Tag: Health / Medical

01 Nov

Should living kidney donation be incentivized?

Hull & Hull LLP Health / Medical Tags: 0 Comments

A recent Canadian study suggests that compensation in the amount of $10,000 could greatly increase numbers of individuals willing to act as living kidney donors.  A reward system could also result in lower costs to provincial healthcare, due to the high costs associated with dialysis, and significantly improve the quality of life for those now awaiting kidney transplants.

The kidneys are a paired organ, but only one is required to remain in good health.  Living kidney transplants have the highest success rate of any transplant procedure, yet its frequency is much lower than it could be.  9,800 Ontarians are currently in need of a kidney transplant, and many suitable living donors, who are capable of saving lives, already exist.

The procedure for a living transplant is not risk-free.  However, with ongoing developments and highly experienced surgeons who are familiar with such procedures, the risks associated with donating a kidney are less significant than in the past.

There tend to be better survival rates for individuals who receive kidneys from live donors.  This is thought to be due to the better health of the kidney from a live donor, the potential for a match to be found prior to the removal of the kidney, and the immediate functioning of a live kidney after transplanted in its recipient.  The timing of the transplantation can be better planned, so that it is scheduled for a time when the donor and recipient are both in good health and less likely to suffer complications as a result of the procedure.

Currently, living donors benefit from the payment by the provincial government of donation-related costs, such as travel, parking, food, accommodation, and loss of income, but do not receive any further compensation.  Donating a kidney is a compassionate gesture, with the potential to save a life.  The typical alternative for the transplant recipient often involves living on dialysis until the death of a compatible registered organ donor.

There is some reluctance to implement this kind of financial incentive.  Some worry that paid donation could become a mere financial transaction or, subsequently, lead to the development of a two-tiered system, in which organs are donated to those who are willing to further incentivize the donation with their own funds.

Kidneys are not the only organ that can be donated by a living donor – parts of the liver, lungs, small bowel, and pancreas are all capable of being removed without compromising the health of the donor.  More information about becoming a living organ donor is available at the Gift of Life website.

Thank you for reading.

Ian M. Hull


21 Oct

Organ Donation: Is the Canadian “Opt-In” Model Working?

Hull & Hull LLP Health / Medical Tags: 0 Comments


Last year at this time Prince Edward Island was debating whether to initiate a plan that had the potential to automatically transform PEI’s 140,000 residents into automatic organ donors, unless they “opted-out”. This plan gained momentum when it became clear that there was an organ shortage and the province was desperately in need of donors.

This month a very interesting comment in the National Post has sparked discussion amongst Ontarians regarding this important issue and the contrasting models of “opting-in and “opting-out”.

There are two main methods for determining voluntary consent: “opt in” (only those who have given explicit voluntary consent are donors) and “opt out”(anyone who has not refused is a donor).

The “opt-out” model presumes consent of organ donation and all citizens are automatically considered donors, unless they specifically register to opt-out.

Opt-out models are widespread across Europe and countries such as Spain, Portugal and Belgium have one of the highest rates of organ transplants.

According to The Canadian Transplant Society, over 90% of Canadians support organ and tissue donation, but less than 25% have made plans to donate. The comment in the National Post discusses the option of shifting the current opt-in model, as the numbers of organ donation remain stagnant and nearly 1,500 people are waiting for a life-saving transplant.

Organ and Tissue donation is an important cause that has the ability to save many lives. According to the Trillium Gift of Life, one donor can save up to eight lives through organ donation and enhance as many as 75 others through tissue donation.

Thank you for reading.

Ian M. Hull

10 Oct

How to Save a Life: The Truth About Organ and Tissue Donation

Hull & Hull LLP Health / Medical Tags: 0 Comments

Organ and Tissue donation is an important cause and has the ability to save many lives. If you are thinking of registering to donate, it is important to be well-informed in order to make an educated decision.

Many people mistakenly believe that their age or medical history makes them ineligible to be an organ or tissue donor. The physical and medical condition of the organs and tissue will be assessed at the time of death and will determine what can be donated. Anyone 16 years of age regardless of their medical condition is encouraged to register consent for organ and tissue donation in Ontario.

On www.beadonor.ca you can listen to stories from adults and children whose lives have been saved by organ donors. You will hear about a young girl named Ryley who had an enlarged heart and needed a heart transplant when she was only a few months old. The transplant saved her life and her family is so thankful. Ryley is now an active six year old child with her whole life ahead of her.

If you do choose to register your consent, your registered donation decision is stored in a confidential Ministry of Health and Long-Term Care database and is only disclosed at end of life to your family for the purposes of honouring your decision. Organ and tissue donation has no financial impact on one’s family or estate and donation does not impact funeral arrangements. Also, you can withdraw or change your donor registration at any time.

To register your consent, or to check your registration status in Ontario visit www.beadonor.ca. To learn more information about organ and tissue donation visit www.giftoflife.on.ca or contact Trillium Gift of Life Network, Ontario’s agency responsible for organ and tissue donation and transplantation, at 1-800-263-2833 or by email at info@giftoflife.on.ca.

Thank you for reading.

Ian M. Hull

02 Oct

To Be or Not To Be: The Right to Die in Canada

Hull & Hull LLP Health / Medical Tags: 0 Comments

In several countries and states in the US, those suffering from terminal illnesses which give rise to unbearable mental or physical suffering are able to choose to die with the assistance of a medical physician. This controversial route is often seen as the best option in dire circumstances, where one wishes to maintain dignity in the face of impending death.

Only days before his own death, respected physician Dr. Donald Low made a public plea for Canadians to encourage assisted suicide legislation to be passed in Canada. Dr. Low’s views are being echoed by the vast majority of Canadians in recent years, where some statistics show that 80% of Canadians support the idea of allowing a medical doctor to assist a fully informed and competent patient suffering from a terminal illness to end their life.

Currently, no Canadian jurisdictions have right-to-die legislation in effect; however, for the first time in Canada, Quebec tabled Bill 52 which contains draft right-to-die legislation this past June. Federally, assisted suicide is illegal across Canada due to the application of section 241 of the Criminal Code; however, at least one recent Supreme Court ruling has questioned the constitutionality of this Criminal Code provision.

If Bill 52 passes and becomes law, Canadians may have the opportunity to create living wills which spell out circumstances in which euthanasia is a desirable alternative. Clearly, the controversy associated with such a drastic shift in attitude by the legislatures raises concerns for many. One such concern is based upon the need to ensure that the elderly do not feel compelled to agree to assisted suicide in order to reduce financial burdens on their families. Clearly, the capacity to decide to end one’s own life is also a serious issue which requires clarification by the legislatures.

Assisted suicide legislation will likely take some time to pass. Bill 52 has only passed its first reading in Quebec, and some feel that the Bill touches upon federal jurisdiction, raising issues as to the constitutionality of the proposed laws. Regardless of the outcome of currently tabled law and judicial findings, it appears that Canadian attitudes are shifting towards a greater acceptance of the right-to-die, which may lead to serious changes in laws reflecting these controversial policies in years to come.

Thank you for reading!

Suzana Popovic-Montag

25 Sep

Google’s Newest Mission: Immortality

Hull & Hull LLP Health / Medical Tags: 0 Comments

Google’s launch of its new biotechnology company called Calico (short for the California Life Company), an organization aimed at extending life expectancy through the curing of diseases related to aging, was announced last week.  The illnesses that Calico ambitions to tackle include various cancers, age-related mobility issues and mental incapacity, and aging itself. 

Since 2011, Google has invested in “numerous so-called moonshots”, including cars capable of operating without a driver and pieces of clothing that also function as computers.  At first glance, this new venture may appear to be just as far-fetched as its predecessors.

While the mission of the organization may seem unrealistic, there has been recent progress in the treatment of aging and aging-related illnesses.  Just last week, a study was published that claims that aging can be reversed on a cellular level through the combination of a plant-based diet, physical activity, and stress reduction. 

The two-group, five year study was coordinated by the Preventative Medicine Research Institute at the University of California, San Francisco.  The long-standing theory that telomeres shorten with age offers an explanation to the result.  Telomeres function to protect DNA and reduce in length as cells continue to divide.  Once a telomere becomes too short, the DNA that it protected is exposed to fraying by external elements.  Eventually, the DNA becomes damaged past the point of cellular repair mechanisms and ceases to replicate.  The remaining cells then expire, without the replacement by new cells.  Shortened telomere length has also been linked to the development of cancer, heart disease, obesity, stroke, and diabetes.

Telomere length is generally correlated to age.  Prior to this study, it was widely believed that telomeres could only shorten, without the capacity to re-extend.  Healthy lifestyle, however, is now believed to result in the lengthening of telomeres.  The study group saw an overall increase in telomere length within the cells of approximately ten percent over a period of five years, contrasted with an average reduction of three percent every five years for the general population.

Once Calico begins its operations, it is expected to fund similar studies that it hopes will reveal further anti-aging and disease-curing potential.

Thank you for reading!

Suzana Popovic-Montag

12 Sep

Hospital Survival Rates Increase

Hull & Hull LLP Health / Medical Tags:

Nosocomephobia describes an excessive fear of hospitals. Richard Nixon, who likely suffered from the affliction, once famously said, “If I ever go into the hospital, I’ll never come out alive.”

While checking the death rate at your local hospital may sound morbid, in Canada, it may offer peace of mind.

In Canada, the rate of deaths in hospital decreased in 2011-2012, according to a report by the Canadian Institute for Health Information. The death rate for each hospital is calculated based on the number of deaths at the hospital and the number of deaths expected in the region.

Of the 82 hospitals in Ontario, only four had death rates that were higher than the national average. All hospitals were found to have made improvements.

Holly LeValliant

16 Jul

Crematorium’s Plans Conflict with Neighbours’ Right to Clean Air?

Hull & Hull LLP Health / Medical Tags:

Crematoriums, according to a new regulation, are not supposed to be built closer than 300 metres away from residential areas. But, in Moore Park, in the GTA, the crematorium was built only 16.5 metres away from the neighbourhood.

“When I go outside and sniff, I wonder ‘Is this human remains or animal remains,’ according to a resident interviewed by the Toronto Star.

The crematorium applied to the Ministry of the Environment, and was granted the right to build new cremators that will allow for more frequent burns. The crematorium argues that the emissions produced by the cremators will be reduced and regardless, they do not need to follow the new regulations as their original facility was built prior to the regulations.

The local councillor has launched an appeal of the Ministry’s decision, arguing that the new cremators should be subject to the new regulations. The purpose of the regulations, according to the councillor, is to protect public health. Dr. Perry Kendall, B.C.’s chief medical health officer, warns that emissions from crematoriums pose potential health risks. Cremation, according to Dr. Kendall, could cause the release of contaminants, including mercury, cadmium, and lead.

As cremation becomes a more popular choice, the issue of emissions from crematoriums is likely to grow.

Holly LeValliant


15 Jul

The Kindness of Strangers

Hull & Hull LLP Health / Medical Tags: 0 Comments

Recently, the Welsh Assembly backed legislation which will create major reform for organ donation by switching from an opt-in to an opt-out system. Once this legislation comes into force in 2015, consent for organ donations will be presumed unless expressly refused by potential donors. Wales will join countries such as Spain, Poland, Sweden and many more which currently use a similar opt-out scheme. For these nations, the belief in the ‘kindness of strangers’ is no longer relied upon for organ donation.

This new Welsh legislation reflects studies similar to those conducted by a leading Canadian charity, which stated that while 90% of Canadians support organ donation, under a quarter have expressly opted to legally signify their intentions to donate.

Organ donation is a controversial subject for religious, ethical and political reasons. Canada continues to rely on an opt-in system in all provinces and territories due to concerns regarding whether a potential donor has stated their wishes clearly enough to allow for organ harvesting.

These tensions will continue as the trend towards longer waiting lists and less donors is predicted to increase. Statistically, “the older sector of the population is both a larger consumer of donated organs and a smaller contributor of donated organs.” Therefore, as the Canadian population ages, the pressure to explore alternative options will escalate, and the friction between principles of self-determination and the need for greater access to viable donors will likely intensify.

If Canada does chose to switch to an opt-out system, then it will be of even greater importance for all individuals who are concerned about opting-out of donating to ensure that their intentions are clearly expressed in their will and Powers of Attorney. This is especially so as relying on donor cards is problematic as they can be easily misplaced; and testimony of relatives can be misinformed. Wills, however, are always readily consulted and available, and copies are kept in the possession of the estate practitioner who drafted them.

Indeed, even without such a bill present in Canadian legislatures today, it is still of the utmost importance for Canadians to express their wishes in a legally binding document as opposed to relying on relatives, who’s own wishes may conflict with those of a potential donor after they have passed.

Thank you for reading!

Ian Hull

01 May

A Vial Dispute

Hull & Hull LLP Health / Medical Tags: 0 Comments

 When a person dies, those left behind are tasked with the challenge of dividing and distributing his or her property.  Disputes often erupt about how to split this property, and the answers usually lie in a will or statute setting out to whom the property is to go.  It is only in very rare circumstances that the discussion turns to whether certain items count as property.  The issue becomes particularly complicated when the putative property consists of human reproductive materials.

In J.C.M. v. A.N.A., the Supreme Court of British Columbia recently dealt with such an issue in the context of a separation agreement.  The couple, both women, had obtained sperm from an anonymous donor through an American company.  Each spouse had given birth to one of their two children using the donated gametes, so that their children were biologically related to each other.  Several years later, the couple separated.  The separation agreement divided all joint property of the relationship.  At the time of separation, they did not turn their minds to the remaining samples of sperm then stored at a facility in Vancouver.  Several years later, J.C.M. entered a new relationship and wished to use the remaining samples to conceive so that their child would be biologically related to the two children from her prior relationship.  A.N.A. wanted the vials destroyed and refused to consent to their release. 

Faced with the difficult decision, the court had to consider whether the vials were "property", such that they fell under the terms of the separation agreement.  There is a longstanding common law rule that parts of the human body are not property.  The court looked closely at an American case, Hecht, which dealt with whether or not a deceased testator could bequeath gametes to his girlfriend by way of his will.  The American courts declined to decide whether human gametes were property generally, deciding only that they were property for the limited purpose of the applicable legislative provisions.  At one stage, it was decided that 20% of the sperm vials belonged to Ms. Hecht based on a settlement agreement pertaining to the testator’s will between herself and his existing children.  This was overturned on appeal, wherein the court found that, although the vials were the testator’s property for the purpose of wills legislation and available for Ms. Hecht’s use, they were not subject to division through an agreement. 

Weighing Hecht and several other American and Canadian cases, the B.C. court held that, in this context, the vials were property and therefore were to be divided as such pursuant to the terms of the separation agreement.  Important to the court’s reasoning was that A.N.A. would not have a parental relationship to any children that might be born to J.C.M.

While some other jurisdictions have taken legislative steps to address this question, the issue of whether or not gametes can be dealt with by way of will in Ontario is still evolving.  As reproductive technology continues to advance, new questions will inevitably arise. 

Thanks for reading.

Suzana Popovic-Montag

13 Feb

A Beginner’s Guide to Advance Directives

Hull & Hull LLP Health / Medical Tags: 0 Comments


Advance directives, in general terms, are ways through which people can indicate ahead of time whether they would wish to accept or refuse certain types of medical treatment in the event that they become incapable of making that decision when that treatment is needed. 

Colloquially, advance directives are usually understood to mean written forms provided by hospitals, wherein individuals give instructions about the sorts of treatment they might like in an end-of-life care scenario if that individual is not able to speak for him or herself.  There is some confusion, in practice, between the more general meaning above, and this second, more colloquial meaning, and how these advance directives might interact with an individual’s power of attorney, or the instructions of his or her next of kin. 

The rules regarding consent to medical treatment in Ontario can be found in the Health Care Consent Act (the "HCCA").  In order for treatment to be administered, the patient must give informed consent.  If the patient is incapable of giving that consent, then s. 20 provides that the person’s substitute decision maker is responsible for giving or withholding consent.  This section also provides a hierarchy of who the substitute decision maker will be.  At the top of the list is a court-appointed guardian, followed by the patient’s attorney for personal care.  Further down the list are the person’s spouse, children, parents, siblings, and other relatives.   

The HCCA provides further under s. 21 that the substitute decision maker must make the decision according to certain principles.  If the substitute decision maker knows of a wish that the incapable person expressed while still capable and over the age of 16, then he or she is obligated to give or refuse consent in accordance with that wish.

This is where advance directives come into play.  They do not bind doctors or other medical professionals; rather, they bind substitute decision makers in giving or refusing consent to doctors or medical professionals by providing proof of the incapable individual’s prior capable wishes. 

These wishes can be expressed in a power of attorney for personal care as well, either by limiting the types of treatment to which the donee may give or refuse consent, or specifying the grantor’s prior capable wishes.  In this sense, a power of attorney itself is a form of advance directive.

If there is no prior capable wish, a substitute decision maker must make a decision in accordance with the incapable person’s best interests, a complicated and often contentious determination.  See my recent blog post on the Rasouli matter and Ian Hull’s recent blog on the care of Desmond Watson for a few examples of high profile debates over best interests.

As difficult as it may be to decide what care you might want in the event of a loss of capacity, it can be even more difficult for others to decide what care you might want.  Advance directives, either in the form of a power of attorney for personal care or in the form of written directives given in hospital, can be powerful tools to ensure that your wishes are followed.

Suzana Popovic-Montag


Enter your email address to subscribe to this blog and receive notifications of new posts by email.



Hull e-State Planner is a comprehensive estate planning software designed to make the estate planning process simple, efficient and client friendly.

Try it here!