關於 75 f to c ，我們在網路上蒐集到這些相關的討論、資訊與評價

急性心衰竭 (心衰竭指引 ESC guidelines, 2021)

Part 2~~

key words:
AHF: 急性心衰竭(Acute heart failure)
ADHF: 急性失償心衰竭(Acute decompensated heart failure)
Cardiogenic shock: 心因性休克
MCS：機械式循環輔助 (Mechanical circulation Support)
RRT：腎臟替代療法(Renal replacement therapy)
Natriuretic peptides (BNP, NT-proBNP, MR-proANP)
MR-proANP = mid-regional pro-atrial natriuretic peptide
NT-proBNP = N-terminal pro-B-type natriuretic peptide

AHF流行病學、診斷和預後

AHF 是指 HF 的症狀和/或癥兆迅速或逐漸發作，嚴重到足以使患者尋求緊急醫療照護，導致意外入院或急診就診。AHF患者需要緊急評估，隨後開始或積極治療，包括經由靜脈治療或裝置步驟。AHF在院內死亡率為4%-10% 。出院後一年死亡率: 25–30%，死亡或再入院率高達 45% 以上。

AHF 可能是 HF第一次發作，或者是由於慢性 HF 的急性失償。與急性失償心衰竭相比，新發HF患者的院內死亡率可能較高，但出院後死亡率和再住院率較低。

AHF的診斷檢查包括心電圖、心超、胸部X光、檢查和肺超檢查。尤其無法檢測Natriuretic peptides(NP)時。如果診斷無法確定是否心因性心衰竭時，則檢驗血漿 NP數值（BNP 或 NT-proBNP 或 MR-proANP）。

NPs正常：排除AHF 的診斷。
急性 HF 的臨界值是：
BNP <100 pg/mL、
NT-proBNP <300 pg/mL
MR-proANP <120 pg/mL。

但NP值升高與多種非心臟疾病相關， 在一些患有晚期失償末期HF、肥胖、突發性肺水腫(flash pulmonary edema)或右側AHF的患者可測得低值NP。有AF和/或腎功能異常，其NP數值較高。

AHF診斷流程
• 初步驗血檢驗包括肌鈣蛋白(troponin)、血清肌酐、電解質、血尿素氮或尿素、TSH、肝功能檢查及D-dimer(疑似肺栓塞)；和procalcitonin (感染)，動脈血氧分析(呼吸窘迫)，以及lactate(低灌注的情況)。(註：procalcitonin降鈣素原可用於肺炎的診斷，數據 >0.2 μg/L 時，可能有使用抗生素治療的適應症。)
• 特定檢查包括冠狀動脈造影（疑似 ACS）和 CT（疑似肺栓塞）。
• 急性心衰診斷的NT-proBNP臨界值：
<55歲：> 450 pg/mL
55 -75 歲：> 900 pg/mL
> 75 歲> 1800 pg/mL

AHF臨床表現

AHF呈現四種主要的臨床表現，主要根據充血和/或外周血流灌注不足的原因所呈現出來不同的臨床表現。(參考表21)

四種臨床表現分別是：
1.急性失償心衰竭
2.急性肺水腫
3.孤立性右心室衰竭
4.心因性休克

各種急性心衰竭的臨床表現：

1.急性失償心衰竭(Acute decompensated heart failure, ADHF)
急性失償心衰竭 (ADHF) 是 AHF 最常見的形式，佔臨床表現的 50-70%。它發生在有HF病史和心臟功能異常，包括 RV 功能異常。與急性肺水腫表型不同，發作時程呈現漸進，主要變化是導致全身充血，液體滯留。
治療：
a. 使用環利尿劑，減少水份滯留。
b. 強心增壓劑(Norepinephrine)：於周邊低灌注時使用。
c. 短暫使用機械式循環輔助(MCS)：於周邊低灌注，器官受損時使用
c.腎臟替代療法(RRT: Renal replacement therapy)：如果利尿劑無效或腎病末期時，可考慮使用RRT (Class IIa)

2.急性肺水腫
急性肺水腫診斷的臨床標準包括:
呼吸困難合併端坐呼吸、
呼吸衰竭（低血氧症-高碳酸血症）、
呼吸急促、
>25 次/分鐘和呼吸功增加。

治療：
a. 給予氧氣，持續氣道正壓通氣、非侵入性正壓通氣和/或高流量鼻管。
b. 給予靜脈利尿劑。
c. 如果收縮壓 (SBP) 高，可以給予靜脈血管擴張劑，以減少 LV 後負荷。在少數晚期 HF 病例中，急性肺水腫可能與低心輸出量有關，在這種情況下，需要使用強心劑(Inotropics)、血管加壓藥(vasopressors)和/或MCS 來恢復器官灌注。

3. 孤立性右心衰竭 (Solitary RV Failure)
a. RV 衰竭是由於 RV 和心房壓力增加以及全身充血。RV 衰竭也可能損害 LV 填充功能，最後導致心輸出量減少。
b. 利尿劑通常是治療靜脈充血的首選藥物。
c. Norepinephrine，強心劑、血管加壓劑：適用於低心輸出量和血流動力學不穩定。可能優先選用能降低心臟充填壓的強心劑, 如，levosimendan, phosphodiesterase type III inhibitors。
d. 由於強心劑可能會使動脈低血壓更嚴重，必要時，可以與norepinephrine合用。

4.心因性休克
心因性休克是由於原發性心臟功能異常導致心輸出量不足的症候群，包括危及生命的組織低灌注狀態，可導致多器官衰竭和死亡。

心因性休克的診斷要件：

灌注不足的臨床症狀：例如四肢冷汗、少尿、精神錯亂、頭暈、脈壓變窄、低灌注。血清肌酐升高、代謝性酸中毒和血清乳酸升高，反映出組織缺氧和細胞代謝改變導致器官功能障礙。低灌注並不常合併低血壓，因為可以通過代償性血管收縮（使用/不使用升壓劑）來維持血壓。

應儘早開始治療心因性休克：早期識別和治療潛在原因。
尋找病因(口訣：CHAMPIT)：(see photo)
包括急性冠心症，高血壓急症，快速心律不整，嚴重心搏過慢，傳導阻滯，機械性原因(如，急性瓣膜返流，急性肺栓塞，感染，心肌炎，心包填塞)

嚴重休克病人則需要考慮將MCS(Class IIa)作為移植的過渡時期使用。

急性心衰竭的藥物治療：

利尿劑
靜脈利尿劑是AHF治療的基本。它們增加鈉和水份的排泄，適用於治療大多數AHF患者的體液過度負荷和充血。
a. Furosemide: 起始劑量為 20-40 mg，或靜脈推注 10-20 mg。Furosemide可以每天 2-3 次推注或連續輸注。由於給藥後，會有鈉滯留的可能性，因此不鼓勵每日單次推注給藥。連續輸注時，可使用負荷劑量以更早達到穩態。
b. 利尿劑治療開始後應立即評估利尿反應，並可通過在2或6小時後進行當時尿鈉含量(urine sport sodium) 和/或通過測量每小時尿量來評估。
c. 適當的利尿反應可以定義為2小時後，尿鈉(urine spot sodium) >50–70 mEq/L and/or
d. 前6小時尿量 >100–150 mL/h。
e. 如果利尿反應不足, 環利尿劑IV劑量可以加倍，並進一步評估利尿反應。
f. 如果利尿反應仍然不足，即使利尿劑劑量加倍，但每小時利尿量<100 mL，可以考慮同時使用其他作用於不同部位的利尿劑，即thiazides, metaolazone, acetazolamide。但需要仔細監測血清電解質和腎功能。

血管擴張劑
a. 靜脈血管擴張劑，如nitrate，可以擴張靜脈和動脈，因此減少靜脈返回心臟，充血減少，後負荷降低，增加心搏出量，因此緩解症狀。
b. Nitrate主要作用於靜脈，而nitroprusside則是動靜脈擴張。由於它們的作用機制，靜脈注射後，血管擴張劑可能比利尿劑更有效。急性肺水腫是由於後負荷增加和液體重新分配到肺部，而沒有周邊積液。
c. 當 SBP > 110 mmHg 時，可以考慮使用靜脈血管擴張劑來緩解AHF症狀。它們可以以低劑量開始並逐漸增加以達到臨床改善和血壓控制。應注意避免因前負荷和後負荷過度降低而導致的低血壓。因此，對於 LVH 和/或嚴重主動脈瓣狹窄的患者，應謹慎地使用。

強心升壓劑 (Inotropes)
a. 低心輸出量和低血壓患者的治療需要強心升壓劑（見表 22）。使用於左室收縮功能障礙、低心輸出量和低收縮壓（例如 <90 mmHg）導致重要器官灌注不良的情況。必須從低劑量開始謹慎使用，並在密切監測下逐漸增加。

b. Inotropes其是那些具有腎上腺素能機制的藥物，可引起竇性心動過速，增加 AF 患者的心室率，可能誘發心肌缺氧和心律異常，增加死亡率。

血管加壓藥(Vasopressors)
a. Norepinephrine具有顯著動脈收縮，適用於嚴重低血壓患者。主要目的是增加對重要器官的灌注。但會增加 LV 後負荷。因此，可以考慮同時併用Intropes + Norepisnephrine，特別是對於晚期 HF 和心因性休克的患者。

a. 休克患者第一線血管加壓藥的比較：Dopamine vs Norepinephrine，顯示在心因性休克患者Dopamine發生較多的心律不整，和死亡率。但低血容量或敗血性休克則沒有。

b. 在另一項前瞻性隨機試驗中，在急性 MI 引起的心因性休克患者中比較了Epinephrine vs Norepinephrine，由於頑固性心因性休克發生率較高，該研究提前終止。

c. Epinephrine會有較快的心率和乳酸中毒。儘管存在樣本量相對較小、追蹤時間短以及缺乏有關最大達到劑量的數據，但該研究表明Norepinephrine有較好的療效和安全性。這些數據與一項包括 2583 位心因性休克患者的綜合分析一致，顯示與Norepinephrine相比，心因性休克患者使用Epinephrine的死亡風險增加了三倍。因缺乏有關劑量、持續追蹤時間，和病因，使這些結果仍需進一步探討。

鴉片類製劑(Opoid)
a. Opoid類藥物可緩解呼吸困難和焦慮，在非侵入性正壓通氣期間用作為鎮靜劑，以改善患者的適應能力。 副作用包括噁心、低血壓、心搏過緩和呼吸抑制。
b. Morphine給藥與會使機械通氣頻率更多、住院時間延長、重症監護病房入院次數增加和死亡率增加。因此，不推薦在AHF中常規使用opoid類藥物。嚴重頑固性疼痛或焦慮治療的情況下，亦可考慮使用opoid類藥物。
c. SBP <90 mmHg時，勿用Morphine.
d. Morphine會抑制呼吸，使用時特別注意呼吸狀況及保持呼吸道通暢。

Digoxin
a. AF患者使用了乙型阻斷劑，但仍有心室心率過快(AF with RVR) (>110 b.p.m.) ，可考慮使用Digoxin。
b. 如果未曾使用過Digoxin，可以靜脈推注 0.25–0.5 mg。
對於CKD或影響Digoxin代謝的其他因素（包括其他藥物）和/或老年人，維持劑量可能難以理論上估計，應檢查血清Digoxin level。

血栓栓塞預防
a. 推薦使用肝素（例如低分子量肝素）或其他抗凝劑預防血栓栓塞。
c. 若正服用服抗凝劑或禁忌，則不需使用肝素。

短期機械式循環輔助(MCS)
a. 心因性休克可能需要短期 MCS 以增加心輸出量和維持器官灌注。
b. 短期 MCS 可用作恢復前(BTR, bridge to recover)，治療策略決定前(是否繼續積極治療或視為無效醫療, BTD, Bridge to decision) 暫時過渡期的使用。臨床研究證據仍然很少。因此，不支持在心因性休克患者中未經選擇地使用 MCS。
c. 心因性休克 II (IABP-SHOCK-II) 研究中的IABP-SHOCK-II顯示，主動脈內球泵浦 (IABP) 和合適藥物治療之比較，於心因性休克患者接受早期血管再灌注的急性 MI 後之休克中，30天和長期死亡率沒有差異。根據這些結果，不推薦 IABP常規用於 MI後的心因性休克(Class III)。然而，其他非ACS引起的心因性休克，對藥物治療無效，IABP作為BTD、BTR ，仍有幫助(Class IIb)。
d. 在小型隨機試驗和傾向匹配分析中將其他短期 MCS 與 IABP 進行了比較，但結果不確定。ECMO與 IABP或 MT進行比較的RCT亦無確定結果。
e. 一項僅包括觀察性研究的綜合分析顯示，與對照組相比，接受靜脈-動脈 (VA-ECMO) 治療的心因性休克或心臟驟停患者的預後良好。 VA-ECMO 也可用於治療暴發性心肌炎和其他導致嚴重心因性的疾病。
f. 根據心肌功能異常和/或合併二尖瓣或主動脈瓣閉鎖不全的嚴重程度，VA-ECMO 可能會增加 LV 後負荷，同時增加 LV 舒張末期壓力和肺充血。在這些情況下，可以通過經中隔/心室心尖通氣口或使用解除LV 負荷（例如 Impella 裝置） 。

本文出處：
https://reurl.cc/VEy9Gn

Ref:
European Heart Journal (2021) 00, 1-128
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab368/6358045#292214341

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.

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冷凍パイシートを使って、片手で食べられるミニパイができちゃいます♪
甘酸っぱいミックスベリーパイから、シナモンがきいたアップルパイまで、いろんな味が楽しめます！
焼き上がったらクリームで楽しくデコレーション♪ぜひ作ってみてくださいね！

ミニパイ5種
8人分

材料：
薄力粉（打ち粉用）　30g
冷凍パイシート　2枚
卵　1個
水　大さじ1

■いちごクリームパイ
クリームチーズ（常温)　55g
砂糖　大さじ1
バニラエクストラクト 小さじ1
いちご（みじん切り）　4個

■ミックスベリーパイ
ラズベリー　40g
ブルーベリー　35g
砂糖　大さじ1
レモン汁　大さじ1/2
レモンの皮　小さじ1/2

■チョコバナナパイ
チョコレートスプレッド　75g
バナナ（スライス）　1本

■アップルパイ
青りんご（スライス)　1/2個
ブラウンシュガー　大さじ1
シナモン　小さじ1/8

■トッピング用クリーム
粉砂糖（ふるっておく）　120g
牛乳　大さじ1
バニラエクストラクト　小さじ1/4

作り方：
1. 作業台の上に軽く薄力粉をまぶし、冷凍パイシートを23x30cmの長方形になるまで綿棒で伸ばす。パイシート1枚を3回折り畳み、折り線で8つの長方形を作る。クッキングシートを敷いた天板に載せる。

2. いちごクリームパイのフィリングを作る。小さめのボウルにクリームチーズ、砂糖、バニラエクストラクトを入れて混ぜる。

3. ミックスベリーパイのフィリングを作る。小さめのボウルにラズベリーを入れてフォークでつぶす。ブルーベリー、レモン汁、砂糖、レモンの皮を加えてよく混ぜる。

4. (3)をパイシートの長方形2つの真ん中に載せる。

5. 3つ目と4つ目の長方形にチョコレートスプレッドを塗り、バナナのスライスを載せる。

6. 5つ目と6つ目の長方形に(2)を塗り、いちごを載せる。

7. 7つ目と8つ目の長方形にはりんごのスライスを並べ、シナモンとブラウンシュガーを振りかける。

8. オーブンを200˚Cに予熱しておく。

9. パイに塗る卵液を作る。小さめのボウルに卵と水を混ぜ合わせる。刷毛でパイ生地の折線に沿って塗る。もう2枚目のパイシートを上から被せ、折線に沿ってフィリングの周りの生地を押す。

10. ピザカッター、または包丁で折線に沿って切る。縁にフォークを押し付けて真ん中に穴を3-4ヶ所開ける。表面に卵液を塗る。

11. オーブンで25分焼く。焼き色がついたら取り出し、5分冷ます。

12. トッピング用のクリームを作る。ボウルに粉砂糖、牛乳、バニラエクストラクトを入れ、滑らかになるまで混ぜる。

13. クリームを絞り袋に入れる。パイの表面をクリームでデコレーションしたら、完成！

===

Sheet Pan Stuffed Pastry Pockets
Servings: 8

INGREDIENTS
¼ cup all-purpose flour (30 g), for dusting
2 sheets puff pastry, thawed if frozen
1 egg, beaten with 1 tablespoon water or milk

GLAZE
1 cup powdered sugar (120 g), sifted
1 tablespoon milk
¼ teaspoon vanilla extract

STRAWBERRIES ‘N’ CREAM FILLING
¼ cup cream cheese (55 g), softened
1 tablespoon sugar
1 teaspoon vanilla extract
4 strawberries, stemmed and diced

VERY BERRY FILLING
⅓ cup raspberry (40 g)
⅓ cup blueberry (35 g)
1 tablespoon sugar
½ tablespoon lemon juice
½ teaspoon lemon zest

CHOCOLATE BANANA FILLING
¼ cup chocolate hazelnut spread (75 g)
1 banana, sliced

APPLE PIE FILLING
½ green apple, sliced
1 tablespoon brown sugar
⅛ teaspoon cinnamon

PREPARATION
1. On a lightly floured surface, roll out the puff pastry sheets to 9x12-inch (23x30-cm) rectangles. Set one pastry sheet aside and fold the other in half lengthwise, then in half crosswise twice, to form creases for 8 pockets. Unfold the pastry sheet on the prepared baking sheet.

2. Make the Strawberries ‘n’ Cream filling: In a small bowl, combine the cream cheese, sugar, and vanilla, and mix until smooth.

3. Make the Very Berry filling: In a small bowl, mash the raspberries, then add the blueberries, sugar, lemon juice, and lemon zest. Mix with a fork.

4. Spoon the berry mixture over the center of 2 of the 8 rectangles.

5. Use a spatula to spread the chocolate hazelnut spread over the center of 2 more rectangles, then top with the banana slices.

6. Use a spatula to spread the cream cheese mixture in the center of 2 more rectangles, then top with the strawberries.

7. Place apples slices in the center of the remaining 2 rectangles, then sprinkle with the brown sugar and cinnamon.

8. Preheat the oven to 400˚F (200˚C). Line a baking sheet with parchment paper.

9. Brush the egg wash over the pastry around the edges and between each filling, then top with the remaining puff pastry sheet. Use your fingers to press the pastry down around each filling. Once tightly pressed, use a pizza cutter or knife to cut out each pocket.

10. Seal the outside edges with a fork. Poke the top of each pocket with a fork 3-4 times to ventilate. Brush the tops with egg wash.

11. Bake for 25 minutes, or until golden brown.

12. Make the glaze: In a medium bowl, combine the powdered sugar, milk, and vanilla. Stir until smooth and thick.

13. Remove the pockets from the oven and let cool for 5 minutes. Decorate with the glaze, then serve immediately, or wrap in wax paper and freeze for up to a week. Reheat in the toaster oven.

14. Enjoy!

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