Message to Our Members: Statement on Invoking the Notwithstanding Clause on Gender-Affirming Care

Dear Members,

Earlier this week, the Government of Alberta introduced legislation (Bill 9) invoking the notwithstanding clause to protect three previously enacted laws from Charter court challenge while they remain in effect. These laws address:

• Restrictions on gender-affirming care for youth
• Requirements related to school pronoun and name notification
• Sports eligibility rules for amateur sports targeting transgender women and girls

This use of the clause is widely viewed as extraordinary and precedent-setting, with significant implications for clinical practice and patient rights.

WHERE THE ACFP STANDS

Our statement on gender-affirming care for youth reinforces that:

• Gender-affirming care is a medical decision grounded in evidence
• Decisions must occur within the physician-patient relationship, with families involved as appropriate
• Government directives must not override clinical judgment, informed consent, or individualized care

We have consistently used clear, clinical language – including “gender-affirming care,” “medical decision-making,” “physician-patient relationship,” and “shared decision-making” – to centre evidence-based care and patient safety.

WHY THIS MATTERS FOR FAMILY PHYSICIANS

The government’s actions raise significant concerns regarding:

• Clinical autonomy
• Informed consent and confidentiality
• Access and safety for vulnerable patients
• The precedent of legislating specific clinical practices and removing pathways for legal challenges
• Dismissing expert opinions and not using an evidence-based approach

Many of our members provide longitudinal, relationship-based care to gender-diverse children, youth, and families, making these issues direct and immediate.

WHAT THE ACFP IS DOING

1. Advocacy and Monitoring

• Monitoring legal proceedings and working with provincial and national partners, including the Canadian Medical Association (CMA)
• Advocating for clinical-led, evidence-based approaches to care

2. Member Support

• Preparing clear guidance and FAQs regarding documentation, consent, confidentiality, and risk management
• Offering support to members experiencing constraints or uncertainty

3. Professional Unity

• Encouraging members contacted by media or community groups to rely on the ACFP statement and statements from other professional organizations
  • Alberta Medical Association (AMA)
    • The AMA President has stated that this legislation “steps into the exam room” and places government between patients and physicians, undermining clinical autonomy and evidence-based care.
  • Canadian Paediatric Society (CPS)
    • The CPS’s statement raises concerns that this decision will “erode the health and well-being of some of Alberta’s most vulnerable.”

• Inviting members to share concerns about patient safety or impeded access to care

4. Tracking Legal Developments

• Monitoring the CMA’s legal challenge to the earlier Alberta legislation that restricts clinical decision-making for gender-affirming care. This new invocation of the notwithstanding clause intensifies concerns about the erosion of the physician-patient relationship and the potential for further restrictions. If passed, the invocation of the notwithstanding clause will prevent this and other legal challenges to this legislation from proceeding.
  
  

WHAT YOU CAN DO NOW  

• Review your internal processes around documentation, informed consent, and confidentiality
• Ensure your team knows where to find the ACFP’s statement and upcoming guidance
• Share support resources with patients who may be struggling with this announcement
  • The Canadian Mental Health Association has a robust compilation of resources

The ACFP recognizes that this is a pivotal moment for both patient safety and the practice of family medicine in Alberta. Thus, it will continue to speak clearly and advocate for evidence-based care, the integrity of the physician-patient relationship, and the well-being of patients. Research¹ overwhelmingly shows the positive mental health impacts of access to gender-affirming care for youth, and we are particularly reminded of how crucial it is to bring this to the forefront, having just observed Transgender Day of Remembrance on November 20.

We will keep you updated as developments unfold. In the meantime, please do not hesitate to contact us: acfppres@acfp.ca.

Sincerely,

Melanie Hnatiuk, MD, CCFP, FCFP
President
Alberta College of Family Physicians