Appendix “B”

Full Text

B1.    From 1991 to 2008 the College of Physicians and Surgeons of Alberta (CPSA) policy on abortion provided the framework for accommodating patients seeking morally contested services and physicians unwilling to provide them for reasons of conscience. The policy required physicians to provide patients with information necessary to enable informed medical decision-making, but did not require them to provide contested services or to facilitate them by referral or other means. The CPSA Registrar promised that this would not change when Standards of Practice were adopted in 2009.

B2.    The standard Moral or Religious Beliefs Affecting Medical Care was adopted in 2010 and re-issued in 2011 and 2014. Among other things, it required objecting physicians unwilling to provide or offer access to information about a contested procedure to offer patients “timely access” to a physician or resource able to provide accurate information about “all available medical options.” This was not problematic because objecting physicians were generally willing to provide information about contested procedures, and those who were not had to offer patients access to someone willing to provide information, but not to someone providing the contested procedure.

B3.    While the Registrar had promised in 2009 that the new standards of practice would not change CPSA policy about referral for contested procedures, from the outset he offered mixed messages on the subject. The Alberta Medical Association elected to accept his assurance that physicians would not be obliged to facilitate procedures to which they objected for reasons of conscience. However, by 2014 media were reporting that CPSA policy required objecting physicians to make such referrals and the CPSA published an ethics commentary to the same effect.

B4.    Further, in 2015, without the approval of College Council, a CPSA official expressed strong support for a policy of mandatory effective referral in a formal submission to the College of Physicians and Surgeons of Ontario. Meanwhile, at least one CPSA staffer was reportedly telling Alberta physicians that CPSA policy required effective referral. Finally, directly contradicting the assurance he had given the medical profession six years earlier, the College Registrar openly advocated effective referral for euthanasia and assisted suicide.

B5.    Moral or Religious Beliefs Affecting Medical Care was reviewed in 2015/2016, when “effective referral” was rejected by four of six stakeholders and all but 31 of 645 consultation respondents. It was re-issued as Conscientious Objection, which was virtually identical to the original standard. It differed principally in requiring either “timely access” to a practitioner willing to provide the contested service or to a resource able to provide information about all available medical options. Once more, the policy was not problematic because ‘offering access’ to someone who would provide the contested service was optional. However, accommodation of objecting physicians is complicated by differences between two practice standards, Conscientious Objection and Medical Assistance in Dying.

B6.    If accommodation of physician freedom of conscience in Alberta has been satisfactory, it has probably been so in spite of the efforts of influential College officials, because tolerance has encouraged by broad-minded individuals in key positions in government and the health professions, and because the relatively few physicians who refuse to refer patients for morally contested services treat patients respectfully, discuss their concerns and options and provide them with contact information for Alberta Health Link.