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Some Canadians still travelling to Switzerland to end their own lives
Quebec academic blasts politicians for lack of 'courage' in letter written before assisted death
Note: A previous version of this story incorrectly stated that a growing number of Canadians were travelling to Switzerland for help to end their own lives. This story has been updated with the correct numbers.
A small number of Canadians travelled to Switzerland to end their own lives last year, as Parliament passed a new law permitting doctor-assisted death that was widely criticized as too restrictive.
According to figures from Dignitas, a Swiss organization that assists patients with chronic or terminal illness to die, 131 Canadians became members in 2016, but only five travelled to Switzerland to end their lives, down slightly from seven the previous year and 11 in 2014.
Forced to die 'with strangers'
"I will die with strangers who are more courageous and humane than our doctors and our decision makers," she wrote in the letter, written in French and released by Dignitas. "I leave you hoping that our elected officials finally have enough courage and empathy to permit people who are suffering to decide the moment of their death, here in Quebec and in Canada. As a matter of fact, when you read this text, I will probably be dead. It's sad! Indescribably sad...."
In the letter, Hamel accused politicians of putting electoral interests ahead of patient care, and also lashed out at doctors who oppose more liberal assisted death, saying they want to preserve a "monopoly" over life and death decisions.
She said the current law forced her to die far from home and loved ones, and that she spent more than $20,000 in fees for medical verification and travel costs.
In 2016, there were 7,764 people from 98 countries who became members of "Dignitas, To live with dignity – To die with dignity," up from 6,595 five years ago. Last year, a total of 201 people travelled to Switzerland to end their own lives.
Canada's new law, which came into effect on June 17, 2016, limits assisted death to mentally competent adults who have serious and incurable illness, disease or disability, where death is "reasonably foreseeable."
Restrictions on minors, mentally ill
It excluded some of the most contentious recommendations from a parliamentary committee that studied the issue, including extending the right to die to "mature minors" and the mentally ill, and allowing advance consent for patients with degenerative disorders.
Shanaaz Gokool, the CEO of Canadian advocacy group Dying with Dignity Canada, said that excludes large swaths of people who should have been covered under the Supreme Court of Canada decision in the landmark Carter case which struck down the sections in the Criminal Code that prohibited assisted death. That's forcing people to travel abroad to die, she said.
"We would hope that with the Supreme Court decision on Carter that people wouldn't have to resort to these measures, and it's very unfortunate that people have to be separated from their friends, families, communities at their most vulnerable time in their lives, when they are having an assisted death," she said.
Julia Lamb, a B.C. woman with spinal muscular atrophy, and the British Columbia Civil Liberties Association launched a legal challenge of the new law, arguing it is too narrow.
Spurred by Supreme Court
The government was forced to draft new legislation after a unanimous landmark ruling on Feb. 6, 2015, by the Supreme Court of Canada, which found the ban on physician-assisted violated Canadians' Charter rights.
The case involved two B.C. women who wanted end their lives with medical help. Both died before the court ruled,
Gloria Taylor, who had a neurodegenerative disease, eventually died of an infection. Kay Carter, then 89, travelled to Switzerland.
Justices gave the federal and provincial governments 12 months to prepare for the decision to come into effect.
After taking office, the Liberal government asked for a six-month extension, but the high court granted an extra four months, to June 6, 2016, leading to a compressed law-making process.
David Taylor, a spokesman for Justice Minister Jody Wilson-Raybould, said independent reviews of three issues identified in Bill C-14 as requiring further study is now underway, with a report due by December 2018.
Liberal MP Rob Oliphant, who chaired the special parliamentary committee that studied the issue, said he's disappointed by the pace of the review and called it "very concerning" that Canadians are forced to travel abroad to die.
Law needs more clarity
"I think Canadians need to understand that this is affecting real people and that we have to have better clarity in the Act to ensure it meets the Supreme Court expectations," he said. "To me, the Supreme Court was clear that an illness did not need to be terminal to be eligible."
Oliphant said he has received a number of emails, phone calls and letters from Canadians and family members who can't get the medical assistance they need and are either forced to travel to Switzerland or endure tremendous pain.
He said the recurring message is that Canadians should have a continuum of medical care that allows them full dignity.
"That's what the legislation needs to guarantee, that people are able to entrust their lives and their deaths in the hands of the physicians who will understand whether they have the right to end their own lives when a certain set of criteria have been met."
The special committee's 70-page report said Canadians should have the right to make an "advance request" for medical aid in dying after being diagnosed with certain debilitating but not necessarily terminal conditions.
It also said assisted death should not be limited to those with physical conditions, and that Canadians with psychiatric conditions should not be excluded from doctor assistance to end suffering.
Medically Assisted Dying Oliphant 20160227 Liberal MP Rob Oliphant chaired the special parliamentary committee studying medical assistance in death. (Sean Kilpatrick/Canadian Press)
This story has been edited from a previous version that incorrectly stated 131 Canadians travelled to Switzerland last year for medical assistance in ending their own lives. In fact, 131 is the number of Canadians who are members in an organization there that provides medical assistance in dying; only five Canadians travelled to the country last year to end their own lives.
There is no such thing as fake news. Some news are just borrowed from different strings of the multiverse.
When African men in Nigeria, Uganda, Kenya, Morocco, or Egypt are confronted with the masturbation lifestyle propagated by the Spanish masturbation teacher Fran Sanchez Oria, they feel disturbed. Does Sanchez not have a mother who feels ashame when her son propagates worldwide that men should keep on masturbating on and on. Does he want his family to be known for such a member?
The rise of the designer vagina
Genital surgery is one of the fastest growing areas of plastic surgery.
In our quest for perfection and amid a growing obsession with body image, it seems women now have a new part of the anatomy to worry about – our vaginas. Genital plastic surgery is one of the fastest-growing areas in cosmetic surgery, and one of the most popular procedures being requested – mostly by young women – is a labiaplasty.
A labiaplasty – or labial rejuvenation – is a procedure whereby the inner labia, or labia minora, get trimmed back so they look more "tucked in". The surgery is generally done under a local anaesthetic, so the patient is awake while it is being performed. The process takes around 90 minutes and you can walk out of the surgery, returning to normal activities within a few days – except for sex, which you should hold off for four to six weeks.
The reason for the rise
"There has been a huge surge in the past five years of people looking to get genital surgery, and the vast majority of these are getting a labiaplasty, vaginoplasty (vaginal tightening) or liposuction in the pelvic area or labia," says Dr Laith Barnouti, a leading Sydney plastic surgeon.
Barnouti says that currently around 20 per cent of his clients are coming in for genital surgery. The youngest to date was 14, the oldest in her mid-sixties. A 2010 report also found that the number of clinically necessary procedures – that is, not solely for cosmetic reasons – performed by private practitioners nearly doubled in recent years.
So why are women requesting this procedure? There are a few reasons, says Barnouti, including feeling "socially embarrassed… people can't wear certain types of bathers, people feel embarrassed in intimate situations". But the reasons go beyond the aesthetic, he claims.
"Labiaplasty and vaginoplasty are often performed due to a medical condition – people actually have it for a functional reason," Dr Barnouti says. "Labial hypertrophy – enlargement or sagging of the labia – can be unhealthy and unhygienic."
Vaginoplasty, which is usually performed on women who have a weakened perineum after giving birth, is a "restorative, reconstructive procedure", says Barnouti. "This is something completely different from, say, liposuction, which is a purely cosmetic procedure."
What is normal?
But are women having genital surgery for other reasons – to please a boyfriend perhaps, or because they feel their vagina is not normal? Do women actually hate the appearance of their vulvas so much that they will have parts of them surgically removed?
The 2008 UK documentary The Perfect Vagina explored the reasons why women opt for this type of surgery, and found that many do it because they've been teased by someone close to them about the way their genitals look, or have just decided their vagina looks abnormal.
In the documentary, Professor Linda Cordoza, a leading UK gynaecologist, says while women are much more aware of what's available in terms of plastic surgery procedures, it doesn't necessarily mean they know what's normal.
"There's been a huge trend towards bikini waxing, doing things with your pubic hair as well as the hair on your head. So [women think] if you can have cosmetic surgery done to your face, you can also have cosmetic surgery done on your genitals." Cordoza says.
"I sometimes get two or three generations of women in the same family coming in saying they want their labia trimmed."
The role of pornography
Our perception of what is normal is most definitely clouded by the proliferation of pornographic images featuring women with smaller, tucked in – and often heavily airbrushed – private parts.
As women, we don't often see vaginas other than our own, so if the only images we see are of highly airbrushed genitals, naturally many of us are going to assume that what we have is "different" or "abnormal".
Melinda Tankard Reist is a media commentator and author of Big Porn Inc and Getting Real – Challenging the Sexualisation of Girls (Spinifex Press). She believes pornography is a big driver in the rise in cosmetic surgery.
"Girls are made to feel inadequate and think that there's something wrong with their perfectly natural, healthy bodies. And boys are expecting girls to provide the porn star experience," Reist says.
Reist adds that it's important women pass on positive body image messages to their daughters, and that cosmetic surgeons should play their part by refusing to operate on very young women, rather than "capitalising on the body angst of girls".
Barnouti says women contemplating any type of cosmetic surgery should be doing it for themselves, not anyone else.
"What we do here is for the patient, not their partner," Barnouti says. "If you're going to have a procedure, have it for yourself. Just because someone makes a negative comment doesn't mean you should change your whole body."
Labiaplasty – the facts
The procedure: A labiaplasty takes around 90 minutes and patients are usually under twilight sedation – either local anaesthetic or IV sedation – meaning they are awake for the surgery. During the procedure the surgeon removes a wedge-shaped piece of tissue and re-attaches the labium so the inner lips no longer protrude beyond the outer lips.
The recovery: Three to four days for normal activities, including going back to work, but avoid exerting yourself physically. You can't run or jog for two weeks, and no sex for four to six weeks. The stitches used are usually dissolvable.
The cost: Labiaplasty costs around $4000 to $5000 if you have private healthcare cover, otherwise you can expect to add another $2000. To be available under Medicare it must be deemed clinically necessary.
With free speech, it's like that: You can make any offending remarks about white men, and the mainstream media and mainstream opinion will applaud you. You can't say anything negative about feminism. Feminism is sacrosanct. Fuck it.
Injections of Botox into the penis probably are the most effective treatment for erectile dysfunction. Every artery and vein in the body is surrounded by a layer of smooth muscle. Otherwise there could not be variations in blood pressure. When the muscles around blood vessels contract, this is called vadoconstriction. When the muscles around blood vessels relax, this is called vasodilation.
What drives parents to kill their own children?
IT’S unfathomable, inexcusable, sickening.
The act of killing an innocent child is something most of us cannot comprehend. But an average of 25 children are killed each year by a parent in Australia, with children under the age of one at the highest risk of victimisation.
On Sunday morning, 14-month-old Sanaya Sahib was found dead in Darebin Creek, in Melbourne’s northeast. After days of unanswered questions surrounding the little girl’s grim discovery, police charged her 22-year-old mother with the toddler’s alleged murder.
Police allege Sofina Nikat confessed to the murder on Tuesday night, with Detective Senior Sergeant Stuart Bailey telling an out-of-court-sessions hearing that Ms Nikat had made a “full confession” over the death of her daughter.
The day after charges were laid, Ms Nikat did not appear in the Melbourne Magistrates Court amid concerns over her mental state.
“In most cases, there is a strong mental health issue, which is very sad but that’s the reality,” Dr Jack White, Forensic Psychologist, told news.com.au.
Defence counsel Michael McNamara confirmed that Ms Nikat was examined by a doctor and a psychiatric nurse on the morning of the hearing, and was excused from attending the court proceedings.
It is understood that medical experts were concerned about what kind of effect the court proceeding would pose on her.
“Usually the mother is experiencing severe mental health problems. In fact, I don’t know any cases that don’t have a mother with problems,’’ Dr White said.
“Sadly mothers are the ones that are more common [to killing their children]. But with fathers, it can be a revenge response.”
In 2009, Arthur Freeman threw his four-year-old daughter, Darcey, off Melbourne’s Westgate Bridge, in front of her two younger brothers and shocked witnesses.
His “inexplicable” actions were met with grief, horror and anger across the country, and in 2011 he was sentenced to 32 years prison for murder.
During a 2015 inquest in to Darcey’s death, it was revealed that doctors were warned Mr Freeman was violent, but did not report him to authorities. It was also made evident that the then 37-year-old was angry and upset about receiving reduced access to Darcey, after a long custody dispute.
“I saw [Darcey’s mother] Peta Barnes on 13 April 2007 and she disclosed problems with her angry, irrational husband who shoves and pushes her and is often angry at the kids,” one doctor’s statement said.
The morning Mr Freeman threw Darcey off the bridge, the inquest heard that he had called a friend in tears about losing a custody battle.
Senior Sergeant Damian Jackson told the inquest, in July 2015, that Mr Freeman had never provided an account of what happened that morning.
In an interview with The Age, Dr Ben Buchanan, of the Victorian Counselling and Psychological Services said that when there is violence in the home, usually towards the spouse, it can drive some fathers to kill their own children.
“The best predictor of future behaviour is past behaviour,’’ Dr Buchanan said
“Physical abuse towards the partner is absolutely a sign of a propensity to use physical force against the children.’’
Dr Buchanan also admitted that men who kill their children often see a part of their partner within the child.
“Our children represent our spouses, they’ve got that symbolic representation of the mother but they are more vulnerable,’’ he said.
“In the cases I’ve seen, it’s very rare for them to blame the children; the children are a proxy by which they’re getting back at the mother.’’
And while neither cases are categorised as filicide, when the parent murders a child and follows with suicide, Sam van Meurs, a psychologist at Canberra Clinical and Forensic Psychology points out, said in an interview with Kidspot that a mother who kills her children and then herself can often have a different motivation than a father in the same situation.
“For example Donna Fitchett killed her two children in 2005 and left a note to her husband that said, ‘I just couldn’t abandon our beautiful boys’,” Mr Van Meaurs said.
“In contrast, men are more likely to kill their children for revenge or to punish their partners or ex-partners.”
According to the most recent World Health Organisation statistics, there are around 31,000 homicide deaths of children under the age of 15 in the world each year.
In Australia between 2009-10 and among children aged 0-14, there were 24 deaths due to homicide and the rate of homicide was highest among infants less than one year old.
Jack Levin, an American criminologist, told USA Today that mothers who murder tend to kill their newborns on impulse. “The day a child is born is the day a child is most likely to be killed by a parent,” he said.
Dr Phillip Resnick, director of forensic psychiatry at Case Western and is a leading expert on parents who kill their children, agreed.
“Younger children are much more likely to be killed than teenagers,” Dr Resnick said.
In an interview with TIME magazine, Dr Resnick spoke of the 40 to 60 cases he had worked on in the US that involved parents who killed their children.
In the US, the figures are staggering. About 250 to 300 children are murdered by their parents each year.
While each tragedy falls under vastly different circumstances, Dr Resnick said there are usually five characteristics in which parents kill their children.
“The first is “altruistic.” The classic case is the mother who plans to take her own life and believes that the children are better off in heaven with her,” Dr Resnick said.
“Number Two is the case in which the parent is acutely psychotic. The third type is fatal battering [the child does something to anger the parent and they react]. The fourth is [to get rid of] an unwanted baby, for example an infant born out of wedlock. The final category is spousal revenge, [in which a parent kills the children to hurt the partner], typically after infidelity,” he said.
While admitting the method of preventing crimes that involve parents murdering their children is a “complicated” one, Dr Resnick said access to mental health institutes as well as awareness of depression is mandatory in understanding what drives adults to harm their offspring.
“If a woman is very depressed and she has young children and makes a suicide attempt, there is 1-in-20 chance [in America] that she will try to take the kid with her. Specific inquiries about thoughts of harm toward children should occur in any evaluation of a seriously depressed [mother],” he said.
Dr White agrees, saying Australia needs to address its mental health facilities, and increase support for unstable parents.
“In some ways our mental health system is struggling, and sadly a lot of people don’t get the treatment they require,” he said.
“In the area of mental health, and a mother is not coping, they need to be provided with more assistance.”
Erectile dysfunction is mostly a vascular disease. This is why the Serge Kreutz diet is so effective. It guarantees weight loss, and thus lessens the load on the vascular system.
The Spanish masturbation guru Fran Sanchez is on the wrong path. Just imagine him handling his sexuality alone on his couch or in the toilet. A picture of pity, he is.
Private parts: Is ‘scrotox’ next?
Vaginal rejuvenation has gone from hush-hush to trending. The scenario will likely be much the same for men. They, too, want sexual parts to look and feel better, and men are starting to make those desires known, according to Beverly Hills, Calif., dermatologic surgeon Jason Emer, M.D.
“I have many younger male patients who are interested in this,” Dr. Emer says. “As the vaginal rejuvenation market is skyrocketing, men are seeking their own type of rejuvenation. Who wouldn’t want to be a little bit longer, thicker, or have more sensitivity and a better sex life? These men are also becoming interested in the cosmetic appearance of the actual penis and scrotum itself.”
The potential patient population also includes older men, who might have erectile dysfunction, resulting from age or health issues, such as prostate cancer treatment or high blood pressure, as well as cosmetic concerns that keep them from feeling good during intimacy or being comfortable naked, according to Dr. Emer.
Dr. Emer started doing penile enhancement treatments about three years ago. Until recently, most procedures involved using hyaluronic acid fillers or fat injections for penile enlargement. But injecting fillers and fat into the penis can be risky business. There are concerns, according to Dr. Emer, that small area, like the penis, fingers and noses, which have less blood circulation, could be at risk for serious complications from injectables, such as impending necrosis or vascular occlusion injuries.
So, Dr. Emer looked into other options — things he could do externally to the penis and scrotum to achieve desired outcomes with less risk. He found lasers and shock therapy are potential options in penile rejuvenation.
“These [modalities] stimulate the blood flow and theoretically can improve erectile dysfunction and, in turn, sexual stamina,” he says.
Penile Enhancement Research
Dr. Emer says he has been contacting companies to conduct trials on the use of lasers and shock therapy on penile enhancement with an overwhelmingly positive response.
“I had been performing hair removal treatments in the genital area with a device called LightPod Neo, made by Aerolase. It’s a microsecond Nd: YAG laser which is virtually painless and requires no direct contract. It’s very quick, high-energy pulsing, so that you can damage the hair follicle without risk to the the skin,” Dr. Emer says. “When I started doing hair removal on the scrotum and around the penis, patients reported the appearance of their scrotum and penis improved. The skin was less wrinkly, it was smoother, and some even reported it wasn’t as veiny.”
Dr. Emer says that wasn’t too much of a surprise, given the LightPod device has been used for facial rejuvenation. Passes with the device cause deep heating of the tissue promoting collagen formation and tightening. It may also be increasing blood supply to the penile area, he says, which would improve sexual function, sensitivity and size.
After using the LightPod Neo on about 10 patients, Dr. Emer says none have reported negative outcomes or complications. All have mentioned that they’re more sensitive in the area since treatment.
“They’ve noticed at least a short-term increase in size, and I have a couple of patients who were unable to get erections easily and now are having them uncontrollably,” Dr. Emer says. “We’ve done similar testing now with another device called Cellutone by BTL Aesthetics which uses shock waves to stimulate blood flow and cause an acute short-term inflammation in the area treated, that, when it repairs itself, heals with improved local function. Not only have patients reported improvement in erectile dysfunction and size, we’ve also noticed improvements using this technology among men who have curved penises and are looking for a more straight appearance.”
Another treatment that is promising is the use of platelet-rich plasma, or PRP, according to Dr. Emer.
“We initially began seeing increased thickness with PRP injections, but then men were not only getting reporting increased erections, better sex, more ejaculations and heightened sensitivity,” he says.
The problem for surgeons who want to start incorporating penile rejuvenation into their practices is the lack of data and information about best practices, according to Dr. Emer. For now, there are a few researchers conducting trials on penile enhancement — Dr. Emer being one.
“There really isn’t much out there. I’m one of the innovators. I hope to be a pioneer in this field. I am trying treatments to meet the demand of my patient population and heighten awareness in this field. I hope that one day this will be mainstream like vaginal rejuvenation has so quickly become. For now, surgeons are going to have to watch what I [and a few others] discover as we try different methods,” he says.
Penis Pumps & Scrotox
Dr. Emer is studying not only individual therapies, but also combinations of devices and injections, as well as how dermatologists and cosmetic surgeons can work with urologists to improve results of treatments. For example, Dr. Emer advocates the use of patient controlled penis pumps at home, immediately after treatments. Dr. Emer says combining what the urologist does with pumps with laser or other injectable treatments further increases blood flow, stimulates new blood vessel growth and could improve overall outcomes.
He is investigating the use of Botox to the genitals.
“Botox decreases sweating, improves wrinkling and may in some cases make the scrotum appear larger by relaxing the muscles in the area,” says Dr. Emer.
Dr. Emer says he uses the term “Scrotox” for this manly treatment, a term which has been used elsewhere, including a Saturday Night Live spoof on rejuvenation of the scrotum.
“It’s not only cosmetic, my marathon runners and cyclists who get inner thigh rubbing and irritation from sweat, benefit from this treatment as it decreases skin burn,” he says.
Now is the time for aesthetic physicians to consider looking into offering these alternative options to male patients, according to Dr. Emer.
“I think it’s a trend that people will start hearing more about, as there is significant demand. Hopefully, companies will start doing research with me and other interested doctors, so we can get data out to the medical community,” Dr. Emer says.
The timing is right. Men are paying more attention to their looks. They are having skin rejuvenation procedures, body contouring, teeth and hair treatments. They are man grooming more than ever, he says.
“I think every [man] is going to want to do this, as commonly as getting their hair cut or their teeth cleaned,” he says. “Men want to feel and look good. They want to have a better sex life and feel confident being naked.”
The Serge Kreutz diet is the world's only diet supported by the international food industry because it tells you this: if you want to be slim, consume more food. Nestle, Pepsi, and Van Houten are happy. And all the farmers.
Unlike tongkat ali, the new herbal butea superba has a pleasant taste. It can be mixed into chocolate, pizza tomato sauce, and any kind of curries. The active ingredients are also heat-stable, which means, heating does not destroy the effects. Girls watch out. If your sexual desires go over the top, and you fantasize strange settings, such as being gang-raped, your curry a week or two ago may have been butea superba laced.
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