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The College of Physicians and Surgeons of Alberta has proposed changes to its policy on conscientious objection by requiring all doctors to provide “effective referrals”.

The College licenses and regulates doctors in the province. It has the power to investigate and discipline any doctors who do not follow the College’s policies.

Albertans can share their views on this proposed change until January 15. This is an opportunity to stand up for ethical, conscientious doctors. We offer some advice on how to do so at the end of this article.

Proposed ‘Conscientious Objection’ Policy

The College’s proposed policy would require doctors to clearly state their conscientious objection, to provide accurate information about available services, and to continue providing care for a patient as long as required. But it would also require doctors to “proactively maintain an effective referral plan for the frequently requested services they are unwilling to provide.” Similarly, it requires members not to “expose patients to adverse clinical outcomes due to a delayed effective referral.” In other words, although the policy does not require doctors to provide objectionable services (such as abortion or physician-assisted death), it requires them to facilitate a patient’s timely access to such services.

Effective Referral

Currently, only Ontario and Nova Scotia explicitly require an effective referral, with Alberta set to become the third if this policy is adopted. While the CPSA does not define ‘effective referral,’ others have defined it as “Taking positive action to ensure the patient is connected to a non-objecting, available, and accessible physician, other health-care professional, or agency.” Essentially, an ‘effective referral’ requirement ensures that a doctor facilitates euthanasia or abortion by connecting a patient with a doctor or resource that will help the patient receive the requested service. Effective referral policies violate doctors’ consciences and undermine our healthcare system. You can read more about effective referral and why it is a concern here.

Participate in the Consultation

Any Albertan can provide feedback directly to the College. There are two ways to do so. First, you can fill in a comment box on the College’s website and select whether to make your comment public or not. Second, you can fill out a brief survey, consisting of 14 questions – just be aware that the survey touches various aspects of the proposed policy besides effective referral. Choose the option that is best for you and share your thoughts by January 15, 2024.

Suggested Talking Points

Here are some talking points that you can use to help form a response to the consultation.

• Freedom of conscience and religion are fundamental freedoms under the Charter of Rights and Freedoms.
  • Doctors should be permitted to pursue their profession without violating their conscience.
  • While there is no requirement in Alberta for physicians to administer MAiD or other controversial services, many doctors object to participating in the process through an effective referral because they see it as participation in the procedure.
• Most provincial medical regulatory bodies do not require effective referrals for issues of conscience.
• Doctors’ conscience rights also matter for patients.
  • Limiting conscience rights will limit the number of conscientious objectors who enter or remain in the medical field and reduce access to health care. In Ontario, doctors have been leaving the profession, moving out of the province, or retiring from their careers due to effective referral requirements.
  • Patients should be able to choose a doctor they can trust to make ethical decisions. For example, many patients want a doctor who will never offer them MAiD, particularly in a society where MAiD is often easier to access than care.
• The medical profession is strengthened through diversity of thought and diversity of doctors.
  • Doctors should be able to provide the best possible medical advice, whether or not the patient disagrees with that advice.
  • In other medical situations, such as requests for dramatic liposuction or a tongue splitting, doctors are permitted to deny the patient’s request without fear of discipline from the College.
  • Forcing a doctor to do something that they believe is not in the best interest of the patient muzzles a doctor from giving an honest medical opinion.
• The number of Albertans dying through MAiD has been steadily increasing. As MAiD may extend to those with mental illness by March 17, 2024, more doctors are concerned about even more patients being eligible for MAiD. As a recent brief by the Society of Canadian Psychiatry noted, most psychiatrists oppose expanding MAiD to mental illness, despite not being conscientious objectors to MAiD in general.

Once again, please send your thoughts to the College by January 15, 2024. We encourage you to use the ideas in this article, expand on them, and present them in your own words.

**Update**

As of January 11, 2024, the College has updated its consultation page with the following:

“Based on initial feedback received, the term ‘effective referral’ will be removed from the Conscientious Objection standard. Those that provide feedback during the consultation period will be consulted again during the re-consultation phase and see additional edits before final approval.”

While we have yet to see what a revised policy looks like, the decision to remove the term ‘effective referral’ is a promising development for which we can be thankful. We encourage you to still weigh in on the proposed policy, and also support the College in their decision to remove the term ‘effective referral.’