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November – Message from the President & Executive Director

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With new legislation being tabled that affects family physicians, it is important that your voice is heard. We have a close working relationship with the Alberta Medical Association (AMA) and the Sections of Family Medicine and Rural Medicine in Alberta through our chair at the Primary Care Alliance (PCA). We use our collective voices to ensure a unified and consistent message is provided when health policy is developed, or system level changes are proposed. We also work closely with the College of Family Physicians of Canada (CFPC) to develop and implement various levels of advocacy at a provincial and national level.

This year, with the omnibus Bill 21 Ensuring Fiscal Sustainability Act, 2019 and, more recently, Bill 207 Conscience Rights (Health Care Providers) Protection Act being debated, we feel a unique message must come from you as members, as it directly impacts your practices. The ACFP Board of Directors you have elected to govern your organization, and to represent you, meet regularly to set strategic direction and to respond to the provincial issues, challenges, and opportunities. We will reach out to you at every opportunity to stay connected and understand your position on health care in Alberta and how it can support better provision of care for your communities.

An opinion editorial article regarding Bill 21 has been submitted to the Globe and Mail and we will be following up with a letter to the Minister. We feel strongly that the approach the government is proposing to ensure human resources are deployed in underserviced areas will not address the problem and we are making suggestions for a more evidence based approach referring to recommendations made in the Rural Road Map for Action: Directions recently developed by the CFPC and Society of Rural Physicians of Canada (SRPC).

The private member’s bill introduced last week, Bill 207, is a dangerous piece of legislation that creates gaps in the provision of services to people in their most vulnerable moments of their lives—it would be a step back for us as a province. It also is unnecessary. The College of Physicians and Surgeons of Alberta’s Standards of Practice on “Conscientious Objection” provides a balance between providing timely health care to patients in need and a physician’s Charter freedom of conscience and religion. We will be in contact with the Minister of Health and other members through a multi-pronged approach and we urge you to reach out to your MLAs directly to ensure that they hear the range of views from their constituents on this matter.

We will continue to advocate on your behalf regarding the proposed legislation and would like to ask that you continue to send us your thoughts on the recent decisions and directions our government is taking.

Vishal Bhella, MD, CCFP
Alberta College of Family Physicians

Terri Potter, BA PMP CAE
Executive Director, PCA Representative
Alberta College of Family Physicians

29 Responses

  1. Thanks for these proactive messages and outlining collective advocacy on behalf of patients, our discipline and the system as a whole. These are unusual times. Really appreciate your strategic leadership.
    Wendy Tink

  2. Dear Dr Bhella,

    I am very concerned regarding your comments about Bill 207. This is not dangerous legislation unless you believe that protecting the rights of conscientious and ethical physicians is dangerous. In fact, most of the physicians that I know not only support Bill 207, but they provide some of the highest quality and non judgemental medicine that I know.

    The fact that so many individuals are coming out against Bill 207 is precisely why we need it. Medical judgement and care MUST be based on clinical grounds well formed by education, experience and ethics and NOT patients whims and biases.

    Furthermore, the CPSA in no way protects physicians. They are mandated to protect patients. It should be the AMA and the ACFP who are protecting our rights.

    I am curious why you feel most family physicians do not support Bill 207. I do not recall reading or seeing any surveys on this matter.

    Before you go on record as opposing Bill 207, I believe you have an obligation to poll your members.

    We need now, more than ever, to have freedom of conscience enshrined in our legislature.

    1. I am confident if this went to a poll, you would find yourself in the small minority.

      Can you elaborate on your comment “Medical judgement and care MUST be based on clinical grounds well formed by education, experience and ethics and NOT patients whims and biases.”?

      Do you feel it is in your “medical judgement” that a 16 year old should be denied contraception? That a trans man should be denied a PAP? That a G5P5 unemployed single mom should be denied a TA? A suffering a palliative patient denied MAiD?

      No physician that supports “non-judgemental” medicine would support this bill. I urge you to read the bill again, and consider how withholding information or access to care could impact your patients.

      1. Well said Sonja- I particularly appreciate that you picked that quote out of his response as it highlights the paternalistic judgment that leads to instructions of care

  3. With all due respect, stating that “the private member’s bill introduced last week, Bill 207, is a dangerous piece of legislation” is totally inappropriate for the ACFP. At no time were the members consulted on how to respond to Bill 207.

    As you may know, the College of Physicians and Surgeons of Ontario has a policy that removes physicians duly held Charter Rights. Provincial legislation is required to ensure that professional associations do not overstep their mandate.

  4. I agree that we had a good process going with the previous government of measured responsible changes on both sides. We do not want to return to the Ralph Klein era which saw many doctors leaving the province.
    Bill 207 is unnecessary. We are currently covered adequately by the policy of the college of physicians and surgeons of Alberta. We are currently covered adequately by the policy of the college of physicians and surgeons of Alberta. I think it is likely the more severe attitude of the college in Ontario that is precipitating this action on behalf of some physicians.

  5. I strongly disagree with Bill 207, and support the ACFP advocating against it.

    As physicians, we are already protected under the CPSA standards, and are NOT required to perform any procedures or directly provide care that we morally oppose. Those physicians who do not feel they are protected with these standards, should reflect on the quality of care they are providing.

    As health care providers we hold the balance of power and it is unequivocally unethical to impose our beliefs on patients. This Bill will allow providers to withhold any information, based on their beliefs, and this is not acceptable.

    This Bill is an assault on human rights of patients, and will result in restricted access in patient care that is often time sensitive and in many cases will result in no care. Patients who live rurally or are already marginalized will be disproportionally affected. It is not the Caregivers role to impose their beliefs on anyone else; this is a clear abuse of power. This is not acceptable.

    1. Again I agree whole heartedly with you Sonja. I expect the college to continue to represent the majority of physicians and to help us to advocate for our patients, especially the marginalized.

    2. I wholeheartedly agree and expect our colleges to support the majority of physicians and to help us support our patients, especially the marginalized.

  6. Thank you for your strong response to Bill 207. As the CPSA has stated, this bill is completely unnecessary as the status quo allows physicians to decline services under “Conscientious Objection” but ensures appropriate referrals or access so patients are still able to receive the care they need and deserve. I completely agree with your statement that bill 207 is dangerous. Marginalized populations, rural patients, individuals requesting MAID and women will be harmed if this bill passes.

  7. This bill is a travesty. Physicians’ consciences are already protected. What this bill will do is reduce access for patients in underserved areas who already have a hard time getting care. To include publicly funded hospitals is outrageous. If your loved one winds up, at the end of their life, at a “catholic” hospital, how is acceptable that they would not have access to the same options as someone at the non-catholic hospital across the city? Medical assistance in dying (MAID) is a legal healthcare service and all patients should be able to access it if they wish, regardless of which hospital the ambulance brought them to.

  8. I am strongly against Bill 207. As a rural locum and provider of services often objected to I have first hand seen the detriment that not having access to a referral system can have for patients access. The implications of the wording of this bill are very far stretching. I completely support conscience objection but I cannot support this bill. The CPSA already has protections in place for physicians. Patients often do not know how to navigate the medical system but have a right to access the services they desire. By removing this resource it will only isolate the most vulnerable patients.

    1. I agree with you 100%, Lindsey – as a rural locum myself, there is already sometimes a harder time for patients to access services with a referral system, let alone if physicians would no longer need to provide that. I do no support Bill 207.

  9. Any physician who refuses to provide effective referral to another practitioner for a medical service they will not provide themselves has NO BUSINESS BEING A DOCTOR. End of.

  10. I strongly oppose Bill 207. As a family physician I hold a great deal of power in providing information when my patients request it; it is essential that physicians be mandated to list all treatment options available to patients regardless of their personal beliefs. I do not need to perform procedures which are against my beliefs but I must not withhold information or refuse referral for patients because of my own Conscientious objection. This Bill is a concerning affront to patient rights and disregards the fiduciary relationship physician’s hold in patient interactions.

  11. Thank you ACFP for eloquently stating the obvious that Bill 207 is unnecessary and even harmful in regards to patients having timely access to required/desired services. Any physician that holds themselves to the standards laid out by CPSA will recognize this bill as redundant and going against the basic human rights patients have and should expect in their doctor/patient relationships.

  12. Bill 207 is indeed dangerous, and unnecessary. Ethics dictate that we respect our patients’ autonomy and we do not block their access to timely care. Making a referral — or even a transfer of care to someone who will — should not weigh as heavily on our consciences as denying our patients either of those things, and certainly not as heavily as denying them the right to complain should we do so. Our values may not be the same as our patients’. That’s the way it is in a diverse society, and we as physicians have no right to place our values above theirs.

  13. Thank you for speaking up against Bill 207. Bill 207 is entirely unnecessary, and does indeed have the potential to do serious harm.

    Although I fully support a physician’s right to conscientious objection, I am particularly concerned about the following clauses:

    “2(2) For greater certainty, nothing in this Act derogates from a health care provider’s or religious health care organization’s obligations to their patients, which may include informing individuals of options in respect of receiving a health care service.”
    – I am very worried about the wording “MAY include”, as it implies informing individuals of options is not ALWAYS required. This would significantly undermine the ability of patients to make an informed choice.

    “3 If a health care provider or religious health care organization determines that their conscientious beliefs would be infringed by providing a specific health care service to an individual, the health care provider or religious health care organization is not required to provide that health care service to the individual.”
    – “Conscientious beliefs” is a vague term, and open to interpretation, which I feel is dangerous, as it could lead to also refusing care and services arbitrarily or to entire of groups of the population, such as the LGBTQ+ community or those suffering from substance abuse. These populations are already extremely vulnerable, and allowing instances where they could be further discriminated against, and denied care, is unconscionable.

    “5(1) On receiving a complaint in accordance with section 55(1) of the Health Professions Act, the subject matter of which is a health care provider’s decision not to provide a health care service based on their conscientious beliefs, the complaints director for the regulatory body that received the complaint must immediately
    (a) dismiss the complaint, and
    (b) provide notice of the dismissal to the complainant.”
    – This clause is terrifying to me. There is no circumstance where a complaint brought forth from a patient should EVER be simply dismissed immediately. This is unacceptable. I also find it unsettling that this bill would legislate how our own regulatory body manages complaints.

    As family doctors, it is our obligation to advocate for those who are unable to advocate for themselves, so thank you for standing up for ethical and patient-centered care.

  14. I strongly oppose Bill 207. It is our professional responsibility to provide the best care possible for the patient ACCORDING TO PATIENT VALUES. Bill 207 not only unnecessarily places physicians values into medical care for patients, it also LIMITS ACCESS TO GOOD CARE. Some patients will require the guidance of a physician to access medical abortion, MAID, contraception, surgical abortion, etc. due to limitations in knowledge of the healthcare system and in geographic restraints. Some of these matters are time sensitive and require timely referral – which is OUR DUTY AS GOOD FAMILY PHYSICIANS to be that first link to good medical care for our patients. Referring and providing care are our professional responsibilities, limiting care is not professional and breeches the Hippocratic oath – do no harm.

  15. Physicians have been required to treat complex medical conditions like opioid addictions, diabetes, and cancer. This bill would allow physicians to conscientiously object to treating these conditions. Walk-in clinics could turn down any visit that won’t pay well in the name of conscientious objection. If a nurse is accused of malpractice, they could claim they conscientiously object to the standard of care. What safeguards is this bill providing against these scenarios?

  16. Thank you to the ACFP and to my numerous colleagues for speaking out against Bill 207. It is unnecessary and harmful. As a physician who works in sexual and reproductive health, MAiD and LGBTQ2S+ care, my patients already face harmful systemic barriers in accessing appropriate care. This bill would make their situations even more precarious and result in patient harm far more severe than any harm a physician would sustain from the basic professional requirement of ‘referring on’.

  17. I echo what those before me have so eloquently stated. I more than strongly oppose Bill 207. It is wrong on so many levels.

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