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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. However, from the outset, he offered mixed messages about referral by objecting physicians. 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.

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 another state regulator. At least one CPSA staffer was reportedly telling Alberta physicians that CPSA policy required effective referral, and the College Registrar openly advocated effective referral for euthanasia and assisted suicide. These developments directly contradicted the assurance he have given the medical profession in 2009.

The overwhelming majority of respondents to the 2016 consultation about conscientious objection opposed requiring effective referral by objecting physicians, and the standard does not require it. However, the document is essentially the same as the 2009 version, and has been cited on various occasions as requiring physicians to refer patients for services to which they object — without contradiction by the College. Accommodation of objecting physicians is further complicated by differences between two practice standards, Conscientious Objection and Medical Assistance in Dying.

While there appear to have been no complaints about non-compliance, and the Alberta model has been praised by freedom of conscience advocates, this is probably in spite of existing policies and tendentious interpretation of those policies by CPSA officials.

If accommodation of physician freedom of conscience in Alberta is currently satisfactory, it is probably because tolerance is encouraged by individuals in key positions within 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.

See Physician freedom of conscience in Alberta