man who dressed a certain way, yes, but that cast a too-powerful suspicion over him and had fatal consequences. Although the police officer who shot Sammy went overboard — he fired nine times — I’m not sure he’s entirely to blame. The exposed genitals and the waving knife suggested that Sammy was either mentally ill or pumped up on drugs. It was the gangsta outfit, however, that likely sealed his fate: it suggested that drugs were more likely and that he was used to fighting with knives. Although it’s hard to know what Officer Forcillo was thinking, the accumulation of visual cues, which we are all exposed to via our media, must have been powerful.

Read my review of Robyn Doolittle’s Crazy Town: the Rob Ford Story. 

So given the mileage the Toronto Star has gotten with the crack photo, it’s ironic that they have taken a soft-hearted approach with Sammy Yatim and an antagonistic one with the police. It was no coincidence that of all the photos available, they chose the one including his mother to support articles pointing at police wrongdoing. The photo of Sammy holding a bottle of Jack Daniel’s wouldn’t have been as effective.

The public is not sovereign over the media -- the owners and managers, seeking ads, decide what is to be offered and the public must choose among these. People watch and read in good part on the basis of what is readily available and intensively promoted. Polls regularly show the public would like more news, documentaries, and other information, and less sex, violence and other entertainment even as they do and listen to the latter. There is little reason to believe that they would not like to understand why they are working harder with stagnant or declining incomes, have inadequate medical care at high costs, and what is being done in their name all over the world. If they are not getting much information on these topics, a propaganda model can explain why: the sovereigns who control the media choose not to offer such material. -From Manufacturing Consent, the Political Economy of the Mass Media
“The public is not sovereign over the media — the owners and managers, seeking ads, decide what is to be offered and the public must choose among these. People watch and read in good part on the basis of what is readily available and intensively promoted. Polls regularly show the public would like more news, documentaries, and other information, and less sex, violence and other entertainment even as they do and listen to the latter. There is little reason to believe that they would not like to understand why they are working harder with stagnant or declining incomes, have inadequate medical care at high costs, and what is being done in their name all over the world. If they are not getting much information on these topics, a propaganda model can explain why: the sovereigns who control the media choose not to offer such material.”
–From Manufacturing Consent, the Political Economy of the Mass Media

In Manufacturing Consent, Noam Chomsky describes two kinds of victims when it comes to war: the worthy and the unworthy. The worthy, he says, are those victims who have been abused by countries the U.S. and its allies are on adversarial terms with, like Serbia in 1999, when they victimized Kosovo Albanians. Unworthy victims are those who have been abused  by countries the U.S. is on good terms with, like Indonesia, whose military quietly started massacring the East Timorese in the 1970s, without raising nary a flutter on the world stage.

As a sensitive young man, Sammy Yatim would have felt the angst of watching the west treating Syrian casualties as unworthy, and so the stress of making himself feel at home here while his country’s innocents were being slaughtered, must have been considerable. Although Sammy was a good kid, he used alcohol and pot to cope.

How to die old

The Toronto Star used the crack photo to impugn Ford and they cast young men, who look a lot like Sammy, to provide an amoral landscape.

That, I believe, is a reflection of their values.

A similar pattern can be found in the use of another photo, this one impugning the reputation of Sandro Lisi, one of the mayor’s friends.

I don’t have an opinion of Lisi, but I suspect he is not a nice man. However, it’s not his behaviour I’m interested in, it’s how the media, and again the Toronto Star, is manipulating information in ways I find offensive. In a breathless list of alleged offences, the article only stops twice to state that much of the information cannot be confirmed. It’s understandable that not all Torontonians want Ford as their mayor; what’s harder to understand is why no one is calling the media out on their questionable practices. Like photographs of starlets’ dimpled buttocks and thighs, the Toronto Star is beginning to look like it’s having an affair with that other Star, that magazine of truly dubious distinction.

How so? In a recent article, commenting on a 1999 accident, the caption under the leading photo reads: Anna Kupraty was 76 when struck by a car driven by Alexander “Sandro” Lisi. It’s a lengthy article for the Toronto Star and it’s not until three quarters of the way down that an explanation, one which actually diminishes Lisi’s responsibility for the accident, appears. The photo of Kupraty, along with an ambiguous statement about her death, is being used as a hook at the beginning of the article; various other bad behaviours of Lisi’s are also described, including the ominous “[Lisi] was driving in a car crash that critically injured an elderly woman pedestrian, according to newly obtained court documents.”

Anna Kupraty
Anna Kupraty

Since I am an elder-abuse activist, you might wonder why I object to this story. I object for the same reason I object to the Star’s use of the crack photo. Individuals who have almost no bearing on the intention of the article are being used, against their best interests, to emotionally manipulate readers. The death of Anna Kupraty, which is provocative given her age, is being used to discredit Lisi and, by extension, Ford. The three reporters responsible for the article go so far as to quote eye-witnesses from the 1999 accident: “Witnesses described her flying and spinning through the air after making contact with Lisi’s windshield. ‘I can see her in my head — laying on the ground,’ one witness told a police officer, who recorded it in his notes. ‘I can’t believe she’s alive. I thought she was dead.’” Lisi was 21 at the time.

One of the characteristics of unworthy victims, as defined by Chomsky, is their absence in the media. Since 2008 I have been following medical malfeasance stories as they apply to the elderly in this country. It hasn’t kept me very busy because there isn’t much to read. It’s an odd situation, made odder still by the fact that media alerts I subscribe to in the U.K. and Australia, which focus on institutional elder abuse, are constantly sending me links to articles published in those countries. On any given day, I will receive 10 to 20. I read stories of court cases, of nurses and personal support workers arrested, of physicians being “struck off” medical registers, etc. But none of those stories, or at least only a very, very few, appear in our nation’s media.

Websites by private citizens are willing to cover stories of institutional elder abuse. Why won't our nation's media do the same? Websites by private citizens are willing to cover stories of institutional elder abuse. Why won’t our nation’s media do the same?

It’s not because abuse isn’t happening here — it is. I know because I am part of a Canadian network of activists and most of us, at one time or another, have sent articles about institutional abuse to our major media outlets. Most of us are professionals; most of us have seen or recorded outright incidents of abuse; many of us are good writers. But no one wants our stories. Not the Toronto Star, not the National Post, not the Globe and Mail nor the CBC or CTV or Global. These outlets will report on resident-on-resident violence in nursing homes, they will report on the trouble with waiting lists or dementia patients who attack staff. But when a patient or a resident is abused by a healthcare worker — a physician, a nurse or a personal aide — it’s as if these incidents simply don’t happen.

A video of my mother telling me about an odd drugging incident in her nursing home. 

So when the Toronto Star uses a vividly rendered story like Kupraty’s death for the sole purpose of harming a politician, in this case Rob Ford, I see red. I wonder why they are willing to provide a technicolour report for their own advantage, when reporting on suspicious hospital or institutional deaths of the elderly, in the usual course of things, is barely done at all. I wonder why those of us who are trying to keep our parents safe in our country’s healthcare institutions aren’t seeing our concerns reflected in our media. Like the disadvantaged young men in the Ford photograph, the young men who don’t see much of a future ahead of them, we’re feeling a void too. It’s as if we simply don’t exist.

Read: Why is the CBC promoting euthanasia? 

The Star and the Toronto Star -- having an affair?
The Star and the Toronto Star — having a lurid affair?

Emmett Shane, a CBC producer, has read my critiques and called me a crank; he says I am seeing a conspiracy where there is none. But I’ve spoken to families in almost every province and territory in Canada and we’re all having the same experience. So despite his claims, the paternalism of Canada’s media is clear to me and many other activists: we know there are only a handful of powerful Canadians who determine what’s fit for publication, and if they want to keep certain stories out of the news, they can.

There are also agencies like the Canadian Medical Protection Association that threaten television stations with heavy-handed CRTC complaints if they expose physician abuse. It happened to CHEX-TV in the Rouge River last year. There are also unions, like nurses’ and support workers’ unions, that speak to other unionized people working in the media. These are connections I’ve come to appreciate because I see them at work on Twitter, a social media site that can tell you a lot about who’s talking to whom.

The Canadian Liberal Party has announced that they will be voting on the issue of assisted suicide. This is happening with very little fanfare, very little debate. People like me, with parents in nursing homes, are worried: most of us aren’t religious and our objections aren’t moral. We are simply afraid hospitals and nursing homes that are already under-serving our elderly are going to get worse. A permissive atmosphere will develop and what will start off as a voluntary procedure will segue into an involuntary one, especially in institutions that have long waiting lists or are chronically understaffed.

To see my articles about Canadian healthcare, click here.

The bad news coming out of countries like Belgium and the Netherlands, which have both legalized euthanasia, supports this. The level of involuntary euthanasia is escalating and there is much in the way of peer-reviewed literature to prove it. But again, our media is not listening. I’ve attended several press conferences where specialists from these countries — academics, physicians and legal experts — have come to tell their stories. Very few reporters have turned up and yet most of our nation’s media outlets are writing articles that subtly and not-so-subtly support assisted suicide.

Yes, let's do that Hedy. And let's talk about why stories of medical malfeasance aren't appearing in our media and why the Liberals support assisted suicide despite overwhelming evidence that it's not working in other countries.
Yes, let’s do that Hedy. And let’s talk about why stories of medical malfeasance aren’t appearing in our media and why the Liberals support assisted suicide despite overwhelming evidence that it’s not working in other countries.

A video of my mother after being given her sleeping medication at 4:00 in the afternoon.

I suspect that influence from upper-echelon earners and learners and in this country is what’s causing the “inexplicable” absence of bad news. Study after study shows that it’s the wealthy and the educated, of both political persuasions, who are pushing for the decriminalization of assisted suicide. They are the ones most concerned about their dignity. So as long as these individuals get what they want — their made-to-order deaths — they and the media outlets they influence and control are willing to let the little people, like my mother and Sammy Yatim, die.

This is just one elephant in the room when it comes to the selective vision of the Canadian media. I imagine there are many, many more.

Sign my petition asking the Canadian government for more discussion of assisted suicide. Here is a video that illustrates what I mean by nursing home abuse:

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Ode to my mother

I’ve been in touch with Tom Mortier, a Belgian professor who lost his mother to euthanasia. She was 64 and suffering from depression. Although it’s a treatable disorder, a doctor in Belgium decided she was a good candidate for the procedure. Her children were not consulted beforehand.

It’s stories like Mortier’s that we need to hear while we debate the issue of legalizing euthanasia in Canada. 

This is a repost from May 2012 to remind us that every life is important. A link to Tom Mortier’s story is at the end of this article. 

I had the edifying experience of helping my mother survive a stroke. The same week, she had her non-paralysed leg amputated. She went from being an active 77 year-old—who swam at the Y six days a week—to a person with only one functioning arm.

When I say the experience was edifying, I mean precisely that: to edify means to instruct especially so as to encourage intellectual, moral, or spiritual improvement.

By choice, I never married or had children. I knew at ten I was destined for an unconventional life. Nancy Drew was my hero and I lived in a world of books, orchards and forests. Growing up on a farm gave me plenty of time to live in my imagination. What most people don’t realize is that farm work is often a solitary affair.

So when I was in my forties and my mother fell gravely ill, I had the life-changing experience of bringing home a human being who had to be changed and fed regularly. She needed 16 different medications and puréed food. Luckily, she could still talk.

ND1tsotocI had to buy a hospital bed, a shower chair and an electronic lift, and I had to learn how to manipulate my mother’s body in ways that wouldn’t harm either of us. I had to hire a live-in caregiver — to allow me to return to work — and had to orchestrate a bevy of caregivers to give our live-in time off over the weekends. Transporting my mother to the hospital for her bi-monthly check-up took more planning than I could ever have imagined.

For twenty months, I lost myself completely. And when I say lost, I’m not talking about that bewildering experience of losing one’s bearings. I mean I left my old self behind, took a break from my ego, and emerged a completely different person. I’m not sure I believe in God, but I do believe in a benevolent universe and it’s that universe that saw fit to teach me a few things about humility. This might be obvious to all parents out there, but you can’t be up to your elbows in a loved one’s dirty diapers without experiencing grace — it’s just not possible.

I also learned, from our many conversations, that my mother believed my father had been mentally ill and not just hopelessly tyrannical. This was a revelation for me. I had spent many years fearing my father and now all of that experience, years of it, was reframed in the time it took my mother to utter a few words. I wondered how it was that I had just missed this simple truth.

What else did I learn?

I learned it’s possible to navigate life with equanimity and goodwill even when one is profoundly disappointed. (In my case, by a healthcare system that does not serve the elderly very well.) I learned that we human beings are very adaptable: we can get used to virtually anything. For example, my mother is quite happy to be alive, even with her limitations. At 82, she is still an incorrigible flirt and beloved by the staff at her nursing home. She has a shy person’s vulnerable and irresistible smile, and an abiding and deep capacity for joy. I know because when I walk into her room and she says, “Hey, I’m glad to see you!”, I can tell she really means it.

But I’ve learned some hard lessons too. I’ve learned that I have limits as a human being and that I can’t help everyone. I find it harder to tolerate disrespect, especially when it’s directed toward the elderly. I speak up, even when it makes me unpopular. If I get angry, I try to walk away with love. I meditate. I cry—a lot. I’d like to say I’m grateful for all these lessons, but if I’m honest, there are days when I’m not. There are days when I want to be a child again, hiding out in the orchard or exploring the forest, building a birdhouse with my brother or just playing tag. Days when, like everyone, I just want to go home.

To read Tom Mortier’s story, click here.

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Assisted Suicide: Choosing Life or Death

euthanasia, assisted suicide, ogrizek, health, healthcare, canada
Life or Death
Dr. Margaret Cottle

Initially I wrote this article about the Liverpool Care Pathway. My opinion about assisted suicide, which is an entirely different procedure, has changed because of my exposure to compelling research. I now believe it should not be allowed or made legal. Vulnerable patients may have life-saving procedures withheld because medical practitioners deem their lives worthless. That became the predicament faced by my family. 

I’ve written two articles now about euthanasia. The experiences I had taking care of my mother are what inspired me.

I’ve also touched on the controversy surrounding the Liverpool Care Pathway. It’s a care-withdrawal protocol used with terminally ill patients in the UK. At the moment, Canada’s Supreme Court is deciding whether doctors here should have the same rights.

Most of us aren’t against assisted suicide in cases where the person requesting it is of sound mind. In 1993, I remember sympathizing with Sue Rodriguez, a 42 year-old ALS sufferer from Victoria, British Columbia. She took her fight for the legal right to die to the Supreme Court of Canada. She lost twice and in 1994, took her own life with the help of an unnamed physician. In 2012, Gloria Taylor, also diagnosed with ALS, was granted permission to end her own life. Taylor was granted an exemption to the law, but died of an infection before she could act on it.

Cases like Rodriguez and Taylor’s are compelling. They prompt us to question ourselves: what would we do if a disease like ALS found us?

assisted suicide, the right to chooseProbably because of my relatively young age, I had always been on the liberal side of the assisted suicide issue. Thinking of Sue Rodriguez, I couldn’t imagine myself moving forward, calmly, into the future that awaited her. However, over the last four years, I’ve watched my mother adjust to a significant degree of paralysis and that has given me another perspective. We humans are a fairly adaptable bunch and, fearful though we may be, I suspect most of us are capable of adjusting to the worst.

For example, unlike Rodriguez or Taylor, my mother wanted to live, even with her poor prognosis. In part 1 of this series, “The Right to Die,” I detailed the difficult conversation I had with her, the one where I told her what her future held. She was lucid and decisive. “I’m not ready to go” were her exact words; I repeated them verbatim when I asked to have her DNR reversed. The difficulty I had getting doctors to respect this reversal is outlined in Part 2, “The Right to Live.”

The Liverpool Care Pathway got my attention, probably because the controversy around it raises a lot of the same concerns I had when it came to watching the mishaps that befell my mother. She experienced a sequence of misdiagnoses, delays and postponements that were as inexplicable as they were catastrophic. I was dumbfounded by this: she had gangrene, a disease with an obvious symptom and an obvious cause.  The death of one’s flesh is due to a loss of circulation; the only wildcard here is the question of what is causing it.

Life or Death
My mother

My mother was not treated in a timely way and what started as one serious problem – a gangrenous toe – compounded exponentially. She is now wheelchair-bound and paralyzed everywhere except for her right arm. I was left with the very clear impression she had not been taken seriously by the various doctors she consulted. My conclusion is based on three things: what she reported to me in our daily phone calls; the conversations I had with doctors I had asked to intervene; the stonewalling I encountered after the worst happened. No one was willing to explain exactly what had taken place.

The LCP is raising concerns, not because of its intent, which is to alleviate the suffering of the terminally ill, but because like most drastic solutions, it is not without its problems. Since I was the caregiver for an elderly parent, I’m going to start with what I think are the most obvious:

  1. Timing: As Dr. Patrick Pullicino states, in his critique of the LCP, “Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically.” It is also subjective. On the advice of doctors at my mother’s acute-care hospital, I signed a DNR for her in October, 2008. It is now December of 2012 and she is still alive. Another example: an elderly man Dr. Pullicino pulled off the LCP recovered enough so that he was able to return home. The 71 year-old had been admitted for pneumonia; another bout with it landed him in hospital 14 months later, at which time he was again put on the LCP. He was dead five hours later.
  2. Lack of consultation with families: Dr. Margaret Cottle, a palliative care doctor from BC, stated that in an article published in the Canadian Medical Association Journal, a confidential study showed that a full 32% of 208 Belgian doctors had performed assisted suicide without the knowledge or consent of the families of patients. A further 20% had euthanized patients without the patient’s consent. They felt that to have that conversation – like the conversation I had with my mother – would stress the terminal patients too much. It was simpler, instead, to euthanize. The same lack of consultation is a problem in the UK. It was the families of patients, for example, who raised the initial alarm about LCP; they did so when they realized loved ones had been put on the pathway, also without their consent.
  3. Creating the conditions and premature deployment: In part 1 of this series, I wrote about Diana Ford’s struggle to keep her father alive. Like Rodriguez, she is also taking her case to court, via the Ontario Appeals Board. Her argument? Many doctors habitually under-treat the elderly, allowing dangerous conditions and diseases to worsen. By doing so, they are creating favourable conditionsforaprotocolliketheLCP. In my mother’s case, her symptoms of diminishing circulation, and then her gangrene, were treated as if she were on a slow boat to China. Although gangrene is potentially fatal, there was no urgency in her treatment that I could detect.AsPatrickPullicino has noted: “Very likely many elderly patients who could live substantially longerarebeingkilledbytheLCP.” Why? Because it’s the elderly that are particularly susceptible to the deployment of these
    My mother and her loving caregivers
    My mother and her loving caregivers, Vivian, Shannon and Lucy

    passive, let-nature-take-its-course strategies. It’s hard to imagine a doctor allowing a 32 year-old, with symptoms similar to my mother’s, being treated in quite the same way.

  4. The use of funding to promote the LCP: In England, reporters using the Freedom of Information Act discovered that hospitals that met quotas for putting patients on the LCP received significant financial rewards. Hospitals that failed to meet those quotas were heavily penalized. (One source of one hospital’s funding was halved when they didn’t hit their “target” numbers.) This creates a top-down incentive: administrators are motivated to look the other way when the LCP is abused. They do so to maintain high funding levels and to keep their jobs.
  5. Incapacitated patients may be abused: Not all sons and daughters are capable of taking care of their parents. Not all relatives or people who have power-of-attorney are honest. They may support the hastened death of an elderly relative or ward because they stand to gain financially. Again, this is a particular risk for older patients: most younger patients haven’t had the chance to accumulate wealth and most of them, like Sue Rodriguez for example, are of sound mind. The elderly are more likely to have significant assets and are also more likely to suffer from conditions which interfere with their decision-making. Easy access to the LCP may aid unscrupulous legatees.

(For more information on the Canadian version of this issue listen to Dr. Paul Saba here. )

These issues are not reasons to withhold a treatment like the LCP from everyone. For patients who are discernibly close to death, and who are in extraordinary pain, the LCP is humane if it is what they choose. The problem, of course, is creating a decision-making protocol to protect those most vulnerable to its abuses. The elderly are far more likely to be hastened towards death, as their deaths seem imminent and inevitable anyway.

In conclusion, we need to hold families and doctors accountable when the decision is made to end a life. Mandates for care have to be explicit and difficult conversations have to happen. The LCP pocket guide is shamefully vague. As someone who teaches young people, and insists they express themselves clearly, I read this pamphlet with dismay: it is one of the worst examples of weasel-wording I’ve ever seen.

When it comes to the right to choose, the LCP protocol is supposed to be offered to dying patients. It entails the withdrawal of food, water and medication. Patients are sedated so that they don’t feel these deprivations and their suffering is minimized. Nowhere in the information pamphlet are those hard facts made clear. They should be: the terminally ill and their families deserve to know the truth.

I hope the Supreme Court of Canada chooses well. The law may need to change, but poor ideas about transparency have to change too. Just making it easier for doctors to euthanize patients is not the answer.


Related: The Right to Die, The Right to Live, The Right to Choose

irene ogrizek, cheeky canadianIf you like this post, please share it on social media and/or make a comment below. My site is designed to offer an alternative to the mainstream media: adding your voice may help journalists and politicians of all stripes remember what common sense looks like. Feel free to comment anonymously. 

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The Right to Life

The Right to Life

Yesterday I wrote about how I signed a DNR order for my mother and then had difficulty having it reversed. Today I’m going to continue that discussion and take a look at the Liverpool Care Pathway. The LCP is an eponymous care-withdrawal protocol; doctors in the UK are meant to use it with terminally ill patients.

After I asked to have my mother’s DNR reversed, I encountered a lot of passive-resistance at her acute-care hospital. Staff became scarce and I suspected a lot of foot-dragging was going on. When she developed pulmonary embolisms, a few days after her stroke, I was told she had about 24 hours to live. Pulmonary embolisms are blood clots that form in a patient’s lungs; the danger associated with them is described on Medscape:

Pulmonary embolism is a common and potentially lethal condition. Most patients who succumb to pulmonary embolism do so within the first few hours of the event. Despite diagnostic advances, delays in pulmonary embolism diagnosis are common and represent an important issue. As a cause of sudden death, massive pulmonary embolism is second only to sudden cardiac death.

Pulmonary embolisms are like snowballs rolling down a hill: they just keep growing. An infection in another part of the body is what provides the embolisms in the lungs with the material that enlarges them. As blood circulates, smaller clots from the infection join those bigger, deadlier ones, and eventually patients’ airways are cut off. In my mother’s case, her gangrenous leg was the source.

For those of you who don’t know, gangrene is extremely painful and consequently is very difficult to ignore. In the weeks leading up to her hospitalization, my mother told me about her frequent visits to various doctor’s offices and walk-in clinics. It would be fair to say she sought help almost daily for two months, and so I had a hard time understanding why it took so long for her to be diagnosed properly. When that did happen, it was weeks before she was hospitalized. I also couldn’t understand why an important appointment, after her diagnosis, had been cancelled and then rescheduled much later.

When I tried to talk to the various doctors she’d seen, I was stonewalled. No one could give me a satisfactory explanation for what amounted to an inexplicable chain of delays and postponements. Instead they pointed to my mother’s age and suggested she’d probably been shy about asking for help because “old people don’t like to make trouble.” When I countered that my mother was an assertive 77 year-old who went to the gym everyday, they shook their heads or shrugged their shoulders. It became a habitual response: blame was routinely redirected back at her. Occasionally it was redirected back at me. I would be asked why it had taken me so long to come to her aid.

So like Diana Ford,* I found myself in an adversarial situation at a time when I was already managing shifting and unstable circumstances. Dealing with the bigger picture – taking in the accumulation of poor decisions made by various doctors – was something I was actively discouraged from doing.

Read “Hospitals, Shame and Vulnerability.” 

I mention my mother’s pulmonary embolisms because I became suspicious when I saw how that crisis was being handled. More specifically, I was not told why the radiologist, who was meant to install a venous filter in my mother’s infected leg, had scheduled my mother at the end of the next day, rather than at the beginning. Radiologists are doctors who read x-rays. They can also, if they are interventionist radiologists, perform procedures like installing filters in patients’ veins. This particular filter would prevent the micro-embolisms from my mother’s infected leg from attaching themselves to the larger embolisms in her lungs. The filter would save her life.

right-to-lifeImagine my agony as I watched hours tick by and saw other patients, who turned up for non-emergency x-rays, going ahead of her. It was only when I truly lost it – in a fit of profanity-laced behaviour I hope to never repeat again – that the hospitalist on duty took action. By my reckoning, my mother had the procedure a full 30 hours later, six hours longer than she was expected to live. That doctors were hoping she would die in the meantime does not seem farfetched. Whether by accident or design, the poorly managed timing of that procedure points to an ominous fact: some healthcare professionals are just plain menaces when it comes to treating the elderly.

So Ford’s contention that “her father’s case highlights a dark truth: that elderly hospital patients are not offered the same level of care as younger ones,” rings true to me. The inexplicable delays, the redirected blame, the oft-repeated theme of “old people don’t like to make trouble,” all frustrated me in the extreme. I often joked I’d be willing to sacrifice a month’s salary just to find someone in the hospital willing to tell me the truth.

Now I’d like to turn my attention to the Liverpool Care Pathway.

This care-withdrawal protocol first came to my attention when I stumbled across an article about Professor Patrick Pullicino, “a consultant neurologist who raised concerns that euthanasia had become a ‘standard way of dying’ on the National Health System.” His concerns echo those of Dr. Margaret Cottle, the Canadian Palliative Care doctor whose video I included in Part 1 of this series. The article about Pullicino appeared in the October 26, 2012, Mail Online and details the controversy.

right-to-lifeNHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds, a senior consultant claimed yesterday. Professor Patrick Pullicino said doctors had turned the use of a controversial ‘death pathway’ into the equivalent of euthanasia of the elderly.He claimed there was often a lack of clear evidence for initiating the Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country. It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent.

There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 per cent – 130,000 – are of patients who were on the LCP. Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway’.

What is most disturbing is that the protocol is supported and sanctioned by many healthcare bodies in the UK. In another Mail Online article by the same reporter, Steve Doughty, he makes it clear it was patients’ families who raised the initial alarm. Doctors who agreed with the families were outnumbered by those who continued to support the LCP. Doughty reports that:

right-to-lifeSeveral families have been shocked to find that their loved ones have been put on the pathway – which involves the withdrawal of food and fluids as well as medical treatment – without their consent. The average lifespan of a patient on the pathway is 29 hours. Yet, some patients who were taken off the pathway at the insistence of their relatives have lived for several months.

It is only recently that the APM, the Association for Palliative Medicine in the UK, has broken “ranks with the public stand of other medical bodies, who continue to give the pathway full support.” The APM did this because of the number of complaints they received from families of the terminally ill. In other words, it is the families who are now trying to regain some semblance of control when it comes to deciding the fates of their loved ones. This outcry should be ringing alarm bells on this side of the Atlantic; I hope Canada’s Supreme Court judges are listening.

The Mail Online, as well as other new outlets, has been criticized for sensationalizing the controversy surrounding the LCP, and for needlessly spreading fear about a way of dying that provides some dignity for the terminally ill. I’m not sure I agree and I’ll be discussing that in the Right to Choose.


Related: The Right to Die, The Right to Live, The Right to Choose

irene ogrizek, cheeky canadianIf you like this post, please share it on social media and/or make a comment below. My site is designed to offer an alternative to the mainstream media: adding your voice may help journalists and politicians of all stripes remember what common sense looks like. Feel free to comment anonymously. 

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