The Paikin Podcast - How to Fix Canada’s Health Care System

Episode Date: August 20, 2026

Michael Decter and Michael McCarthy join Steve to discuss their book The Canadian Health Care Guerrilla Handbook, how to be a “ninja warrior” for your health care, the role of family doctors as ��gatekeepers,” non-urgent emergency room visits, and why patients need to advocate for themselves to get good care. They also discuss Canadians going to the United States for health care, the crisis of accessing mental health care, and concerns over MAID.  Support us: patreon.com/thepaikinpodcast Follow The Paikin Podcast: YOUTUBE: http://www.youtube.com/@ThePaikinPodcastSPOTIFY: https://open.spotify.com/show/1OhwznCIUEA11lZGcNIM4h?si=b5d73bc7c3a041b7X: x.com/ThePaikinPodINSTAGRAM: instagram.com/thepaikinpodcastBLUESKY: bsky.app/profile/thepaikinpodcast.bsky.social Email us at: [e-mail]  Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

There are a lot of books out there about how you should navigate your way around Canada's health care systems, but I'm not sure there are too many that suggest you should be a ninja warrior for your health care. We'll find out why two healthcare experts are advocating that approach coming up next on the Paken podcast. I am delighted to welcome to, I will confess, long-time friends of mine, who are about to share their knowledge, which I think you can sum up in decades and decades, of experience of the health care systems of this country. Michael Dexter is a former Deputy Minister of Health in the province of Ontario. He's a former chair of the Health Council of Canada.

Mike McCarthy is a senior policy, former senior policy advisor to the Ontario Minister of Health. And they have teamed up on a new book. There it is right there. It is called the Canadian Health Care Gorilla Handbook, How to Fight for What You Need. And in the interest of full disclosure, as I welcome you, gents to the program, let me say, not only are you both friends of mine, but you have both at different times of your various careers, worked with my wife, who's a health policy consultant. So we put that on the record in the interest of full disclosure, and we ask, Mike McCarthy, where are you coming from today?

I'm coming from Sebringville, Ontario. Which is near the Stratford Festival. Good for you, okay. And Michael Dexter, where are we finding you? From Midtown, Toronto. Amen. Okay. Near the Summer Hill Liquor store, actually. Well, that begs the question, do you spend too much time there?

Because I've read in your book that one of the things to do to have better health is not drink so much. I don't drink so much anymore. I'm taking my own advice. Excellent. Mike McCarthy, let's start with this because you've got a fairly provocative opening chapter in the book in which you say, be a ninja warrior for your health care. What does that mean? It means you just can't rely on the system to make sure that you get great care.

We used to believe that Canada had an advantage over the rest of the world when it came to health care. It was a single source service type of thing. And now we find in 2026 that we're facing a crisis of access and quality. And if you don't take matters into your own hand and stand up for yourself and your rights as a patient and a Canadian, you're going to get kind of mediocre care at best. Well, let's dive into the book then in some of the points that you make. And Michael, we'll start with access because, of course, Family doctors are the gatekeepers to the health care system, and yet six million people in Canada don't have a family doc.

So if you don't have one, how do you suggest people get one? Well, there are efforts underway in every province to try and recruit doctors, train more doctors. But it's slow business when you're missing six million doctors for six million people. And the other problem is the boomer doctors are starting to retire. and they're mostly old school, work long hours, look after a lot of patients. And I have to say the new graduates are wary of getting into a situation where they're overwhelmed by patients. So a lot of them are doing locums.

They're doing hit work. It's important and they're great. They're really well-trained doctors. But the shortage is going to go on for quite a while despite all of these efforts. And a quick follow up, Michael. Is there any alternative to having family doctors? being the so-called gatekeepers of the system? We've made the family doctor the gatekeeper over a long period of time.

One of the initiatives that's underway is to look at what could be done by others. And so you've got on one end pharmacists getting a lot more scope of practice to renew prescriptions, even prescribe. You're seeing nurses given more authority. And you're seeing nurse practitioners given a pretty full scope to do primary care with a couple of problems. One, there are only 9,000 nurse practitioners in the whole country, so it's hard to solve a problem of tens of thousands of doctors that aren't there with a small number of nurse practitioners. The other is we have referral systems for testing and referral systems for specialist care that the family doctor is still the gatekeeper for. So even if you can find someone who can give you some amount of care, people end up in emergency.

emergency rooms right across the country because that's the only place they know they can get care and a referral and then a huge number of them go home without being treated. I'm going to follow up on that in a second because I did learn something quite shocking about that situation from your book. But one more question, and Mike McCarthy will go to you on this one as it relates to increasing the number of family docs in the country. We had kind of an intriguing situation take place in the province of Ontario a couple of years ago when the progressive conservative government of Ontario hired the former liberal federal health minister Jane Philpott to lead an initiative over several years to increase the number of family docs in the province. What hopes do you

have for that actually hitting pay dirt sometime down the road? I think it's a great start to solving a big problem that we're currently facing Steve. And Dr. Philpott's, you know, in my opinion, when it comes to delivery of care for Canadians, despite her being a liberal cabinet minister federally at one time. I think the important thing for what they're trying to achieve in Ontario is to identify where the orphan patients are and not just provide more doctors where they can come to Toronto and practice in big cities and leave big holes of primary care access

for people to fend for themselves in rural and remote Ontario where the need for family physicians is huge. So identifying where these folks can practice and sort of buddy them up to jurisdictions that need the kind of primary care that's missing right now is probably the most important piece. Let me do a follow on that, Mike, which is to say, is it an advisable thing or is it even possible to do? For example, if let's say foreign trained doctors move to Canada, are we allowed to say to them, sure you can come to Canada, we want you here.

but we're not going to give you a billing number unless you move to a remote or rural place for, let's say, five years. Can you do that? Well, we tried to do that when we brought in foreign trained physicians when we were in office and it was very difficult because they had a right to practice where they want and a number of them took a challenge to court to say that a return to service agreement wasn't legally bounding. However, I think Michael Decker would be able to tell you in certain jurisdictions in Canada that doctors won't get a billing number unless they practice in an area that requires their services. So it's kind of a mixed thing, but I do think the government has the ability to challenge where physicians should practice based on providing the OHIP code where they

get paid. So Michael, you might want to add to that. Yeah, I did spend some time testifying in a case in New Brunswick some number of years ago about whether the government had the right to assign billing numbers geographically. And the government actually won that case, partly on an analogy to judges. So governments can't tell judges what decisions to render, but they do decide where the courthouses are built. So they do decide where justice is dispensed. And then the judge in that case ruled that essentially the government had the right to assign billing numbers to geographies. But here's the practical end. So a group of doctors in the larger cities in New Brunswick went north to where they

were more needed, got billing numbers, and then they spent a day or two a week up there and the rest of their time back in the city. So practically speaking, you can impose it, illegally speaking, you can impose it, but practically speaking, you're dealing with human behavior. And if people don't want to practice somewhere, it's very hard to bribe them to do it. Okay, Michael, let me. do, as I said I would a moment ago, circle back to this issue about a million Canadian emergency room visits every year where the patient leaves without being treated. In other words,

I mean, I inferred from that when I read that in your book that these were actually not emergency situations, but they still took up valuable staff time, caused patients to wait for hours, ultimately for non-emergent, non-urgent reasons. And I guess the question is, how close do you think we're getting to creating a system where non-urgent circumstances don't overwhelm our emergency departments and instead patients can get appropriate care elsewhere. Oh, we're a long way from that at the moment. The emergency rooms are still getting swamped. Partly it was a feature of bringing in very rapidly a couple million new Canadians and not having a plan to attach them to doctors or to primary care. But the other part of this is we rationed care by people's ability to wait.

You might think that someone who waits eight or 10 or 20 hours in an emergency and then goes home without being seen is feeling better. But that doesn't mean they're not ill. And there are some tragic cases where people have gone home without a diagnosis, without being other than triage, and then had a fatal incident. And there were also people who, you know, celebrated case in my old hometown of Winnipeg where someone in a wheelchair died in the emergency room and they didn't notice for 24 hours

or some such length of time. So there are, you know, the problem is triage isn't perfect. So even if you don't, you're not bleeding, you don't look like you're in bad shape, you might go home and, And you've missed the diagnosis that you needed. And a disturbing number that came out of a study at Mount Sinai in Toronto, they're diagnosing significant number of cancer cases in the emergency.

And that's not supposed to be how you're supposed to be catching the cancers much earlier through screening, through family doctors. If you're picking up a cancer because there's symptoms that are severe enough for the person to be in an emergency, room situation. You're very late to get a good result. Mike McCarthy, how much success are we having at recruiting doctors either who are Canadian living in the United States or American doctors from the United States to come to Canada? Well, we have standards for physicians to practice in Canada that's reciprocal to a number of G7 countries and they can come to Canada and quickly get

licensed here and practice. It's the other countries that We see that many countries provide medical graduates with a doctorate in medicine, but yet they didn't actually ever treat a patient. So we don't know, you know, we all want doctors, but we don't want doctors that aren't well trained. And, you know, by the time to get to Canada, and we hear the stories that they're driving a taxi cab and not treating people, for most cases, they're not supposed to be treating people in Canada. They're not to our standards. And that's why we need to do the proper training.

and all that takes a long time, and it takes a lot of money to train folks to become doctors. I think the answer is to train Canadians to be doctors. We're not taking doctors from other countries and leaving a hole in their system. We're getting it done here, and I think that's where it's got to go. I just want to just make one comment about the emergency room that is not fully understood by the public. Many doctors and family practices in Canada are in a family health team, is what they call it. And they close their doors at 5 o'clock. a contract that they have with the province that pays them, they're supposed to provide after-hour services.

And I've talked to many jurisdictions where many of these patients find themselves in trouble after hours, and they end up getting a message from their family doctor to go to the ER because they're closed. And meanwhile, the contract says they're supposed to provide that primary care in their office after hours. And when I talk to government, they say, well, that's true. And they did sign a contract, but we're afraid of upsetting doctors, so they don't enforce it. And so we don't, we don't. We have an enforcement problem of contractual obligation for primary care services in this country as well. How could they enforce it, Mike?

Withhold money. That's the whole deal, right? That's what we roster patients through family practice, and many doctors never or rarely see these patients, but they're on the roster and they get paid to put them on the roster so that they become a family identified physician for that person. I think the penalty is if you go to an ER and you have a family physician, that cost of that should fall on the back of the family practice. All right. I want to ask, go back to Michael Dexter here, and that is, we have a Medicare system.

We allegedly have a single-tier Medicare system to which you cannot buy your way to the top of the line or the front of the line. But then we've also seen circumstances where doctors who have been told they're not allowed to extra bill in a lot. other words, bill patients beyond what the fee schedule will pay, we see them charging so-called administrative fees so that they can provide their patients with a little something extra, or even in some circumstances, patients are able to, let's say if you're an executive, you can go to one of these sort of privately owned clinics in a very nice building and get full body scans and you pay extra for that. What do we think about the advisability of all that? You're running several key issues together.

So first of all, it's always been a mixed system. And yes, the government stepped up to pay the vast majority of hospital and later doctor costs. And in those days, that was most of health care. But over the decades, drugs have become far more important. And other services for people aging, home care, there's a whole raft of a broader set of services. And yet the Canada Health Act services are quite narrow. So you've got this single payer argument, but the single payer argument only applies to Canada Health Act services,

and that's largely doctors and hospitals. Let me put it this way, 40 million Canadians, that's all of us, even refugees who've just arrived, have coverage from either the provincial governments or in some cases the federal government. 27 million Canadians have some of the government. Canadians have supplementary health insurance, mostly through their employer. And that other insurance often pays for drugs, dental, and other services that aren't covered

or aren't fully covered by government. So it's a mixed system. When I go to get a prescription filled, I've got two plans, one from my employer, one from a former employer, and I've got ODB. And that happens behind the counter. I don't know who's paying for what. I just know what my share of it is. So there's some out of pocket, even with those three plans ahead of me.

So what we haven't sorted out is how to integrate. Now, the pharmacy one is pretty well integrated. I don't have to sort it out. The pharmacist sorts it out. But a lot of the rest is the existence of services. You mentioned the clinics that are pay out of pocket. or membership driven. There's large debates about that.

Is that an erosion of Medicare or does it take some pressure off Medicare? They're very strong views on both sides of that question. So I think the reality is we have a mixed system and we're not managing it very well. Yes, I'll follow up with Mike McCarthy on this. And I'm sure all three of us know people who have advised us somewhere along the way to, go across the border, go to the United States if necessary, get one of those full body scans. You know, we're mostly in Toronto. So it's, you know, drive to Buffalo and get a full scan, give them whatever cost, 1,500

bucks to do so because we don't want to wait however long it will take to have the same kind of treatment here in Canada. Mike, what's your advice on whether or not that's worth doing? It depends how long you're waiting, Steve. And if you're hurting and you don't have a MRI book for eight months, and you can't wait. And the cost of $3 or $400 to go to Buffalo or Detroit, I'd say go. It's not an equitable system any longer.

And folks that have the ability to pay out of pocket to do these things, if it means going over the border to get it done, the books really, and what we advise, it's about taking care of yourself at this point in time is the system is more reactive instead of active in order to provide timely services. The same goes with more serious cases. If you have the ability to pay, we recommend for a second opinion that you may want to go to the Mayo Clinic or John Hopkins in the United States for the price of a minivan to look at what kind of cancer you got and the treatment that you need for it.

We advise in certain cases if the time of the access and care is not available to you, depending on where you are in the country, you've got to take matters into your own hand and take charge of your own health care and not wait for the state to be there for you because it is not. The data shows people are suffering needlessly because they're waiting a long time. And when they do get in the system, Steve, the adverse consequences of being in an overcrowded system is medical error of the tune of 150,000 people. And in this country, 20,000 people plus die from medical error in this country. And that is just not acceptable. And so we say take matters into your own hand. If you've got to go to the states to get a diagnostic thing or a second opinion for a serious disease, you should consider it seriously. Well, Michael Decker, that's a nice segue

to get to the next thing I wanted to raise, which is, again, according to your book, more than 200,000 people a year in Canada, contract infections that they get in the hospital while they're being treated for something else. Does that suggest that we should try to do, both as a system, and in terms of being in control of our own health,

should we do everything we can to avoid going to the hospital in the first place? Well, if you can get the treatment without a hospital stay, you're reducing your risk. And that is we're doing many, many more things on a day basis with keyhole surgery, people having very short hospital stays. In most other countries, that work has moved to freestanding clinics or surgery centers,

which hasn't happened in Canada and probably should. The idea that you're putting people who are in for a procedure into a building where they have a significant chance of getting a bad infection called a no-sacomial infection, which means it was acquired in the hospital. And then they have a much longer length of stay while the hospital tries to deal with that infection. We have some lessons to learn from, particularly the European countries, about how to sort out treatment and how to reduce this ongoing saga. This is when I chaired the Kai High Board many years ago, we had a big study done, a Canadian Institute for Health Information.

It brought out some very alarming statistics about adverse events and hospital-acquired infections. And they've published those statistics every year since. And the numbers haven't moved that much. So three million people a year go to hospital, a couple hundred thousand of them have an adverse event, often an infection. and we have not succeeded in making safety and quality job one in the health system. And we need to do that. And part of that is not putting people into a hospital or if you're a patient asking if you can get the procedure done in a day clinic and get some home care rather than being in a hospital bed where you've got other risk. Well, Mike McCarthy, you go further.

You say you should never go to the hospital alone. How come? Well, we believe, and I've seen it as a health care provider myself as a nurse for many years, those that bring a family member or a close relative or a good friend tend to get better care because you see other eyeballs watching the delivery of the care. When you're faced with a serious event and you go to the hospital or a doctor for a diagnosis, it's good to have a health buddy with you because you're really not listening to what the doctor has to say other than words like cancer

or diabetes or some other at a serious diagnosis. And so any kind of health teaching kind of goes out the window because you're so freaked out about what's currently happening to you in terms of what the doctors just told you. The health buddy's there to take notes, to ask questions, to provide validation of what the doctor said. We believe, and it's borne out repeatedly, if anybody ever goes to the hospital with somebody that's with them

that is part of the discussion with the treater, you get better care. Michael Dexter, I want to ask you about something that I know everybody watching or listening to this has felt or experienced in their guts and they just don't know what to do about it. And that is this. There are times when we have an interaction with the health care system and we want something else. We want a second opinion. We want to ask questions of our doctors. we want something more.

And we're afraid to ask for more because we don't want to alienate our health care provider and become, quote, unquote, that patient who they are ultimately going to be annoyed with and perhaps not give us good health care because they don't like us because we've been advocating too strongly for ourselves. How do we figure all that out?

Let me give you a very simple way of dealing with that. Patients should go to the Canadian Medical Association Association website and they should print out the statement from the CMA which says you are entitled to and you should get a second opinion and they have a long list of situations in which they believe that it's not only appropriate but it's an excellent idea to get a second opinion and I would say print that out put it in your pocket you don't have to you're not going to alienate most doctors by saying, I'd like to get a second opinion. Because these are serious situations. This is the medical profession thinks you should. Now, how do you get one? The easiest way is if your

doctor has a colleague or they have someone that they have a high regard for that can look at the data, look at you, give you the second opinion. But you're absolutely right. People are worried that somehow their treatment will be adversely affected or their access if they ask for a second opinion. But I think the reality of it is it's how you ask for it. And you shouldn't ask for it by saying, well, I don't trust you, Doc. I'd like to get an answer from someone else. I think if you say, look, this is a serious thing, surgery, you know, and I'd just like to know, I've got more than one pair of eyes on my situation.

And I think we need to demystify it. And we do need to say the leadership in medicine believe in second opinions for patients. Not for everything. I mean, if you got a cold, I wouldn't bother a second doctor on it. But if it's anything on this long list of serious things, exercise your right to get a second opinion. There are second opinion services offered by a lot of the insurance companies. So if I go back to the 27 million people with some form of employer coverage, often that includes access to a second opinion service.

And we'll be back right after this. Mike, I'll do a follow up with you on something else I learned in the book, which is to say you know that it seems to be the case, that nowadays people are being released after procedures from hospital, and the expression is quicker and sicker. According to your book, if I'm in the hospital, and I've just had a procedure done, and I don't feel like I'm ready to go home yet

because I don't, I'm just not sure that I'm able to take care of myself. You're allowed to insist on staying another day or two or three in the hospital? Is that right? Absolutely. I don't think there's anything written in Canada Medicare that forces an exit from you from a hospital bed if you're still unwell or believe you're unwell. Some people may want to stay in that bed a lot longer

because they don't like where they're going to go, and that's another matter in terms of a disposition. to a long-term care bed or a rehab bed. But if you're not well and you don't think you're ready to go home because you don't think you can be cared for or you don't feel that you're up to it yet, you absolutely have a right to tell your physician and the hospital folks that I need a couple more days to get stuff together. And frankly, a lot of after-hospital care is fairly limited and rationed in this country.

So you might get three visits. And if you're really sick, three visits isn't going to do it for whatever. it's ailing you for while you're in hospital. Again, people have to find their voice, be prepared to stand up for their care that they believe that they should be getting and be politely insistent that they're not ready. And it's good, again, to have a health buddy with you

to say, there's nobody home for this person. You don't got enough health services lined up for them after they leave hospital. Can we have a little more? And so hospitals would want to get you out of the bed because those beds are premium of people waiting 18, 24 hours and beyond in the ER on a gurney to get into that bed and the pressure that that has on the system, the hospital will obviously go the extra mile

and make sure that there's better care for the appropriate time to release that patient. Michael Dexter, I mean, your book is, I won't say replete with horror stories, but there are horror stories in the book about encounters people have had with the health care system that just went south and badly. And I think one of the ones that really stayed with me was a woman named Catherine who needed a lumpectomy. And what ensued was a series of cascading complications because, at least the way you've described it, nobody gave a damn enough in her case to make sure that she ended up healthy at the end of it all. I don't know if you want to share some of the additional details around that, but what do we do when we find ourselves in a situation where it just feels like nobody at various steps in the health care journey cares enough to ensure.

sure that we get to the finish line and healthy. If you look at some of the stories like that one that have a real negative journey, it usually takes more than one error. It's usually a cascade of things. Someone goes on vacation. Someone doesn't do the handoff. You know, there isn't, the person doesn't have someone with them to keep track of where they're going. So there are completely tragic cascades of negative events that happen, that shouldn't happen. There's actually a jurisdiction, Minnesota, which passed a statute listing never events, things that should never happen. And they do happen. And people are injured. People are, in some cases, they die. What you want to do is if it's a case where you think the care is going off track, you need to

escalated in the hospital you're in, go to the patient care representative or whatever they're calling them, and ask a lot of questions. Say this feels like it's not going the right direction. And if you have to move, if it turns out that you're in a small place and it looked simple and then suddenly it isn't, get moved to an academic medical center where there's deeper resources. You have to, as a family member, as a supporter, as a loved one, you have to be pretty forceful because there's this tendency of Canadians to be patient patients and to maybe just think,

well, it's going to get better. And if it's not getting better, you do need to take action and remove yourself for your patient, loved one from the circumstances and get a real alternate situation for care. And that's not always an easy decision to make. There's a lot of pressure to just hang in and, you know, we'll get to you soon. And, you know, if one thing goes wrong, other things may go wrong. And that's the cascade that ends up with, in many cases, horrific and tragic results. Mike McCarthy, I want to ask you about something that sounds awfully simple.

And yet, again, I learned in your book that this is one of the most significant reasons that people end up in hospital. And that is they fall down. I mean, if we're just average citizens, what tips would you offer to ensure that we don't have these catastrophic falls that can end up putting us in hospital and really setting us on a course for poor health for the rest of our lives? Well, fall proof your home, if you can, your elderly, you're sick. You're taking care of your parents or a loved one. That's at least a start. You know, set your washrooms up and make sure you're on one floor where you don't have to use. stairs. Be careful that if you're worried about your mom or dad, you're worried they're going to

fall, so you've got to put them in a long-term care home. There's actually more falls in a long-term care home than your own home. It's because of the patient mix that's there. There's lots of dementia and others where people are panicking and grabbing people in the long-term care home, pushing them down. But to be honest with you, Steve, it really is about just proofing your home, making it as, you know, making sure somebody's there to clean up after you, making sure that you have a walker or a cane or what have you. These are things that you, you know, get other people to do some of the work that you think you can do when you're older and like mowing the lawn or going on a step ladder. Big mistake for old people, right? Of course. And it really is just a common sense

approach to staying healthy as long as you can and keeping yourself out of harm's way. Maybe you could settle a bet for me because somebody told me a long time ago that one of the reasons that elderly people fall down so often is not that they lose their balance or misstep, but it's in fact because they're so old, their bones become brittle. The bones break just through simple walking, and that's why they fall. So is it a chicken or egg here? Do you know? I see lots of people that are 100 years old that are still walking around. I don't think bones just break from walking. It's about being in shape as long as you can. Yes, the bones get brittle as you get older, but it takes an event to break the bone.

It's usually somebody falls and breaks their hip because they land on it and then it breaks. It's not from them from walking, Steve. Okay, Michael Dexter, I want to, actually, I want to pose this question and then pause a second and give people a chance to think about what they think the answer is because you have described in the book

what you believe to be the greatest crisis in health care in Canada today. So I invite people to guess what they think it might be, and as they're guessing, the answer is, according to you, accessing mental health services. Why is that number one? There is a huge amount of mental health issue in Canada. There's almost no one who can look at their family and not identify someone who has significant mental health.

It may be a temporary issue. It may be a lifelong issue. But the resources are thin to start with, and they're not well spread out geographically. So if you're in a rural or northern area, getting access to mental health services is, I don't want to say impossible. It's very difficult.

It's a little better in the cities, but we moved away from locking people up. And there was a good thing, good part of that to treat people in the community. But when we downsized in-hospital mental health treatment, we were supposed to put the resources into community treatment. And that didn't really happen. So there's far fewer resources than there need to be for mental health.

And it along with home care is sort of the poor, you know, step sister in the health care pantheon. It's easy to raise money, not easy, but easier to raise money for a new neonatal intensive care unit than it is for mental health. although CAMH raised a lot of money to transform what they're doing. There's still stigma, even though the Mental Health Commission spent years trying to reduce the stigma. Lots of prominent people have come forward to say, I've had mental health issues or my child has, but we're still a long way from putting mental health at the same level as physical health. It's a huge problem for the country because of work absenteeism. And it's a terrible problem for Canadians because the mental health is often coped with

by using alcohol or drugs to mute the immediate impacts. And that can move people from mental health into addictions, which are just as hard to deal with and just as under-resourced. Let me raise one more issue with you too, and I'll get both of you to comment on this. Mike McCarthy, do you first? I guess about a decade ago in Canada, we politically at least embraced legislatively the notion that if people are suffering pain and they know it will not go away and death is foreseeable, they should be allowed to exit the world on their own terms at a time of their choosing. Maid, medical assistance in dying.

A decade later, there are, I guess, a lot of concerns about whether or not the conditions under which people go for made are becoming too easily accessible. What's your view on that? Well, I'll start first here because I'm a mental health nurse by trade, work 20 years in a psychiatric facility. In the depths of mental depression and other types of psychosis, people feel helpless and that this is all that there is and that their life's going to always be that dark. The truth is, people do get better with mental health.

Many, many do. And they go on to lead full and productive lives. So in the moment of their crisis is probably the last time we should be offering up made. Unfortunately, in this country, it's easier to get made than it is to get a number of services to keep you healthy and make you better. And that's part of the problem that we're faced. We've got this full open book of what you want as an individual to end your life with. And the reality is there are certain things that in good credence we shouldn't allow folks to be able to take their lives when there's hope.

And I think that really boils down to the fact that we may have moved quickly on made. I think it's important for serious end-of-life diseases where the finality is evident. The reality is there's a number of other things that we should proceed with great caution. Michael Dexter, in your view, is made becoming too easily accessible. Well, it's still early. We have a lived experience of it. And I find it increasingly a conversation among people I know about themselves or others. But I do share Mike's view that this frontier of,

mental health is a challenging one. And I know that there's a big division. There are people who feel very strongly that we should expand it. I think it's going to end up being back in the Supreme Court and see where they go this time on that. But I agree with Mike that if we don't put sufficient resources into allowing people or supporting people to recover from mental illness, I think that we're we're going to find people using made that could have been helped, could have been supported, could have had fuller lives, and instead we created this exit. So I think we need to be very careful about expanding the definition too far too quickly. And in saying that, I know there are people out there who are suffering horribly and just want it

to end and I'm sympathetic to that but I think you we need as a policy and as as a delivery of health care to be careful that we don't go too far too fast. Mike, let me do one more follow up with you and that is to ask this question. If somebody's had enough and it's their life, why does the state have an interest in keeping them alive against their will? Well, that's a good question. It used to be if you had suicidal ideulation and it's still true. true, the state can hold you against your will for at least 72 hours.

And if you remain a harm to yourself or others, they can keep you hospitalized indefinitely under the Mental Health Act. You get a review from the review board of courts. The state doesn't want people to needlessly kill themselves if they don't want to live, because there's always tomorrow. And that's the, you know, we're a compassionate society. The state believes that every life is worth something, at least we're told that. And so that is, you know, to do no harm has always been the sort of the jingoism of health care for health care providers that the last thing we would support would be people wanting to kill themselves.

And so when you've got the base of a modern society that believes life is important and we, there's religion involved in some of this as well, depending on what they believe in. And we come from that kind of past. killing yourself is a difficult thing for a lot of people to get their heads around unless they're really sick and it's of some of some physical nature. I want to finish up now by asking each of you two rather personal questions, but you have dealt with both of these issues in the book, so I think I'm okay treading on this ground here. Michael Dexter, to you first, both of your parents died too young. And I wonder what influence that had on your health care advocacy over the last many decades.

A great deal of impact. My mother was a heavy smoker. She died at 61. Her twin sister, who didn't smoke, died at 93 of COVID. So I had a lived experience of the difference that one decision can make. My father was a workaholic and became diabetic and did not manage his diabetes very well, despite the fact that he was a surgeon and knew what was going on. And he died at 64. And my belief is that if he behaved differently, had a different lifestyle, and managed his diabetes, he might have lasted a lot longer. So it has influenced me a great deal in terms of things I'm passionate about in health. Once you outlived both of your parents, in other words, once you hit age 65, how did that feel? A bit like uncharted territory, although I did have some grandparents that lived to significantly older ages, which which in some ways just made it more painful and poignant that my parents didn't live longer. Because you sort of expect generations will live longer than the one before. But that's not always true.

Mike McCarthy, you have been on one of the most astonishing health care journeys of anybody I've ever met. You were born a hemophiliac. Well, maybe you should pick up the story there because in some respects, you shouldn't be alive today and you are. Go ahead. Science tried to kill me and science tried to help me at the end of the day. So born with hemophilia, there was no effective treatments when I was born in the 1959. In the 60s, it was bed rest and lanced the bleed, which was incredibly painful and created lifelong pain and injury to the joints. Blood products came along, and that was a

life-saving discovery by the health system, and by the 70s, we had concentrate blood products that hemophiliacs could take, and they could lead a relatively normal full life. Unfortunately, The system wasn't paying attention to what was going into those blood products. And Justice Kriever did an inquiry on it through the late 70s and the early 80s. The blood system became contaminated in this country and others. And many people had a terrible outcome. Many died. Many got sick with lifelong injury.

In my family, I had an uncle died of hemophilia before blood products. I had an uncle die of AIDS from blood products. and another uncle died from hep C from blood products as well. And I got Hep C from tainted blood. And it became sort of my early understanding of what advocacy was all about and how to fight back and how to make sure, first of all, needed answers to why this happened. Second of all, is there any treatment to help people?

Third of all, what are we going to do with the wreckage that occurred to the system so we don't repeat it? And so that was my goal to, goal to find those answers out and along with Justice Kriever and as important inquiry that you did on the contamination of the blood supply, we found out. People screwed up. Money got ahead of science. The patients didn't really have a voice. They were told it was one in a million and we believed the system. We didn't question it. And ultimately, these are lessons now that we've learned. First of all, stand up for yourself. And through my journey of getting helped, amongst others helping

me getting help to virtually everybody who was harmed through the blood system, I realized that you can fight back as a patient, that you can stand up for your rights, that you can question health providers of why you're taking a treatment and what happens if something bad happens. And ultimately, all that leads to the system being forced to change for the better for patients. And that's currently where we're at now is the system is much better, but it would have never happened without finding the patient voice, which was integral to making the system change for the better. I think I'm right in saying that the very fine Globe and Mail health columnist, Andre Picard, described the tainted blood scandal as the worst crisis in the history of Canadian

healthcare, the biggest scandal in the history of Canadian health care. And Mike, I mean, you did tremendous advocacy to get people compensated for what they went through. I guess my last question to you is, given that you were injected with tainted blood somewhere along the way, how is it you didn't get HIV and end up dying of AIDS? Again, again, it's a sort of Russian roulette. And I, of course, got Hep C in 84, identified from blood collected of prisons in the United States that was sent to Canada to be made into these blood products. But I, at that point when it was becoming common knowledge that there was something wrong

with the blood and you could get what was the beginning of HIV, I could. stopped taking blood products in 1984. And for eight years, I refused to take blood products. It crippled my joints up because I had bleeds. I had nothing to treat them with. But I was definitely afraid of getting HIV, which was a death sentence. And in fact, they told me when I got Hep C that, oh, don't worry about that one. It won't kill you like AIDS will. And I was just lucky enough to listen to that little voice in my head to say, maybe not. Maybe you need to take matters into your own hand. And I'm very fortunate. that I did. And that's not taking anything away from anybody who took blood products and got sick

from it and died from it because they had to do it because they were sick. But, you know, they trusted the system. I was worried that the system wasn't there for me. Well, you got two kids who are pretty grateful that you made that decision because otherwise they wouldn't be born today. So good on you. Thank you. Let me do a little housekeeping before we sign off here. And that is to say we are adamant that this program will always be free of charge for anybody who wants to watch it. But of course, we are happy to take the public support should they want to throw a few bucks every month our way. Patreon.com forward slash the Paken podcast is our site where we're creating a bit of a a bit of a Paken podcast community.

People can support the show there. We have web exclusive videos there. They can pitch show ideas and guest ideas. And so I invite them to check that out. All of our shows are archived at stevepaken.com at that website. And I want to thank Michael Dexter and Mike McCarthy, the dynamic duo behind the Canadian Canadian health care, guerrilla handbook, be ninjas out there, folks, how to fight for what you need. Michael and Mike, thanks so much for coming on the program and peace and love to you both.

Thank you, Steve. Thank you, Steve.