Forced addictions treatment will cause more harm than good, ethics expert warns N.B.
Timothy Christie urges investments in social determinants of health instead of Compassionate Intervention Act
It's "highly likely" New Brunswick's plan to force some people with severe addiction into involuntary treatment will cause more harm than good, according to an ethics expert.
Timothy Christie, the regional director of ethics services for the Horizon Health Network, says he conducted an ethics analysis of the proposed Compassionate Intervention Act and found "huge problems" related to Charter violations and evidence-based medicine, he said.
He also believes he has identified a better approach — investing more in the social determinants of health; the non-medical factors that influence health outcomes. These are the conditions in which people are born, grow, work, live and age, such as education and employment.
If the Higgs government intends to push ahead with the legislation, Christie contends it should be amended. "We will have to do things to make it as humane and ethical as we possibly can."
This includes having a "rigorous evaluation plan," so if forcing people into treatment against their will does prove to be more harmful than beneficial, clear stopping rules will be established, said Christie, who is also an adjunct professor of bioethics at Dalhousie University and an adjunct professor of philosophy at the University of New Brunswick.
"However, if there's an option to take another path, I would strongly encourage considering the social determinants of health and optimizing that in New Brunswick," he said.
Authorities are not bound to follow Christie's advice. "The only thing I have is power of persuasion," he said.
Notwithstanding clause is 'very extreme action'
Addictions and Mental Health Minister Sherry Wilson is expected to introduce the bill in the legislature this month.
Premier Blaine Higgs has described the legislation as necessary to address the homelessness crisis, because shelters are not equipped to help people recover from addiction.
Public Safety Minister Kris Austin has said the legislation will "absolutely, 100 per cent" include a process allowing medical professionals, family members and others to weigh in on whether someone with severe addiction needs to be forced into treatment.
Still, Christie contends it violates the right to liberty and security, guaranteed under Section 7 the Canadian Charter of Rights and Freedoms.
"Taking people's rights away is a harm," he said. "By being forced into treatment, you're taking my liberty away. And forcing treatment on me is violating my security of the person."
Other critics have argued the bill is unconstitutional because Section 9 of the Charter stipulates everyone has "the right not to be arbitrarily detained or imprisoned."
Higgs said last month he has not ruled out using the Constitution's notwithstanding clause as part of legislation to protect it from a Charter challenge.
Christie describes that as a "very extreme action."
The notwithstanding clause, which allows a legislature to insulate a bill from a court challenge by declaring that some Charter sections do not apply, "is used very reluctantly," he said.
This is what prompted him to conduct his analysis, he said. He wanted to try to identify the values guiding the policy and make sure those values meet ethical standards and are not influenced by a biased perspective.
No cure, relapse predictable
One of Christie's main concerns with the bill relates to the fact that there is no cure for addiction. It's a chronic condition.
While there are some treatments, none are "100 per cent effective for 100 per cent of the people," he said.
"Some people can be struggling with this for the rest of their life."
So if relapse is a possible predictable outcome, mandated treatment "becomes problematic," said Christie.
In addition, there are some addictions for which we have no effective evidence-based treatments, he said, citing crystal meth as an example. A recent drug-use study in Saint John found 90 per cent of the roughly 40 participants had a problem with crystal meth, he said.
"If no evidence-based treatment exists, mandating individuals into treatment will, by definition, be a failure," Christie said.
"If a person improves, it won't be because of the treatment. In this sense, the legislation will be overbroad because it will impact people for whom there is no rational expectation of improvement."
Christie also questions how long people will be mandated to attend treatment for since there is no cure, and worries treatment might be enforced through some sort of punishment, even though relapse is a "natural phenomena."
If that's the case, "not only have we taken away from their rights, but we've also caused considerable amount of harm," violating the ethical principle of non-maleficence, or do no harm, he said.
"So I think from an evidence-based medicine perspective, there are some very serious concerns that if we were going to do this, we would have to address properly."
Instead, Christie urges the government to invest more in the social determinants of health, which he contends are responsible for about 75 per cent of the health of the population.
As it stands, the majority of funding goes into medical services, such as hospitals and doctors, which account for only about 25 per cent, he said.
Horizon's budget last year, for example, was $1.4 billion. "We do not invest anywhere near that in the social determinants of health," Christie said, describing them as "significantly underfunded."
"I think that if we adequately invest in the determinants of health, the problem that the Compassionate Intervention Act is trying to address, if it's not eliminated, it would be radically and drastically reduced," he said.
Christie dismisses the notion that such investments could be infinite. New Brunswick has a defined population and a limited number of problems, he said.
He also stressed he's not suggesting to stop funding the medical side. "We definitely need to do both.
"But … if we don't address the determinants of health, we're in a position like we currently are, where we're thinking about taking people's rights away in order to try to deliver some type of intervention."
With files from Rachel Cave