Conscience Protection

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The College of Physicians and Surgeons of Alberta (CPSA) just made a big announcement.

It has dropped plans to force doctors and other healthcare workers to participate in medically and morally problematic procedures such as abortion, assisted suicide (MAiD), and “gender-affirming” interventions by requiring them to make an “effective referral.”

This is a big win for all Alberta doctors and healthcare workers.

And, this win was made possible because so many of you took the time to contact the CPSA letting them know why this proposed policy update was a bad idea. It was also great to see so many excellent groups coming together to oppose this terrible proposal. When we work on a common goal, we achieve great things!

 The Alberta Committee for Conscience Protection is calling on us to write to the College of Physicians and Surgeons Alberta (CPSA) with comments on their Consultation on the current Standard of Practice on Conscientious Objection. This consultation is open until January 10, 2024.

The Conscientious Objection standard was last reviewed in 2016. Amendments to this standard are intended to better outline expectations for regulated members in navigating ethical dilemmas relating to personal beliefs and patient beliefs. The addition of a preamble, glossary and directions provide more context around when and how regulated members can decline to provide treatment and what must be provided for the patient to ensure they continue to receive high quality care.

What’s changed?

• Addition of a preamble and glossary to provide context for the standard and more detailed definitions;
• Inclusion of clarifying language to better communicate the balance between a regulated members’ right to limit health service based on reasons of conscience, cultural belief or religion and patients’ rights to timely access to safe, high-quality care;
• Section added to clearly break down permitted and prohibited actions with a focus on reducing risk of harm and maintenance of respect for patient;
• Expansion of the related standards of practice and addition of companion resources to better support regulated members.

One of the concerns expressed by the Alberta Committee for Conscience Protection is around "effective referral". The glossary of the Model Practice Standard proposed by Health Canada defines:

Effective referral: taking positive action to ensure the person requesting MAID is connected in a timely manner to a non-objecting, available, and accessible physician or nurse practitioner, other health-care professional, or [name of agency, program, office responsible for patient navigation] that provides the health service (eligibility assessments for, and provision of, MAID) or connects the person directly with a health-care professional who does. ‘Timely manner’ means such that the person will not experience an adverse clinical outcome or prolonged suffering due to a delay in making the connection. [Note to users: delete this definition if the regulatory authority uses wording of effective transfer of care instead of effective referral]

Effective transfer of care: a transfer made by one physician or nurse practitioner in good faith to another physician or nurse practitioner who is available to accept the transfer, accessible to the person requesting MAID, and willing to provide MAID to that person if the eligibility criteria are met. [Note to users: delete this definition if the regulatory authority uses the wording of effective referral instead of effective transfer of care]

For further information, please read the points below and the drafts at https://cpsa.ca/physicians/standards-of-practice/consultation/consultation-028/028-conscientiousobjection (you can also read comments from other Albertans there and add your own). Feedback may be provided via survey, email or the comment form on each page.

Alberta Committee for Conscience Protection

Talking Points on the College of Physicians and Surgeons of Alberta (CPSA)
Draft Standard of Practice on Conscientious Objection Consultation 028

As many of you are aware, the CPSA has invited comments on their Consultation on the current Standard of Practice on Conscientious Objection. This consultation is open to CPSA members, partner organizations, other healthcare professionals and Albertans until January 10, 2024. We are hoping that we can send a clear message to the CPSA Council that the introduction of the term “effective referral” that was added to the draft policy is not acceptable to many physicians and concerned members of the public. This new term is borrowed from the Model Practice Standard proposed by Health Canada, and in Alberta we already have a solid framework for patients to access services they are looking for without requiring an “effective referral.”

We propose the following revisions to the draft Standard of Practice:

• Section 1.f. could be revised as “Proactively maintain a non-judgmental approach and be aware of resources to provide for frequently requested services they are unwilling to provide.”
• Section 2.c. should be removed due to lack of clarity.  
  • If a patient were to experience pain while waiting for MAID, this could be claimed an adverse clinical outcome. Although the procedure sought out should not be impeded as in 2c, there are a lot of subjective possibilities that could emerge from so-called "exposures" from "delayed effective referral."
  • Specifically, “adverse clinical outcomes” and “delayed” are not objectively defined and are open to wide subjective interpretation. 
  • "Delayed"  is not clearly defined either and in many ways the seeking of care is dependent on what the patient decides to do after visiting a provider.
  • Many psychiatrists have warned that it will be extremely difficult for physicians to discern which patients are making a fully informed, consensual decision to pursue MAID and which are not. 

Other talking points

• It needs to be clearly stated, whether in this policy or for the understanding of the draft standard committee, that a member who declines to provide a service (e.g. MAID) or a referral for the same (while still providing resources) is doing so because they believe it is in the best interest of the patients.  Their care of the patient compels them down this path. A sober second thought on the part of a provider who wants to provide a variety of different perspectives may allow a patient to see their concerns from a new or different angle and can be a source of support for that patient.
  • Many from the disability community have called for safe spaces where they know the practitioner sees their life as worth living and wouldn’t agree to end their lives when they are at a low point.
  • Since "effective referral" has been introduced in other provinces, many providers have left, retired early, or sought registration in Alberta because of our more reasonable conscience objection standard. Adopting this language from other provinces potentially exposes our system to further loss of providers who would be frustrated with the addition of this wording.
  • It should be emphasized that the Supreme Court gave its assurance that nothing in its original ruling on the constitutionality of MAID “…would compel physicians to provide assistance in dying.” Participation through an effective referral would directly involve physicians in MAID to which many of us are opposed.
  • The government and College does not want to micro-manage the doctor-patient relationship but does expect non-judgmental professionalism adhering to obligations
  • Based on opinion polling, many Canadians are concerned about compelling physicians to do something they are not comfortable with, e.g. "54 percent of Canadians give “quite a lot” or a “great deal” of weight to the concern that the confidence of patients in doctors could be compromised, given that patients look to doctors “to heal, comfort, and fight for them.” Sixty-three percent of visible minorities share this concern.
  • This is not about competing rights but about mutual freedoms.  It is not about limiting access but about redirection to different resources.  In reality, patients' and physicians' rights are not opposed. The patient and physician work together as a team and navigate medical decisions in a shared decision making framework.  
  • Conscience is not an expression of a physician’s personal preference, it is a judgment based on what the physician feels is in the patient’s best interest.  Patients and physicians disagree on a regular basis on a large number of issues, and these usually do not come to the point of conflict; they are usually resolved in professional and friendly ways. 
  • Physicians are not solely responsible for ensuring access to medical assistance in dying.  CMAJ February 20, 2018 190 (7) E181; DOI: https://doi.org/10.1503/cmaj.180153
    • "The responsibility to ensure access to MAID does not rest with an individual physician, but with society. Recognizing this, most provinces have developed access programs for MAID... When it comes to MAID, balancing the rights of physicians and patients is not an easy task, but both deserve protection."While this standard emphasizes the right of a physician, it also needs to consider the fact that many patients want providers whose values fit with theirs, and a large group of patients want to be served by providers who decline to offer certain procedures like MAID. Finding the right physician fit requires a diverse medical system with a variety of different providers with different opinions.

The above talking points are for reflection and to help formulate comments in your own words, using resources and references that you are familiar with. Please complete the online form here (https://cpsa.ca/physicians/standards-of-practice/consultation/consultation-028/028-conscientiousobjection/), or by email on the same page.

– Alberta Committee for Conscience Protection

Independent Seniors Advocate Initiative

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Alberta/Mackenzie Provincial CWL Vision for an Independent Seniors Advocate

The CWL journey to lobby for an Independent Seniors Advocate began with a CWL provincial initiative back in 2015 calling members to sign a petition.

The petition read:

Urge the Alberta Provincial Government to amend the Alberta Health Act to ensure that the Seniors Advocate is an Officer of the Legislature and therefore independent.

We asked the CWL members to begin a grassroots movement through the MLA’s.  At that time, there was a seniors advocate, but he was accountable to the Minister of Health and there was no separate office.  Because there was no separate office when a government changes, the position is at the mercy of the new government.

This CWL Call to Action sees the work of the advocate and her/his office as one that monitors and analyzes senior services as well as a resource for seniors looking for information on a variety of issues.  Because seniors’ issues cross so many different ministries (health, finance, housing, social development transportation, housing, etc.) it seems necessary to have someone co-ordinate across all the ministries. 

It would be the first stop for any senior or caregiver to get the necessary information they require be it health, housing, financial abuse, etc. related. It would also have the authority to investigate complaints such as inadequate care in nursing homes or abuse, etc. It would make recommendations to the government through the Standing Committee on Legislative Offices.

Human trafficking action plan

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The Government of Alberta is implementing a nine-point Action Plan to Combat Human Trafficking to protect at-risk individuals from being trafficked in Alberta, empower survivors of trafficking, and provide new remedies to deal with traffickers.

Human trafficking is a serious crime that takes three forms: sexual exploitation, forced labour trafficking, and trafficking in human organs or tissues. Traffickers exploit people of all ages, ethnicities and genders, forcing their victims to provide labour or sexual services against their will and using threats of violence to trap them in a cycle of exploitation.

Key actions

The nine-point Action Plan to Combat Human Trafficking will:

1. adopt the “2002 Protocol to Prevent, Suppress and Punish Trafficking in Persons” (Palermo Protocol) definition of human trafficking
2. create a provincial Human Trafficking Task Force which will bring together representatives of relevant ministries, agencies, police services, and community groups to share information and coordinate action on an ongoing basis
3. increase efforts to educate the public, particularly vulnerable groups, about the reality of human trafficking, and report tips to the new National Human Trafficking Hotline
4. ensure appropriate training for judges, prosecutors and first responders, including police officers, nurses and doctors
5. ensure the Ministry of Labour provides information to Temporary Foreign Workers in Alberta about their rights under Canadian law
6. work with community groups, other provinces and the federal government to collect and share better data on human trafficking, and to ensure coordinated action as part of the National Action Plan to Combat Human Trafficking
7. name and shame traffickers by publishing the names of businesses found to have knowingly facilitated human trafficking
8. lobby the federal government to strengthen penalties against human traffickers by bringing Bill C-452 into force
9. Introduce legislation to establish a process for restraining orders, torts and proclaim a Human Trafficking Awareness Day.

Source: Government of Alberta

Community Initiatives

Blood Tribe police (March 2022) announce plans to have a human trafficking outreach program by fall 2022. Read more

In-School Dental screening for Children in Alberta in Grades K-12

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One of the actions local CWL councils are called upon by the Alberta Mackenzie Provincial Council is to contact provincial government officials regarding our provincial resolution 2019.01 which was passed last June at the Alberta Mackenzie Provincial Convention.

On February 24^th, the Catholic Women’s League Provincial President Judy Look and members of her executive met with representatives from Health, Education, and Children’s Services of the Alberta government.

I invite you to use the following two template letters to write to the Members of the Alberta Legislative Assembly regarding Alberta Mackenzie Provincial Resolution 2019.01:  that annual universal dental screenings be immediately implemented in all Alberta schools for school-aged children from grades K-12.

Please use the first letter template to write the Premier, the Minister of Education, and the Minister of Health.  Use the second template for your own MLA. You may find your MLA’s contact information at Who is my MLA? which will ask for your address and provide you with their name and contact information.

Tips:  It will be more effective if you change the letter slightly to make it your own.  (Form letters are not effective.)   Be brief.  Be polite.  Ask a question. Be sure to use exact wording from the resolution.

For God and Canada,

Gayleen Hamilton
Legislation Chair,
Calgary Diocesan Catholic Women’s League

Palliative Care

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During the past months we have been given the blessing of time to contemplate what is important in our lives and in our society.  Many of us are prioritizing the importance of a health care system that cultivates a culture of care and love for people at all life stages..

This is an opportune time to use our letter-writing energy to urge our government to seriously hear our concerns about two issues:  (1)  the providing of palliative care for all Canadians who choose this option near the end of their lives; and (2) the suggested removal of safeguards to Bill C-7.

National President Anne Marie Gorman's letter to the Prime Minister is posted on the National website "Letters" page. Access it at: https://cwl.ca/wp-content/uploads/2020/03/20200304-Gorman-to-Trudeau-re.-Bill-C7.pdf

We encourage everyone to contact government leaders on the following two concerns. 

1. Palliative Care: In 2017 the Federal Government put forward the Framework on Palliative Care in Canada.   The government promised to invest $3 billion into national home care services including palliative care. Has funding been made?   How can Canadians make informed decisions about their end of life treatment when quality palliative care is readily available to only 15% of Canadians (2018 Health Canada Report)? On May 17, 2020 Zi-Ann Lum published “Will the Pandemic Finally Make Us Talk About Palliative Care?” in the Huffington Post, Canadian Edition.  I encourage you to read it if you want more information.
   
   
2. Bill C-7, Medical Assistance in Dying (MAiD):  There are concerns about removing some of the safeguards placed in the existing legislation.  First, the government is proposing to remove the mandatory 10 day waiting period before a patient can receive medically assisted death stating that the waiting period may unnecessarily prolong suffering.  Second, the government is proposing to remove the need for two witnesses. Both safeguards exist so that patients can make an informed decision about their end of life care without pressure and with appropriate verification.   Presently the Bill has undergone two readings.  There is still time to write letters and email the government to express our concerns about the removal of these safeguards.

Sample letters to the Prime Minister, Justice Minister, Health Minister and Member of Parliament are posted under Legislation Tips and Tools.  Adjust them as you wish.  See the Forms and Resources page for our letter writing guide and contact information for MPs and MLAs.

Through faith, we have a moral compass that guides our actions daily to help and protect the vulnerable in our society.  May our Lady of Good Counsel guide you as you work for God and Canada.