Judged 'Not Criminally Responsible', Yet a Community Threat

Hamilton Police

"He pulled out a knife and began stabbing her with it in the back. She was stabbed upwards of seven times and suffered a severed bicep and collapsed lung amongst other injuries."

"He resumed using cannabis during the time he was living with his parents."

"[The panel] concluded that Mr. Ghawar remained a significant threat to the safety of the public and that a detention order was necessary and appropriate. With respect to the additional privileges suggested by the hospital, the panel determined that it was appropriate to include in the disposition seven-day passes accompanied by an approved person, and seven-day passes indirectly supervised with a pre-approved itinerary."

Ontario Review Board (ORB)  

"In April 2014, Mr. Ghawar stopped taking his anti-psychotic medication, and his mental health symptoms intensified almost immediately."

"According to his family, Mr. Ghawar became very anxious and irritable, and would refuse to leave the house alone."

Hospital Report  

This is an Ontario resident who twice stabbed people multiple times in the back, and subsequently found not criminally responsible, which led to his being granted a series of day passes, despite the fact that he remains, in the professional opinion of health experts, a "significant threat to the safety of the public". 

 

Diagnosed with schizophrenia and cannabis use disorder "in remission in a controlled environment", Muneeb Ali Ghawar was found in February of 2024 to be not criminally responsible for aggravated assault while wearing a disguise. The second episode where he stabbed a woman took place in 2023, at a Hamilton cannabis store. 

 

He had entered the Sweet Releaf Cannabis shop on February 3, 2023 wearing a mask and a trapper hat pulled down over his forehead. A female clerk began the process of ringing up his cannabis purchase, and while she was thus engaged, the man moved behind her, and withdrawing a knife, stabbed her back repeatedly. Ghawar ran from the store when another employee screamed and called 911. 

 

Lighting up a marijuana joint. Photo by Adobe Stock

 

Ghawar was identified through studying the surveillance video at the cannabis operation where he had appeared on a previous occasion, unmasked. Six days following the stabbing he was arrested. He is now under the jurisdiction of the Ontario Review Board for a second time. He had been declared 'not criminally responsible' for a similar attack nine years previously, when an acquaintance was stabbed in the back and torso by him. He was hospitalized in a psychiatric ward for two years then discharged to live with his family.   

"Mr. Ghawar was compliant with his medication, met consistently with the outpatient team, and maintained stable mental health. He was granted an absolute discharge on February 11, 2019."

"There has been no evidence of mood disorders or psychotic breakthrough. He engages appropriately with co-patients and staff and is always pleasant and polite during interactions."

"His persistent use of cannabis is a  significant risk factor."

"He was using cannabis at the time of the first index offence in 2014, and at the time of the current index offence in 2023. He became extremely psychotic and committed very violent offences that could have resulted in the death of either victim."

Ontario Review Board ruling  

Mental health symptoms had afflicted the man for years. He began the use of cannabis at age 15. In 2024 he was ordered to be placed at St. Joseph's Healthcare where he was given privileges whereby he could enter the community of Hamilton under indirect supervision. He has been treated for anxiety and depression since 2012 by a psychiatrist. He also has amassed a criminal record including assault, mischief, break-and-enter, and assault with a weapon.

 

A psychological assessment in 2023 revealed that Ghawar "expressed delusional thought content, such as that the victim of the index offence was selling bad cannabis to kids in order to draw them into sex trafficking", the ORB decision noted. Ghawar admitted long-standing auditory hallucinations, and that he had stopped taking his medication prior to the offence, while smoking marijuana. 

 

Sweet Releafs Inc.

 

"He again denied using cannabis, and suggested that the positive urine result was from others smoking cannabis around him", noted the ORB decision. And this is the man his parents plan to take to Pakistan to have him married there. "This would be an arranged marriage to a woman he has not met", even while his psychiatrist "expressed concern that bringing another person into the family home would increase the stress at a time when Mr. Ghawar is struggling with cannabis use".  

 

Far Reaching Consequences in Air Quality From Canadian Wildfires

A smoky haze continues to linger over Ottawa on Friday afternoon.  (Westin Camera)

 

"We have these massive fires going on out west in Manitoba, in Saskatchewan, and all this smoke is being lofted high up into the atmosphere and then you have the jet stream, the strong winds higher up in the atmosphere blowing it over to Ontario."

"Even if you’re not smelling it at the ground, you’re probably noticing the sky is a bit of milky colour, kind of a white colour, this is all smoke that’s just been blown over from these massive prairie fires." 

Environment Canada meteorologist Crawford Luke

 

"Things like asthma, cough, headaches — we know that over time [smoke exposure] can increase your risk of things like respiratory infections. It can also increase your risk for long-term disease like lung cancer if you have high exposure."

"Clean air quality is definitely becoming more of an awareness concern because we are experiencing more wildfire seasons that are increasing. They’re longer, they start earlier, they get worse. We’re noticing a lot more air quality alerts."

"Check the air quality and if it’s over five, six, seven, that’s when you need to pay attention. That means air quality could be bad, even if the sky looks clear." 

"This affects the youth, seniors, as well as people with lung disease, heart disease. Anyone with a lowered immune system tends to be considered higher risk. They would be the ones we’d want them to watch the alert a little bit earlier."

Jamie Happy, health promotion coordinator, Alberta Lung

 

"The particle air pollution event is the result of extensive wildfires in central and Western Canada."

"Wind patterns are forecasted to transport plumes of smoke from these fires across much of New England and New Hampshire."

New Hampshire Department of Environmental Services 

A skateboarder cruises down Rideau Street in Ottawa on Friday as drifting smoke from wildfires in Western Canada shrouded the city. (Gabrielle Huston/CBC)

 

Hundreds of wildfires are burning across Canada, many of them out of control with flames sending plumes of smoke skyward, resulting in unhealthy air wafting off with the prevailing winds, reaching distant places. The more gigantic of the blazes deliver thick smoke spreading southward into the United States and far across the Atlantic Ocean to the United Kingdom. 

 

Fires in British Columbia, Alberta, Saskatchewan, Manitoba, from Western Canada, as well as northern Ontario in central Canada burning out of control. Some of the fires range between 100,000 to 300,000 hectares. Fire season in Canada is earlier than usual this year. And this year more of the fires are considered to be man-made; fewer have resulted from lightning strikes and excessively dry conditions along with warmer temperatures than usual. 

 

These early-appearing wildfires have already consumed vast tracts of land and forest, in comparison to the long-term average with about a normal half year's worth of land at this early stage already scorched.  

 

A photo released by the government of the Canadian province of Manitoba shows wildfires burning last week in Flin Flon, Manitoba.   Credit...Government of Manitoba

 

Three provinces have evacuated over 25,000 people altogether, whose habitation is in the line of fire. In Manitoba alone 17,000 of the evacuations have left people stranded away from their homes in fire-vulnerable towns and villages. In Alberta roughly 1,300 people were forced to relocate, as well as some 8,000 people affected by the need to evacuate in Saskatchewan.

 

The largest of two fires in Manitoba scorched 189,834 hectares on the border with Ontario, about 100 km northeast of Winnipeg. On the border with Saskatchewan several fires around Flin Flon are responsible for most of the evacuations there, where this fire season has been recognized as the worst in decades. The fires burn largely in rural forest, threatening communities nearby that remain under evacuation orders, among 20 towns forced from homes in the province. 

 

Smoke that crossed the Atlantic Ocean is blowing over the United Kingdom, contained in a thin, high-altitude layer not expected to seriously affect air quality. "No impacts expected as it remains at height, but could lead to some striking sunsets and sunrises", advised Georgie Myers of the UK's Met Office.  

 

Members of the Royal Canadian Air Force help evacuees board an aircraft in Norway House, Manitoba, on June 3.   Credit...David Lipnowski/The Canadian Press, via Associated Press

 

Smoke, carried by the river of air in the sky known as the jet stream, ended up south as far as the coastal Southeast United States where skies turned hazy as far south as northern Florida. The Midwest saw smoke particularly thick with  high temperatures held down several degrees, irrespective of sunshine. Visibility dropped as low as a kilometre or so in North Dakota as smoke drifted groundwise. 

 

Parts of British Columbia to Ontario south of Hudson Bay, saw air quality alerts warn populations. Environment Canada warns residents in harder-hit areas of northern Alberta, Saskatchewan and Manitoba to limit outside time and cancel or reschedule outdoor events. Much of Minnesota, Wisconsin and close locations are under a code orange alert. 

 

The Canadian wildfires have already early in this season burned about half of the average major fire seasons up to 2023 and 2024, translating to over 1.1 million hectares this year so far.  Seasonal wildfire burns saw a yearly average of 2.1 million hectares as opposed the 2023 historic season when 17.3 million hectares were scorched.  

 

A photo from the Manitoba Royal Canadian Mounted Police shows firefighting efforts in northern Manitoba, in May.   Credit...The Canadian Press, via Associated Press

 

 

The Goals of Medical Care

"[Patients -- outside of this study -- have said that having permanent disabilities that made it impossible to get out of bed, communicate, or reason, would be] worse than death. And yet these outcomes are rarely explicitly discussed."

"[Pursuing] longevity-focused care when a person is living in a state they consider worse than death is contrary to resident-centred principles for which long-term care homes strive."

Bruyere Health Research Institute and Institute for Clinical and Evaluative Studies research (ICES)

 

"We are not offering resident-centred care or evidence-based care if we don't talk about the possibility of severe disability and ask about the circumstances when life prolonging treatments should not be acceptable." 

"[In interviews some long-term care residents have expressed that loss of independence is] more distressing to them than the thought of dying."

Lead research author Ramtin Hakimjavadi, internal medicine resident, University of Ottawa 

Bruyere Health

 

The study published in the journal JAMA Network Open, outlines a situation that is anything but salubrious for the elderly placed into long-term care, for whatever reason. It found that one of five people, within five years of admission to long-term care, become permanently disabled. Residents in some instances become incapable of making personal decisions for things as fundamentally simple as what to eat or what to wear. And they become unable to communicate with those most familiar to them; their own family members.

 

The study's purpose was meant to cast light on severe cognitive and physical impairment that affects some individuals who have been admitted to long-term care homes. Open discussions relating to the "natural course of frailty trajectories" in long-term care inclusive of permanent impairment, could assist in supporting medical decisions focusing on the wishes of residents. 

 

A total of 120,238 adults aged 65 and up who had been newly admitted to long-term care facilities in Ontario between the years 2013 and 2018 were followed by the research team which set out to trace residents' experiences admitted to long-term care, as well as those who had already lived a year or longer in a state of severe disability. Twenty percent of residents admitted to long-term care were found to have become permanently unable to make everyday decisions in five years following admission. 

Of those studied, 13 percent became completely dependent on all care at every level which included eating, bathing and toileting. Half of those studied lived with that steep level of disability for over 45 days. Some seven percent surrendered to an inability to communicate and interact with others, including those most familiar to them, while 32 percent became fully incontinent. The researchers contended that the potential outcomes affecting a significant number of long-term care residents should be anticipated and acknowledged when families speak of end of life wishes with their loved ones.

 

Dr. Kowbewka, the study's senior author, admitted to surprise learning how long some long-term care residents endured with severe disabilities. He pointed out that family members who have had open discussions prior to the time when severe disabilities became evident were better equipped to make decisions. It was revealed that 65 percent of residents in the study chose a do-not-resuscitate order, while a quarter had do-not-hospitalize orders. The result was that those with advanced care directives lived a shorter time with a severe disability.

 

The takeaway from that was the likelihood that the residents' preferences had been discussed prior to their descending into severe disability mode, and their care partners or providers were as a result prepared on how best to support their end-of-life decisions. There are two other issues here that don't appear to have been discerned, mentioned or taken account of; that people placed in such institutions tend to physically and mentally deteriorate since the very nature of their placement is to remove their self-agency.

 

The other is that, unspoken, but certainly to be inferred, is that in agreeing not to impose strenuous life-saving measures in situations of extreme collapse, the end result is akin to hands-off assists in ushering in premature death on the basis of potential harm arising from medical intervention, in favour of allowing the natural process of aging and accompanying deterioration leading to a more imminent death.  Which brings to mind Canada's MAID program: Medical Assistance in Dying.

Ontario Palliative Care Network

"The goals of medical care are generally to help people live longer, to feel better and to function better.} But in serious illness there does come a time when those goals are in conflict with each other and so having that conversation about when is pursuing longevity adding to discomfort, or when is pursuing comfort more aggressively going to shorten life [helps with decision making]."

"I think we are trying to make that concrete [when to discuss values and wishes in end of life care] with these really clear outcomes [such as] being in a state where you cannot understand others and cannot make yourself understood and being permanently like that."

"Everyone understands that and  you can talk about what you would want if you were like that even though it is scary and hard to hear."

Daniel Kobewka, Bruyere investigator, adjunct scientist at ICES