Transplant

This past week there were two separate stories about liver transplants. The first was about the parents of adopted twins, both of whom need a liver transplant. The dad's liver is compatible - but he is only able to donate part of his liver to one of the children (CBC). Somehow he has to chose which of his three year old daughters gets part of his liver. The family are making a public appear for another donor. The second story was about the widow of a long term alcoholic who was told he was not eligible for a liver transplant until he had stopped drinking for six months. She is planning on constitutional challenge of the policy, stating that it wrong to discriminate against alcoholics because of their illness (National Post).

For the parents of the twins it is an impossible decision. No parent should ever have to decide which of their children will die. Their agony must be unbearable. Similarly I can understand the frustration of the wife who had to watch her husband die because of a medical rule, that while it may make some sense, denied her husband the opportunity to get better.  These stories are particularly sad at least in part because not enough people are prepared to donate their organs upon death.  If there were more organs available, I suspect the father of the twins would not be facing the decision he is, and doctors and hospitals would not be forced to decide upon who gets access to a limited number of livers.

There is however, a relatively simple and achievable resolution for both of these scenarios. Upon death, organ donation should be automatic. It makes no sense to me that people are dying because they cannot get an organ transplant while other people, who are already dead are being buried with what could have been a life saving organ. It make even less sense to me that a family member has the right to make this decision.

While there appears to be a fair amount of academic research as to why people neither sign a donor card and/or tell their family and friends that they wish to be have their organs used when they no longer need them, much of it is not available without expensive journal subscription. However in perusing some of the abstracts on Goggle Scholar it would appear that at least some people are reluctant because of a profound mistrust of the medical system (CriticalCareNurse). Indeed if one delves into the darkness that is the internet one can find sites that argue this point of view. Some blogs etc. clearly state that one should not sign a donor card because it means that the hospital will let you die so that they can harvest your organs (and make money) (Crawford).

(As a side point, it would seem to me that these sites that spread false information potentially kill far more people than do the sites that advocate radical extremism. Yet our government ignores the former while spending millions trying to track down the latter.)

People also appear to have some apprehension about who decides and when it is decided that a person is dead.  While I understand people's unease I suspect however, that for the vast majority of people who are dying, the decision is pretty obvious. Surely this is something that people who have some unease over this issue, can clarify with a doctor.

And finally there appear to be some people who do not believe in organ transplants because they want or believe they need to have all of their body parts still attached to them when they get to heaven. I wonder if that means that everyone who has lost their tonsils or their appendixes or had an amputation are ineligible to get past Saint Michael's steely gaze just outside the Pearly Gates.

We need to have a national discussion about organ transplants. I suspect that many of the reasons that people give for not signing the card have not been thought through.  I also suspect that if organ donation was automatic unless the person said no, that the vast majority of people would not bother putting in writing why they were refusing.

I also wonder if it was government policy that only those who agreed to donate would be eligible to receive an organ, if more people would sign the card.   If altruism does not motivate people, perhaps self interest would.

Tim Hortons

The various media outlets are all abuzz with the news that Tim Hortons and its now parent company, Burger King, are laying off a significant percentage of its head office employees. The actual number is not clear. While corporate headquarters have announced that they will be letting go 350 staff go (Globe and Mail), at least one employee suggested that up to 40% of the staff would lose their jobs. I would suspect that the final count will never be known in part because some of the positions will be lost through attrition.  The layoffs appear to be a surprise only to the employees. Economists predicted within days of the announced buyout that layoffs would happen (Huff Post). It was the Canadian government, when they approved the sale of the Tim Hortons to a large multinational, who set the percentage of jobs that would be.

It is not that Tim Hortons are broke or even close to bankruptcy. Out of every ten coffees sold in Canada, Tim Hortons sells eight. A year ago the corporation reported that both their revenue and the return on their shares had increase (Huff Post). Staff lost their jobs because 3G Capital, the Brazilian investment firm that owns roughly 70 per cent of the merged company strips their new acquisitions of everything they can to maximizes its profits (Globe and Mail).

But Tim Hortons are not the only profitable company in Canada that have announce layoffs. CIBC have announced that they will "selectively reduce a number of positions," (CBC). CIBC in 2013 made the most money it has ever made in a single year (CBC). In May of last year, the most dominant store in North America, Wal-Mart announced that it was going to lay off 750 head office employees (CBC).

These three companies are not unique. They, like so many of the companies that we appear to rely on, have one thing in common with each other. They are multinational organizations with obligations to their shareholders; obligations that far supersede any sense of loyalty to their employees. These shareholders have created a new definition of the phrase "record year". They demand that every year the company have a record year. That is, every year they must make more money than the year before. If their profits are not up, then the company's share prices will go down and someone will demand the head of the CEO. A record year should mean that the company has had an exceptional year. It should be accepted that not every year can be exceptional; that some years the company will make less profit.  Clearly the three above companies amongst thousands of others have bought into the concept that profits must increase. I suspect that the large institutional investors including insurance companies mutual funds and teacher's pension funds (whose members demand a high return) are part of the problem.

While many, as they line up for their morning coffee, will rightly complain about the 3G Capital's shoddy treatment of Tim Horton's head office staff, nothing will change. People will still demand coffee at the lowest possible price from either Tim Hortons, Starbucks or MacDonald's. How those multinationals achieve those low prices will not concern very many people in those lines for very long. Except of course for those who are now unemployed.

All of the people in that line up for their morning fix of caffeine and who have money invested in mutual funds or have a pension fund should feel just a little but responsible.

Canada's Criminal Justice Sytem #1

Earlier this week, in the tablet edition of the Globe and Mail there were two separate stories on Canada's attempt to change (or in one case not change) our laws and practices in terms of our correctional system. While the Globe did not connect the two stories, I think they are very closely connected. Both stories should encourage Canadians to once again visit the larger debate as to the purpose of incarceration.

One story was about the Canadian government's rules on solitary confinement in federal prisons  being constitutionally challenged by a second group of concerned citizens (Globe & Mail). The second story was about the government's plan to propose legislation that would ensure that criminals who are found guilty of first degree murder can be incarcerated for their entire lives with no possibility of parole (Globe & Mail).

While the issue of if we should, or how long we should, isolate prisoners has been revitalized since the tragic and unnecessary death of Ashley Smith and the resultant Ontario coroner's inquest, and the more recent death of 24-year-old Edward Snowshoe, it is not a new debate. Solitary confinement was, at least in North America originally created in the early 1800s to allow prisoners time for solitude, so that they could reflect, read the Bible and repent of their devious ways (NPT; Mother Jones). From the very beginning of this experiment it was noted that instead of people changing in a positive way, their mental health became worse (NPT; Scientific American). More recently there have been numerous  studies all suggesting that depriving individuals from contact with other individuals will negatively affect their mental health and therefore their behaviour (Haney; Hresko; Rhodes). It is very clear that solitary confinement does nothing to either rehabilitate the individual or to prepare them to live in society (Scientific American). Its only value is to punish people in a way that cruel and ineffective. It would be perhaps more useful to look at reasons why solitary confinement is now being used and what would be more an effective alternative to managing that behaviour. 

This focus on prisons being a place of long term punishment is not new. In the past few years the Conservative government has established mandatory sentencing, the new "Truth in Sentencing" law and allowed that both sentences (for multiply murders) and parole ineligibility can be now be applied consecutively. The fact that the Canadian Government has refused to deal with the larger systemic problems of our correctionalsystem confirms that for the Conservatives, prison is about harsh punishment not rehabilitation. 

All of these policies were designed to lengthen the amount of time prisoners spend in prison. Clearly these laws pander to the Conservative's base who are of the belief that crime is rampant and that the only way to deal with crime is to incarcerate people who deviate from the norm in the harshest manner, for the longest period of time. I agree.

Or rather I would agree if there was one shred of proof that (1) Canada's crime rate is spiralling out of control or (2) that harsher punishment stops people from committing crime. Neither of those assumptions are true.  Less than a year ago it was reported that Canada's crime rate is at its lowest point in forty years both in terms of numbers of offenses and the severity of those offenses (Star). Secondly, while there are indications that if a potential criminal is certain that he is likely to get caught (e.g. there are more police with radar guns on the highway during a long weekend), they are less likely to commit an offense (less likely to speed), the actual severity of the consequence is not relevant (Chen,Sapario; Wright) when they are deciding to commit the crime.

The Conservatives are quite right. There is a problem within the Canadian justice system. Incarcerating people for longer times will, once again, only deal with the symptoms of those problems and ignore the real issues.

What else is new?