Beruflich Dokumente
Kultur Dokumente
The Roundtable
Winter 2007
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By Don Renaud, CPABC Director In November 2006 Britains Royal College of Obstetricians and Gynaecology sought open debate on the ethics of life-shortening and deliberate interventions to kill infants in the way of management options available to the sickest of newborns. Britain seemed far away until it became the subject of my discussion over coffee with a lawyer who was representing an obstetrician in a medical malpractice case. She held a similar view to that of the RCOG. Perhaps because she had bought me coffee she felt at liberty to attempt to persuade me of the common sense of the obstetricians position on euthanasia. I felt as though the top of my head was going to come off. Obstetricians and the lawyers that represent them in court are elite opinion shapers. Their quality of life for family and caregivers arguments are a veneer for the real issue its about the money. At least The Economist, in an editorial in a November 9, 2006 editorial, was honest enough to say so; calling the RCOGs submission brave but clearly supporting it based on the financial cost savings to the state. So if we are really just talking about money, where does a professional association of obstetricians get off calling for a debate on infanticide? Obstetrics, along with orthopedics and neurosurgery, is a medical specialty to which insurers assign the greatest risk. Insurers assess premiums based on the risk of specialty. Obstetricians pay much more for malpractice insurance than most other specialists. Human birth is an extraordinary natural phenomenon involving an intricate series of events. At almost any stage, things can go very wrong. For the vast majority of human existence, childbirth was a leading cause of death for infants and young women. During the 20th century, the infant and maternal death rate plummeted due to a series of adjustments and innovations which constitute todays obstetrics package. Yet we are facing increasing rates of infant disability and in particular cerebral palsy. Whats going on? Like so many things, the answer is complicated. One reason may be that women are much more often putting off childbirth to later and riskier ages to accommodate lifestyle and career preferences. Use of fertility drugs as become much more common, in part to facilitate this preference. This adds further risk as multiple and/or premature births become more common. Another theory has to do with our industrialized, production line approach to childbirth. Pregnancy, labour, and delivery are not so much individualized experiences as managed processes with multiple health professionals. Systems have glitches. They break down when theres
communication failure or delay or an unclear chain of command. Yet another theory has todays quite safe cesarean section delivery as the culprit. The C-section rate is much higher today than in previous generations. The flip side is that obstetrical skill levels in performing safe assisted vaginal deliveries have dropped off through disuse. Then when called upon, non-surgical techniques achieve a live but injured infant. To complicate the situation further, government bureaucracy steps in to monitor and then try to push down the Csection rate because of the financial cost to the health care system. Bean-counters see the cesarean delivery as being a too frequent and usually unnecessary type of surgery. They see it as tying up a surgical team and operating theatre and extra days of hospital stay. They dont see a tried and true means of saving a fetus from asphyxiation in a hostile uterine environment before the brain is damaged. Certainly they dont recognize how non-surgical obstetrical rescue skills have become rusty. All of this has put the obstetricians and allied health professionals in the eye of the storm where large sums of money are at stake. Given the British debate on infanticide and money - what is the American position? First, do not expect the American College of Obstetricians and Gynecologists to join their British colleagues and invite debate on infanticide any time soon. In the U.S. the religious right holds such political clout ACOG would be foolish to advance any such argument. The money saving approach of American obstetricians has been to go after the rights of the victims of malpractice to recover civil damages. To that end the insurance companies who sell these doctors liability insurance have had no difficulty finding a friend in George W. Bush. Fortunately, in the interests of civil justice, an earlier American president got it right - you cant fool all of the people, all of the time. Although he may have fooled most Americans regarding weapons of mass destruction, Bushs initiatives aimed at tort victims and their lawyers did not pass muster in Congress. The second approach of ACOG was a bit more insidious and still flies under the publics radar. This is the now prevailing obstetrical view that asphyxia rarely causes CP. This is remarkable in that obstetricians do not resuscitate depressed or asphyxiated newborns; interpret diagnostic or imaging tests to determine the cause of infant brain injury; diagnose or treat infants with hypoxic-ischemic encephalopathy; or otherwise determine the cause or treat seizures, CP or other brain injuries. Instead, the analysis of events leading to CP is the stuff of pediatric neurologists, pediatric radiologists, pediatric pathologists, neonatalogists, and geneticists not obstetricians.
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CEREBRAL PALSY ASSOCIATION OF BRITISH COLUMBIA (CPABC) DOES NOT SUPPORT THE SO - CALLED ASHLEY TREATMENT
The Cerebral Palsy Association of British Columbia is speaking out against the so-called Ashley Treatment, or growth-attenuating therapy and surgery performed upon a young girl living with a disability in Seattle. As a parent of a daughter with Cerebral Palsy, which is also a life-long disability, I cannot support these parents in their decision to modify their daughters physical development through drug therapy and surgery, says parent and CPABC board member Carol Stinson. My daughters greatest wish is to be as typical as possible. Turning your child into a doll-like eternal child should not be an option for parents or medical professionals. The CPABC believes that the Ashley Treatment is a response to the difficulties all parents face when raising a child with a disability. Supports and services for parents and families are generally poorly funded (in British Columbia the responsibility lies with the Provincial Government) with very narrow eligibility requirements and long wait lists. If adequate supports were in place for people with disabilities to live with dignity in their communities and if adequate supports for parents caring for children with disabilities were in place, this treatment would never be an option and would be seen as what it is, a grave injustice against a person with disabilities. There are two questions that need be asked: Is this a therapy that would ever be considered for a child without a disability? Why would having a disability take away an individuals right to live as typical a life as possible? The parents concerns that they do not want their child cared for by strangers begs the question, What will these parents expect to happen when they die? Will the next step be euthanasia? Again, only in Ashleys best interests of course. -30CONTACT: Craig Langston, CPABC President Cell: 604-614-4423 Fax: 604-408-9489 Toll Free: 1-800-663-0004 ...Continued from Page 1 Words from President The current inadequate state of home support services has already put people with disabilities and seniors in dangerous situations. I currently receive home support services and I clearly see gaps that can no longer be ignored. I have a vested interest to have improvements implemented to bring the level of service to where it compliments our lives and not create a barrier. This is in the infancy stage and I look forward to further collaborations with the BCPA on this important and necessary review. These initiatives keep me occupied and out of trouble OR Does it get me into trouble?? I hope you all have a great spring full of many colors and full of positive energy. Thanks, Craig Langston, President
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...Continued from Page 2 Infanticide, Money, and It is true that potential causes for CP include infection, physical trauma, coagulation disorders, malformations, and genetic disorders. However it is wrong for American obstetricians and their insurance companies to negate the role of asphyxia as a cause of neonatal brain damage and CP. A substantial number of babies are born with CP because of asphyxia and hypoxic-ischemic injury potentially preventable injury. So now the question arises as to where Canada fits into all this. This in turn requires some discussion of the Canadian Medical Protective Association. And what about the situation in our own country? To understand where Canada fits in all of this you first must appreciate the role of the Canadian Medical Protective Association (CMPA). While in the United States most physicians are covered by malpractice insurance, in Canada most physicians are protected from malpractice lawsuits by the CMPA. In 2004 it had reserves of $2.3 billion. While generally acting like an insurance company it is in fact a private association and therefore not subject to federal or provincial insurance regulation. Where as a traditional insurer will attempt to provide indemnity at the lowest possible cost and generally settle meritorious claims, the CPMA's objective is - to support, maintain and protect the honour, character and interests of its member doctors. The upshot is that the CMPA will not settle a case simply because it is cheaper to settle than to take to court. Only if it appears that the case is indefensible will there be an out of court settlement. If there is some way to defend a case, the objective of protecting the doctors reputation is pursued. This is done regardless of cost by way of a concept referred to as the vigorous defence. Plaintiffs lawyers who fall to the vigorous defense are often unwilling to take on another medical malpractice case. The result is that even those with legitimate malpractice claims are often unable to obtain legal representation and many valid claims go unfiled. With billions of dollars in reserve, the CMPA can easily afford to fund an aggressive defense. CMPA lawyers have access to a large pool of experts with a natural predisposition toward defending the actions of a colleague.
The CMPA has the money to assure its member doctors receive excellent legal representation. It can cultivate opinions such as the pro-infanticide view expressed over coffee in the earlier example. It can litigate strategically taking select cases to the Supreme Court of Canada, if necessary, to shape the law in its favour. It can work politically to persuade government to enact legislation which works in subtle ways to make pursuit of legitimate claims difficult and expensive. In the end, the CMPA has been effective in getting its way. Our politicians and the legal establishment should be embarrassed for it. Where does this leave Canadian children with CP and their families? Where does this leave the CPABC? First, we need to maintain our vigilance and be outspoken in regard to cases such as the Latimer Case and the Ashley Treatment. We know we are on a slippery slope and lawmakers need to know we will scream bloody, blue murder on these ethical issues. Second, we need to critically and aggressively challenge exculpatory opinions regarding the causes of CP, such as those of the American Society of Obstetricians and Gynecologists. When such marketing effort spills over the border, and it always does, we need to alert legislators, judges and the general public as to the agenda. Lastly, we need to be aware a substantial proportion of CP cases could have been prevented by the exercise of reasonable medical care. We need to resist the conspiracy of silence parents are facing. We need to assist parents when treating physicians are reluctant to discuss with them whether their child was exposed to damaging asphyxia. We need to follow up these cases courageously, with persistence and determination. From what I see, there is plenty of courage, persistence and determination in the CP community.
Don Renaud is a Trial Lawyer with over 20 years experience in the courts of British Columbia. He is a past president of the Trial Lawyers Association of British Columbia, a member of the Medical Negligence and Birth Trauma subsections of the Association of Trial Lawyers of America, and a Director of the Cerebral Palsy Association of B.C.
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NEWS...SITES...NEWS...SITES...NEWS...SITES...NEWS...SITES...
Champlain Hts Community Centre Vancouver Aquatic Centre Riley Park Community Centre West End Community Centre Dunbar Community Centre
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THE ROUNDTABLE
WINTER 2007
C P A If you are looking for work, an organization named ConnecTra might be able to B help you make the right connections. C
The ConnecTra Society, one of six inter-dependent non-profits which make up the Disability Foundation, assists job-ready individuals in the pursuit of employment and volunteer opportunities. It also acts as a social and recreational outlet, mainly through its sister societies. ConnecTra hosts several workshops each year, offering information sessions on training and vocational opportunities available through a wide range of organizations, educational institutions and access help groups. Employment agencies and potential employers forward their job postings to ConnecTra, asking for referrals of appropriate individuals for each posting. Some companies ensure that a certain percentage of employees on their staff are individuals with disabilities, and some job postings are even specific to such individuals. ConnecTra members have worked for a wide range of companies such as VanCity, Architectural Institute of BC, Vancouver Airport Authority, BC Human Resources Management Association, Triage Emergency Services, Vancouver Film Studio, Old Navy and Famous Players Theaters. Our most recent successful placements have been with The Flag Shop, The Kidney Foundation of Canada and the Royal Bank. And with the Olympic and Paralymic games coming up, ConnecTra will be busier than ever with the new opportunities which will present themselves to the disabled community. We refer people to jobs, explained ConnecTra program administrator Steve Street. We inform our members of opportunities available." People need to have skills, a resume and be job-ready. We are able to work within the requirements of Persons With Disabilities benefits, providing part-time, casual opportunities. Since its inception in 2000, ConnecTra has worked with more than 700 members. The society is free to join. If you have a specific skill set, some education, and a current resume, and are interested in any work opportunities, please contact Steve Street at 604-688-6464 ext. 115.
CRAIG LANGSTON (President) Burnaby PETER SHIPLEY (Vice President) White Rock JONN OLLDYM Vancouver (Treasurer) KIM DE WILDT N. Vancouver (Secretary) CAROL STINSON Burnaby TRISH MCKAY West Vancouver DON RENAUD Burnaby KENT LOFTSGARD Vancouver TONY KRUSE Burnaby TERREANE DERRICK Vancouver LIZ CALDER Fort St. John
D I R E C T O R S
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ConnecTra members have full use of the related societies: BC Mobility Opportunities Society: Opportunities for people with disabilities to explore the great outdoors. Info: www.disabilityfoundation.org/bcmos/index.html Disabled Independent Gardeners Association: Self-growth through nurturing plants. Info: www.disabilityfoundation.org/diga/ Disabled Sailing Association of BC: Independence on the open water. Info: www.disabilityfoundation.org/dsa/index.html Tetra Society of North America: Volunteer engineers creating customized assistive devices for any aspect of day-to-day life. Info: www.tetrasociety.org/ Vancouver Adaptive Music Society: Development through music composition and performance. Info: www.disabilityfoundation.org/vams/index.html
Thanks to our on going volunteers .... Tony Kruse Mike Stevens Patricia Furdek Ron Wyant Pamela Liu Ronald Lee Sue Ginley Wesley Kong George Pope
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Example 3 Purchase Stripped Bonds A bond is a loan to an institution (often a government such as with BC Bonds). With stripped bonds, the interest coupons have been stripped or removed, making them fairly boring as an investment tool. As a result, they can be purchased at a major discount from their face value. By Halldor K. Bjarnason, Barrister and Solicitor For example, a $15,000, 25-year stripped bond might sell for $3,000. You can donate the $3,000 to the charity with the instructions to purchase a stripped bond. In this examWe are all committed to supporting organizations such ple, you would get an immediate $3,000 tax receipt, and as the CPABC. Unfortunately, the reality of modest in- when the bond matures, the charity gets $15,000. comes, combined with paying living expenses and income taxes, make significant contributions in the form of gifts Example 4 Give a Gift of Residual Value (while we are alive) and bequests (donations made A fourth example of a way to maximize income tax benethrough our wills) often seem beyond our means. Fortu- fits is through a gift of the residual value of capital propnately, with creative thinking and proper planning, it is pos- erty. This technique is particularly helpful if you are a bit sible to both benefit your favorite charity AND maximize older and need to liquidate investments with significant tax the income tax savings for yourself. consequences, such as RRSPs or investments with large When making a contribution, you often think of writing a cheque. This results in the charity giving you an income tax receipt for the amount of your donation. To put in the simplest terms, this means that the amount that you take out of your pocket and give to the CPABC is equal to: a) the amount that the charity receives, and b) the amount of the income tax receipt you receive. There are other ways of giving that can have significantly greater tax benefits for you and/or will net greater results for CPABC. While it is important to look at individual circumstances, the following are a few examples of how creative planning can result in benefits for both you and the charity: Example 1 Giving Company Shares Suppose you wish to give a $10,000 gift to the charity. Assume you need to sell $10,000 worth of shares (with a capital gain of $8000) to make the gift. As 50% of capital gains are taxed, you will end up giving away $10,000, and paying about $2000 in income tax to get a $10,000 receipt. However, if you donate the $10,000 in shares to the charity, thanks to recent revisions to the Income Tax Act, you dont pay tax on any capital gains on any public shares donated to a charity. The charity is sheltered from paying any capital gains, and you still get a $10,000 receipt. With a bit of pre-planning, the charity receives the same donation, and the donor saves $2000 in income tax. Example 2 - Life insurance People often dream of making a large donation or bequest, but believe such is not possible. Such a perception is not necessarily true. One way of accomplishing this is through life insurance. The process is quite simple. CPABC takes out a term life insurance policy in your name. You pay the cost of the premiums, either a lump sum or installments, to CPABC. CPABC pays the premium to the insurer, and gives you an income tax receipt for the amount of the premiums. You get an immediate income tax deduction, and when you pass on, CPABC gets a tax-free gift that is significantly more than the amount of the premiums paid. You both win! capital gains. This technique is best demonstrated by the following example: You need a large income tax donation receipt in order to off-set income. You have already decided to make a significant donation to CPABC. By transferring the title of your home to the CPABC, while you retain a life interest a right to use it for as long as you (or you and your spouse) live - you can get an immediate, and presumably large, income tax donation receipt. The benefit of the receipt can be carried forward for up to five years, and you get the use of your home for the rest of your life. On your demise, CPABC will sell your property and reap the benefits of your generosity. This technique works on any capital property that has a residual interest - homes, vacation property, art work, etc. One key consideration is that the Canadian Revenue Agency factors in your age when assessing how much of a benefit you get from making a residual gift. As a result, the younger you are, the less of a tax benefit you will receive. The above are just a few examples of ways that giving can be custom-fitted to meet individual circumstances. While each of the above examples have additional factors that need to be considered, they provide insight into some strategies that can be used to maximize your contribution to the charity, while minimizing income tax consequences for you. A planned giving scheme can be designed for almost any lifestyle or economic situation. A discussion with your favorite estate planning expert - be it a lawyer, an investment advisor, an insurance agent, or an accountant (or even better - a combination), can turn up a variety of creative ideas to fit your situation. A properly designed estate plan can enable you to help CPABC, while minimizing your income taxes. For more information www.trustlawyers.ca. on estate issues,
visit:
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THE ROUNDTABLE
WINTER 2007
Celebrating 52 Years in British Columbia! The Roundtable is the official newsletter of the CPABC. The CPABC and the editor of this newsletter take no responsibility for, nor do they necessarily agree with, the opinions contained in this publication. Contributing Writers: Craig Langston, Don Renaud, Judy Hoffman, Halldor Bjarnason The Roundtable Designer: Feri Dehdar Cerebral Palsy Association of British Columbia 801-409 Granville St. Vancouver, BC V6C 1T2 Phone: 604.408.9484 Toll-Free (Enquiry CP): 1.800.663.0004 Fax: 604.408.9489 Email: info@bccerebralpalsy.com Office Hrs: 9 AM to 5PM, Monday to Thursday
Members with expertise are available for public speaking engagements. Call the office for more details.
Membership: $20 Or whatever you can afford Donation: I would like to make a donation to support the services and programs of the Cerebral Palsy Association of British Columbia. Income tax receipts are only issued for donations of $10 or more, unless requested. $100 $75 $50 $25 My choice: _________ Method of Payment: I have enclosed a cheque payable to the CPABC or: Visa #:________________________________ Expiry Date: _____________________ Name on Card: _________________________ Todays Date: ____________________ Signature: _____________________________ Please mail to: Cerebral Palsy Association of British Columbia 801 409 Granville Street, Vancouver, BC V6C 1T2
Charitable Registration Business Number 10690 4204 RR0001