Quebec at the forefront of assisted dying effort in Canada

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Exciting developments in Quebec. There is a cross-party consensus in the provincial parliament that assisted dying ought to be available to certain patients, namely those who are on palliative care, who suffer from a terminal illness and who consider their lives not worth living any longer. There is currently contradictory information in the media-reporting about whether assisted dying extends all the way to voluntary euthanasia or just assisted suicide. What seems clear is that the legislators avoid - likely for legal reasons - from calling what they proposing what it is. 

I have not been able to get my hands on an English version of what is reportedly a 400pp legal document indicating that Quebec is on firm legal grounds, constitutionally, if it decided to go ahead with this plan.

Here is how the Huffington Post has reported the gist of it: 

'Under the recommendations, patients themselves would have to make the request to a doctor on the basis of unbearable physical or psychological suffering. Two physicians would have to approve the request, which would have to be made in writing.
Doctors would not face criminal charges in these circumstances, the report said. Any law should state that the refusal, interruption, abstention from care or the application of a terminal sedative in those circumstances could not be considered a suicide.The Quebec panel, which was headed by lawyer Jean-Pierre Menard, said people suffering from an incurable or degenerative illness should be allowed to ask for medical assistance to help them die.'

'Discrimination' - always a wrong?

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I recall teaching in South Africa, in this case a large class of medical students (likely 300+ were in the lecture theatre). For some reason or other that I do not recall a student replied in response to a particular scenario (I think it was a resource allocation justice case study) that that would be discriminatory, implying that that in its own right would make it a wrong.

Indeed, in common language usage people often wield the discrimination flag when they think they have been wronged in an unfair way. Gay people in Russia claim that they are discriminated against, and that therefore they have been wronged. Some religious people claim discrimination in various contexts, for instance when they are asked to do certain things that their profession requires of them as professionals. They consider this form of religious discrimination wrong. British readers will see these sorts of claims frequently pop up in reporting of the Daily Telegraph.

What people tend to miss is that discrimination simply describes that someone is making choices for or against something. Say, I choose coffee over other beverages in the morning, that means I discriminate against those other beverages. Or I choose to fly in the front of the bus if I can afford to avoid the back of the bus, certainly on all flights longer than, say 5 hours or so. I discriminate against the cramped seating conditions in the back of the bus.

Discrimination is about making choices between options, it is about drawing distinctions.

Now, it seems to me that someone just claiming 'discrimination' is begging the question then. What question? The question of whether or not a particular discriminatory act is justifiable or not. Many people claiming 'discrimination' tend to beg this question. Think of discrimination based on ethnicity. Is it always wrong? If so, most affirmative action programs in operation today would then be wrong, too. Perhaps we should try, in our common usage of the term, to distinguish between 'just discrimination' and 'unjust discrimination'. 'Discrimination' claims without the qualifier should probably be ignored because it is unclear wether there is a problem to begin with. They constitute mere handwaving in the public sphere kind of activities. Once someone claims 'unjust discrimination' we should ask for a justification of the 'unjust' claim. It certainly is not the case, that 'Discrimination of any kind is wrong.'

Simple enough, isn't it?

Canada's Conservative government delivers to religion

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Canada's conservative PM Stephen Harper finally delivers on a promise made to his conservative religious constituency. He establishes today an Office of Religious Freedoms. Thankfully it seems to be a window dressing activity, soon to be forgotten, given its measly 5 mio C$ annual budget. There ain't much it can do with that amount of money.

What's wrong with a taxpayer funded outfit designed to protect religious freedoms in other parts of the world? Nothing in principle, but... there is no good reason to privilege people's interest in holding religious views (that are fundamentally ideological views about the world) over other ideological views of the world. Why not establish an office aimed at protecting moral views of the world, conscience views or whatnot, if one sees the urgent need to protect people's (however implausible) views about how the world came about, or if one sees the need to protect their medieval takes on sexual mores or any number of other issues.

Clearly this outfit serves to realize a promise the current Canadian government made to its religious hard core of voters. While its 5 bio C$ budget suggests that even this government doesn't quite see the point of putting a lot of money into protecting people's religious freedoms in other parts of the world, it is still money that could have gone to better causes (eg the protection of people's human rights, including their right to hold ideological views of the world).

Addendum: Turns out my suspicions about this outfit were well justified. It is headed by a Catholic 'Dean' of a religious college graduating reportedly some 16 or so students. The college reportedly praises itself as an institution celebrating a model of 'education' that was in operation prior to the enlightenment age. I can't help but wonder whether Mr Harper was keen on discrediting his religious freedom operation before it even got into action. If that's what he aimed for, he certainly succeeded.

Philadelphia Perpetuates the Myth To Clamp Down On Public Feedings of the City's Most Vulnerable and Poor

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Philadelphia Mayor Michael Nutter has yanked a page straight out of the old "Quality of Life" crimes playbook to inflict some shiny new misery on people who are already challenged to survive on a daily basis.

Waaaayyy back in November 2007, the National Coalition for the Homeless (NCH) and the National Law Center on Homelessness & Poverty (the Law Center) worked collaboratively to publish Feeding Intolerance: Prohibitions on Sharing Food with People Experiencing Homelessness. Back then, they provided a spreadsheet that listed the US cities that had some sort of ordinance or ban on street feeding:
 Almost 6 years later, not much has changed and in fact, this spreadsheet is woefully outdated today because a number of new cities need to be added, including Nashville and now, Philly (and Nashville initiated theirs so long ago that it's barely worth mentioning and is only listed here because I happen to live here). 

Why, you might ask, are Mayors like Nutter still justifying their actions years later based on debunked excuses for implementing punitive measures on peeps who are hungry?

Well, Mayors across the country participate each year via via The U.S. Conference of Mayors’ Task Force on Hunger and Homelessness, and they strategize on how best to eradicate homelessness.  The U.S. Conference of Mayors is the official nonpartisan (supposedly, anyway) organization of cities with populations of 30,000 or more. There are 1,139 such cities in the country today, each represented in the Conference by its chief elected official, the Mayor.



Now I would really like to think that all these participating Mayors were honestly interested in ending homelessness by providing real options for their city and the people who're experiencing perhaps one of the most traumatic and challenging times of their lives. This real policy change is accomplished by promoting housing-first strategies and approaches for the city's most vulnerable, ensuring a well-trained staff of direct service providers, and facilitating a collaborative and coordinated cross-agency effort that utilizes evidence-based and promising practices empirically proven to end - not manage - homelessness. 

But I also know that these approaches are not always fully embraced by communities - at first, anyway.  And money is tight in every city, as we're all painfully aware.  I also know that trying to navigate through the political land mines saturating the field of social policy choices bring with it high risk for those who're considering pushing upstream against the currents of the mighty river of Status Quo. 

I've got more than a sneaking suspicion that because these risks, should they go bad, have very high consequences to the good Mayors; and because those experiencing homelessness don't contribute to campaigns; nor are they typically a block of courted voters, since they don't usually vote (with any regularity, anyway); our Mayors tend to take a path of least resistance in terms of potential political ramifications and execute the "end" of homelessness through illusion, rather than through good, solid systemic policy change. 

And that path of least resistance seems to usually culminate in the Mayor of a given city, in this most recent case, Philadelphia, the "City of Brotherly Love," trotting out these lame justifications for the enactment of quality of life criminalization measures rather than to tackle the real issues related to the systemic problems that often lie at the root of an individual's homelessness, hunger, and poverty....    

Posted at 02:37 PM ET, 08/23/2012

In Philadelphia parks, churches fight to feed the homeless

By Charles C. Haynes Church ministries have been feeding homeless people in Philadelphia’s public parks for decades – not as a charitable gesture, but as an act of faith.
But earlier this year, city officials passed an ordinance banning public feeding of groups of more than three people in any city park – taking care, of course, to exempt city-sanctioned special events, family picnics and other gatherings the city finds more palatable.
The law targets church groups and charities that give meals to the homeless on land along the Benjamin Franklin Parkway, home to major museums such as the Philadelphia Museum of Art and the newly opened Barnes Foundation art collection.
Why make it so hard to feed the homeless in the City of Brotherly Love?
Philadelphia Mayor Michael Nutter’s official explanation for the ban is that he wants to move feeding the homeless inside (though the city is vague about how or when this will happen). Moreover, the city argues, church feeding programs are health hazards that create a mess in the park. The mayor offered part of the plaza surrounding City Hall as a temporary alternative location.
Religious leaders dismiss the city’s objections to meal distribution in public parks as bogus, pointing out that no one has gotten sick from the food distributed and volunteers clean up the space used. Moreover, many of the homeless who live in the park are reluctant to travel elsewhere (leaving their few possessions) – and some are too disabled to do so.
According to critics of the law, the real reason for the ban is the proximity of the feeding programs to tourist attractions, especially the new $150 million building housing the Barnes Foundation collection that opened in May.
To stop the law from taking effect, religious groups (with support from the American Civil Liberties Union) filed suit in federal court charging that prohibiting churches from feeding the homeless in city parks violates religious freedom ( Chosen 300 Ministries, Inc. v. City of Philadelphia).
The city responded by claiming that because the law “imposes no restrictions upon praying or preaching or reading the Gospel or engaging with the homeless,” the ban on feeding doesn’t interfere with the churches’ right to practice their faith.
In July, U.S. District Judge William H. Yohn, Jr., rejected the city’s argument and granted a temporary injunction barring implementation of the law. In a written opinion issued two weeks ago explaining his order, the judge wrote that government has no business ascribing some of the churches’ religious activities more religious significance than others.
To support his conclusion that the park feeding ban violated the religious freedom of the ministries, Yohn relied not on the First Amendment, as might be expected, but on the Pennsylvania Religious Freedom Protection Act.
That’s because the U.S. Supreme Court weakened the protections of the First Amendment’s free exercise clause in 1990, declaring that government no longer had to show a compelling state interest before denying religious exemptions to generally applicable government laws that substantially burden the free exercise of religion ( Employment Division v. Smith ).
In response to the court’s 1990 ruling, some states – including Pennsylvania – have passed legislation restoring the “compelling interest” test.
According to Yohn, Philadelphia’s public feeding ban would likely fail that test because the city has not shown that governmental interests are strong enough to override religious freedom in this case. Moreover, the city has not provided a truly viable alternative for relocating the feeding programs.
Philadelphia is not the only city trying to move homeless people and those who serve them out of public parks. According to the National Law Center on Homelessness and Poverty, more than 50 other cities have passed anti-camping and anti-feeding ordinances.
Nutter is appealing the court injunction. But whatever happens in the courts, church leaders in Philadelphia promise to keep the meals coming – even if it means defying the law.
After all, when it comes to helping “the least of these,” they believe in obeying a higher law.
By Charles C. Haynes  |  02:37 PM ET, 08/23/2012

" I totally understand the 'no money, no mission' paradigm. I also know that without collaboration and resource sharing, true, lasting change is not possible."

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Dr. Centrone elucidates a common situation those experiencing homelessness know all too well in just about every city in the country.  It is certainly true that in some towns providers have more effectively collaborated to accomplish far more together than they ever could have individually, but the truth is that even in most of those places, increased collaboration among agencies, services and resource allocators continues to be elusive and below the level that is actually available.

Homeless services have never been at the top of the priorities list for funding opportunities from their local, state and federal purse-holders.  They've always had to fight for very scarce resources and for a very long time, because so little was known about both the numbers of homeless in a given community and how best to serve them, oversight was....tepid; how does one provide oversight if one doesn't know the scope of - or the remedy(ies) needed to - correct the problem?  

As a result, agencies have learned to be protective of their funding streams while at the same time figuring out for themselves how best to address the niche they carved out as a result of the funding stream.

Let me explain:

 WARNING: BRAIN GLAZING FUNDING INFORMATION COMING!

grants are narrowly targeted. It's not like an agency can send in a "proposal" with a vague and overly broad request to "help people who are homeless" to someone like Housing and Urban Development (HUD) or the Substance Abuse and Mental Health Services Administration (SAMHSA)  That proposal must be pretty specific to the announcement of funding opportunity (a Request For Proposal/RFP. or Request for Application/RFA).  As a result, organizations often find themselves building their approach around a specific RFP, which then also essentially ties their hands to remain within the parameters of the requirements laid out in the RFP.

Because these funds originate at the Federal level (usually), it's challenging, to say the least, for Federal policy makers seeking to provide some help to local entities for their problems or issues to know exactly what this might entail.  They work around this in a couple of ways; first, by providing "block grants" to states so that the state itself can decide what priorities it will set and then release RFPs for the available funds. Second, the feds put out federal RFPs (duh) targeting specific approaches known as Evidence Based Practices (EBPs) or Promising Practices.   

Understand I'm being overly broad and vague myself on this as I don't want to put you to sleep, nor am I in any way, shape or form a Subject Matter Expert (SME) on grants and funding procurement.  But I do know probably just enough about them to be dangerous to myself and others with it, and part of this danger I think many of us share when we apply for funding at the local level.

This is because as I mentioned earlier, we find ourselves tied to the requirements - and the restrictions - within the grant itself.  And if the grant is disbursed over a period of years, as many of them can be, whole departments; hell, whole organizations may be built upon them.

This is a key point, because what then becomes an issue - sometimes the overarching issue - is keeping that funding in order to keep the staff employed in order to keep bringing the service(s) to the population being served; the “no money, no mission” paradigm. 

There's little incentive to collaborate or to share resources because a. the requirements of the grant narrow the scope of what the agency is able to do, and b.the agency is already running on a shoestring and the last thing they want to do is to give a competitor for those scarce resources any of the goodies - or the inside info around the grant requirements -  they worked their tails off to get for themselves. There's also little incentive to change funding streams, since winning a grant is always "iffy" and it used to be much easier to write a continuation application rather than a new RFP. 

Let be LOUD and clear here; agencies DO want to collaborate, and they often DO SO even when they know it can be potentially harmful to the funding they receive for the job they're doing.  It's just that for a very long time, there wasn't really a directive to find ways to to collaborate, nor was there a paradigm shift from - and this is a critically important point - managing homelessness to ending homelessness. 

Over the last 5-7 years, the Federal government has ramped up their investigative efforts around homelessness and have begun to understand much more clearly the scope of the problem. This in turn has helped to identify the remedies needed to accomplish this shift.

What they've discovered is what most folks on the ground providing services have known for quite some time; the precursors leading to - as well as the issues chaining people to - homelessness are varied, complex, and there is no "one size fits all" answer.

And, s it is so often, when we figure out one thing, new challenges and barriers suddenly materialize or come more sharply into view as a result.

Now one of the bigger problems we're all facing is getting people to understand the need for the paradigm shift from management of homelessness to the idea of ending homelessness, and this is no easy task.  People have some very deeply held beliefs around the causes and conditions of homelessness, and there are widely held stereotypical beliefs that, while often erroneous, continue to be pervasive and hard to eliminate.

All of this "discovery" and tactical shifting takes time, especially when it must come from something like the Federal government, who is as far removed from the realities of the daily life on the ground in Murfreesboro, TN or Round Rock, TX or Davenport, IA., as is a citizen of Zimbabwe.

The key here of course is to raise awareness, but it is also to ensure that as money flows from federal to state to local programs, those programs are evaluated based on outcomes tied tightly to ending - not managing - homelessness.  If, as your program has contact with individuals experiencing homelessness, you are releasing them back onto the streets when your "treatment" is complete rather than being able to release them into housing, we need to rethink continuing funding to this organization under a homeless services grant. 

Let me be crystal clear here; services to address the immediate needs of those experiencing homelessness are essential and must be continued.  HOWEVER, these services should NOT be stand alone services, and we must begin to hold agencies accountable for helping to end homelessness with every individual they engage with who is currently experiencing homelessness. If your service is not directly connected in some way, shape or form in the measurable reduction of people experiencing homelessness in your community, funding for your program should come from some other source to allow the scarce dollars allocated to homelessness to be used solely to assist with ending it. 

I know this sounds a little extreme, but if we want to reduce the costs associated with homelessness and bring an end to the scourge itself, there is only one real answer:
we must put people into houses. 

Slaying the Ego in Homeless Services Delivery by Wayne Centrone

Posted on September 11, 2012 by C4 Thought
At the end of our talk today at the San Diego, California Region IX Health Care for the Homeless Conference, I had an opportunity to speak with a service provider. He told me about his efforts to get organizations to build a coalition in his community. He told me about the six months it took him to schedule the first meeting of the homeless services agencies in his area.
He told me that he had not given up hope that the coalition will pay off with great dividends. I complimented him on his efforts and reassured him that his efforts would indeed pay off. I told him that he may never know the impact of his efforts, but, I told him, if his efforts led to ending the experience of chronic homelessness for one person, then it was worthwhile.
I enjoy speaking at these conferences. They are full of amazing people working in homeless services. I love to reconnect with old friends, inspiring thought leaders, and change agents. The people who work in homeless health clinics, supportive housing programs, mental health and substance use treatment programs around the country are gifted and courageous people.
I spoke at this conference with my colleague Steven Samra. We talked about our work on a new model of outreach we are calling “Housing-Focused Outreach” (HFO). Steven and I, along with the leadership and thoughtful intellect of Ken Kraybill, have been incubating the ideas of HFO for a few years. Our ideas are not unique. They are born from the work of Dr. Sam Tsemberis at Pathways to Housing, and the visionary work of the 100,000 Homes Project. Our ideas are also born from our years of experience in serving people experiencing homelessness and the work we have all been doing over recent years in visiting supportive housing programs around the United States.
The talk was about shifting the paradigm of service delivery. We are considering how to develop and operationalize a new model to impact agency level activities. A summary of our conversation, a work in progress, looks like this:
(1) In order to truly end chronic homelessness, we [homeless service providers, peers, and advocates] need to lead with housing and build effective bridges to supportive services.
(2) The only way to ensure adequate access to housing and supportive services is to build bridges of collaboration with a number of organizations and resources.
We talk about the fact that most communities around the country have the pieces to put together a really effective model to end chronic homelessness. The issue, however, is that these pieces are fractured and disjointed from one another. Our main predicate for the Housing Focused Outreach model is training service providers to be experts in building partnerships.
When we give this talk, we hear repeatedly how little collaboration actually occurs on the ground. I hear over and over again at talks like this: “Oh, that [collaborating with partner agencies] won’t work . . . we are all fighting for the same pot of money, and we can’t really collaborate or we will lose our agency level effectiveness.”
Don’t get me wrong, I totally understand the “no money, no mission” paradigm. I also know that without collaboration and resource sharing, true, lasting change is not possible. I am not sure how we can get more people invested in the idea that collaboration is one of greatest and most underutilized tools. One thing I do know: it will take some serious ego slaying and a strong commitment to service.

Trail Food: Justin's Honey Peanut Butter

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While shopping at a local Target department store, we were browsed the food aisles looking for possible backpacking fare. While standing in front of a wall of peanut butter, we noticed some small boxes with individual packets of peanut butter. From the four boxes we selected a small packet of Justin's Honey Peanut Butter to sample at the office. Today was the day.

The packet of peanut butter stated to knead before opening. Being a military veteran, this brought back memories of little green packets of peanut butter in the ubiquitous Meals-Ready-to-Eat (MREs). We once failed to knead and were punished with oil and a thick peanut flavored nougat. We rolled the packet between our palms rapidly.

Finding a small nick along the side, we opened the packet slightly and squeezed a dollop onto a waiting cracker. We definitely tasted peanut butter, but not a heavy taste of peanut butter. On our second dollop we distinctly could identify the taste of honey. Finally, we tore open the pouch and dug in with a small plastic spoon. The peanut butter was tasty, but a bit mealy feeling in the mouth. Perhaps we had not spent enough tie kneading it before use.

The packet indicates Justin's Honey Peanut Butter is kosher and gluten-free. A 1.15 oz. (32 grams) packet provides 190 calories. The very high calories to weight ratio and the good taste makes packets of Justin's Honey Peanut Butter a new inclusion on our backpacking meal plan this year. Last year we flagged a bit after a few days out, so we'll toss in some peanut butter packets to see if that helps us maintain our appetite around day four.

UPDATE 5/31/12 - We bought ten packets of Justin's Honey Peanut Butter for our upcoming 10-day section hike of New York.

Disclosure: We select and purchase the product(s) reviewed. We have no material connection to either the manufacturer nor the retailer(s).

Stop the bike vs car wars - we're all at fault

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No matter what mode of transportation you name: cars, bikes, feet, bus, trains, airplanes, or rollerblade, someone is going to gripe about people that use that form of transportation. With a background in bicycle advocacy, I have heard more than my share of gripes about the way bicyclists and motorists operate.

Instead of arguing who's right or wrong, or what road users break the law more often, I try to diffuse the tension and give people a little perspective with a couple of thoughts.

First, my personal opinion is that all road users should obey all traffic laws all the time. That includes signalling turns, not speeding, yielding to pedestrians, not going through an "orange" light, full stop at stop signs, etc. But we all know that everyone breaks at least some laws every time they take to the road. Yes, even you. Let's try to concentrate on stopping people from doing things that are going to endanger other people.

And before all my biking friends jump down my throat, and if anyone else is interested in a perspective on why bicyclists blow stop signs, here's a little article from Toronto to give the other side.

My second approach, to try to get people off the "who's worse" train, is that it's not the vehicle that causes bad behavior. It's the person using the vehicle. And most bicyclists are also drivers. They are probably scofflaws when they drive as well. You may see them, or only pay attention when they are on their bikes, but they probably get behind the wheel and break the law there too. If someone is in a hurry or is reckless when riding their bike, then they are likely in a  hurry and reckless in a car as well.

And finally, people ask me what they can do to improve the driving (or biking) of others. As an elected official, people constantly asked me how to get people to stop speeding, or how to get people to yield to pedestrians. Well, it's not easy, and we all have a part. We have to speak up, and it may be speaking up to those we love.

How often do each of us ride in a car with someone else, and notice that person speeding, blowing a red, not coming to a full stop before making a turn, or not yielding to a pedestrians? And how many of us say something to our spouse, friend, co-worker, neighbor, parent or sibling? If we see our neighbor blow the stop sign at the end of the block every day, and don't say anything about it, how can we expect anyone else to get through to that person?

So yes, the police can run around ticketing people for every little thing, but that is going to cost you, the taxpayer a ton of money. Contrary to what some people think, it costs the city money to enforce those laws. The time required to stop someone, do a license check, write the ticket, file the paperwork, and then possibly go to court when the person contests the ticket, is far more in staff time and resources than the money coming in from that ticket. That's not to say that we shouldn't enforce traffic laws, but we are never going to get perfect compliance by using law enforcement only.

Why do people yield to pedestrians in California and many other parts of the US? Because that's just the way things are done, and you learn that from the time you start to walk. It's cultural, like being stoic about cold weather in Wisconsin. (Or a more negative cultural tradition, drunk driving.)

We all have to start being responsible for our own behavior and also speaking up when we get the chance. Don't sit silent if you see someone speeding, and you are sitting in the car next to him. Say something. And let's all watch our own behavior as well. none of us is perfect, regardless of whether we walk, bike, drive, roll, or run.

We can make the streets safer for everyone, but we all have to be part of that change.