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Policies that advocate for the medical profession and Canadians


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Presentation to the Senate Special Committee on Aging

https://policybase.cma.ca/en/permalink/policy9061
Last Reviewed
2020-02-29
Date
2008-01-28
Topics
Population health/ health equity/ public health
  1 document  
Policy Type
Parliamentary submission
Last Reviewed
2020-02-29
Date
2008-01-28
Topics
Population health/ health equity/ public health
Text
Thank you Madam Chair and Committee members for the opportunity to speak to you today. I am Briane Scharfstein, Associate Secretary General at the Canadian Medical Association (CMA) and a family physician by training. I am speaking on behalf of the CMA and our 67,000 physician members across the country. We commend the Senate for striking this Committee. We are concerned that the aging population has not received sufficient national policy attention. With regard to today's discussion I would note that the CMA has advocated for the elimination of mandatory retirement and we are pleased to see that in general, provincial jurisdictions have eliminated mandatory retirement based on what has become an arbitrary age cutoff. With some obvious exceptions, such as athletics, competence is not related to age per se for most areas of human endeavour. Where human activity may pose risk to the safety of others we believe that the best approach is to develop evidence-based tools and procedures that can be used to assess competence on an ongoing basis. While physicians play a significant role on a variety of fronts related to aging, I am going to focus my remarks on two specific areas: * Ensuring the competence of physicians; and * Fitness to operate motor vehicles and the role of physicians. Turning first to the competence of the medical workforce, physicians are making diagnoses and performing procedures on a daily basis, both of which may entail a significant amount of risk for our patients. I would add that this is being done in an era where medical knowledge is rapidly increasing. As a profession that continues to enjoy a high degree of delegated self-regulation, we recognize the importance of ensuring that physicians are and remain competent across the medical career lifecycle. This entails both an individual and collective obligation to: * engage in lifelong learning; * recognize and report issues of competence in one's self and one's peers; and * participate in peer review processes to assure ongoing competence. First and foremost, physicians have an individual ethical and professional obligation to maintain their competence throughout their career lifecycle. The CMA Code of Ethics calls on physicians to: * practise the art and science of medicine competently, with integrity and without impairment; * engage in lifelong learning to maintain and improve professional knowledge skills and attitudes; * report to the appropriate authority any unprofessional conduct by colleagues; and * be willing to participate in peer review of other physicians and to undergo review by your peers1 I would stress the importance of peer review in medicine, which is one of the defining characteristics of a self-regulating profession. Simply put, physicians are expected to hold themselves and their colleagues accountable for their behaviour and for the outcomes they achieve on behalf of their patients.2 The individual accountability that physicians have to themselves and to each other is reinforced by a collective accountability for lifelong learning and peer review that is mandated by the national credentialing bodies and by the province/territorial licensing bodies. With regard to lifelong learning, both national credentialing bodies require evidence of ongoing continuing professional development as a condition of maintaining credentials. The College of Family Physicians of Canada operates a Maintenance of Proficiency program that requires its certificants to earn 250 credits over five years.3 The Royal College of Physicians and Surgeons of Canada operates a Maintenance of Certification Program that requires its Fellows to achieve 400 credits over a five year period with a minimum 40 in any single year.4 The Canadian Medical Protective Association, the mutual defence organization that provides liability coverage for the vast majority of physicians in Canada also plays a role in identifying high risk areas of medical practice and providing a range of educational materials and programs designed to mitigate such risk.5 Each province and territory has a licensing body - usually known as a College of Physicians and Surgeons that is established to protect the public interest. These colleges operate mandatory peer review programs that ensure that physician's practices are reviewed at regular intervals. These programs typically involve a review of the physician's practice profile based on administrative data, a visit to the physician's office by a medical colleague in a similar type of practice and an audit of a sample of patient charts, followed by a report with recommendations. In addition, most jurisdictions now have or will soon have in place a program pioneered in Alberta that provides a 360o assessment by administering questionnaires to a sample of a physician's patients, colleagues, and co-worker health professionals. These probe several aspects of competence and reports are provided back to the physician.6 Peer review is even more rigorous in the health care institutions where physicians carry out practices and procedures that involve the greatest potential risk to patients. Physicians are initially required to apply for hospital privileges that are reviewed annually by a credentials committee. These committees have the authority to renew, modify or cancel a physician's privileges. In between annual reviews a physician's day-to-day performance is subject to review by a variety of quality assurance processes and audit/review committees such as morbidity and mortality. Health care institutions in turn are subject to regular scrutiny by the Canadian Council on Health Services Accreditation which would include the oversight of physician practice among its review parameters. In summary, the medical profession subscribes to the notion that competence is something that must regularly be reviewed and enhanced across the medical career life cycle, and that such reviews and assessments must be grounded in evidence that is gathered from peers and other validated tools. Turning to our patients, one area that our members are regularly called on to assess competence is the determination of medical fitness to operate motor vehicles. To assist physicians in carrying out this societal responsibility, the CMA recently released our 7th edition of the Driver's Guide.7 What you will note about this 134 page guide is that the section on aging is only 3 pages long. The focus of the guide is on how substances such as alcohol and medications and a range of disease conditions such as cardiovascular and cerebrovascular disease may impose risks on fitness to operate a range of motor vehicles including automobiles, off-road vehicles, planes and trains. It provides graduated guidelines that relate to the severity and stage of the condition. As is noted in the section on aging, while the guide acknowledges the greater prevalence of health conditions in older age groups and hence the higher crash rates among the 65 and over age group, it states that the high crash rates in older people cannot be explained by age-related changes alone. In fact, by avoiding unnecessary risk and possessing the most experience, healthy senior drivers are among the safest drivers on the road. Rather, it is the presence and accumulation of health-related impairments that affect driving that is the major cause of crashes for older people. Because older age per se does not lead to higher crash rates, age-based restrictions on driving are not supportable. Rather than focusing on arbitrary age cutoffs what are required are evidence-based tools such as the Driver's Guide that can be used to detect and assess conditions that may present at any point in the life cycle. I would like to return to the physician workforce and the practical implications of arbitrary age cutoffs. As you may know Canada is experiencing a growing shortage of physicians - the effects of which are about to be compounded as the first of the baby boomers turn 65 in 2011. Currently we rank 24th out of the 30 OECD countries in terms of physician supply per 1,000 population - our level of 2.2 physicians per 1,000 is one third below the OECD average of 3.0. As of January 2008, according to the CMA physician Master File there are just over 8,200 licensed physicians in Canada who are aged 65 or older. They represent more than 1 in 10 (13%) of all licensed physicians. Moreover, they are very active; they work on average more than 40 hours per week and in addition more than 40% of them still have on-call responsibilities each month. These doctors make vital contributions to our health care system. In conclusion, the CMA believes that the public interest is best served by ensuring that all competent physicians, regardless of age, are able to practice medicine. Artificial barriers to practice based on age are simply discriminatory and counter productive in an era of health human resource shortages. Finally Madam Chair, we hope that the CMA will be invited back to appear before your committee. We have long been concerned with the access of the senior population to health care services and I will leave you with a copy of our policy on principles of medical care of older persons.8 We also hope you will examine the issue of long-term care which has had little if any national policy attention. I will also leave you with a copy of our recent technical background report on pre-funding of long-term care that we tabled at the Federal Minister of Finance's Roundtable in November 2007.9 Thank you again for this opportunity and I would be pleased to answer any questions. REFERENCES 1 Canadian Medical Association. CMA Code of ethics.(Update 2004). http://policybase.cma.ca/PolicyPDF/PD04-06.pdf. Accessed 01/23/08. 2 Canadian Medical Association. Medical professionalism (Update 2005). http://policybase.cma.ca/dbtw-wpd/Policypdf/PD06-02.pdf. Accessed 01/23/08. 3 College of Family Physicians of Canada. Mainpro(r)Maintenance of Proficiency. http://www.cfpc.ca/English/cfpc/cme/mainpro/maintenance%20of%20proficiency/default.asp?s=1. Accessed 01/23/08. 4 Royal College of Physicians and Surgeons of Canada. Maintenance of Certification Program. http://rcpsc.medical.org/opd/moc-program/index.php. accessed 01/23/08. 5 Canadian Medical Protective Association. Risk management @ a glance. http://www.cmpa-acpm.ca/cmpapd03/pub_index.cfm?FILE=MLRISK_MAIN&LANG=E. Accessed 01/23/08. 6 College of Physicians and Surgeons of Alberta. Physician Achievement Review Program. http://www.cpsa.ab.ca/collegeprograms/par_program.asp. Accessed 01/23/08. 7Canadian Medical Association. Determining medical fitness to operate motor vehicles. CMA Driver's Guide 7th edition.Ottawa, 2006. 8 Canadian Medical Association. Principles for medical care of older persons. http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD00-03.pdf. Accessed 01/23/08. 9 Canadian Medical Association. Pre-funding long-term care in Canada: technical backgrounder. Presentation to the Federal Minister of Finance's roundtable, Oshawa, ON, November 23, 2007.
Documents
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Presentation to the Senate Subcommittee on Population Health

https://policybase.cma.ca/en/permalink/policy9182
Last Reviewed
2020-02-29
Date
2008-05-28
Topics
Population health/ health equity/ public health
  1 document  
Policy Type
Parliamentary submission
Last Reviewed
2020-02-29
Date
2008-05-28
Topics
Population health/ health equity/ public health
Text
On behalf of the CMA, I thank you very much for the opportunity to be here today and commend the Subcommittee for focusing on the critical issue of child health. My presentation today will focus on three areas: 1. What the CMA has done and plans to do in the area of children's health; 2. Why the CMA has chosen to focus on the early years as a priority; and 3. What the CMA recommends to the Subcommittee and government for action in the area of children's health. The CMA's Role & Next Steps Physicians see the adverse effects of poor child health all too often and we strongly believe that all children should have access to the best possible start in life. That healthy start includes opportunities to grow and develop in a safe and supportive environment with access to health services as needed. The CMA is proud to have been a partner in the Child Health Initiative (CHI), an alliance between the CMA and the Canadian Paediatric Society (CPS) and the College of Family Physicians of Canada (CFPC) that has pressed for improvements in child health and the development of Child Health Goals. The CHI held the Child and Youth Health Summit last year where it developed a child health charter based on three principles: * a safe and secure environment; * good health and development; and * a full range of health resources available to all. The Charter states that all children should have things such as clean water, air and soil; protection from injury and exploitation; and prenatal and maternal care for the best possible health at birth. Further, the charter recognizes the need for proper nutrition for proper growth and long term health; early learning opportunities and high-quality care, at home and in the community; and a basic health care including immunization, drugs, mental and dental health. Delegates at the Summit also endorsed the Child Health Declaration and the Child and Youth Health Challenge, a call to action to make the charter a reality. Going forward, the CMA will invest considerable time and effort to develop policy targeting children from birth to five years of age. To that end the CMA will host the Child Health Expert Consultation and Strategy Session on June 5-6, 2008. The purpose of this consultation is to create a discussion paper to: * First, identify how CMA can help physicians improve the health of children under five; and second, * Identify the key determinants of early child health and identify goals and recommend ways to achieve optimal health outcomes for children under five. This paper will inform a Roundtable Discussion of Child Health Experts in Fall 2008 where we hope to produce a final report on the Key Determinants of Children's Health for the Early Years. We then hope to be invited to come before this Subcommittee once again to present this report and discuss our conclusions and recommendations. Why the Early Years The CMA is focusing on the period from birth to five years old because it is a critical time for children and when the physicians of Canada are perhaps in the best position to make a difference. Recent human development research suggests that the period from conception to age six has the most important influence of any time in the life cycle on brain development. As well, we are all well aware that Canada could be and should be performing better in comparison to other OECD nations in a number of key areas such as infant mortality, injury and child poverty. We also know that: * Early screening for hereditary or congenital disease must take place between the ages of zero and five in order to provide effective intervention; and * Brain and biological pathways in the prenatal period and in the early years affect physical and mental health in adult life. Physicians are well positioned to identify and optimize certain conditions for healthy growth and development. Physicians can identify and prescribe effective interventions following many adverse childhood experiences in order to improve health outcomes for children and as they grow into adults. Recommendations The CMA believes that there are a number of actions government could be taking today in the area of children's health. First, Canada should not be at the bottom of the list of developed countries when it comes to spending, as a percentage of GDP, on early childhood programs and development. Investing in early development is essential for an optimal start to life and a physically, mentally and socially healthy childhood. Second, we need to improve our surveillance capability to better monitor changes in children's health because we can't manage what we can't measure. That is why the CMA recommends the creation of an annual report card on child health in Canada. Third, nearly one child in six lives in poverty in Canada. This can impact a child's growth and development, his or her physical and mental health and ultimately the ability to succeed as teenagers and adults. Governments can and must do more. Finally, there are a number of recommendations within the recently released Leitch Report in areas such as injury prevention, environment vulnerabilities, nutrition, aboriginal and mental health. The CMA strongly supports these recommendations and urges this Subcommittee to consider them. However, if there are two recommendations within the Leitch Report that the CMA believes government could and must act upon immediately, they would be the creation of a National Office of Child Health and a Pan-Canadian Child Health Strategy. Conclusion In conclusion, the CMA strongly supports the Subcommittee's work and its focus on child health. Again, we hope to return to see you again this fall with specific recommendations to address child health determinants, especially those affecting children from birth to age five. Canada can and should be among the leading nations on earth in terms of children's health status. Our children deserve no less. Thank you.
Documents
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Aboriginal peoples and mental illness

https://policybase.cma.ca/en/permalink/policy9210
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC08-21
The Canadian Medical Association urges Canadian medical schools to include in their curricula material related to the deleterious effect of negative stereotyping of Aboriginal peoples suffering from mental illnesses and substance use disorders.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC08-21
The Canadian Medical Association urges Canadian medical schools to include in their curricula material related to the deleterious effect of negative stereotyping of Aboriginal peoples suffering from mental illnesses and substance use disorders.
Text
The Canadian Medical Association urges Canadian medical schools to include in their curricula material related to the deleterious effect of negative stereotyping of Aboriginal peoples suffering from mental illnesses and substance use disorders.
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Acute care beds

https://policybase.cma.ca/en/permalink/policy9224
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Resolution
GC08-43
The Canadian Medical Association and provincial/territorial medical associations will work with governments to implement transparent and publicly available principles for the supply and effective management of functional acute care beds.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Resolution
GC08-43
The Canadian Medical Association and provincial/territorial medical associations will work with governments to implement transparent and publicly available principles for the supply and effective management of functional acute care beds.
Text
The Canadian Medical Association and provincial/territorial medical associations will work with governments to implement transparent and publicly available principles for the supply and effective management of functional acute care beds.
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Patient-focused funding

https://policybase.cma.ca/en/permalink/policy9233
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Resolution
GC08-53
The Canadian Medical Association recognizes that any patient-focused funding model should incorporate an incentive for providing timely access to services close to the patient's home to minimize increases in medical travel costs.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Resolution
GC08-53
The Canadian Medical Association recognizes that any patient-focused funding model should incorporate an incentive for providing timely access to services close to the patient's home to minimize increases in medical travel costs.
Text
The Canadian Medical Association recognizes that any patient-focused funding model should incorporate an incentive for providing timely access to services close to the patient's home to minimize increases in medical travel costs.
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Mental health services and Canadian Forces members

https://policybase.cma.ca/en/permalink/policy9235
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Resolution
GC08-26
The Canadian Medical Association will work with the Department of National Defence to provide high quality evidence-based mental health services to Canadian Forces members and their families resulting from operational stress injury including post-traumatic stress syndrome.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Resolution
GC08-26
The Canadian Medical Association will work with the Department of National Defence to provide high quality evidence-based mental health services to Canadian Forces members and their families resulting from operational stress injury including post-traumatic stress syndrome.
Text
The Canadian Medical Association will work with the Department of National Defence to provide high quality evidence-based mental health services to Canadian Forces members and their families resulting from operational stress injury including post-traumatic stress syndrome.
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Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health care and patient safety
Health systems, system funding and performance
Resolution
GC08-70
The Canadian Medical Association and provincial/territorial medical associations call on governments to work in close collaboration with health care stakeholders to include information on novel psychoactive substances as part of prevention activities aimed at avoiding devastating effects in Canadian provinces.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health care and patient safety
Health systems, system funding and performance
Resolution
GC08-70
The Canadian Medical Association and provincial/territorial medical associations call on governments to work in close collaboration with health care stakeholders to include information on novel psychoactive substances as part of prevention activities aimed at avoiding devastating effects in Canadian provinces.
Text
The Canadian Medical Association and provincial/territorial medical associations call on governments to work in close collaboration with health care stakeholders to include information on novel psychoactive substances as part of prevention activities aimed at avoiding devastating effects in Canadian provinces.
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Children's health and environmental toxins

https://policybase.cma.ca/en/permalink/policy9239
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health care and patient safety
Resolution
GC08-71
The Canadian Medical Association urges the federal government to participate in Canadian-based research studies on children's health and environmental toxins.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health care and patient safety
Resolution
GC08-71
The Canadian Medical Association urges the federal government to participate in Canadian-based research studies on children's health and environmental toxins.
Text
The Canadian Medical Association urges the federal government to participate in Canadian-based research studies on children's health and environmental toxins.
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Physician assistants

https://policybase.cma.ca/en/permalink/policy9243
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Resolution
GC08-75
The Canadian Medical Association will work with the Canadian Association of Physician Assistants and appropriate stakeholders to develop a national certification and licensing process for physician assistants that ensures competency and portability across Canada.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Resolution
GC08-75
The Canadian Medical Association will work with the Canadian Association of Physician Assistants and appropriate stakeholders to develop a national certification and licensing process for physician assistants that ensures competency and portability across Canada.
Text
The Canadian Medical Association will work with the Canadian Association of Physician Assistants and appropriate stakeholders to develop a national certification and licensing process for physician assistants that ensures competency and portability across Canada.
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Physician-led anesthesia care teams

https://policybase.cma.ca/en/permalink/policy9244
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC08-76
The Canadian Medical Association endorses the concept of physician-led anesthesia care teams.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC08-76
The Canadian Medical Association endorses the concept of physician-led anesthesia care teams.
Text
The Canadian Medical Association endorses the concept of physician-led anesthesia care teams.
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National environmental health strategy

https://policybase.cma.ca/en/permalink/policy9250
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health care and patient safety
Resolution
GC08-80
The Canadian Medical Association and provincial/territorial medical associations call on the federal government to work with the provinces and territories to adopt a national environmental health strategy.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health care and patient safety
Resolution
GC08-80
The Canadian Medical Association and provincial/territorial medical associations call on the federal government to work with the provinces and territories to adopt a national environmental health strategy.
Text
The Canadian Medical Association and provincial/territorial medical associations call on the federal government to work with the provinces and territories to adopt a national environmental health strategy.
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Obesity prevention and management

https://policybase.cma.ca/en/permalink/policy9256
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Resolution
GC08-87
The Canadian Medical Association encourages provincial/territorial medical associations to work in conjunction with the Canadian Obesity Network to help develop chronic care models for obesity prevention and management.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Resolution
GC08-87
The Canadian Medical Association encourages provincial/territorial medical associations to work in conjunction with the Canadian Obesity Network to help develop chronic care models for obesity prevention and management.
Text
The Canadian Medical Association encourages provincial/territorial medical associations to work in conjunction with the Canadian Obesity Network to help develop chronic care models for obesity prevention and management.
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Canadian tuberculosis control programs

https://policybase.cma.ca/en/permalink/policy9260
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health care and patient safety
Resolution
GC08-91
The Canadian Medical Association advocates for mobilization of federal resources to facilitate Canadian tuberculosis control programs to screen refugees and immigrants new to Canada in accordance with current health policy.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health care and patient safety
Resolution
GC08-91
The Canadian Medical Association advocates for mobilization of federal resources to facilitate Canadian tuberculosis control programs to screen refugees and immigrants new to Canada in accordance with current health policy.
Text
The Canadian Medical Association advocates for mobilization of federal resources to facilitate Canadian tuberculosis control programs to screen refugees and immigrants new to Canada in accordance with current health policy.
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Distribution of physicians in Canada

https://policybase.cma.ca/en/permalink/policy9277
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Ethics and medical professionalism
Health human resources
Resolution
GC08-111
The Canadian Medical Association and the provincial/territorial medical associations will work with the Federation of Medical Regulatory Authorities of Canada and provincial/territorial medical regulatory bodies to assess the national and international implications for the supply, mix and distribution of physicians in Canada as a result of the requirement for full labour mobility as set out in the Agreement on Internal Trade.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Ethics and medical professionalism
Health human resources
Resolution
GC08-111
The Canadian Medical Association and the provincial/territorial medical associations will work with the Federation of Medical Regulatory Authorities of Canada and provincial/territorial medical regulatory bodies to assess the national and international implications for the supply, mix and distribution of physicians in Canada as a result of the requirement for full labour mobility as set out in the Agreement on Internal Trade.
Text
The Canadian Medical Association and the provincial/territorial medical associations will work with the Federation of Medical Regulatory Authorities of Canada and provincial/territorial medical regulatory bodies to assess the national and international implications for the supply, mix and distribution of physicians in Canada as a result of the requirement for full labour mobility as set out in the Agreement on Internal Trade.
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Admissions criteria

https://policybase.cma.ca/en/permalink/policy9279
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Health human resources
Ethics and medical professionalism
Resolution
GC08-105
The Canadian Medical Association urges Canadian medical schools to revise admissions criteria to require a minimum of two years of post-secondary education.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Health human resources
Ethics and medical professionalism
Resolution
GC08-105
The Canadian Medical Association urges Canadian medical schools to revise admissions criteria to require a minimum of two years of post-secondary education.
Text
The Canadian Medical Association urges Canadian medical schools to revise admissions criteria to require a minimum of two years of post-secondary education.
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Access to medical information

https://policybase.cma.ca/en/permalink/policy9280
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Ethics and medical professionalism
Health information and e-health
Resolution
GC08-113
The Canadian Medical Association objects to the current practice of insurers, employers and other third parties requesting and gaining access to unlimited medical information obtained as a result of patients signing forms that grant unrestricted 'consent for release of medical information' when claiming eligibility for disability benefits.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Ethics and medical professionalism
Health information and e-health
Resolution
GC08-113
The Canadian Medical Association objects to the current practice of insurers, employers and other third parties requesting and gaining access to unlimited medical information obtained as a result of patients signing forms that grant unrestricted 'consent for release of medical information' when claiming eligibility for disability benefits.
Text
The Canadian Medical Association objects to the current practice of insurers, employers and other third parties requesting and gaining access to unlimited medical information obtained as a result of patients signing forms that grant unrestricted 'consent for release of medical information' when claiming eligibility for disability benefits.
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Medical information

https://policybase.cma.ca/en/permalink/policy9281
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Ethics and medical professionalism
Health information and e-health
Health systems, system funding and performance
Resolution
GC08-114
The Canadian Medical Association and provincial/territorial medical associations will seek legislative amendments that make the requesting third party responsible for payment for the provision of medical information collected (with patient understanding and consent) for the purposes of a return to work program or accommodation in the workplace.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Ethics and medical professionalism
Health information and e-health
Health systems, system funding and performance
Resolution
GC08-114
The Canadian Medical Association and provincial/territorial medical associations will seek legislative amendments that make the requesting third party responsible for payment for the provision of medical information collected (with patient understanding and consent) for the purposes of a return to work program or accommodation in the workplace.
Text
The Canadian Medical Association and provincial/territorial medical associations will seek legislative amendments that make the requesting third party responsible for payment for the provision of medical information collected (with patient understanding and consent) for the purposes of a return to work program or accommodation in the workplace.
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“Surgical Safety Checklist” campaign

https://policybase.cma.ca/en/permalink/policy9293
Last Reviewed
2020-02-29
Date
2008-05-27
Topics
Health systems, system funding and performance
Ethics and medical professionalism
Resolution
BD08-05-123
The Canadian Medical Association endorses the concept of the World Health Organization’s “Surgical Safety Checklist" campaigns.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-05-27
Topics
Health systems, system funding and performance
Ethics and medical professionalism
Resolution
BD08-05-123
The Canadian Medical Association endorses the concept of the World Health Organization’s “Surgical Safety Checklist" campaigns.
Text
The Canadian Medical Association endorses the concept of the World Health Organization’s “Surgical Safety Checklist" campaigns.
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Accreditation Standards for Continuing Medical Education

https://policybase.cma.ca/en/permalink/policy9379
Last Reviewed
2020-02-29
Date
2008-10-04
Topics
Ethics and medical professionalism
Physician practice/ compensation/ forms
Resolution
BD09-03-32
The CMA commends the rigorous accreditation standards for continuing medical education adopted by the Committee on Accreditation of Continuing Medical Education and supports constant vigilance to ensure that the content of accredited CME events is consistent with the best available scientific information and ethically sound practice.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-10-04
Topics
Ethics and medical professionalism
Physician practice/ compensation/ forms
Resolution
BD09-03-32
The CMA commends the rigorous accreditation standards for continuing medical education adopted by the Committee on Accreditation of Continuing Medical Education and supports constant vigilance to ensure that the content of accredited CME events is consistent with the best available scientific information and ethically sound practice.
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The CMA commends the rigorous accreditation standards for continuing medical education adopted by the Committee on Accreditation of Continuing Medical Education and supports constant vigilance to ensure that the content of accredited CME events is consistent with the best available scientific information and ethically sound practice.
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Caring in a Crisis: The Ethical Obligations of Physicians and Society During a Pandemic

https://policybase.cma.ca/en/permalink/policy9109
Last Reviewed
2019-03-03
Date
2008-02-23
Topics
Ethics and medical professionalism
Population health/ health equity/ public health
  1 document  
Policy Type
Policy document
Last Reviewed
2019-03-03
Date
2008-02-23
Topics
Ethics and medical professionalism
Population health/ health equity/ public health
Text
Inherent in all health care professional Codes of Ethics is the duty to provide care to patients and to relieve suffering whenever possible. However, this duty does not exist in a vacuum, and depends on the provision of goods and services referred to as reciprocal obligations, which must be provided by governments, health care institutions and other relevant bodies and agencies. The obligation of government and society to physicians can be seen as comparable to the obligations of physicians to their patients. The recent experience of Canadian physicians during the SARS epidemic in Toronto has heightened the sensitivities of the medical profession to several issues that arose during the course of dealing with that illness. Many of the lessons learned (and the unanswered questions that arose) also apply to the looming threat of an avian flu (or other) pandemic. Canadian physicians may be in a relatively unique position to consider these issues given their experience and insight. The intent of this working paper is to highlight the ethical issues of greatest concern to practicing Canadian physicians which must be considered during a pandemic. In order to address these issues before they arise, the CMA presents this paper for consideration by individual physicians, physician organizations, governments, policy makers and interested bodies and stakeholders. Although many of the principles and concepts could readily be applied to other health care workers, the focus of this paper will be on physicians. Policies regarding physicians in training, including medical students and residents, should be clarified in advance by the relevant bodies involved in their oversight and training. Issues of concern would include the responsibilities of trainees to provide care during a pandemic and the potential effect of such an outbreak on their education and training. A. Physician obligations during a pandemic The professional obligations of physicians are well spelled out in the CMA Code of Ethics and other documents and publications and are not the main focus of this paper. However, they will be reviewed and discussed as follows. Several important principles of medical ethics will be of particular relevance in considering this issue. Physicians have an obligation to be beneficent to their patients and to consider what is in the patient's best interest. According to the first paragraph of the CMA Code of Ethics (2004), "Consider first the well-being of the patient". Traditionally, physicians have also respected the principle of altruism, whereby they set aside concern for their own health and well-being in order to serve their patients. While this has often manifested itself primarily as long hours away from home and family, and a benign neglect of personal health issues, at times more drastic sacrifices have been required. During previous pandemics, many physicians have served selflessly in the public interest, often at great risk to their own well-being. The principle of justice requires physicians to consider what is owed to whom and why, including what resources are needed, and how these resources would best be employed during a pandemic. These resources might include physician services but could also include access to vaccines and medications, as well as access to equipment such as ventilators or to a bed in the intensive care unit. According to paragraph 43 of the CMA Code of Ethics, physicians have an obligation to "Recognize the responsibility of physicians to promote equitable access to health care resources". In addition, physicians can reasonably be expected to participate in the process of planning for a pandemic or other medical disaster. According to paragraph 42 of the CMA Code of Ethics, physicians should "Recognize the profession's responsibility to society in matters relating to public health, health education, environmental protection, legislation affecting the health and well-being of the community and the need for testimony at judicial proceedings". This responsibility could reasonably be seen to apply both to individual physicians as well as the various bodies and organizations that represent them. Physicians also have an ethical obligation to recognize their limitations and the extent of the services they are able to provide. During a pandemic, physicians may be asked to assume roles or responsibilities with which they are not comfortable, nor prepared. Paragraph 15 of the CMA Code of Ethics reminds physicians to "Recognize your limitations and, when indicated, recommend or seek additional opinions or services". However, physicians have moral rights as well as obligations. The concept of personal autonomy allows physicians some discretion in determining where, how and when they will practice medicine. They also have an obligation to safeguard their own health. As stated in paragraph 10 of the CMA Code of Ethics, physicians should "Promote and maintain your own health and well-being". The SARS epidemic has served to reopen the ethical debate. Health care practitioners have been forced to reconsider their obligations during a pandemic, including whether they must provide care to all those in need regardless of the level of personal risk. As well, they have been re-examining the obligation of governments and others to provide reciprocal services to physicians, and the relationship between these obligations. B. Reciprocal obligations towards physicians While there has been much debate historically (and especially more recently) about the ethical obligations of physicians towards their patients and society in general, the consideration of reciprocal obligations towards physicians is a relatively recent phenomenon. During the SARS epidemic, a large number of Canadian physicians unselfishly volunteered to assist their colleagues in trying to bring the epidemic under control. They did so, in many cases, in spite of significant personal risk, and with very little information about the nature of the illness, particularly early in the course of the outbreak. Retrospective analysis has cast significant doubt and concern on the amount of support and assistance provided to physicians during the crisis. Communication and infrastructure support was poor at best. Equipment was often lacking and not always up to standard when it was available. Psychological support and counselling was not readily available at the point of care, nor was financial compensation for those who missed work due to illness or quarantine. Although the Ontario government did provide retrospective compensation for many physicians whose practices were affected by the outbreak, the issue was addressed late, and not at all in some cases. It is clear that Canadian physicians have learned greatly from this experience. The likelihood of individuals again volunteering "blindly" has been reduced to the point where it may never happen again. There are expectations that certain conditions and obligations will be met in order to optimize patient care and outcomes and to protect health care workers and their families. Because physicians and other health care providers will be expected to put themselves directly in harm's way, and to bear a disproportionate burden of the personal hardships associated with a pandemic, the argument has been made that society has a reciprocal obligation to support and compensate these individuals. According to the University of Toronto Joint Centre for Bioethics report We stand on guard for thee, "(The substantive value of) reciprocity requires that society support those who face a disproportionate burden in protecting the public good, and take steps to minimize burdens as much as possible. Measures to protect the public good are likely to impose a disproportionate burden on health care workers, patients and their families." Therefore, in order to provide adequate care for patients, the reciprocal obligation to physicians requires providing some or all of the following: Prior to a pandemic - Physicians and the organizations that represent them should be more involved in planning and decision making at the local, national and international levels. In turn, physicians and the organizations that represent them have an obligation to participate as well. - Physicians should be made aware of a clear plan for resource utilization, including: - how physicians will be relieved of duties after a certain time; - clearly defined roles and expectations, especially for those practicing outside of their area of expertise; - vaccination/treatment plans - will physicians (and their families) have preferential access based on the need to keep caregivers healthy and on the job; - triage plans, including how the triage model might be altered and plans to inform the public of such. - Physicians should have access to the best equipment needed and should be able to undergo extra training in its use if required. - Politicians and leaders should provide reassurances that satisfy physicians that they will not be "conscripted" by legislation. During a pandemic - Physicians should have access to up-to-date, real time information. - Physicians should be kept informed about developments in Canada and globally. - Communication channels should be opened with other countries (e.g. Canada should participate in WHO initiatives to identify the threats before they arrive on our doorstep). - Resources should be provided for backup and relief of physicians and health care workers. - Arrangements should be made for timely provision of necessary equipment in an ongoing fashion. - Physicians should be compensated for lost clinical earnings and to cover expenses such as lost wages, lost group earnings, overhead, medical care, medications, rehabilitative therapy and other relevant expenses in case of quarantine, clinic cancellations or illness (recognizing that determining exactly when or where an infection was acquired may be difficult). - Families should receive financial compensation in the case of a physician family member who dies as a result of providing care during a pandemic. - In the event that physicians may be called upon in a pandemic to practice outside of their area of expertise or outside their jurisdiction, they should to contact their professional liability protection provider for information on their eligibility for protection in these circumstances. - Interprovincial or national licensing programs should be developed to provide physicians with back-up and relief and ensure experts can move from place to place in a timely fashion without undue burden. - Psychological and emotional counselling and support should be provided in a timely fashion for physicians, their staff and family members. - Accommodation (i.e. a place to stay) should be provided for physicians who have to travel to another locale to provide care; or who don't want to go home and put their family at risk, when this is applicable, i.e. the epidemiology of the infectious disease causing the pandemic indicates substantially greater risk of acquiring infection in the health care setting than in the community. - Billing and compensation arrangements should ensure physicians are properly compensated for the services they are providing, including those who may not have an active billing number in the province where the services are being provided. After a pandemic - Physicians should receive assistance in restarting their practice (replacing staff, restocking overhead, communicating with patients, and any other costs related to restarting the practice). - Physicians should receive ongoing psychological support and counselling as required. C. How are physician obligations and reciprocal obligations related? Beyond a simple statement of the various obligations, it is clear that there must be some link between these different obligations. This is particularly important since there is now some time to plan for the next pandemic and to ensure that reciprocal obligations can be met prior to its onset. Physicians have always provided care in emergency situations without questioning what they are owed. According to paragraph 18 of the CMA Code of Ethics, physicians should "Provide whatever appropriate assistance you can to any person with an urgent need for medical care". However, in situations where obligations can be anticipated and met in advance, it is reasonable to expect that they will be addressed. Whereas a physician who encounters an emergency situation at the site of a car crash will act without concern for personal gain or motivation, a physician caring for the same patient in an emergency department will rightly expect the availability of proper equipment and personnel. In order to ensure proper patient care and physician safety, and to ensure physicians are able to meet their professional obligations and standards, the reciprocal obligations outlined above should be addressed by the appropriate body or organization. Conclusion If patient and physician well-being is not optimized by clarifying the obligations of physicians and society prior to the next pandemic, in spite of available time and resources necessary to do so, there are many who would call into question the ethical duty of physicians to provide care. However, the CMA believes that, in the very best and most honourable traditions of the medical profession, its members will provide care and compassion to those in need. We call on governments and society to assist us in optimizing this care for all Canadians.
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