關於 level of evidence c ，我們在網路上蒐集到這些相關的討論、資訊與評價

【三級警戒未來何時解？從研究找依據！】
疫情進入三級警戒至今，本週似有趨穩趨勢，但還難稱真正緩和。不過隨著高強度防疫持續，生計受影響的行業越來越多，也讓人擔心民眾出現「防疫疲乏」的現象，雖然目前還沒到鬆懈的時候，但未來我們有沒有一個「警戒降級」的明確標準，用科學化的方式，及最保險的部署，逐步回復原本的生活？

＃修改疫情警戒標準增列查核條件 ＃訂出解除三級之明確安全標準
根據先前2021/1/21發布的疫情警戒標準，各級警戒的升降依據是病例數與傳播鏈，譬如：『出現感染源不明之本土病例（二級）』、『單周出現3件以上社區群聚事件或1天確診10名以上感染不明的本土病例（三級）』，藉此標準去規定防疫的層級。

和一月時相比，不論國際上或國內，都已經開始進行疫苗施打，而雙北大流行之後，也有更多的數據來反映本土流行的樣態。團隊和我在近期討論過程中，也都會從國際上的實證研究，來參考如何讓大家在安全狀況下解封。我們大致上提出三個建議：

1. 根據實證證據，納入疫苗接種率考量
2. 確保流行熱區疫調、匡列、檢驗作為足夠
3. 各項限制分別逐步開放

我們先來討論疫苗接種率，根據《自然醫學》（Nature Medicine）6月10日刊登的論文[1]指出，在177個以色列社區中，疫苗施打率每增加20%，未施打疫苗族群的陽性檢驗率就會下降一半，這篇研究由於使用以色列四大健保之一的資料，涵蓋百萬人以上，因此有相當的證據力，可以讓我們看出，疫苗接種率在還沒達到理論上的「群體免疫閾值」以前，和保護力就有一定的正向關係。打疫苗不僅保護自己，並可間接保護沒打疫苗的他人。

這篇研究的附件中，更動各種參數，保護力都相對穩定。但要注意若僅算「高齡族群（>66歲）施打率」，則對未打疫苗族群的保護力就很弱，這可能是因為高齡族群本身活動力就低，較不會「主動產生」傳播鏈。

當然，根據由美國、南韓、德國三國數據的實際分析，疫苗先打高齡者，可以拯救最多生命[2]，英國研究也顯示，先打60歲以上高齡族群，可以讓武漢肺炎造成的死亡降低96%、住院降低80%、加護病房入住也降低65%[3]。顯示台灣先打高齡族群的政策當然正確。

但要疫苗要涵蓋到一定比率中壯年人口（若把55~65歲加進來就有效），才能有效抑制輕症與無症狀傳播。也就是說，在解封過程中，需考量中壯年人口施打疫苗比率來「漸進放寬」管制措施。

但在疫苗接種以外，同一篇文章作者也提到，以色列的封鎖等NPI政策，與疫苗是相輔相成，此因素無法被獨立排除。我們也看到，能夠妥善進行疫調、擴大往外匡列、搭配對高風險群大量篩檢的地方，在圍堵疫情上表現都不錯。例如指揮中心進駐苗栗後，成功控制大量移工感染疫情，近幾日確診個案都早已被隔離，這才能確保社區的安全。而社區的安全性，也可以用抗原快篩陽性率、抗體陽性率、背景病毒量幾種方式去推估，已確保疫情已被侷限住。

最後，解封過程中，一定要小心謹慎，現行三級警戒不少限制，譬如停課、展覽館、社團交接、公祭、群聚人數限制、餐廳需外帶......等等規定，也應該研擬「風險區分」來分開開放。

根據英國研究，第一次封鎖令的對國民行為的影響，以及減少死亡的效應，遠高於第二次封鎖令，很可能有「防疫疲勞」的現象[4]。顯示解了又封，國民遵守的程度就沒這麼好。因此，我希望把「關鍵人口疫苗接種率」(例如65歲以上50%)、「青壯人口（18~65歲）疫苗接種率」（例如20%）、縣市疫調匡列與篩檢能量（能否確實掌握多層對象，外圈的篩檢陽性率）都納入「解封標準」，訂定更嚴格、更安心、更透明的標準，讓社會大眾了解，穩定民心，並得以達到社會共識。

在這次解封以後，今年都不用再倒退，才能讓經濟振興、產業輔導轉型等後續政策順利推展，這有賴與大眾的溝通和討論，重建國人信心，而不只是頒布命令而已。

期待台灣經此一役，能成為一個真正的公衛國家！

1.Milman, O., Yelin, I., Aharony, N., Katz, R., Herzel, E., Ben-Tov, A., ... & Kishony, R. (2021). Community-level evidence for SARS-CoV-2 vaccine protection of unvaccinated individuals. Nature Medicine, 1-3.

2.Goldstein, J. R., Cassidy, T., & Wachter, K. W. (2021). Vaccinating the oldest against COVID-19 saves both the most lives and most years of life. Proceedings of the National Academy of Sciences, 118(11).

3.Cook, T. M., & Roberts, J. V. (2021). Impact of vaccination by priority group on UK deaths, hospital admissions and intensive care admissions from COVID‐19. Anaesthesia, 76(5), 608-616.

4.Davies, N. G., Barnard, R. C., Jarvis, C. I., Russell, T. W., Semple, M. G., Jit, M., & Edmunds, W. J. (2021). Association of tiered restrictions and a second lockdown with COVID-19 deaths and hospital admissions in England: a modelling study. The lancet infectious diseases, 21(4), 482-492.

這是前些日子爆出已經被加拿大法院接理對藏傳佛教噶舉派法王的訟訴。（加拿大法院鏈接在此：https://www.bccourts.ca/jdb-txt/sc/21/09/2021BCSC0939cor1.htm?fbclid=IwAR2FLZlzmUIGTBaTuKPVchEqqngcE3Qy6G_C0TWNWVKa2ksbIYkVJVMQ8f8）

這位法王的桃色事件，我是幾年前才聽到。但，藏傳佛教的高層有這些性醜聞，我已經聽了幾十年。我以前的一位前女友也被一些堪布藉故上她的家摟抱過，也有一些活佛跟她表白。（這不只是她，其他地方我也聽過不少）

這是一個藏傳佛教裡面系統式的問題。

很多時候發生這種事情，信徒和教主往往都是說女方得不到寵而報仇，或者說她們也精神病，或者說她們撒謊。

我不排除有這種可能性，但，多過一位，甚至多位出來指證的時候，我是傾向於相信『沒有那麼巧這麼多有精神病的女人要撒謊來報仇』。

大寶法王的桃色事件，最先吹哨的是一位台灣的在家信徒，第二位是香港的女出家人，現在加拿大又多一位公開舉報上法庭。

對大寶法王信徒來說，這一次的比較麻煩，因為是有孩子的。（關於有孩子的，我早在法王的桃色事件曝光時，就有聽聞）

如果法庭勒令要驗證DNA，這對法王和他的信徒來說，會很尷尬和矛盾，因為做或不做，都死。

你若問我，我覺得『人數是有力量的』，同時我也覺得之後有更多的人站出來，是不出奇的。

我也藉此呼籲各方佛教徒，如果你們真的愛佛教，先別說批判，但如鴕鳥般不討論這些爭議，你是間接害了佛教。

（下面是我從加拿大法院鏈接拷貝下來的內容，當中有很多細節。）

Table of Contents

INTRODUCTION

BACKGROUND

ANALYSIS

A. The Spousal Support Claim in this Case

B. The Test to Amend Pleadings

C. Pleadings in Family Law Cases

D. The Legal Concept of a Marriage-Like Relationship

E. Is There a Reasonable Claim of a Marriage-Like Relationship?

F. Delay / Prejudice

CONCLUSION



INTRODUCTION
[1] The claimant applies to amend her notice of family claim to seek spousal support. At issue is whether the claimant’s allegations give rise to a reasonable claim she lived with the respondent in a marriage-like relationship, so as to give rise to a potential entitlement to spousal support under the Family Law Act, S.B.C. 2011, c. 25 (“FLA”).

[2] The facts alleged by the claimant do not fit within a traditional concept of marriage. The claimant does not allege that she and the respondent ever lived together. Indeed, she has only met the respondent in person four times: twice very briefly in a public setting; a third time in private, when she alleges the respondent sexually assaulted her; and a fourth and final occasion, when she informed the respondent she was pregnant with his child.

[3] The claimant’s case is that what began as a non-consensual sexual encounter evolved into a loving and affectionate relationship. That relationship occurred almost entirely over private text messages. The parties rarely spoke on the telephone, and never saw one another during the relationship, even over video. The claimant says they could not be together because the respondent is forbidden by his station and religious beliefs from intimate relationships or marriage. Nonetheless, she alleges, they formed a marriage-like relationship that lasted from January 2018 to January 2019.

[4] The respondent denies any romantic relationship with the claimant. While he acknowledges providing emotional and financial support to the claimant, he says it was for the benefit of the child the claimant told him was his daughter.

[5] The claimant’s proposed amendment raises a novel question: can a secret relationship that began on-line and never moved into the physical world be like a marriage? In my view, that question should be answered by a trial judge after hearing all of the evidence. The alleged facts give rise to a reasonable claim the claimant lived with the respondent in a marriage-like relationship. Accordingly, I grant the claimant leave to amend her notice of family claim.

BACKGROUND
[6] It should be emphasized that this is an application to amend pleadings only. The allegations by the claimant are presumed to be true for the purposes of this application. Those allegations have not been tested in a court of law.

[7] The respondent, Ogyen Trinley Dorje, is a high lama of the Karma Kagyu School of Tibetan Buddhism. He has been recognized and enthroned as His Holiness, the 17th Gyalwang Karmapa. Without meaning any disrespect, I will refer to him as Mr. Dorje in these reasons for judgment.

[8] Mr. Dorje leads a monastic and nomadic lifestyle. His true home is Tibet, but he currently resides in India. He receives followers from around the world at the Gyuto Monetary in India. He also travels the world teaching Tibetan Buddhist Dharma and hosting pujas, ceremonies at which Buddhists express their gratitude and devotion to the Buddha.

[9] The claimant, Vikki Hui Xin Han, is a former nun of Tibetan Buddhism. Ms. Han first encountered Mr. Dorje briefly at a large puja in 2014. The experience of the puja convinced Ms. Han she wanted to become a Buddhist nun. She met briefly with Mr. Dorje, in accordance with Kagyu traditions, to obtain his approval to become a nun.

[10] In October 2016, Ms. Han began a three-year, three-month meditation retreat at a monastery in New York State. Her objective was to learn the practices and teachings of the Kagyu Lineage. Mr. Dorje was present at the retreat twice during the time Ms. Han was at the monastery.

[11] Ms. Han alleges that on October 14, 2017, Mr. Dorje sexually assaulted her in her room at the monastery. She alleges that she became pregnant from the assault.

[12] After she learned that she was pregnant, Ms. Han requested a private audience with Mr. Dorje. In November 2017, in the presence of his bodyguards, Ms. Han informed Mr. Dorje she was pregnant with his child. Mr. Dorje initially denied responsibility; however, he provided Ms. Han with his email address and a cellphone number, and, according to Ms. Han, said he would “prepare some money” for her.

[13] Ms. Han abandoned her plan to become a nun, left the retreat and returned to Canada. She never saw Mr. Dorje again.

[14] After Ms. Han returned to Canada, she and Mr. Dorje began a regular communication over an instant messaging app called Line. They also exchanged emails and occasionally spoke on the telephone.

[15] The parties appear to have expressed care and affection for one another in these communications. I say “appear to” because it is difficult to fully understand the meaning and intentions of another person from brief text messages, especially those originally written in a different language. The parties wrote in a private shorthand, sharing jokes, emojis, cartoon portraits and “hugs” or “kisses”. Ms. Han was the more expressive of the two, writing more frequently and in longer messages. Mr. Dorje generally participated in response to questions or prompting from Ms. Han, sometimes in single word messages.

[16] Ms. Han deposes that she believed Mr. Dorje was in love with her and that, by January 2018, she and Mr. Dorje were living in a “conjugal relationship”.

[17] During their communications, Ms. Han expressed concern that her child would be “illegitimate”. She appears to have asked Mr. Dorje to marry her, and he appears to have responded that he was “not ready”.

[18] Throughout 2018, Mr. Dorje transferred funds in various denominations to Ms. Han through various third parties. Ms. Han deposes that these funds were:

a) $50,000 CDN to deliver the child and for postpartum care she was to receive at a facility in Seattle;

b) $300,000 CDN for the first year of the child’s life;

c) $20,000 USD for a wedding ring, because Ms. Han wrote “Even if we cannot get married, you must buy me a wedding ring”;

d) $400,000 USD to purchase a home for the mother and child.

[19] On June 19, 2018, Ms. Han gave birth to a daughter in Richmond, B.C.

[20] On September 17, 2018, Mr. Dorje wrote, ”Taking care of her and you are my duty for life”.

[21] Ms. Han’s expectation was that the parties would live together in the future. She says they planned to live together. Those plans evolved over time. Initially they involved purchasing a property in Toronto, so that Mr. Dorje could visit when he was in New York. They also discussed purchasing property in Calgary or renting a home in Vancouver for that purpose. Ms. Han eventually purchased a condominium in Richmond using funds provided by Mr. Dorje.

[22] Ms. Han deposes that the parties made plans for Mr. Dorje to visit her and meet the child in Richmond. In October 2018, however, Mr. Dorje wrote that he needed to “disappear” to Europe. He wrote:

I will definitely find a way to meet her

And you

Remember to take care of yourself if something happens

[23] The final plan the parties discussed, according to Ms. Han, was that Mr. Dorje would sponsor Ms. Han and the child to immigrate to the United States and live at the Kagyu retreat centre in New York State.

[24] In January 2019, Ms. Han lost contact with Mr. Dorje.

[25] Ms. Han commenced this family law case on July 17, 2019, seeking child support, a declaration of parentage and a parentage test. She did not seek spousal support.

[26] Ms. Han first proposed a claim for spousal support in October 2020 after a change in her counsel. Following an exchange of correspondence concerning an application for leave to amend the notice of family claim, Ms. Han’s counsel wrote that Ms. Han would not be advancing a spousal support claim. On March 16, 2020, counsel reversed course, and advised that Ms. Han had instructed him to proceed with the application.

[27] When this application came on before me, the trial was set to commence on June 7, 2021. The parties were still in the process of discoveries and obtaining translations for hundreds of pages of documents in Chinese characters.

[28] At a trial management conference on May 6, 2021, noting the parties were not ready to proceed, Madam Justice Walkem adjourned the trial to April 11, 2022.

ANALYSIS
A. The Spousal Support Claim in this Case
[29] To claim spousal support in this case, Ms. Han must plead that she lived with Mr. Dorje in a marriage-like relationship. This is because only “spouses” are entitled to spousal support, and s. 3 of the Family Law Act defines a spouse as a person who is married or has lived with another person in a marriage-like relationship:

3 (1) A person is a spouse for the purposes of this Act if the person

(a) is married to another person, or

(b) has lived with another person in a marriage-like relationship, and

(i) has done so for a continuous period of at least 2 years, or

(ii) except in Parts 5 [Property Division] and 6 [Pension Division], has a child with the other person.

[30] Because she alleges she has a child with Mr. Dorje, Ms. Han need not allege that the relationship endured for a continuous period of two years to claim spousal support; but she must allege that she lived in a marriage-like relationship with him at some point in time. Accordingly, she must amend the notice of family claim.

B. The Test to Amend Pleadings
[31] Given that the notice of trial has been served, Ms. Han requires leave of the court to amend the notice of family claim: Supreme Court Family Rule 8-1(1)(b)(i).

[32] A person seeking to amend a notice of family claim must show that there is a reasonable cause of action. This is a low threshold. What the applicant needs to establish is that, if the facts pleaded are proven at trial, they would support a reasonable claim. The applicant’s allegations of fact are assumed to be true for the purposes of this analysis. Cantelon v. Wall, 2015 BCSC 813, at para. 7-8.

[33] The applicant’s delay, the reasons for the delay, and the prejudice to the responding party are also relevant factors. The ultimate consideration is whether it would be just and convenient to allow the amendment. Cantelon, at para. 6, citing Teal Cedar Products Ltd. v. Dale Intermediaries Ltd. et al (1986), 19 B.C.L.R. (3d) 282.

C. Pleadings in Family Law Cases
[34] Supreme Court Family Rules 3-1(1) and 4-1(1) require that a claim to spousal support be pleaded in a notice of family claim in Form F3. Section 2 of Form F3, “Spousal relationship history”, requires a spousal support claimant to check the boxes that apply to them, according to whether they are or have been married or are or have been in a marriage-like relationship. Where a claimant alleges a marriage-like relationship, Form F3 requires that they provide the date on which they began to live together with the respondent in a marriage-like relationship and, where applicable, the date on which they separated. Form F3 does not require a statement of the factual basis for the claim of spousal support.

[35] In this case, Ms. Han seeks to amend the notice of family claim to allege that she and Mr. Dorje began to live in a marriage-like relationship in or around January 2018, and separated in or around January 2019.

[36] An allegation that a person lived with a claimant in a marriage-like relationship is a conclusion of law, not an allegation of fact. Unlike the rules governing pleadings in civil actions, however, the Supreme Court Family Rules do not expressly require family law claimants to plead the material facts in support of conclusions of law.

[37] In other words, there is no express requirement in the Supreme Court Family Rules that Ms. Han plead the facts on which she relies for the allegation she and Mr. Dorje lived in a marriage-like relationship.

[38] Rule 4-6 authorizes a party to demand particulars, and then apply to the court for an order for further and better particulars, of a matter stated in a pleading. However, unless and until she is granted leave and files the proposed amended notice of family claim, Ms. Han’s allegation of a marriage-like relationship is not a matter stated in a pleading.

[39] Ms. Han filed an affidavit in support of her application to amend the notice of family claim. Normally, evidence would not be required or admissible on an application to amend a pleading. However, in the unusual circumstances of this case, the parties agreed I may look to Ms. Han’s affidavit and exhibits for the facts she pleads in support of the allegation of a marriage-like relationship.

[40] Because this is an application to amend - and Ms. Han’s allegations of fact are presumed to be true - I have not considered Mr. Dorje’s responding affidavit.

[41] Relying on affidavit evidence for an application to amend pleadings is less than ideal. It tends to merge and confuse the material facts with the evidence that would be relied on to prove those facts. In a number of places in her affidavit, for example, Ms. Han describes her feelings, impressions and understandings. A person’s hopes and intentions are not normally material facts unless they are mutual or reasonably held. The facts on which Ms. Han alleges she and Mr. Dorje formed a marriage-like relationship are more important for the present purposes than her belief they entered into a conjugal union.

[42] Somewhat unusually, in this case, almost all of the parties’ relevant communications were in writing. This makes it somewhat easier to separate the facts from the evidence; however, as stated above, it is difficult to understand the intentions and actions of a person from brief text messages.

[43] In my view, it would be a good practice for applicants who seek to amend their pleadings in family law cases to provide opposing counsel and the court with a schedule of the material facts on which they rely for the proposed amendment.

D. The Legal Concept of a Marriage-Like Relationship
[44] As Mr. Justice Myers observed in Mother 1 v. Solus Trust Company, 2019 BCSC 200, the concept of a marriage-like relationship is elastic and difficult to define. This elasticity is illustrated by the following passage from Yakiwchuk v. Oaks, 2003 SKQB 124, quoted by Myers J. at para. 133 of Mother 1:

[10] Spousal relationships are many and varied. Individuals in spousal relationships, whether they are married or not, structure their relationships differently. In some relationships there is a complete blending of finances and property - in others, spouses keep their property and finances totally separate and in still others one spouse may totally control those aspects of the relationship with the other spouse having little or no knowledge or input. For some couples, sexual relations are very important - for others, that aspect may take a back seat to companionship. Some spouses do not share the same bed. There may be a variety of reasons for this such as health or personal choice. Some people are affectionate and demonstrative. They show their feelings for their “spouse” by holding hands, touching and kissing in public. Other individuals are not demonstrative and do not engage in public displays of affection. Some “spouses” do everything together - others do nothing together. Some “spouses” vacation together and some spend their holidays apart. Some “spouses” have children - others do not. It is this variation in the way human beings structure their relationships that make the determination of when a “spousal relationship” exists difficult to determine. With married couples, the relationship is easy to establish. The marriage ceremony is a public declaration of their commitment and intent. Relationships outside marriage are much more difficult to ascertain. Rarely is there any type of “public” declaration of intent. Often people begin cohabiting with little forethought or planning. Their motivation is often nothing more than wanting to “be together”. Some individuals have chosen to enter relationships outside marriage because they did not want the legal obligations imposed by that status. Some individuals have simply given no thought as to how their relationship would operate. Often the date when the cohabitation actually began is blurred because people “ease into” situations, spending more and more time together. Agreements between people verifying when their relationship began and how it will operate often do not exist.

[45] In Mother 1, Mr. Justice Myers referred to a list of 22 factors grouped into seven categories, from Maldowich v. Penttinen, (1980), 17 R.F.L. (2d) 376 (Ont. Dist. Ct.), that have frequently been cited in this and other courts for the purpose of determining whether a relationship was marriage-like, at para. 134 of Mother 1:

1. Shelter:

(a) Did the parties live under the same roof?

(b) What were the sleeping arrangements?

(c) Did anyone else occupy or share the available accommodation?

2. Sexual and Personal Behaviour:

(a) Did the parties have sexual relations? If not, why not?

(b) Did they maintain an attitude of fidelity to each other?

(c) What were their feelings toward each other?

(d) Did they communicate on a personal level?

(e) Did they eat their meals together?

(f) What, if anything, did they do to assist each other with problems or during illness?

(g) Did they buy gifts for each other on special occasions?

3. Services:

What was the conduct and habit of the parties in relation to:

(a) preparation of meals;

(b) washing and mending clothes;

(c) shopping;

(d) household maintenance; and

(e) any other domestic services?

4. Social:

(a) Did they participate together or separately in neighbourhood and community activities?

(b) What was the relationship and conduct of each of them toward members of their respective families and how did such families behave towards the parties?

5. Societal:

What was the attitude and conduct of the community toward each of them and as a couple?

6. Support (economic):

(a) What were the financial arrangements between the parties regarding the provision of or contribution toward the necessaries of life (food, clothing, shelter, recreation, etc.)?

(b) What were the arrangements concerning the acquisition and ownership of property?

(c) Was there any special financial arrangement between them which both agreed would be determinant of their overall relationship?

7. Children:

What was the attitude and conduct of the parties concerning children?

[46] In Austin v. Goerz, 2007 BCCA 586, the Court of Appeal cautioned against a “checklist approach”; rather, a court should "holistically" examine all the relevant factors. Cases like Molodowich provide helpful indicators of the sorts of behaviour that society associates with a marital relationship, the Court of Appeal said; however, “the presence or absence of any particular factor cannot be determinative of whether a relationship is marriage-like” (para. 58).

[47] In Weber v. Leclerc, 2015 BCCA 492, the Court of Appeal again affirmed that there is no checklist of characteristics that will be found in all marriages and then concluded with respect to evidence of intentions:

[23] The parties’ intentions – particularly the expectation that the relationship will be of lengthy, indeterminate duration – may be of importance in determining whether a relationship is “marriage-like”. While the court will consider the evidence expressly describing the parties’ intentions during the relationship, it will also test that evidence by considering whether the objective evidence is consonant with those intentions.

[24] The question of whether a relationship is “marriage-like” will also typically depend on more than just their intentions. Objective evidence of the parties’ lifestyle and interactions will also provide direct guidance on the question of whether the relationship was “marriage-like”.

[48] Significantly for this case, the courts have looked to mutual intent in order to find a marriage-like relationship. See, for example, L.E. v. D.J., 2011 BCSC 671 and Buell v. Unger, 2011 BCSC 35; Davey Estate v. Gruyaert, 2005 CarswellBC 3456 at 13 and 35.

[49] In Mother 1, Myers J. concluded his analysis of the law with the following learned comment:

[143] Having canvassed the law relating to the nature of a marriage-like relationship, I will digress to point out the problematic nature of the concept. It may be apparent from the above that determining whether a marriage-like relationship exists sometimes seems like sand running through one's fingers. Simply put, a marriage-like relationship is akin to a marriage without the formality of a marriage. But as the cases mentioned above have noted, people treat their marriages differently and have different conceptions of what marriage entails.

[50] In short, the determination of whether the parties in this case lived in a marriage-like relationship is a fact-specific inquiry that a trial judge would need to make on a “holistic” basis, having regard to all of the evidence. While the trial judge may consider the various factors listed in the authorities, those factors would not be treated as a checklist and no single factor or category of factors would be treated as being decisive.

E. Is There a Reasonable Claim of a Marriage-Like Relationship?
[51] In this case, many of the Molodowich factors are missing:

a) The parties never lived under the same roof. They never slept together. They were never in the same place at the same time during the relationship. The last time they saw each other in person was in November 2017, before the relationship began.

b) The parties never had consensual sex. They did not hug, kiss or hold hands. With the exception of the alleged sexual assault, they never touched one another physically.

c) The parties expressed care and affection for one another, but they rarely shared personal information or interest in their lives outside of their direct topic of communication. They did not write about their families, their friends, their religious beliefs or their work.

d) They expressed concern and support for one another when the other felt unwell or experienced health issues, but they did not provide any care or assistance during illness or other problems.

e) They did not assist one another with domestic chores.

f) They did not share their relationship with their peers or their community. There is no allegation, for example, that Mr. Dorje told his fellow monks or any of his followers about the relationship. There is no allegation that Ms. Han told her friends or any co-workers. Indeed, there is no allegation that anyone, with the exception of Ms. Han’s mother, knew about the relationship. Although Mr. Dorje gave Ms. Han’s mother a gift, he never met the mother and he never spoke to her.

g) They did not intend to have a child together. The child was conceived as a result of a sexual assault. While Mr. Dorje expressed interest in “meeting” the child, he never followed up. He currently has no relationship with the child. There is no allegation he has sought access or parenting arrangements.

[52] The only Molodowich factor of any real relevance in this case is economic support. Mr. Dorje provided the funds with which Ms. Han purchased a condominium. Mr. Dorje initially wrote that he wanted to buy a property with the money, but, he wrote, “It’s the same thing if you buy [it]”.

[53] Mr. Dorje also provided a significant amount of money for Ms. Han’s postpartum care and the child’s first year of life.

[54] This financial support may have been primarily for the benefit of the child. Even the condominium, Ms. Han wrote, was primarily for the benefit of the child.

[55] However, in my view, a trial judge may attach a broader significance to the financial support from Mr. Dorje than child support alone. A trial judge may find that the money Mr. Dorje provided to Ms. Han at her request was an expression of his commitment to her in circumstances in which he could not commit physically. The money and the gifts may be seen by the trial judge to have been a form of down payment by Mr. Dorje on a promise of continued emotional and financial support for Ms. Han, or, in Mr. Dorje’s own words, “Taking care of her and you are my duty for life” (emphasis added).

[56] On the other hand, I find it difficult to attach any particular significance to the fact that Mr. Dorje agreed to provide funds for Ms. Han to purchase a wedding ring. It appears to me that Ms. Han demanded that Mr. Dorje buy her a wedding ring, not that the ring had any mutual meaning to the parties as a marriage symbol. But it is relevant, in my view, that Mr. Dorje provided $20,000 USD to Ms. Han for something she wanted that was of no benefit to the child.

[57] Further, Ms. Han alleges that the parties intended to live together. At a minimum, a trial judge may find that the discussions about where Ms. Han and the child would live reflected a mutual intention of the parties to see one another and spend time together when they could.

[58] Mr. Dorje argues that an intention to live together at some point in the future is not sufficient to show that an existing relationship was marriage-like. He argues that the question of whether the relationship was marriage-like requires more than just intentions, citing Weber, supra.

[59] In my view, the documentary evidence referred to above provides some objective evidence in this case that the parties progressed beyond mere intentions. As stated, the parties appear to have expressed genuine care and affection for one another. They appear to have discussed marriage, trust, honesty, finances, mutual obligations and acquiring family property. These are not matters one would expect Mr. Dorje to discuss with a friend or a follower, or even with the mother of his child, without a marriage-like element of the relationship.

[60] A trial judge may find on the facts alleged by Ms. Han that the parties loved one another and would have lived together, but were unable to do so because of Mr. Dorje’s religious duties and nomadic lifestyle.

[61] The question I raised in the introduction to these reasons is whether a relationship that began on-line and never moved into the physical world can be marriage-like.

[62] Notably, the definition of a spouse in the Family Law Act does not require that the parties live together, only that they live with another person in a marriage-like relationship.

[63] In Connor Estate, 2017 BCSC 978, Mr. Justice Kent found that a couple that maintained two entirely separate households and never lived under the same roof formed a marriage-like relationship. (Connor Estate was decided under the intestacy provisions of the Wills, Estates and Succession Act, S.B.C. 2009, c. 13 ("WESA"), but courts have relied on cases decided under WESA and the FLA interchangeably for their definitions of a spouse.) Mr. Justice Kent found:

[50] The evidence is overwhelming and I find as a fact that Mr. Chambers and Ms. Connor loved and cared deeply about each other, and that they had a loving and intimate relationship for over 20 years that was far more than mere friendship or even so-called "friendship with benefits". I accept Mr. Chambers' evidence that he would have liked to share a home with Ms. Connor after the separation from his wife, but was unable to do so because of Ms. Connor's hoarding illness. The evidence amply supports, and I find as a fact, that Mr. Chambers and Ms. Connor loved each other, were faithful to each other, communicated with each other almost every day when they were not together, considered themselves to be (and presented themselves to be) "husband and wife" and were accepted by all who knew them as a couple.

[64] Connor Estate may be distinguishable from this case because Mr. Chambers and Ms. Connor were physically intimate for over 20 years, and presented themselves to the world as a married couple.

[65] Other decisions in which a marriage-like relationship has been found to exist despite the parties not living together have involved circumstances in which the couple lived under the same roof at previous points in the relationship, and the issue was whether they continued to be spouses after they took up separate residences: in Thompson v. Floyd, 2001 BCCA 78, the parties had lived together for a period of at least 11 years; in Roach v. Dutra, 2010 BCCA 264, the parties had lived together for approximately three years.

[66] However, as Mr. Justice Kent noted in Connor Estate:

[48] … [W]hile much guidance might be found in this case law, the simple fact is that no two cases are identical (and indeed they usually vary widely) and it is the assessment of evidence as a whole in this particular case which matters.

[67] Mr. Justice Kent concluded:

[53] Like human beings themselves, marriage-like relationships can come in many and various shapes. In this particular case, I have no doubt that such a relationship existed …

[68] As stated, Ms. Han’s claim is novel. It may even be weak. Almost all of the traditional factors are missing. The fact that Ms. Han and Mr. Dorje never lived under the same roof, never shared a bed and never even spent time together in person will militate against a finding they lived with one another in a marriage-like relationship. However, the traditional factors are not a mandatory check-list that confines the “elastic” concept of a marriage-like relationship. And if the COVID pandemic has taught us nothing else, it is that real relationships can form, blossom and end in virtual worlds.

[69] In my view, the merits of Ms. Han’s claim should be decided on the evidence. Subject to an overriding prejudice to Mr. Dorje, she should have leave to amend the notice of family claim. However, she should also provide meaningful particulars of the alleged marriage-like relationship.

F. Delay / Prejudice
[70] Ms. Han filed her notice of family claim on July 17, 2019. She brought this application to amend approximately one year and nine months after she filed the pleading, just over two months before the original trial date.

[71] Ms. Han’s delay was made all that more remarkable by her change in position from January 19, 2021, when she confirmed, through counsel, that she was not seeking spousal support in this case.

[72] Ms. Han gave notice of her intention to proceed with this application to Mr. Dorje on March 16, 2021. By the time the application was heard, the parties had conducted examinations for discovery without covering the issues that would arise from a claim of spousal support.

[73] Also, in April, Ms. Han produced additional documents, primarily text messages, that may be relevant to her claim of spousal support, but were undecipherable to counsel for Mr. Dorje, who does not read Mandarin.

[74] This application proceeded largely on documents selected and translated by counsel for Ms. Han. I was informed that Mandarin translations of the full materials would take 150 days.

[75] Understandably in the circumstances, Mr. Dorje argued that an amendment two months before trial would be neither just nor convenient. He argued that he would be prejudiced by an adjournment so as to allow Ms. Han to advance a late claim of spousal support.

[76] The circumstances changed on May 6, 2021, when Madam Justice Walkem adjourned the trial to July 2022 and reset it for 25 days. Madam Justice Walkem noted that most of the witnesses live internationally and require translators. She also noted that paternity may be in issue, and Mr. Dorje may amend his pleadings to raise that issue. It seems clear that, altogether apart from the potential spousal support claim, the parties were not ready to proceed to trial on June 7, 2021.

[77] In my view, any remaining prejudice to Mr. Dorje is outweighed by the importance of having all of the issues between the parties decided on their merits.

[78] Ms. Han’s delay and changes of position on spousal support may be a matter to de addressed in a future order of costs; but they are not grounds on which to deny her leave to amend the notice of family claim.

CONCLUSION
[79] Ms. Han is granted leave to amend her notice of family claim in the form attached as Appendix A to the notice of application to include a claim for spousal support.

[80] Within 21 days, or such other deadline as the parties may agree, Ms. Han must provide particulars of the marriage-like relationship alleged in the amended notice of family claim.

[81] Ms. Han is entitled to costs of this application in the cause of the spousal support claim.

“Master Elwood”

針對 #AF患者評估其中風與出血風險後，對於 #抗凝藥物 選擇的綜合建議：
2020 ESC AF治療指引

(1) 對於CHA2DS2VASc score男性≥ 2分或是女性≥ 3分的AF患者，建議使用口服抗凝血劑包括：warfarin、dabigatran、rivaroxaban、apixaban、edoxaban (Class I, Level of Evidence A)。

(2) 除了是中至重度二尖瓣狹窄或機械瓣膜置換之AF患者外，其他AF患者建議優先使用NOACs (dabigatran、rivaroxaban、apixaban、edoxaban) (Class I, Level of Evidence A)。

(3) 建議使用CHA2DS2VASc score作為AF中風風險評估的指標(Class I, Level of Evidence B)。

(4) 機械瓣膜置換的患者建議使用warfarin (Class I, Level of Evidence B)。#其INR在至少70%的治療期間(TTR)維持於2.0-3.0。(TTR: Time in Therapeutic Range)。

如果TTR<70%, 應選擇換成NOAC藥物，或改善其TTR.

(5) 不論患者是何種形式的AF (paroxysmal、persistent、permanent)抗凝血劑的選擇是依其中風栓塞風險而定 (Class I, Level of Evidence B)。#臨床的AF不應列入預防血栓治療。(Class IIIB)#註：#臨床AF(Clinical AF)

#根據ESC的定義，#臨床AF是：

1、ECG 有AF記錄，包括有症狀及無症狀。
2、AF的ECG 至少要持續30秒。

#所以clinical_AF #不能做為限制血栓預防治療的要件。

(6) 在使用NOACs前應先評估患者的肝腎功能，之後建議至少每年檢驗肝腎功能一次(Class I, Level of Evidence B-NR)。

(7) 在選擇使用口服抗凝血劑時，應依患者個別狀況評估說明其中風與出血風險，尊重其自主意願，並與病人/家屬共同決定治療的方向(shared decision making) (Class I, Level of Evidence C)。

(8) 心房撲動(atrial flutter)患者，建議比照AF患者風險評估，使用口服抗凝血劑(Class I, Level of Evidence C)。

(9) 定期重新評估AF患者中風與出血風險，#以HAS-BLED Score方式評估，#尤其出血高風險HAS-BLED Score ≧3) 更需經常檢視臨床狀況。(Class IIa, Level of Evidence B)。

(10) 對於CHA2DS2VASc score男性1分或女性2分之AF患者，使用口服抗凝血劑預防中風栓塞事件是需要衡量優缺點，依個人情況而選擇(Class IIa, Level of Evidence B)。

(11) 除非是中至重度二尖瓣狹窄或機械瓣膜置換外的AF患者，若CHA2DS2VASc score男性0分或是女性1分，可選擇不使用口服抗凝血劑(Class IIa)。#不要使用口服抗凝血劑(Class Ia)。
#不要使用抗血小板藥物來做AF預防中風的治療。#(Aspirin, Clopidogrel，#無論單一或雙重，#都勿使用) (Class III, A)
● #由於禁忌症而無法長期使用NOAC之病人，可以考慮使用 #LAA封閉手術做為AF預防中風的治療。(Class IIb, A)
● #AF病人接受心臟手術時，可以用外科方式使用 #LAA封閉手術，做AF預防中風的治療。

以上黑色字體是2019台灣腦中風學會指引；
#藍色字體是歐洲心臟學會2020 _AF治療指引。

AF使用口服抗凝劑之指引流程~~
2020 ESC AF guideline, European Heart Journal (2020) 42, 373-498

繼續閱讀~~

FB粉絲專頁：https://www.facebook.com/GoVeganTW
提倡一種新的生活態度，透過動畫宣導"動物權利"！

感謝【台灣素食營養學會】整理資料、提供贊助
【台灣素食營養學會 官網】http://www.twvns.org/
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【補充資料】
豆腐補鈣，鹽滷、石膏哪種好 http://goo.gl/MWcs7w
今天的鈣夠了嗎 http://goo.gl/xGUOe7
蔬食鈣高尚 https://goo.gl/Mz2fkB
素食者是否該喝牛奶 http://goo.gl/NSDmQN

1. 喝牛奶增加死亡率、骨折率 （瑞典研究）：
Michaëlsson K, Wolk A, Langenskiöld S, Basu S, Warensjö Lemming E, Melhus H, Byberg L. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ. 2014 Oct 28;349:g6015.

2. 青少年喝奶量與老年時的骨折率：
Feskanich D, Bischoff-Ferrari HA, Frazier AL, Willett WC. Milk consumption during teenage years and risk of hip fractures in older adults. JAMA Pediatr. 2014 Jan;168(1):54-60. doi: 10.1001/jamapediatrics.2013.3821.

3. 其他喝牛奶與骨折的研究：
Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR. Calcium intake and risk of fracture: systematic review. BMJ. 2015 Sep 29;351:h4580. doi:10.1136/bmj.h4580. Review.

Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Kanis JA, Orav EJ, Staehelin HB, Kiel DP, Burckhardt P, Henschkowski J, Spiegelman D, Li R, Wong JB, Feskanich D, Willett WC. Milk intake and risk of hip fracture in men and women: a meta-analysis of prospective cohort studies. J Bone Miner Res. 2011 Apr;26(4):833-9.

4. D-半乳糖：
Hao L, Huang H, Gao J, Marshall C, Chen Y, Xiao M. The influence of gender, age and treatment time on brain oxidative stress and memory impairment induced by d­galactose in mice. Neurosci Lett 2014;571C:45­9.

Cui X, Wang L, Zuo P, Han Z, Fang Z, Li W, et al. D-­galactose ­caused life shortening in Drosophila melanogaster and Musca domestica is associated with oxidative stress. Biogerontology 2004;5:317­25.

5. IGF-1相關：
Cao Y, Nimptsch K, Shui IM, Platz EA, Wu K, Pollak MN, Kenfield SA, Stampfer MJ, Giovannucci EL. Prediagnostic plasma IGFBP-1, IGF-1 and risk of prostate cancer. Int J Cancer. 2015 May 15;136(10):2418-26. doi: 10.1002/ijc.29295. Epub
2014 Nov 10.

Ma J, Giovannucci E, Pollak M, Chan JM, Gaziano JM, Willett WC, Stampfer MJ. Milk intake, circulating levels of insulin-like growth factor-I, and risk of colorectal cancer in men. J Natl Cancer Inst 2001; 93:1330–6.

Qin LQ, He K, Xu JY. Milk consumption and circulating insulin-like growth factor-I level: a systematic literature review. Int J Food Sci Nutr 2009;60(Suppl 7):330–40.

Allen NE, Appleby PN, Davey GK, Key TJ. Hormones and diet: low insulin-like growth factor-I but normal bioavailable androgens in vegan men. Br J Cancer 2000;83:95–7.

6. 攝護腺癌：
Aune D, Navarro Rosenblatt DA, Chan DS, Vieira AR, Vieira R, Greenwood DC, Vatten LJ, Norat T. Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Am J Clin Nutr. 2015 Jan;101(1):87-117.

7. 牛乳與便秘：
Andiran F, Dayi S, Mete E. Cows milk consumption in constipation and anal fissure in infants and young children. J Paediatr Child Health. 2003 Jul;39(5):329-31.

Irastorza I, Ibañez B, Delgado-Sanzonetti L, Maruri N, Vitoria JC. Cow's-milk-free diet as a therapeutic option in childhood chronic constipation. J Pediatr Gastroenterol Nutr. 2010 Aug;51(2):171-6.

Carroccio A, Mansueto P, Morfino G, D'Alcamo A, Di Paola V, Iacono G, Soresi M, Scerrino G, Maresi E, Gulotta G, Rini G, Bonventre S. Oligo-antigenic diet in the treatment of chronic anal fissures. Evidence for a relationship between food hypersensitivity and anal fissures. Am J Gastroenterol. 2013 May;108(5):825-32.

Dehghani SM, Ahmadpour B, Haghighat M, Kashef S, Imanieh MH, Soleimani M. The Role of Cow's Milk Allergy in Pediatric Chronic Constipation: A Randomized Clinical Trial. Iran J Pediatr. 2012 Dec;22(4):468-74.

8. 牛乳與青春痘：

Melnik BC. Evidence for acne-promoting effects of milk and other insulinotropic dairy products. Nestle Nutr Workshop Ser Pediatr Program. 2011;67:131-45.

9. 鈣質吸收率：
Weaver CM, Plawecki KL. Dietary calcium: adequacy of a vegetarian diet. Am J Clin Nutr. 1994 May;59(5 Suppl):1238S-1241S. Review.

Weaver CM, Proulx WR, Heaney R. Choices for achieving adequate dietary calcium with a vegetarian diet. Am J Clin Nutr. 1999 Sep;70(3 Suppl):543S-548S. Review.

10.溫室氣體排放：
http://www.fao.org/agriculture/lead/themes0/climate/emissions/en/