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Medical Assistance in Dying now accounts for over 4% of deaths in Canada

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11 minute read

The following are interesting statistics pulled directly from the:

Fourth annual report on Medical Assistance in Dying in Canada 2022

Growth in the number of medically assisted deaths in Canada continues in 2022.

  • In 2022, there were 13,241 MAID provisions reported in Canada, accounting for 4.1% of all deaths in Canada.
  • The number of cases of MAID in 2022 represents a growth rate of 31.2% over 2021. All provinces except Manitoba and the Yukon continue to experience a steady year-over-year growth in 2022.
  • When all data sources are considered, the total number of medically assisted deaths reported in Canada since the introduction of federal MAID legislation in 2016 is 44,958.

Profile of MAID recipients

  • In 2022, a slightly larger proportion of males (51.4%) than females (48.6%) received MAID. This result is consistent with 2021 (52.3% males and 47.7% females), 2020 (51.9% males and 48.1%  females) and 2019 (50.9% males and 49.1% females).
  • The average age of individuals at the time MAID was provided in 2022 was 77.0 years. This average age is slightly higher than the averages of 2019 (75.2), 2020 (75.3) and 2021 (76.3). The average age of females during 2022 was 77.9, compared to males at 76.1.
  • Cancer (63.0%) is the most cited underlying medical condition among MAID provisions in 2022, down from 65.6% in 2021 and from a high of 69.1% in 2020. This is followed by cardiovascular conditions (18.8%), other conditions (14.9%), respiratory conditions (13.2%) and neurological conditions (12.6%).
  • In 2022, 3.5% of the total number of MAID provisions (463 individuals), were individuals whose natural deaths were not reasonably foreseeable. This is an increase from 2.2% in 2021 (223 individuals). The most cited underlying medical condition for this population was neurological (50.0%), followed by other conditions (37.1%), and multiple comorbidities (23.5%), which is similar to 2021 results. The average age of individuals receiving MAID whose natural death was not reasonably foreseeable was 73.1 years, slightly higher than 70.1 in 2021 but lower than the average age of 77.0 for all MAID recipients in 2022.

Nature of suffering among MAID recipients

  • In 2022, the most commonly cited sources of suffering by individuals requesting MAID were the loss of ability to engage in meaningful activities (86.3%), followed by loss of ability to perform activities of daily living (81.9%) and inadequate control of pain, or concern about controlling pain (59.2%).
  • These results continue to mirror very similar trends seen in the previous three years (2019 to 2021), indicating that the nature of suffering that leads a person to request MAID has remained consistent over the past four years.
Eligibility Criteria
  • Request MAID voluntarily
  • 18 years of age or older
  • Capacity to make health care decisions
  • Must provide informed consent
  • Eligible for publicly funded health care services in Canada
  • Diagnosed with a “grievous and irremediable medical condition,” where a person must meet all of the following criteria:
    • serious and incurable illness, disease or disability
    • advanced state of irreversible decline in capability,
    • experiencing enduring physical or psychological suffering that is caused by their illness, disease or disability or by the advanced state of decline in capability, that is intolerable to them and that cannot be relieved under conditions that they consider acceptable
  • Mental Illness as sole underlying medical condition is excluded until March 17, 2024

3.1 Number of Reported MAID Deaths in Canada (2016 to 2022)

2022 marks six and a half years of access to MAID in Canada. In 2022, there were 13,241 MAID provisions in Canada, bringing the total number of medically assisted deaths in Canada since 2016 to 44,958. In 2022, the total number of MAID provisions increased by 31.2% (2022 over 2021) compared to 32.6% (2021 over 2020). The annual growth rate in MAID provisions has been steady over the past six years, with an average growth rate of 31.1% from 2019 to 2022.

Chart 3.1: Total MAID Deaths in Canada, 2016 to 2022
Chart 3.1

Access to MAID for individuals whose deaths were not reasonably foreseeable marked its second year of eligibility in 2022. In Canada, eligibility for individuals whose death is not reasonably foreseeable began on March 17, 2021, after the passage of the new legislation.Footnote8 There were 463 MAID provisions for persons whose natural death was not reasonably foreseeable, representing 3.5% of all MAID deaths in 2022. This is just over twice the total number of provisions for individuals where natural death was not reasonably foreseeable in 2021 (223 provisions representing 2.2% of all MAID provisions in 2021). Table 3.1 represents total MAID provisions in Canada from 2016 to 2022, including provisions for individuals where natural death was not reasonably foreseeable.

All jurisdictions, except Manitoba and Yukon, experienced growth in MAID provisions in 2022. The highest percentage year over year increases occurred in Québec (45.5%), Alberta (40.7%), Newfoundland and Labrador (38.5%), Ontario (26.8%) and British Columbia (23.9%). Nova Scotia (11.8%), Prince Edward Island (7.3%) and Saskatchewan (4.0%) had lower growth rates. The Yukon remained at the same level as 2021, while Manitoba was the only jurisdiction to experience a decline in MAID provisions for 2022 (-9.0%).

Table 3.1: Total MAID Deaths in Canada by Jurisdiction, 2016 – 2022
MAID NL PE NS NB QC ON MB SK AB BC YT NT NU Canada
2016 24 9 494 191 24 11 63 194 1,018
2017 62 49 853 839 63 57 205 677 2,838
2018 23 8 126 92 1,249 1,500 138 85 307 951 12 4,493
2019 20 20 147 141 1,604 1,788 177 97 377 1,280 13 5,665
2020 49 37 190 160 2,278 2,378 214 160 555 1,572 13 7,611
2021 65 41 245 205 3,299 3,102 245 247 594 2,030 16 10,092
2022 90 44 274 247 4,801 3,934 223 257 836 2,515 16 13,241
TOTAL
2016-2022
267 156 1,068 903 14,578 13,732 1,084 914 2,937 9,219 84 44,958

3.2 MAID Deaths as a Proportion of Total Deaths in Canada

MAID deaths accounted for 4.1% of all deaths in Canada in 2022, an increase from 3.3% in 2021, 2.5% in 2020 and 2.0% in 2019. In 2022, six jurisdictions continue to experience increases in the number of MAID provisions as a percentage of total deaths, ranging from a low of 1.5% (Newfoundland & Labrador) to a high of 6.6% (Québec). MAID deaths as a percentage of total deaths remained at the same levels as 2021 for Prince Edward Island, Nova Scotia, and Saskatchewan, while Manitoba experienced a decline in MAID deaths as a percentage of all deaths (from 2.1% in 2021 to 1.8% in 2022). As with each of the three previous years (2019 to 2021), Québec and British Columbia experienced the highest percentage of MAID deaths as a proportion of all deaths within their jurisdiction in 2022 (6.6% and 5.5% respectively), continuing to reflect the socio-political dynamics of these two jurisdictions in the context of MAID.

4.5 Profile of Persons Receiving MAID Whose Natural Death is not Reasonably Foreseeable

2022 marks the second year that MAID for persons whose natural death is not reasonably foreseeable is permitted under the law if all other eligibility criteria are met (Table 1.1). New federal MAID legislation passed on March 17, 2021, created a two-track approach to procedural safeguards for MAID practitioners to follow, based on whether or not a person’s natural death is reasonably foreseeable. This approach to safeguards ensures that sufficient time and expertise are spent assessing MAID requests from persons whose natural death is not reasonably foreseeable. New and enhanced safeguards (Table 1.2), including a minimum 90-day assessment period, seek to address the diverse source of suffering and vulnerability that could potentially lead a person who is not nearing death to ask for MAID and to identify alternatives to MAID that could reduce suffering.

In 2022, 3.5% of MAID recipients (463 individuals) were assessed as not having a reasonably foreseeable natural death, up slightly from 2.2% (223 individuals) in 2021. As a percentage of all MAID deaths in Canada, MAID for individuals whose natural death is not reasonably foreseeable represents just 0.14% of all deaths in Canada in 2022 (compared to all MAID provisions, which represent 4.1% of all 2022 deaths in Canada). The proportion of MAID recipients whose natural death was not reasonably foreseeable continues to remain very small compared to the total number of MAID recipients.

This population of individuals whose natural death was not reasonably foreseeable have a different medical profile than individuals whose death was reasonably foreseeable. As shown in Chart 4.5A, the main underlying medical condition reported in the population whose natural death was not reasonably foreseeable was neurological (50.0%), followed by ‘other condition’ (37.1%), and multiple comorbidities (23.5%). This differs from the main condition (as reported in Chart 4.1A) for all MAID recipients in 2022, where the majority of persons receiving MAID had cancer as a main underlying medical condition (63.0%), followed by cardiovascular conditions (18.8%) and other conditions (14.9%) (such as chronic pain, osteoarthritis, frailty, fibromyalgia, autoimmune conditions). These results are similar to 2021.

Chart 4.5A: Main Condition, MAID, Natural Death Not Reasonably Foreseeable, 2022
Chart 4.5a

Of the MAID provisions for individuals where death was reasonably foreseeable, the majority were individuals ages 71 and older (71.1%) while only 28.9% were between ages 18-70. A similar trend was observed for individuals where natural death was not reasonably foreseeable which also showed a greater percentage of individuals who received MAID being 71 and older (58.5%) and a lower number of MAID provisions for individuals between 18-70 years (41.5%). Overall, however, MAID provisions for individuals whose death is not reasonably foreseeable tended to be in the younger age categories than those where natural death is foreseeable.

Chart 4.5B: MAID by Age: Natural Death Reasonably Foreseeable Vs Not Reasonably Foreseeable, 2022
Chart 4.5b

 

Before Post

After 15 years as a TV reporter with Global and CBC and as news director of RDTV in Red Deer, Duane set out on his own 2008 as a visual storyteller. During this period, he became fascinated with a burgeoning online world and how it could better serve local communities. This fascination led to Todayville, launched in 2016.

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Crime

Mexican cartels are a direct threat to Canada’s public safety, and the future of North American trade

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From the Macdonald Laurier Institute

By Gary J. Hale for Inside Policy

RCMP raided a fentanyl ‘superlab’ in Falkland, BC, with ties to a transnational criminal network that spans from Mexico to China.

On October 31, residents of Falkland, BC, were readying their children for a night of Halloween fun. Little did they know that their “quaint, quiet, and low-key little village” was about to make national headlines for all the wrong reasons.

On that day, RCMP announced that it had raided a fentanyl “superlab” of scary proportions near Falkland – one that police called the “largest and most sophisticated” drug operation in Canada. Officers seized nearly half-a-billion-dollars’ worth of illicit materials, including 54 kilograms of finished fentanyl, 390 kilograms of methamphetamine, 35 kilograms of cocaine, 15 kilograms of MDMA, and six kilograms of cannabis” as well as AR-15-style guns, silencers, small explosive devices, body armour, and vast amounts of ammunition.

They also found massive quantities of “precursor chemicals” used to make the drugs. This strongly suggests that the superlab was tied into a transnational criminal network that spans from Mexico to China – one that uses North America’s transportation supply chains to spread its poisonous cargo across Canada and the United States.

The Canada-US-Mexico relationship is comprised of many interests, but the economic benefits of trade between the nations is one of the driving forces that keep these neighbours profitably engaged. The CUSMA trade agreement is the successor to NAFTA and is the strongest example globally of a successful economic co-operation treaty. It benefits all three signatories. This level of interdependence under CUSMA requires all parties to recognize their respective vulnerabilities and attempt to mitigate any threats, risks, or dangers to trade and to the overall relationship. What happens to one affects all the others.

The supply chain, and the transport infrastructure that supports it, affects the balance books of all three. While the supply chain is robust and currently experiences only occasional delays, the different types of transport that make up the supply chain – such as trucks, trains, and sea-going vessels – are extremely vulnerable to disruption or stoppages because of the unchecked violence and crime attributed to the activities of Mexican Transnational Criminal Organizations (TCOs). These cartels operate throughout Mexico, from the Pacific ports to the northern plains at the US-Mexico border.

The sophistication of the Falkland superlab strongly suggests connectivity to multi-national production, transportation, and distribution networks that likely include China (supply of raw products) and Mexico (clandestine laboratory expertise).

For most Canadians, Mexican cartels call to mind the stereotypical villains of TV and movie police dramas. But their power and influence is very real – as is the threat they pose to all three CUSMA nations.

Mexico’s cartels: a deadly and growing threat

Mexican cartels started as drug trafficking organizations (DTOs) in the 1960s. By the late 1990s they had evolved to become transnational enterprises as they expanded their business beyond locally produced drugs (originally marijuana and heroin) to include primarily Colombian cocaine that they transported through Mexico en route to the US and Canada.

Marijuana and the opium poppy are cultivated in Mexico and, in the case of weed, taken to market in raw form. While the cartels required some chemicals sourced from outside Mexico to extract opium from the poppy and convert it into heroin, the large-scale, multi-ton production of synthetic drugs like Methamphetamine and today Fentanyl expanded the demand for sources of precursor chemicals (where the chemical is slightly altered at the molecular level to become the drug) and essential chemicals (chemicals used to extract, process, or clean the drugs.)

The need to acquire cocaine and chemicals internationalized the cartels. Mexican TCO’s now operate on every continent. That presence involves all the critical stages of the criminal business cycle: production, transportation, distribution, and re-capitalization. Some of the money from drug proceeds flow south from Canada and the US back to Mexico to be retained as profits, while other funds are used to keep the enterprise well-funded and operational.

In Mexico, the scope of their activities is economy-wide; they now operate many lines of criminal business. Some directly affect Mexico’s economic security, such as petroleum theft, intellectual property theft (mainly pirated DVDs and CDs), adulterating drinking alcohol, and exploiting public utilities. Others are in “traditional” criminal markets, such as prostitution, extortion, kidnapping, weapons smuggling, migrant smuggling and human trafficking. Organized auto theft has also become another revenue stream.

Criminal Actors

The Cartel de Sinaloa (CDS or Sinaloa Cartel) and the Cartel Jalisco Nueva Generacion (CJNG) are the two principal TCO’s vying for territorial control of Mexico’s air, land, and maritime ports, as well as illegal crossing points. These points on the cartel map are known as “plazas,” and are often between formal ports of entry into the US. By controlling territories crucial for the inbound and outbound movement of drugs, precursors, people, and illegal proceeds, the cartels secretly transport illicit goods and people through commercial supply chains, thus subjecting the transportation segment of legitimate North American trade to the most risk.

That is giving the cartels the power to impair – and even control – the movement of Mexico’s legitimate trade. While largely kept out of the public domain, incidents of forced payment of criminal taxation fees, called “cuotas,” and other similar threats to international business operations are already occurring. For instance, cuotas are being imposed on the transnational business of exporting used cars from the US to Mexico. They’re also being forced on Mexican avocado and lime exporters before the cartels will allow their products to cross the border to the US and international markets. This has crippled that particular trade. Unfortunately, the Mexican government has been slow to react, and the extortion persists throughout Mexico. It is worth repeating – these entirely legitimate goods reach the market only after cartel conditions are met and bribes paid.

The free trade and soft border policies of the US of recent years have allowed cartel operatives to enter that country and work the drug trade with limited consequence. In May, the U.S. Drug Enforcement Administration (DEA) published the National Drug Threat Assessment 2024, where it reported that the Jalisco and Sinaloa cartels operate in all 50 US states and are engaged in armed violence in American cities as they fight for market shares of the sales of Methamphetamine, Fentanyl, and other drugs sourced from Mexico.

The DEA’s findings should sound alarms in Canada. Canada and the US have similar trade and immigration policies, which allow the Mexican cartels to easily enter and control the wholesale component of the drug trade. The long-term effects of the drug trade are the billions of dollars gained that allow for the corruption of government officials. Canada should be on guard: Mexican drug cartels in Canada could begin to not only kill ordinary Canadians by knowingly selling them deadly drugs like Fentanyl – their operatives can also embed themselves in Canadian society, as they have in the US, leading to ordinary citizens on Canadian streets being victimized by the armed violence cartels regularly use to assert their position and power.

Organized crime and Mexican governance

Canada faces these threats directly, but the indirect ones that the cartels present to Mexican governance are no less consequential to Canada in the long term – and likely sooner. Illicit agreements between corrupt Mexican government officials and the cartels assure that the crime organizations retain control of territory and have freedom to operate.

That threat is becoming increasingly existential. Cartel fighters are well disciplined, well equipped and strong enough to challenge Mexico’s military, currently the government’s main tool to fight them. Should the TCOs come to dominate Mexican society or gain decisive influence over government policy, Mexico’s government risks being declared a narco-democracy and the US may come to see the cartels as a threat to national security. That in turn could lead to a US military intervention in Mexico – not an outcome desired by either side.

While that scenario may be considered extreme, it is not as far from reality as many may think. While in many respects the US-Mexico trading relationship remains unchanged, the overall political context has become testy – and could be a real flashpoint for the incoming Trump administration.

Political developments in Mexico have played a role. After his election in 2018, former Mexican President Andrés Manuel López Obrador (commonly referred to his initials, AMLO) demonstrated a disdain for all things North American. This included frequent complaints of US interference or violation of Mexican sovereignty – complaints that were more about keeping Mexican government domestic actions out of the public eye. To retain a shroud of secrecy over government corruption, Mexico under Amlo started in 2022 to limit the activities and numbers of US federal law enforcement agencies operating there, particularly the FBI, DEA, ATF and ICE. These agencies formerly enjoyed a close relationship with the Mexican Federal Police – a force AMLO disbanded and replaced with the National Guard. The AMLO administration reduced the number of US assets and agents in Mexico, particularly singling out the DEA for the most punitive restrictions.

During his administration, AMLO placed the army and navy in charge of all ports of entry and gave them responsibility for all domestic public safety and security by subordinating the Guardia Nacional (GN), or National Guard, to the army. The GN, the only federal law enforcement agency, has been taken over by military officials who are sometimes corrupt and in league with the cartels.

Mexican President Claudia Sheinbaum, who took office in 2024, has continued AMLO’s organizational moves. Sheinbaum comes from the same political party and has so far extended carte blanche to the military, whose administration is opaque and now operates with impunity, under the guise of “national security” and “sovereignty” concerns.

It is expected that Sheinbaum will continue to shield American eyes from Mexico law enforcement and judicial affairs. The fear in the US law enforcement and national security community is that Sheinbaum may even declare DEA non grata, much as then Venezuelan President Hugo Chavez in 2005 and Bolivian President Evo Morales in 2008 did in their countries. Both were anti-American leftists of the same mindset as AMLO and Sheinbaum, who feared detection of their connections to the illegal drug trade.

Sheinbaum has publicly demonstrated disinterest in the consistent application of the rule of law against the TCOs by stating that she will continue the “hugs not bullets” (“abrazos, no balazos”) non-confrontational, non-interventional posture towards organized crime. Agreements with corrupt government officials will allow the cartels to expand their business and to operate with impunity. Through intimidation, bribery, and murder, the cartels affect decision making at the municipal, state, and federal levels of Mexican government. That leverage, while performed outside the public eye, has the potential to negatively affect supply and demand among the three countries at the very least, and at worst, to signal that cartels in Mexico are directly or indirectly involved in the formulation of government security, immigration, drug, and trade policy.

AMLO enacted constitutional changes that will provide Sheinbaum with the powers of a dictator, giving her administration unchecked control of the executive, legislative, and judicial branches of government. As a result, the judiciary in Mexico is in crisis mode with 8 of 11 Supreme Court Justices resigning in October 2024 to protest the unconstitutional disregard for due process that started with AMLO and continues with Sheinbaum thanks to a “voting for judges” law that she and AMLO have rammed into operation without debate. This development portends even more corruption.

Without the existence of an independent judicial system, these institutional changes could give pause to US and Canadian negotiators when it comes time to renew CUSMA in 2026.

Beyond 2025: Mexican organized crime as a threat to the US and Canada, and Greater North American implications

Most worrying, the cartels will be in a yet stronger position to affect and even dictate the pace and volume of legitimate trade between the US and Mexico under Sheinbaum. This makes Mexico the weakest link among the three CUSMA members.

The US and Canada should therefore be concerned about the strength and power of the cartels because the current trajectory could provide them a greater role in Mexico’s performance as a trade partner. Should this trend continue, the US would likely begin to see Mexico through the lens of a threat to critical components of its national security: 1) the public safety of US citizens being killed in epidemic proportions by the drugs produced by citizens of Mexico; 2) the negative impact or increased cost of commerce that supplies goods to the American market; and 3) the CUSMA relationship that sustains the economic strength of all three participating countries.

This worrisome evolution requires proactivity by Canada and the US to insist that Sheinbaum reverse the gains that the cartels have made to influence policy and erode the government’s monopoly on territorial control and the use of violence, and reverse Mexico’s limits on drug enforcement co-operation with what should be its partners to the north. Pressure should also be applied to demand a return to a drug policy model that includes international law enforcement co-operation and a continuation towards the transformation of the Mexican judicial system from a mixed inquisitorial or accusatorial system to an adversarial system that employs the use of juries, witness testimony, oral hearings and trials, and cross-examination of witnesses, as opposed to a system where cartel-influenced elections could dictate judicial outcomes.

The implications of the further development of a Mexico narco-democracy for US-Mexico-Canada relations would be devastating. Co-operation on public safety and security would cease completely, allowing the cartels to take full control of commercial supply lines, significantly reducing trade between the three nations – likely causing the CUSMA trade deal to fracture until governance returned to duly elected civilian officials.

Continental security and Canada’s contribution

The continued success of CUSMA lies with Mexico more than any other country. Should Mexico continue on its path to autocracy, it could upset the trade deal, crucial to the prosperity of all three countries. Canada is not immune from what on the surface may appear to be mostly bilateral, US-Mexico issues, because, regardless of the commodity – whether it’s consumables or manufactured items – the cartels are positioned and empowered to affect imports, exports, trade, and migration throughout North America.

For the foreseeable future, Mexico is not going to voluntarily change its security posture. This enables the cartels to remain persistent threats, especially to trade. Canada and the US need to continue to jointly insist that Mexico take a stronger stance against organized crime and that it take steps to strengthen the judiciary and the rule of law in that country.


Gary J. Hale served 31 years in the Drug Enforcement Administration (DEA), retiring as an executive-level intelligence analyst. In 2010, he was appointed as Drug Policy fellow and Mexico Studies Scholar at the James A. Baker III Institute for Public Policy at Rice University in Houston, Texas.

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Business

Broken ‘equalization’ program bad for all provinces

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From the Fraser Institute

By Alex Whalen  and Tegan Hill

Back in the summer at a meeting in Halifax, several provincial premiers discussed a lawsuit meant to force the federal government to make changes to Canada’s equalization program. The suit—filed by Newfoundland and Labrador and backed by British Columbia, Saskatchewan and Alberta—effectively argues that the current formula isn’t fair. But while the question of “fairness” can be subjective, its clear the equalization program is broken.

In theory, the program equalizes the ability of provinces to deliver reasonably comparable services at a reasonably comparable level of taxation. Any province’s ability to pay is based on its “fiscal capacity”—that is, its ability to raise revenue.

This year, equalization payments will total a projected $25.3 billion with all provinces except B.C., Alberta and Saskatchewan to receive some money. Whether due to higher incomes, higher employment or other factors, these three provinces have a greater ability to collect government revenue so they will not receive equalization.

However, contrary to the intent of the program, as recently as 2021, equalization program costs increased despite a decline in the fiscal capacity of oil-producing provinces such as Alberta, Saskatchewan, and Newfoundland and Labrador. In other words, the fiscal capacity gap among provinces was shrinking, yet recipient provinces still received a larger equalization payment.

Why? Because a “fixed-growth rule,” introduced by the Harper government in 2009, ensures that payments grow roughly in line with the economy—even if the gap between richer and poorer provinces shrinks. The result? Total equalization payments (before adjusting for inflation) increased by 19 per cent between 2015/16 and 2020/21 despite the gap in fiscal capacities between provinces shrinking during this time.

Moreover, the structure of the equalization program is also causing problems, even for recipient provinces, because it generates strong disincentives to natural resource development and the resulting economic growth because the program “claws back” equalization dollars when provinces raise revenue from natural resource development. Despite some changes to reduce this problem, one study estimated that a recipient province wishing to increase its natural resource revenues by a modest 10 per cent could face up to a 97 per cent claw back in equalization payments.

Put simply, provinces that generally do not receive equalization such as Alberta, B.C. and Saskatchewan have been punished for developing their resources, whereas recipient provinces such as Quebec and in the Maritimes have been rewarded for not developing theirs.

Finally, the current program design also encourages recipient provinces to maintain high personal and business income tax rates. While higher tax rates can reduce the incentive to work, invest and be productive, they also raise the national standard average tax rate, which is used in the equalization allocation formula. Therefore, provinces are incentivized to maintain high and economically damaging tax rates to maximize equalization payments.

Unless premiers push for reforms that will improve economic incentives and contain program costs, all provinces—recipient and non-recipient—will suffer the consequences.

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