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Background: Previous Canadian reviews of physician, pharmacist, and dentist disciplinary action have noted differences in discipline outcomes across professions and provinces. The objective of this study was to compare the disciplinary action process across provinces and professions, and to describe the perspectives of health professional regulatory bodies on the disciplinary action process. Methods: Participation from medicine, pharmacy, nursing, and dentistry registrars or complaints directors from 10 Canadian provinces was sought. One-on-one, semi-structured interviews were conducted by telephone or video call. Results: Nineteen interviews with regulators were conducted--8 pharmacy, 5 nursing, 5 medicine, and 1 dentistry. Complaints and discipline processes followed a similar overall pathway with some differences. Differences in process were largely due to differences in health regulation legislation and were noted across professions, across provinces, and within a province. Participants tended to be more aligned with regulators within their province rather than regulators of the same profession across the country. Conclusion: To our knowledge, this paper is the first to describe Canadian health professional regulatory body perspectives on the complaints and discipline process. More research is needed to better understand the factors that affect discipline outcomes and to ultimately improve complaints and discipline processes. [ABSTRACT FROM AUTHOR]

Building upon two previously published research papers exploring Canadian media reporting of childhood in the first wave of the pandemic, this paper investigates how constructions of childhood evolved from the first wave to the fourth wave of the pandemic. This qualitative research is guided by the central research question: Over the span of 2 years, from 2020 to 2022, what changes are evident in discourses reported within media focused on the impact of the COVID-19 global pandemic on Canadians under the age of 18 years? Findings from this study suggest that in the fourth wave young people were constructed as innocent victims of pandemic restrictions framed through an adult-centric lens; noticeably absent were representations of young people under the age of 18 in their voices. A key recommendation emerged from this study: any future research investigating the impact of the pandemic on young people under aged 18 years must include their full participation. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) carries the potential for unprecedented disruption in radiology, with possible positive and negative consequences. The integration of AI in radiology holds the potential to revolutionize healthcare practices by advancing diagnosis, quantification, and management of multiple medical conditions. Nevertheless, the ever‑growing availability of AI tools in radiology highlights an increasing need to critically evaluate claims for its utility and to differentiate safe product offerings from potentially harmful, or fundamentally unhelpful ones. This multi‑society paper, presenting the views of Radiology Societies in the USA, Canada, Europe, Australia, and New Zealand, defines the potential practical problems and ethical issues surrounding the incorporation of AI into radiological practice. In addition to delineating the main points of concern that developers, regulators, and purchasers of AI tools should consider prior to their introduction into clinical practice, this statement also suggests methods to monitor their stability and safety in clinical use, and their suitability for possible autonomous function. This statement is intended to serve as a useful summary of the practical issues which should be considered by all parties involved in the development of radiology AI resources, and their implementation as clinical tools. [ABSTRACT FROM AUTHOR]

PURPOSE: The liberalization of cannabis policies has the potential to affect the use of other substances and the harms from using them, particularly alcohol. Although a previous review of this literature found conflicting results regarding the relationship between cannabis policy and alcohol-related outcomes, cannabis policies have continued to evolve rapidly in the years since that review. SEARCH METHODS: The authors conducted a narrative review of studies published between January 1, 2015, and December 31, 2020, that assessed the effects of cannabis policies on the use of alcohol in the United States or Canada. SEARCH RESULTS: The initial search identified 3,446 unique monographs. Of these, 23 met all inclusion criteria and were included in the review, and five captured simultaneous or concurrent use of alcohol and cannabis. DISCUSSION AND CONCLUSIONS: Associations between cannabis policy liberalization and alcohol use, alcohol-related outcomes, and the co-use of alcohol and cannabis were inconclusive, with studies finding positive associations, no associations, and negative associations. Although several studies found that cannabis policy liberalization was associated with decreases in alcohol use measures, these same studies showed no impact of the cannabis policy on cannabis use itself. The lack of a consistent association was robust to subject age, outcome measure (e.g., use, medical utilization, driving), and type of cannabis policy; however, this may be due to the small number of studies for each type of outcome. This paper discusses several notable limitations of the evidence base and offers suggestions for improving consistency and comparability of research going forward, including a stronger classification of cannabis policy, inclusion of measures of the alcohol policy environment, verification of the impact of cannabis policy on cannabis use, and consideration of mediation effects. [ABSTRACT FROM AUTHOR]

As uses of plasma-derived medical products increase globally, so does the demand to collect plasma from donors. There is evidence that positive interactions with center staff motivate plasma donors to return. This paper reports on a focused ethnography investigating experiences of nurses and phlebotomists in one of Canadian Blood Services’ first source plasma collection center during the COVID-19 pandemic. Participants found the transition from whole blood collection to source plasma amid a global pandemic challenging, but they adapted by coming together as a team, and then worked to put the donor experience first. Their experience resonates with scholarship on emotional labor. As blood services worldwide attempt to increase source plasma collection, there is a need to understand care work that nurses and phlebotomists perform on the front-line. This study offers insight into how blood services can support staff in plasma operations by recognizing emotional labor. [ABSTRACT FROM AUTHOR]

The Indonesian Government is attracting foreign investment in infrastructure to support equitable development by simplifying the bureaucratic process for business licensing through Online Single Submission (OSS). However, from the OSS introduction in 2018, it has not yet transformed Indonesia's investment climate. This paper consists of a normative legal study which uses a statutory, conceptual, and comparative approach with Canada and New Zealand to identify the OSS policy disharmony that negatively impacts the investment climate in the Indonesian infrastructure. The results showed a need to reconstruct systems and policies based on the Government Regulation of the Republic of Indonesia Number 24 of 2018 concerning Online Integrated Business Licensing Services and the Law of the Republic of Indonesia Number 11 of 2020 concerning Job Creation to accelerate and increase investment in the era of the fourth industrial revolution. [ABSTRACT FROM AUTHOR]

Purpose: Health systems are progressively stressed by health spending, which is partially explained by the increase in the cost of health technologies. Countries have defined processes to prioritize interventions to be covered. This study aims to compare for the first time health technology assessment (HTA) processes in Canada and Chile, to explain the factors driving these decisions. Design/methodology/approach: This is a health policy analysis comparing HTA processes in Canada and Chile. An analysis of publicly available documents in Canada (for CADTH) and Chile (for the Ministry of Health (MoH)) was carried out. A recognized political science framework (the 3-I framework) was used to explain the similarities and differences in both countries. The comparison of processes was disaggregated into eligibility and evaluation processes. Findings: CADTH has different programmes for different types of drugs (with two separate expert committees), whereas the MoH has a unified process. Although CADTH's recommendations have a federal scope, the final coverage is a provincial decision. In Chile, the recommendation has a national scope. In both cases, past recommendations influence the scope of the evaluation. Pharmaceutical companies and patient associations are important interest groups in both countries. Whereas manufacturers and tumour groups are able to submit applications to CADTH, the Chilean MoH prioritizes applications submitted by patient associations. Originality/value: Institutions, interests and ideas play important roles in driving HTA decisions in Canada and Chile, which is demonstrated in this novel analysis. This paper provides a unique comparison to highly relevant policy processes in HTA, which is often a research area dominated by effectiveness and cost-effectiveness studies. [ABSTRACT FROM AUTHOR]

Introduction Differences in disability duration after work injury have been observed across jurisdictions, regions and urban and rural settings. A key aspect of effective disability management is the access and utilization of appropriate and high quality health care. This paper presents a framework for analyzing and thus understanding how health service spending and utilization vary across and within work disability management schemes and affect work disability management. Methods Our framework was developed through a literature review and policy analysis. Existing frameworks describing geographic variation in general health care systems identified factors believed to drive that variation. A review of policy and practice documents from Canada's no-fault cause-based work disability management system identified factors relevant to work disability systems. Results We expand on previous frameworks by taking a systems approach that centers on factors relevant to the work disability management system. We further highlight predisposing, enabling, workplace environment and need-based factors that could lead to variation in health care spending and utilization across and within jurisdictions. These factors are described as shaping the interactions between workers, health care providers, employers and work disability management system actors, and influencing work disability management health and employment outcomes. Conclusion Our systems-focused approach offers a guide for researchers and policymakers to analyze how various factors may influence spending and utilization across regions and to identify areas for improvement in health care delivery within work disability management systems. Next steps include testing the framework in an analysis looking at geographic variation in spending and utilization across and within Canadian work disability management systems. [ABSTRACT FROM AUTHOR]

Aims: In 2014, in response to evidence that Canada's tobacco use would lead, inexorably, to substantial morbidity and mortality for the foreseeable future, a group of experts convened to consider the development of a "Tobacco Endgame" for Canada. The "Tobacco Endgame" defines a time frame in which to eliminate structural, political, and social dynamics that sustain tobacco use, leading to improved population health. Strategies: A series of Background Papers describing possible measures that could contribute to the creation of a comprehensive endgame strategy for Canada was prepared in advance of the National Tobacco Endgame Summit hosted at Queen's University in 2016. At the summit, agreement was reached to work together to achieve <5% tobacco use by 2035 (<5 by '35). A report of the proceedings was shared widely. Achievements: Progress since 2016 has been mixed. The Summit report was followed by a national forum convened by Health Canada in March 2017, and in 2018, the Canadian Government adopted "<5 × '35" tobacco use target in a renewed Canadian tobacco reduction strategy. Tobacco use has declined in the last 5 years, but at a rate slower than that which will be needed to achieve the <5 by '35 goal. There remain > 5 million smokers in Canada, signaling that smoking-related diseases will continue to be an enormous health burden. Furthermore, the landscape of new products (e-cigarettes and cannabis) has created additional risks and opportunities. Future directions: A bold, reinvigorated tobacco control strategy is needed that significantly advances ongoing policy developments, including full implementation of the key demand-reduction policies of the WHO Framework Convention on Tobacco Control. Formidable, new disruptive policies and regulations will be needed to achieve Canada's Endgame goal. [ABSTRACT FROM AUTHOR]

Cancer treatment has evolved significantly over the past decade with the emergence of a multitude of new treatments across cancer types. Alongside the pace of drug discovery, the cost of cancer drugs has also increased. In the face of this growth in development and spending, it is crucial to have an understanding of the processes and pressures new drugs navigate to get to the market in Canada. This paper is a review of the complex, multi-step regulatory and funding process undertaken by cancer drugs in Canada. It reviews the role of Health Canada, the Patented Medicine Prices Review Board, the Health Technology Assessment, the pan-Canadian Pharmaceutical Alliance, and finally, the provincial, territorial, and federal payers. Recent developments are highlighted. Strategies to minimize duplication of effort, improve timeliness, and increase efficiency are explored. The cancer drug regulatory and funding process in Canada is complex, and an understanding of the current system and ongoing evolution is essential. [ABSTRACT FROM AUTHOR]

In response to the numerous challenges resident trainees currently face in their ability to competently acquire the requisite skills, knowledge and attitudes upon graduation, medical educators have looked to a competency-based medical education (CBME) approach as a possible solution. As CBME has already been implemented in many jurisdictions around the world, certain challenges in implementation have been experienced. One important challenge identified relates to how regulatory bodies can either assist or unintentionally hinder implementation. By examining the varied experiences from Canada, the USA and the Netherlands in implementing CBME, this paper identifies how regulatory bodies can support and advance worldwide efforts of furthering its implementation. If regulatory bodies restructure accreditation and regulatory criteria to align with CBME principles, work together in a coordinated fashion to ensure alignment of vital regulatory meaures throughout the training and practice continuum of a physician, and allow for (if not incentivize) individuals and programs to be innovative in adapting CBME to meet their local environments, it is likely that the worldwide implementation of CBME will occur successfully. [ABSTRACT FROM AUTHOR]

Cumulative effects assessment (CEA), as a required practice for the environmental assessment (EA) of projects in many countries, faces several practical challenges, especially related to biodiversity. Drawing on the perspectives and experiences of Canadian EA practitioners, this paper explores options or drivers of change for improving project-based assessment to better tackle cumulative effects on biodiversity. An on-line survey was conducted with 40 professionals from the private sector, government departments/agencies, universities, and non-governmental organizations, examining the current challenges and opportunities regarding: CEA process for biodiversity; responsibilities for undertaking CEA tasks; resources to support and promote good CEA practice. In terms of process, there is shared understanding on: (i) the need of EA terms of reference to provide specific directions on CEA; (ii) CEA should capture both human and natural drivers of cumulative change; (iii) spatial boundaries for CEA should be based on ecological boundaries. There are dissenting views about: (i) whether CEA should consider all valued components (VCs) potentially affected by a project or only those for which residual effects are predicted; and (ii) delimitation of future temporal limits. In terms of responsibilities, participants agreed that project proponents should retain a central role in conducting CEA, but government agencies should lead the collection/provision of information about other projects in the study area and baseline VC conditions. Information and knowledge management resources could be also applied in the context of governmental agencies and consultancy firms to support CEA for biodiversity.

Canada has been discussing whether to implement an orphan drug policy for more than 25 years. Recently, the federal government announced funding for orphan drugs starting in 2022, and the Canadian Senate has recommended that the country develop an orphan drug policy. This paper uses a list of orphan drugs approved by the United States Food and Drug Administration between 2008 and 2017, inclusive. It then compares Canada, which has no orphan drug policy, and Australia, which has had such a policy since 1997. There was no difference between the countries in the proportion of orphan drugs approved, the time drugs spent in the regulatory review process, and any delay in marketing the drugs in the respective countries compared to the United States. Both Canada and Australia approved virtually all of the drugs that offered a moderate to significant therapeutic improvement. If Canada hopes to provide faster access to orphan drugs, especially those that are therapeutically innovative, it will need to develop a policy that is significantly different from that in Australia. [ABSTRACT FROM AUTHOR]

BACKGROUND: The paper is a research review focusing on occupational safety in the construction industry. OBJECTIVE: The purpose is to present research that highlights the areas of occupational safety and risks and to identify areas where research is lacking. METHODS: 146 articles from scientific journals, mainly covering the construction industry in Europe, Canada, USA, Australia and Japan have been studied. The findings are presented under 11 categories: accident statistics; individual factors; legislation and regulations; ethical considerations; risk management; leadership, management, organization; competence; safety design; cost-benefit calculations; programs and models; and technical solutions. RESULTS: The research is dominated by initiatives from researchers and government authorities, while the construction industry only appears as the object for the research. There is a scarcity of research on integrated systems encompassing subcontractors, as well as a lack of research with sociological perspectives on accidents. Furthermore, only a few studies have applied a gender perspective on safety in construction, i.e. there is a need of further research in this particular area. CONCLUSIONS: A range of initiatives have been taken to increase safety in the construction industry and the initiatives are mainly reported to be successful. There are some cultural differences, but basically researchers present similar results regardless of country. [ABSTRACT FROM AUTHOR]

This paper examines accounting change decisions in Canada. Evidence gathered from financial statements suggests that there is a relation between bond covenants and the decision to make an accounting policy change. Except for the effect of regulation, the political visibility hypothesis did not hold. [ABSTRACT FROM AUTHOR]

The Supreme Court of Canada has established that commercial speech is protected under the Canadian Charter of Rights and Freedoms and that commercial speech exists along a continuum of utility and value, which is balanced against objectives such as public health. This article examines jurisprudence to determine when infringements on commercial speech are acceptable, analyzing considerations of evidence, rational connections between policies and outcomes, proportionality, and minimal impairment. [ABSTRACT FROM AUTHOR]

Background The estimated effect of cigarette graphic warning labels (GWL) on smoking rates is a key input to the Food and Drug Administration's (FDA) regulatory impact analysis (RIA), required by law as part of its rule-making process. However, evidence on the impact of GWLs on smoking prevalence is scarce. Objective The goal of this paper is to critically analyse FDA's approach to estimating the impact of GWLs on smoking rates in its RIA, and to suggest a path forward to estimating the impact of the adoption of GWLs in Canada on Canadian national adult smoking prevalence. Methods A quasi-experimental methodology was employed to examine the impact of adoption of GWLs in Canada in 2000, using the USA as a control. Findings We found a statistically significant reduction in smoking rates after the adoption of GWLs in Canada in comparison with the USA. Our analyses show that implementation of GWLs in Canada reduced smoking rates by 2.87-4.68 percentage points, a relative reduction of 12.1-19.6%; 33-53 times larger than FDA's estimates of a 0.088 percentage point reduction. We also demonstrated that FDA's estimate of the impact was flawed because it is highly sensitive to the changes in variable selection, model specification, and the time period analysed. Conclusions Adopting GWLs on cigarette packages reduces smoking prevalence. Applying our analysis of the Canadian GWLs, we estimate that if the USA had adopted GWLs in 2012, the number of adult smokers in the USA would have decreased by 5.3-8.6 million in 2013. Our analysis demonstrates that FDA's approach to estimating the impact of GWLs on smoking rates is flawed. Rectifying these problems before this approach becomes the norm is critical for FDA's effective regulation of tobacco products. [ABSTRACT FROM AUTHOR]

Accessible housing is an urgent issue for countries experiencing rapid population aging. For over 20 years the United Kingdom's (UK) building code (Part M) and Lifetime Homes Standard have been researched as leading practices to increase accessible housing stock and allow older adults to stay in their communities. This review compiles key stakeholder groups' perspectives on these regulatory tools. Five main themes and 'lessons learned' were derived to anticipate potential challenges and inform proactive response for planners and policy makers in Canada and other countries when developing their own accessible housing regulation. [ABSTRACT FROM AUTHOR]

Medical tourism is the practice of traveling across international borders with the intention of accessing medical care, paid for out-of-pocket. This practice has implications for preferential access to medical care for Canadians both through inbound and outbound medical tourism. In this paper, we identify four patterns of medical tourism with implications for preferential access to care by Canadians: (1) Inbound medical tourism to Canada's public hospitals; (2) Inbound medical tourism to a First Nations reserve; (3) Canadian patients opting to go abroad for medical tourism; and (4) Canadian patients traveling abroad with a Canadian surgeon. These patterns of medical tourism affect preferential access to health care by Canadians by circumventing domestic regulation of care, creating jurisdictional tensions over the provision of health care, and undermining solidarity with the Canadian health system. [ABSTRACT FROM AUTHOR]

Background: In 2015, a new Liberal Government came to power in Canada, elected on a platform that included legalization and regulation of cannabis for recreational purposes. Their legislation, based on recommendations from a Federal Task Force on Marijuana Legalization and Regulation, is due in early April 2017.Methods: This commentary utilizes Canadian Federal policy papers, previous literature, and internal and international agreements to examine two key areas critical to the development of a nationwide regulated market for cannabis in Canada; the need to overcome restrictions to legalizing cannabis in United Nations' drug control treaties, and the unique challenges that non-medical cannabis creates for navigating interprovincial trade policies in Canada.Results: Irrespective of UN conventions that appear to prohibit legalization of cannabis the Government is preparing to bring forward legislation as this article goes to print. At the same time significant squabbles impede the selling of even beer and wine inter-provincially in Canada. This paper identifies the challenges facing Canadian legalization efforts, but also shows how the legalization legislation may provide opportunities to engender significant change beyond the simple legalization of a specific drug.Conclusion: This commentary does not argue for any specific course of action for Canada, but rather explores the nuance of legalization absent from the declaration in the Liberal party platform. The paper argues that Canada's efforts may hasten the dismantling of the UN drug control structure, and provide renewed opportunities for intern-provincial trade in Canada. [ABSTRACT FROM AUTHOR]

Background: Stringent donor-screening criteria and legislation prohibiting payment for donor gametes have contributed to the radical decline of donor insemination (DI) using sperm provided by Canadian men. Thus, many individuals rely on imported sperm. This paper examines the feasibility of an altruistic sperm donation (ASD) program to meet the needs of Canadians. Methods: Using Canadian census data, published literature and expert opinions, two population-based, top-down mathematical models were developed to estimate the supply and demand for donor sperm and the feasibility of an ASD program. Results: It was estimated that 63 donors would pass Canadian screening criteria, which would provide 1,575 donations. The demand for DI by women was 7,866 samples (4,319 same sex couples, 1,287 single women and 2,260 heterosexual couples). Conclusion: Considerable effort would be necessary to create the required increase in awareness of the program and change in societal behaviour towards sperm donation for an ASD program to be feasible in Canada. [ABSTRACT FROM AUTHOR]

Background: The relevance and quantity of clinical research has caused concern and regulation is claimed to hinder clinical research. This paper compares clinical research regulations in Finland to those of England, Canada, and the USA around 2010-2011., Methods: Several approaches and data sources were used, including semi- or unstructured interviews of experts. For the analysis, a theoretical framework was made, data from various sources was synthesized, and features of the systems were simplified and classified. The various specific names and terms used in the data were changed into general ones., Results: Common structures for the regulation existed in all four countries, but the details and scope varied. The research regulated within the main system was determined by research type (Finland), the financer of the health system (England), or research site (Canada, USA). Only Finland had specific legislation on medical research. The overriding impression of the regulatory systems was one of complexity. All countries had extra regulation for drug research. The types of drug research covered varied from trials with unlicensed (new) products or new indications (USA and Canada), to all types of interventional drug research (England), where 'interventional' was interpreted broadly (Finland). The complexity of regulations had led to the creation of various big and small businesses to help researchers and sponsors. There was notable variation in the role played by the public research funder. The role played by health care was difficult to study and seemed to involve varying interests as researchers were also health care employees. Research ethics committees were important and their tasks also included aspects other than ethics., Conclusions: This study revealed that a comparison between countries can provide useful insights into the distinctive aspects of each country's system, as well as identifying common features that require international action.

This paper addresses recent calls to study the role of the state in private regulation. Integrating current scholarship on the state as a catalyst of private regulatory regimes with prior literature on regulatory failure and self-regulation, it identifies and problematizes unsettled assumptions used as a starting point by this growing body of research. The case study traces the evolution of public debates and the interaction of different regulatory initiatives dealing with corporate social responsibility (CSR) issues in Canada's mining industry. Findings reveal the conditions under which the state is more likely to encourage firm-level, fragmented initiatives than facilitate and promote industry-wide regulatory strengthening and consolidation. I discuss the need for greater analytical precision regarding the variation in regulatory policy preferences across time and branches of government and the interaction between public and private regulatory initiatives. The conclusion outlines suggested areas for future research as well as the likely outcome of Canada's current CSR policy framework. [ABSTRACT FROM AUTHOR]

When the patent of a brand-name, marketed drug expires, new, generic products are usually offered. Small-molecule generic and originator drug products are expected to be chemically identical. Their pharmaceutical similarity can be typically assessed by simple regulatory criteria such as the expectation that the 90% confidence interval for the ratio of geometric means of some pharmacokinetic parameters be between 0.80 and 1.25. When such criteria are satisfied, the drug products are generally considered to exhibit therapeutic equivalence. They are then usually interchanged freely within individual patients. Biological drugs are complex proteins, for instance, because of their large size, intricate structure, sensitivity to environmental conditions, difficult manufacturing procedures, and the possibility of immunogenicity. Generic and brand-name biologic products can be expected to show only similarity but not identity in their various features and clinical effects. Consequently, the determination of biosimilarity is also a complicated process which involves assessment of the totality of the evidence for the close similarity of the two products. Moreover, even when biosimilarity has been established, it may not be assumed that the two biosimilar products can be automatically substituted by pharmacists. This generally requires additional, careful considerations. Without declaring interchangeability, a new product could be prescribed, i.e. it is prescribable. However, two products can be automatically substituted only if they are interchangeable. Interchangeability is a statistical term and it means that products can be used in any order in the same patient without considering the treatment history. The concepts of interchangeability and prescribability have been widely discussed in the past but only in relation to small molecule generics. In this paper we apply these concepts to biosimilars and we discuss: definitions of prescribability and interchangeability and their statistical implementation; the relation between bioequivalence and interchangeability for small-molecule drug products; regulatory requirements and expectations of biosimilar products in various jurisdictions; possible statistical approaches to establish the similarity and interchangeability of biologic drug products; definition of other technical terms such as switchability and automatic substitution. The paper will be concluded with a discussion of the anticipated future use of interchangeability of biological drug products.

Copyright of Canadian Public Administration is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims This paper provides a historical review of gambling in Canada and examines the benefits and shortcomings of present-day Canadian gambling policies and practices. This includes a discussion of provincial and federal government roles in gambling regulation and an overview of problem gambling prevention and treatment initiatives. Methods The gambling studies literature was probed for pertinent information on factors such as historical development, legislative changes, economic conditions and cultural influences that have affected gambling participation and social responsibility strategies in Canada. Results Two major Criminal Code of Canada amendments (in 1969 and 1985) were pivotal in Canadian gambling expansion. The first decriminalized lotteries and casinos, while the second allowed electronic gambling devices and authorized provinces to operate and regulate gambling. These changes resulted in a radical gambling expansion which, in addition to raising provincial revenues, created public policy concerns. Varying provincial government interpretations of the ambiguous Criminal Code gambling statutes led to a lack of uniformity in how provinces regulate and operate gambling; when gambling expanded, there were no legislative safeguards in place to deal with the personal and societal effects of problem gambling. Subsequent programs designed to prevent and treat problem gambling have not been overly effective. Conclusions Canadian provinces have a monopoly on gambling within their borders and treat the activity as a profit-driven business enterprise. Problems associated with widespread gambling such as addiction, increased crime, bankruptcy and suicide are seen as minor concerns and not addressed in an aggressive fashion. Given the Canadian federal government's detachment from gambling policy and Canadian provinces' heavy reliance on gambling revenues, little change in the Canadian gambling landscape is anticipated in the near future. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Law & Society/Revue Canadienne Droit et Societe (Cambridge University Press) is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A recent influx of Asian investment is changing the character of the Canadian oil and gas industry and reviving old debates on the regulation of foreign investment. Particular attention has been placed on investment by state-owned enterprises (SOEs), driven in part by public suspicion about investment from China, which has been the largest source of SOE capital flows to Canada. Recent amendments to theInvestment Canada Acthave made SOE investment more difficult and have raised questions about the country’s attractiveness as an investment destination. This paper makes the case for non-discrimination of SOEs in the investment review process. In the context of a policy framework that is fundamentally supportive of inward foreign direct investment (FDI), the Canadian government does not require a set of redundant measures to protect against the relatively low risk of undesirable investment. [ABSTRACT FROM AUTHOR]

The issue of professional regulation of advanced nursing practice is one of the most controversial in the area of nursing regulation today. The controversy affects the roles and scope of advanced practice as well as education requirements. Nurse practitioner (NP) practice is one kind of advanced nursing practice receiving attention currently, with a view to developing consistent educational and regulatory approaches. Consistency is needed to enhance the mobility and flexibility of these important healthcare provider resources in time of shortages. This paper describes how the regulatory body in British Columbia decided to register only three categories of NP: family/all ages, adult and pediatrics. It describes the state of NP regulation when the work began, the consultation process used in coming to this decision and the principles underlying the decision. Regulators, educators and administrators may benefit from understanding the issues and reasoning presented. Literature to guide this work was lacking, a gap this paper addresses to help inform decision-making in other settings and contexts. Dialogue about this approach may facilitate movement towards consistent approaches to the regulation, education and deployment of NPs in Canada and elsewhere.

This paper examines how current legislative and regulatory models do not adequately govern the pharmaceutical industry towards ethical scientific conduct. In the context of a highly profit-driven industry, governments need to ensure ethical and legal standards are not only in place for companies but that they are enforceable. We demonstrate with examples from both industrialized and developing countries how without sufficient controls, there is a risk that corporate behaviour will transgress ethical boundaries. We submit that there is a critical need for urgent drug regulatory reform. There must be robust regulatory structures in place which enforce corporate governance mechanisms to ensure that pharmaceutical companies maintain ethical standards in drug research and development and the marketing of pharmaceuticals. What is also needed is for the pharmaceutical industry to adopt authentic "corporate social responsibility" policies as current policies and practices are insufficient.

In this paper, I propose the creation of a Canadian agency for the oversight of research involving humans. I describe first a series of significant problems with Canada's current system of oversight. I then argue for the creation of a national-level agency, covering all research involving humans, with three branches (policy and standards, education, and compliance). Of particular note, the proposed compliance branch consists of a number of independent national and regional Research Ethics Boards (i.e., REBs no longer reside within institutions). There is also an Audit Committee and a Non-compliance Committee (with supporting staff of auditors and compliance officers) to ensure compliance with the policies and standards set by the Policy and Standards Branch. Finally, I answer a series of "frequently asked questions" about the proposed agency design such as "What about 'local context'?" and "Why not have a system of accreditation of institutional REBs instead?" In sum, radical reform is needed and, in this paper, I present a proposal for such reform.

Unlike the other contributions to this issue, this paper is concerned with the prospects and potential ramifications of implementing interprofessional practice from the legal standpoint. The authors focus on the two forums where the major legal issues are likely to be played out: the laws under which health care professionals are regulated; and the law of professional malpractice as applied by the courts under the tort of negligence. The goal is to examine the regulatory and medico-legal barriers that might prevent or inhibit health care professionals from working together on an interprofessional basis, and to forecast the kinds of changes within legal systems which will be necessary to accommodate the change. The first part of the paper focuses on the legal regimes which govern the Canadian health care system, and argues that the essential integrity of the system of professional self-regulation must be protected in programs of reform that seek to create space for interprofessional practice. The authors also propose a number of specific initiatives of review and legislative change as examples of the role that legal reform can play in the shift to a culture of interprofessional regulation. The second part of the paper focuses on malpractice law and suggests that, while in the long term the superior quality of care brought about by interprofessional practice should produce less liability, in the short term interprofessional practice may fit uneasily within the legal constructs traditionally employed by the courts to evaluate malpractice claims. The authors propose three strategies designed to minimize this risk.

After more than a decade of study, discussion and debate, the Canadian House of Commons and Senate have approved the Assisted Human Reproduction Act. Building on the earlier Bill C-47, which died on the order paper in 1997, the Act bans human cloning for reproductive or therapeutic purposes, payment for surrogacy arrangements, and trading in human reproductive materials or their use without informed consent. In addition, the Act significantly restricts research using human reproductive materials. This article compares the Act to legislative regimes in other nations with advanced human reproductive science. It concludes that while the Act has many laudable goals, it is flawed in that it tries to cover too much legislative ground. As a result it unreasonable impairs the ability of Canadian scientists to compete in areas such as stem cell research, and area that is expected to yield significant new approaches to treating human disease.

The Global Financial Crisis (GFC) has been the subject of much academic discussion, yet there is no consensus on its root cause. This paper traces the origins of the GFC back to the effects of the Anglo-American model of corporate governance on large financial institutions, and in particular to that model's emphasis on shareholder primacy. Drawing on Karl Polanyi's notion of "embeddedness" and Hyman Minsky's financial instability hypothesis, the author notes that the emphasis on shareholder primacy creates perverse corporate incentives that are detached or "disembedded" from their economic, political and social context. He argues that these perverse incentives were the root cause of the GFC and the subsequent economic and political turmoil. The trajectory of the GFC in both Canada and the UK was shaped primarily by the relative disembeddedness of large financial institutions. In particular, excessive risk-taking by those institutions, combined with a weakening of prudential regulation, led to the emergence of a system that was divorced from its economic and social context. As Minsky predicted, the cracks that developed in this disembedded system compelled states to use fiscal and monetary policy to prevent a depression, sowing the seeds of political unrest in the aftermath of the GFC. The author concludes that long-term economic stability requires that shareholder primacy be replaced with a corporate governance model that acknowledges the economic, political and social influence of financial institutions. [ABSTRACT FROM AUTHOR]

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In this paper, we provide as accurate a picture as possible of transnational trade in human eggs involving Canadians. We explain the legal status in Canada, and call for reform in the regulation, of such trade. [ABSTRACT FROM AUTHOR]

In 2001, the safety of drugs purchased from other countries, especially Canada, became a major policy issue in the United States. A political and geographical line was drawn in the sand separating Canadian and American drugs. Canadian drugs were characterized as dangerous-'a maple peril.' This article explores the practice of cross-border drug reimportation and considers the Bush and Clinton administration's policies regarding the necessary balance between drug access, affordability, and safety. This paper suggests continuity rather than change typified these policies. It connects business, economic, and political history with public policy and it aims to furnish an interdisciplinary overview of the legislative and executive branches, as well pharmaceutical firms and consumers. [ABSTRACT FROM AUTHOR]

A revised framework for the regulation of in vitro diagnostic devices (IVDs) came into force in Australia on July 1, 2010 that aims to 'ensure that public and personal health are adequately protected', but which instead may lead to adverse outcomes in clinical diagnosis and management. The regulatory process aims to regulate all IVDs, including those used by clinical diagnostic laboratories, which are already subject to scrutiny as part of the current laboratory accreditation process. The IVD regulatory process initiated in Australia is similar to that used in Canada, but different to that currently operating in the USA and Europe. However, it is feasible that other countries will in time adopt a similar regulatory framework, given that many countries are involved in the development process. In this opinion paper, the regulatory process for IVDs across several geographies are outlined, as are some benefits and weaknesses of the new regulatory process now applied to Australia, as potentially planned for other regions of the world. [ABSTRACT FROM AUTHOR]

This paper explores the lessons to be learned from why the neighbouring banking systems of Canada and the United States, that share numerous commonalities, fared so differently during two major financial crises. The explanations are deeply rooted in different tolerances for industry concentration and state involvement, and the divergent routes of the development of their financial systems, founding institutions, on-going governance and regulation, and competitive structures. Canada's success during the more recent 2007-09 financial crisis is attributed to more effective regulation and conservative banking practices, including (self-) imposed stricter limits on bank leverage, much stricter limits on unconventional mortgages, and less reliance on the use of more 'creative' investment types (e.g. subprime lending) and structured products. [ABSTRACT FROM AUTHOR]

Section 8 of the Canadian Charter of Rights and Freedoms guarantees to all Canadians the right “to be secure against unreasonable search and seizure.” Decisions regarding this section of the Charter are typically made in the context of charges against an accused, and the accumulation of these decisions defines the boundaries of the privacy interests of Canadians vis-à-vis governmental action. But while the court is focused on the privacy interests of particular individuals who have been accused of contravening the law, it is also determining the privacy rights of all Canadians. This paper explores the judgmental biases that arise naturally in such a situation. The evidence from psychological literature suggests that the degree to which government actions are viewed as intrusive (and thus compromising privacy) will be reduced to the extent that the decision maker takes a third-party perspective (search of others, not oneself) and to the extent that there is knowledge of irrelevant situational information, including the results of the potential search (i.e., whether evidence was produced) and indication of the guilt or innocence of the subject of the search. In deciding the typical section 8 case, judges find themselves in exactly these positions, and they thus run the risk of attenuated perceptions of intrusiveness. Analysis of the empirical literature suggests strategies for minimizing this bias, including considering intrusiveness from a first-person perspective and adopting an explicitly analytical stance on the specific question of whether the actions in question constitute a search or seizure. [ABSTRACT FROM AUTHOR]

Naturally occurring retirement communities (NORCs) are unplanned communities with a high proportion of residents aged 65 years and older. Oasis is a Canadian aging in place model that combines health and supportive community services for adults aged 65 years and older within NORCs. The aims of this study were to explore how physical distancing restrictions during the COVID-19 pandemic impacted older adults living in a NORC (Oasis members) and to investigate whether Oasis served as a context for social connection and well-being during the COVID-19 pandemic. An interpretive description methodology guided this study. Semi-structured interviews were conducted with nine Oasis members (aged 66–77 years) and two Oasis site coordinators. The Oasis members also completed a social network mapping activity guided by the hierarchical mapping technique. Three overarching themes related to the impact of physical distancing on Oasis members during the COVID-19 pandemic were identified: (1) unintended consequences of physical distancing restrictions on participants' wellbeing; (2) face-to-face interactions are important for social connection; and (3) family, friend, healthcare provider, and community support mitigated the impact of physical distancing restrictions during the COVID-19 pandemic. In addition, two of Oasis' core pillars were found to support participants: strengthening social connectivity and connection to pre-existing community services. Findings illustrate that community programs like Oasis acted as a source of resilience during the COVID-19 pandemic and advance our understanding of the impact of aging in place models on community dwelling older adults' experience of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Since economists are often required to testify at regulatory hearings, it is pertinent to inquire as to the extent that their testimony influences the regulatory commission in its decision. Since commissions regularly evaluate the various arguments in the text of their decision, it is certainly possible to ascertain to what extent a commission was influenced by a particular testimony. This paper considers one particular case in detail—the Canadian Radio-television and Telecommunications Commission (CRTC) Phase III cost inquiry for federally regulated telecommunication carriers. The purpose of the paper is to ascertain what motivated this commission in its decision. These hearings provide a particularly good case study, since the intent of the CRTC was to evaluate a number of costing methodologies and, on the basis of the evidence, to select an appropriate methodology; thus a considerable part of the evidence related to economic theory. [ABSTRACT FROM AUTHOR]

The practice of covertly administering medications to patients without their consent is often discussed in the framework of legal questions around the right of patients to consent and refuse medical treatment. However, this practice also raises significant questions surrounding the professional duties and obligations of health care professionals as it relates to the decision-making process of whether to engage in the covert administration of medications. In this paper, I present an overview of the origin of those duties and obligations, and discuss how those duties and obligations when seen from different perspectives may either justify or prohibit the practice. Further, I discuss whether the duties and obligations of health care professionals as they are currently framed are suited to address the complexities of this issue both from the health care professional and patient perspectives. This analysis is conducted in the context of duties and obligations that arise from not only legal framework but also from the ethical requirements from professional codes of ethics. [ABSTRACT FROM AUTHOR]

This exploratory study examines the likely causes of the alarming global rise of antisemitism during the COVID-19 pandemic. Beginning with an appraisal of today's world Jewry, this exploratory study highlights the main social, health, and religious impacts COVID-19 has had on Jews worldwide and goes on to highlight how various Jewish communities managed and adjusted to COVID-19 public health restrictions. From this contextual backdrop, an assessment of how and why antisemitism has surged during the pandemic is presented, along with a review of what efforts are being taken to curtail this rise in hatred toward Jews. A central aim of this study is to underline the point that until meaningful, broad, and international steps are taken to curb online hate, the historic antisemitic tropes and myths suggesting Jews are the cause of disease will undoubtedly evolve and surge (especially across social media) during future pandemics and times of global crisis and unrest. [ABSTRACT FROM AUTHOR]

In Canada, private foundations are subject to greater regulatory scrutiny than public foundations and other types of charitable organizations. Whether this level of regulation is justified is the subject of A. Abigail Payne's Firm Foundations: Putting Private and Public Foundations on Level Ground (2005). In their critiques of Payne's paper, William I. Innes and Patrick J. Boyle support keeping the current regulations, whereas Wolfe D. Goodman supports the lessening of the regulations. In her response to these critiques, the author stresses the importance of gaining a better understanding of the reasons for and the operations of private foundations, relaxing ineffectual regulations, and promoting greater transparency in the activities of these organizations. [ABSTRACT FROM AUTHOR]

Background: Accessing healthcare for immigrants in Canada is complicated by many difficulties. With the continued and upward trend of immigration to Canada, it is crucial to identify the solutions to the barriers from the perspectives of different immigrant communities as they encounter them including the relatively smaller and less studied population groups of immigrants. As such, Nepalese immigrants in Canada are a South Asian ethnic group who have their own distinct language, culture, and socio-economic backgrounds, however, their experience with accessing healthcare in Canada is scarce in the literature. Methods: We conducted 12 focus group discussions with first-generation Nepalese immigrants who had experiences with primary care use in Canada. Informed consent and demographic information were obtained before each focus group discussion. The verbatim transcription of the focus groups was analyzed using thematic analysis. Results: The participants expressed a range of potential solutions to overcome the barriers, which we presented using the socio-ecological framework into 4 different levels. This includes individual-, community-, service provider-, and government/policy-levels. Individual-level actions included improving self-awareness and knowledge of health in general and navigating the healthcare system and proactively improving the language skills and assimilating into the Canadian culture. Examples of community-level actions included community events to share health information with immigrants, health literacy programs, and driving/carpooling to clinics or hospitals. Actions at the service provider level were mainly focused on enhancing communications, cultural competency training for providers, and ensuring to hire primary care workforce representing various ethnocultural backgrounds. Overall, focus group participants believed that the provincial and federal government, as appropriate, should increase support for dental and vision care support and take actions to increase the healthcare capacity, particularly by employing internationally graduated health professionals. Conclusions: Access to primary care is essential for the health of immigrant populations in Canada. Individuals, community organizations, health service providers, and governments need to work both individually and collaboratively to improve immigrants' primary care access. [ABSTRACT FROM AUTHOR]