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Policies that advocate for the medical profession and Canadians


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Principles concerning physician information

https://policybase.cma.ca/en/permalink/policy208
Last Reviewed
2019-03-03
Date
2002-06-02
Topics
Health information and e-health
Ethics and medical professionalism
  1 document  
Policy Type
Policy document
Last Reviewed
2019-03-03
Date
2002-06-02
Topics
Health information and e-health
Ethics and medical professionalism
Text
Principles concerning physician information (CMA policy – approved June 2002) In an environment in which the capacity to capture, link and transmit information is growing and the need for fuller accountability is being created, the demand for physician information, and the number of people and organizations seeking to collect it, is increasing. Physician information, that is, information that includes personal health information about and information that relates or may relate to the professional activity of an identifiable physician or group of physicians, is valuable for a variety of purposes. The legitimacy and importance of these purposes varies a great deal, and therefore the rationale and rules related to the collection, use, access and disclosure of physician information also varies. The Canadian Medical Association (CMA) developed this policy to provide guiding principles to those who collect, use, have access to or disclose physician information. Such people are termed “custodians,” and they should be held publicly accountable. These principles complement and act in concert with the CMA Health Information Privacy Code (1), which holds patient health information sacrosanct. Physicians have legitimate interests in what information about them is collected, on what authority, by whom and for what purposes it is collected, and what safeguards and controls are in place. These interests include privacy and the right to exercise some control over the information; protection from the possibility that information will cause unwarranted harm, either at the individual or the group level; and assurance that interpretation of the information is accurate and unbiased. These legitimate interests extend to information about physicians that has been rendered in non-identifiable or aggregate format (e.g., to protect against the possibility of individual physicians being identified or of physician groups being unjustly stigmatized). Information in these formats, however, may be less sensitive than information from which an individual physician can be readily identified and, therefore, may warrant less protection. The purposes for the use of physician information may be more or less compelling. One compelling use is related to the fact that physicians, as members of a self-regulating profession, are professionally accountable to their patients, their profession and society. Physicians support this professional accountability purpose through the legislated mandate of their regulatory colleges. Physicians also recognize the importance of peer review in the context of professional development and maintenance of competence. The CMA supports the collection, use, access and disclosure of physician information subject to the conditions outlined below. Purpose(s): The purpose(s) for the collection of physician information, and any other purpose(s) for which physician information may be subsequently used, accessed or disclosed, should be precisely specified at or before the collection. There should be a reasonable expectation that the information will achieve the stated purpose(s). The policy does not prevent the use of information for purposes that were not intended and not reasonably anticipated if principles 3 and 4 of this policy are met. Consent: As a rule, information should be collected directly from the physician. Subject to principle 4, consent should be sought from the physician for the collection, use, access or disclosure of physician information. The physician should be informed about all intended and anticipated uses, accesses or disclosures of the information. Conditions for collection, use, access and disclosure: The information should: be limited to the minimum necessary to carry out the stated purpose(s), be in the least intrusive format required for the stated purpose(s), and its collection, use, access and disclosure should not infringe on the physician’s duty of confidentiality with respect to that information. Use of information without consent: There may be justification for the collection, use, access or disclosure of physician information without the physician’s consent if, in addition to the conditions in principle 3 being met, the custodian publicly demonstrates with respect to the purpose(s), generically construed, that: the stated purpose(s) could not be met or would be seriously compromised if consent were required, the stated purpose(s) is(are) of sufficient importance that the public interest outweighs to a substantial degree the physician’s right to privacy and right of consent in a free and democratic society, and that the collection, use, access or disclosure of physician information with respect to the stated purpose(s) always ensures justice and fairness to the physician by being consistent with principle 6 of this policy. Physician’s access to his or her own information: Physicians have a right to view and ensure, in a timely manner, the accuracy of the information collected about them. This principle does not apply if there is reason to believe that the disclosure to the physician will cause substantial adverse effect to others. The onus is on the custodian to justify a denial of access. 6. Information quality and interpretation: Custodians must take reasonable steps to ensure that the information they collect, use, gain access to or disclose is accurate, complete and correct. Custodians must use valid and reliable collection methods and, as appropriate, involve physicians to interpret the information; these physicians must have practice characteristics and credentials similar to those of the physician whose information is being interpreted. 7. Security: Physical and human safeguards must exist to ensure the integrity and reliability of physician information and to protect against unauthorized collection, use, access or disclosure of physician information. 8. Retention and destruction: Physician information should be retained only for the length of time necessary to fulfill the specified purpose(s), after which time it should be destroyed. 9. Inquiries and complaints: Custodians must have in place a process whereby inquiries and complaints can be received, processed and adjudicated in a fair and timely way. The complaint process, including how to initiate a complaint, must be made known to physicians. 10. Openness and transparency: Custodians must have transparent and explicit record-keeping or database management policies, practices and systems that are open to public scrutiny, including the purpose(s) for the collection, use, access and disclosure of physician information. The existence of any physician information record-keeping systems or database systems must be made known and available upon request to physicians. 11. Accountability: Custodians of physician information must ensure that they have proper authority and mandate to collect, use, gain access to or disclose physician information. Custodians must have policies and procedures in place that give effect to the principles in this document. Custodians must have a designated person who is responsible for monitoring practices and ensuring compliance with the policies and procedures. (1) Canadian Medical Association. Health Information Privacy Code. CMAJ 1998;159(8):997-1016.
Documents
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Wait time protocols and benchmarks

https://policybase.cma.ca/en/permalink/policy1491
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-11
The Canadian Medical Association will ensure that practising physicians are involved in the development of wait time protocols and benchmarks that are based on the available evidence, that are administratively straightforward and that are satisfactory to the needs of patients and physicians.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-11
The Canadian Medical Association will ensure that practising physicians are involved in the development of wait time protocols and benchmarks that are based on the available evidence, that are administratively straightforward and that are satisfactory to the needs of patients and physicians.
Text
The Canadian Medical Association will ensure that practising physicians are involved in the development of wait time protocols and benchmarks that are based on the available evidence, that are administratively straightforward and that are satisfactory to the needs of patients and physicians.
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Family physicians and hospital affiliation

https://policybase.cma.ca/en/permalink/policy1502
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-36
The Canadian Medical Association calls on the federal, provincial and territorial governments to work together with the Association and its divisions and affiliates to develop initiatives that are incentive based to encourage family physicians to retain hospital affiliation and provide hospital care in supporting the provision of the full continuum of primary care to patients.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-36
The Canadian Medical Association calls on the federal, provincial and territorial governments to work together with the Association and its divisions and affiliates to develop initiatives that are incentive based to encourage family physicians to retain hospital affiliation and provide hospital care in supporting the provision of the full continuum of primary care to patients.
Text
The Canadian Medical Association calls on the federal, provincial and territorial governments to work together with the Association and its divisions and affiliates to develop initiatives that are incentive based to encourage family physicians to retain hospital affiliation and provide hospital care in supporting the provision of the full continuum of primary care to patients.
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Compensation for remote consultation

https://policybase.cma.ca/en/permalink/policy1505
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health information and e-health
Physician practice/ compensation/ forms
Resolution
GC04-41
The Canadian Medical Association recommends that provincial and territorial authorities recognize that any type of remote consultation such as telemedicine and teleconsultation is a medical act to be duly compensated.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health information and e-health
Physician practice/ compensation/ forms
Resolution
GC04-41
The Canadian Medical Association recommends that provincial and territorial authorities recognize that any type of remote consultation such as telemedicine and teleconsultation is a medical act to be duly compensated.
Text
The Canadian Medical Association recommends that provincial and territorial authorities recognize that any type of remote consultation such as telemedicine and teleconsultation is a medical act to be duly compensated.
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Payment for discussions of patient health with other health professionals

https://policybase.cma.ca/en/permalink/policy1508
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-44
The Canadian Medical Association recommends that provincial and territorial authorities recognize that any discussion regarding a patient's health between a physician and another health professional is a medical act to be duly compensated.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-44
The Canadian Medical Association recommends that provincial and territorial authorities recognize that any discussion regarding a patient's health between a physician and another health professional is a medical act to be duly compensated.
Text
The Canadian Medical Association recommends that provincial and territorial authorities recognize that any discussion regarding a patient's health between a physician and another health professional is a medical act to be duly compensated.
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Physician health and well-being

https://policybase.cma.ca/en/permalink/policy1512
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Physician practice/ compensation/ forms
Resolution
GC04-48
The Canadian Medical Association supports the educational needs of physician leaders with respect to physician health and well-being through the creation of professional development opportunities and programs.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Physician practice/ compensation/ forms
Resolution
GC04-48
The Canadian Medical Association supports the educational needs of physician leaders with respect to physician health and well-being through the creation of professional development opportunities and programs.
Text
The Canadian Medical Association supports the educational needs of physician leaders with respect to physician health and well-being through the creation of professional development opportunities and programs.
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Compensation ceilings for GP's and access to front-line services

https://policybase.cma.ca/en/permalink/policy1524
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-51
The Canadian Medical Association recommends that compensation ceilings for general practitioners where they exist be removed in order to improve access to front-line services.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-51
The Canadian Medical Association recommends that compensation ceilings for general practitioners where they exist be removed in order to improve access to front-line services.
Text
The Canadian Medical Association recommends that compensation ceilings for general practitioners where they exist be removed in order to improve access to front-line services.
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Promotion of physical activity among physicians

https://policybase.cma.ca/en/permalink/policy1525
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Population health/ health equity/ public health
Resolution
GC04-52
The Canadian Medical Association, in keeping with its vision of a healthy population and national advocacy mission, shall vigorously promote physical activity among physicians for the sake of their own wellness, which in turn enhances their ability to care for others and sets an important example in encouraging patients to be physically active.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Population health/ health equity/ public health
Resolution
GC04-52
The Canadian Medical Association, in keeping with its vision of a healthy population and national advocacy mission, shall vigorously promote physical activity among physicians for the sake of their own wellness, which in turn enhances their ability to care for others and sets an important example in encouraging patients to be physically active.
Text
The Canadian Medical Association, in keeping with its vision of a healthy population and national advocacy mission, shall vigorously promote physical activity among physicians for the sake of their own wellness, which in turn enhances their ability to care for others and sets an important example in encouraging patients to be physically active.
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Annual National Physicians' Week

https://policybase.cma.ca/en/permalink/policy1528
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Resolution
GC04-55
The Canadian Medical Association will explore the feasibility of sponsoring, supporting and promoting an annual National Physicians' Week or other similar national event to celebrate the many contributions and achievements of Canadian physicians providing quality health care to their patients.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Resolution
GC04-55
The Canadian Medical Association will explore the feasibility of sponsoring, supporting and promoting an annual National Physicians' Week or other similar national event to celebrate the many contributions and achievements of Canadian physicians providing quality health care to their patients.
Text
The Canadian Medical Association will explore the feasibility of sponsoring, supporting and promoting an annual National Physicians' Week or other similar national event to celebrate the many contributions and achievements of Canadian physicians providing quality health care to their patients.
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Initiatives to reduce wait times

https://policybase.cma.ca/en/permalink/policy1530
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Resolution
GC04-15
The Canadian Medical Association, consistent with A Prescription for Sustainability, advocates to reduce wait times through the following initiatives: a) development of pan-Canadian wait time benchmarks based on available evidence; b) a network of regional registries and referral programs for specialized care; c) streamlined referral for investigation and specialty consultations; and d) Canadian Health Access Fund designed to support inter-jurisdictional portability of care.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Resolution
GC04-15
The Canadian Medical Association, consistent with A Prescription for Sustainability, advocates to reduce wait times through the following initiatives: a) development of pan-Canadian wait time benchmarks based on available evidence; b) a network of regional registries and referral programs for specialized care; c) streamlined referral for investigation and specialty consultations; and d) Canadian Health Access Fund designed to support inter-jurisdictional portability of care.
Text
The Canadian Medical Association, consistent with A Prescription for Sustainability, advocates to reduce wait times through the following initiatives: a) development of pan-Canadian wait time benchmarks based on available evidence; b) a network of regional registries and referral programs for specialized care; c) streamlined referral for investigation and specialty consultations; and d) Canadian Health Access Fund designed to support inter-jurisdictional portability of care.
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Renewing medical equipment in the healthcare system

https://policybase.cma.ca/en/permalink/policy1531
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC04-16
The Canadian Medical Association urges federal and provincial/territorial governments to invest heavily in renewing the medical equipment in the healthcare system.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC04-16
The Canadian Medical Association urges federal and provincial/territorial governments to invest heavily in renewing the medical equipment in the healthcare system.
Text
The Canadian Medical Association urges federal and provincial/territorial governments to invest heavily in renewing the medical equipment in the healthcare system.
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National wait-time monitoring system

https://policybase.cma.ca/en/permalink/policy1532
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC04-17
The Canadian Medical Association advocates for the implementation of a national wait-time monitoring system for a broad range of medical conditions and diagnostic services.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC04-17
The Canadian Medical Association advocates for the implementation of a national wait-time monitoring system for a broad range of medical conditions and diagnostic services.
Text
The Canadian Medical Association advocates for the implementation of a national wait-time monitoring system for a broad range of medical conditions and diagnostic services.
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Bill C-6: An Act Respecting Assisted Human Reproduction and Related Research

https://policybase.cma.ca/en/permalink/policy1620
Last Reviewed
2017-03-04
Date
2004-02-28
Topics
Ethics and medical professionalism
Resolution
BD04-05-92
The Canadian Medical Association reaffirms its position on Bill C-6. [An Act Respecting Assisted Human Reproduction and Related Research]
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-02-28
Topics
Ethics and medical professionalism
Resolution
BD04-05-92
The Canadian Medical Association reaffirms its position on Bill C-6. [An Act Respecting Assisted Human Reproduction and Related Research]
Text
The Canadian Medical Association reaffirms its position on Bill C-6. [An Act Respecting Assisted Human Reproduction and Related Research]
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Tobacco industry donations or grants

https://policybase.cma.ca/en/permalink/policy1882
Last Reviewed
2017-03-04
Date
2004-12-04
Topics
Ethics and medical professionalism
Resolution
BD05-03-57
The Canadian Medical Association recommends and advocates that all Canadian medical schools adopt policies banning donations and/or grants from the tobacco industry.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-12-04
Topics
Ethics and medical professionalism
Resolution
BD05-03-57
The Canadian Medical Association recommends and advocates that all Canadian medical schools adopt policies banning donations and/or grants from the tobacco industry.
Text
The Canadian Medical Association recommends and advocates that all Canadian medical schools adopt policies banning donations and/or grants from the tobacco industry.
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Physicians' professional autonomy and self-regulation

https://policybase.cma.ca/en/permalink/policy73
Last Reviewed
2016-05-20
Date
2002-08-21
Topics
Ethics and medical professionalism
Resolution
GC02-88
That Canadian Medical Association support the divisions in their efforts to maintain professional autonomy and self-regulation for physicians.
  1 document  
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2002-08-21
Topics
Ethics and medical professionalism
Resolution
GC02-88
That Canadian Medical Association support the divisions in their efforts to maintain professional autonomy and self-regulation for physicians.
Text
That Canadian Medical Association support the divisions in their efforts to maintain professional autonomy and self-regulation for physicians.
Documents
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Bill 114, An Act to Ensure the Continued Provision of Emergency Medical Services in Québec

https://policybase.cma.ca/en/permalink/policy1611
Last Reviewed
2016-05-20
Date
2002-08-17
Topics
Ethics and medical professionalism
Resolution
BD02-07-176
That the Canadian Medical Association and its divisions would strongly oppose any government legislation that would undermine the provision of quality patient care and enforce restrictions on the freedom of choice for physicians and patients.
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2002-08-17
Topics
Ethics and medical professionalism
Resolution
BD02-07-176
That the Canadian Medical Association and its divisions would strongly oppose any government legislation that would undermine the provision of quality patient care and enforce restrictions on the freedom of choice for physicians and patients.
Text
That the Canadian Medical Association and its divisions would strongly oppose any government legislation that would undermine the provision of quality patient care and enforce restrictions on the freedom of choice for physicians and patients.
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Notes for an address by Dr. Eugene Bereza, Chair, Committee on Ethics, Canadian Medical Association : Bill C-6 (An act respecting assisted human reproduction) : Presentation to the Senate Standing Committee on Social Affairs, Science and Technology

https://policybase.cma.ca/en/permalink/policy2007
Last Reviewed
2011-03-05
Date
2004-02-18
Topics
Ethics and medical professionalism
  1 document  
Policy Type
Parliamentary submission
Last Reviewed
2011-03-05
Date
2004-02-18
Topics
Ethics and medical professionalism
Text
My name is Dr. Eugene Bereza. I am a physician and clinical ethicist at McGill University Health Centre in Montreal and Chair of the Canadian Medical Association’s Committee on Ethics. I am accompanied today by Dr. Jeff Blackmer, our Director of Ethics. I am here today representing the CMA, but I would also like to advocate on behalf of those patients affected by infertility and those patients suffering, or who will suffer, from the myriad diseases for which medical science is searching out a cure. While there has been considerable debate over the past decade on the moral and ethical issues associated with assisted human reproduction, discussion of this as a health issue has been overlooked all to often. We must remember this is about the practice of medicine and above all, the health of Canadians. My remarks today will focus on the inappropriateness of using criminal sanctions to deal with medical and scientific activities. The Issue It is important to make it clear at the outset that the CMA does not oppose the prohibition of certain medical and scientific activities. Others here today are in a better position to address concerns regarding the specific prohibitions proposed under Bill C-6. Our issue is the means chosen to give effect to these prohibitions and their potential impact on the ability of a physician to ensure the welfare of his or her patients. Criminal law is a blunt instrument. As parliamentarians, you know how difficult it can be to change the law. For some activities prohibited under the criminal law, such as murder and theft, change is not an issue. However, the science of medicine evolves constantly, doubling every 18-24 months. Advances in science and medical practice, coupled with the difficulty of anticipating new developments, make it difficult to adjust the law to remove criminal prohibitions as science and society changes. In the context of prohibiting medical and scientific activities, it is the CMA’s position that the use of criminal law is inappropriate, as it would ultimately not serve our patient’s best interests. Prohibitions, specifically those listed as prohibited activities under Bill C-6, (formerly Bill C-13) could be secured through much less drastic means than criminalization. The CMA proposes that the determination of permissible activities, temporarily or for the longer-term, should be made by the proposed Regulatory Agency working with up-to-date scientific information while providing for public input and ethical review. The Regulatory Agency, as proposed in the Bill, would determine if and when changes in health and safety considerations, public attitudes and values might justify allowing certain formerly prohibited activities to take place under specific conditions. Questions to Consider Bill C-6 begins with the statement: “This enactment prohibits assisted reproduction procedures that are considered to be ethically unacceptable.” However, many Canadians, especially those who are infertile, do not consider some or all of these procedures to be ethically unacceptable nor do the many physicians charged with their care. The CMA questions whether criminal prohibitions are appropriate for dealing with activities about which there is considerable ethical disagreement among Canadians. Legislators in Canada have been justifiably reluctant to use criminal law to deal with medical and scientific issues such as abortion, withdrawal of life-sustaining treatment and the conduct of medical research. Why is an exception being made for assisted reproduction? What sort of precedent will this set for other controversial bioethical issues? What about the chilling effect criminalization will have on research in this important area? For the CMA, the most important question is: what about the patients? What about patients suffering from conditions for which research is banned but may lead to a cure? Should they be denied the opportunity to benefit from this research? Just as Bill C-6 unfairly targets patients, so too does the Bill’s penalties for infractions. Jail terms of up to 10 years and fines up to $500,000 will create a climate of fear and excessive caution for physicians and scientists working in this area. The chill created by these penalties will be such that scientists may well avoid any activity potentially covered by the bill even to the detriment of patient care. The CMA recognizes the good faith among parliamentarians in proposing statutory bans to prohibit certain activities. However, we are convinced in this case the potential for harm outweighs the potential benefits. There is a better way to prohibit these activities while still facilitating important research and necessary treatments. An Alternative Solution Instead of instituting criminal prohibitions within the legislation, the CMA suggest the Assisted Human Reproduction Agency of Canada manage procedures deemed permissible by moving the procedures listed under “Prohibited Activities” to “Controlled Activities.” We recommend that criminal sanctions apply to breaches of agency directives such as performing activities prohibited by the agency and performing controlled activities without a license. Such an approach would have the dual advantage of being able to both prohibit activities deemed unethical while still providing the flexibility to ensure legitimate medical and scientific progress in the treatment of infertility. The regulatory agency should be established as soon as possible and should build on the experience and expertise of existing assisted reproduction organizations and structures that deal with practice standards, education, certification and accreditation. Conclusion The CMA’s overriding concern in addressing this legislation is the well-being of patients, in this case patients who are infertile and patients afflicted by conditions for which medical research offers significant promise of treatment. We support government efforts to regulate assisted human reproduction and related activities, including the prohibition of certain practices temporarily or permanently where necessary. However, we do not believe that criminalization of medical and scientific activities named in the bill is an appropriate way to achieve those objectives. We believe we have advanced a workable alternative within the spirit of the Bill. Thank you.
Documents
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Notes for an address by Dr. Eugene Bereza, Chair, Committee on Ethics, Canadian Medical Association : Bill C-13 - An act respecting assisted human reproduction : Presentation to the House of Commons Standing Committee on Health

https://policybase.cma.ca/en/permalink/policy1963
Last Reviewed
2010-02-27
Date
2002-11-20
Topics
Ethics and medical professionalism
  1 document  
Policy Type
Parliamentary submission
Last Reviewed
2010-02-27
Date
2002-11-20
Topics
Ethics and medical professionalism
Text
BILL C-13 - AN ACT RESPECTING ASSISTED HUMAN REPRODUCTION Presentation to the House of Commons Standing Committee on Health Ottawa, Ontario November 20, 2002 BILL C-13 - AN ACT RESPECTING ASSISTED HUMAN REPRODUCTION Madame Chair and Members of the Committee: My name is Dr. Eugene Bereza. I am a physician and clinical ethicist at the Royal Victoria Hospital in Montreal and Chair of the Canadian Medical Association Committee on Ethics. I am here today representing our members, more than 54,000 physicians from across Canada. I also wish to speak as a advocate for our patients, especially those affected by infertility and those who are or will suffer from diseases for which medical science is searching for cures. I am accompanied today by Dr. John Williams, our Director of Ethics. You will recall that we appeared before this Committee on October 23, 2001 in company with representatives from eight other national health provider and scientific organizations to present our views on draft legislation on assisted human reproduction. Although we were pleased that your December 2001 report recommended the establishment of an assisted reproduction regulatory body outside the Department of Health, we were disappointed that you did not find favour with other recommendations we put forward. The government responded to your report with Bill C-56, now Bill C-13. It is this bill that we are here to address today. Although there are many details in the bill on which we would like either clarification or changes, we intend to focus our remarks on the issue that we consider of greatest importance for our patient’s wellfare and the practice of medicine. That issue is the use of the criminal power to deal with medical and scientific activities. The Standing Committee Report and Bill C-13 In your December 2001 report, you acknowledged our position on this issue: “Some witnesses recommended the elimination of the prohibited activities category altogether. Citing the benefits of regulatory flexibility, they felt that all activities should come under the controlled activity category, including the more reprehensible activities like reproductive cloning for which licences, arguably, would never be allowed under the regulations” (page 9). However, you rejected this view on the grounds that “a licence-related prohibition of this sort would not carry the same weight or degree of social censure as the statutory prohibition…. An outright statutory ban signals more clearly that certain activities are either unsafe or socially unacceptable. The use of the statutory ban also signals that these activities are of such concern to Canadians that their status as a prohibited activity may not be altered except with the approval of Parliament” (page 9). Bill C-13 reflects your views on this matter. We recognize your good faith in proposing and defending this position but we are convinced that its potential for harm outweighs its potential benefits. And so we are pleased to have this opportunity to reiterate the reason why the CMA believes that Bill C-13 will adversely affect the patient-physician relationship and the advance of medical science. Need to Change Bill C-13 As you know, our position on this matter is supported by legal scholars such as Patrick Healy, McGill University Faculty of Law, Tim Caulfield, Director of the University of Alberta Health Law Institute, and Bartha Knoppers, Université de Montréal Centre de Recherche en Droit Publique. In essence, our position is that the criminal law is a blunt instrument and very difficult to change and is therefore appropriate for activities whose status is unlikely to change over time, such as murder and theft, rather than medical and scientific activities that are constantly developing. The latter are better left to a representative regulatory body to determine if and when changes in health and safety considerations and public attitudes and values might justify allowing certain formerly prohibited activities to take place under specific conditions. Bill C-13 begins with the statement: “This enactment prohibits assisted reproduction procedures that are considered to be ethically unacceptable.” This echoes the conclusions in your report. However, as the transcripts of your hearings demonstrate, many Canadians, especially those who are infertile, do not consider some or all of these procedures to be ethically unacceptable. As a matter of public policy, should Canadians who hold this view be denied access to medical treatment for infertility because others consider such treatments to be ethically unacceptable? Should patients who suffer from conditions for which research that is forbidden in Bill C-13 might lead to a cure be denied that opportunity? We question whether criminal prohibitions are appropriate for dealing with activities on which there is considerable ethical disagreement among Canadians. In Canada legislators have been justifiably reluctant to use the criminal law to deal with medical and scientific issues such as abortion, withdrawal of life-sustaining treatment and the conduct of medical research. Why is an exception being made for assisted reproduction? What sort of precedent will this set for other controversial bioethical issues? We are also concerned about the bill’s penalties for infractions: jail terms up to 10 years and fines up to $500,000. These are disproportionate to the penalties for crimes that injure persons or property and, as such, will create a climate of undue fear and excessive caution for physicians and scientists working in this area, such that they will avoid any activity that is potentially covered by the bill, even to the detriment of patient care. Given the rapid advance of science and medical practice and the difficulty of anticipating new developments, it will be difficult to adjust the law to deal with new applications of prohibited activities that may be ethically acceptable. An Alternate Solution The CMA has stated repeatedly that we are not opposed to the prohibition of certain assisted human reproduction activities. Instead of instituting criminal prohibitions within the legislation, we remain convinced that an independent body on an ongoing basis should determine the activities that are permissible or prohibited on the basis of up-to-date scientific research, public input and ethical review. This can be accomplished very easily in Bill C-13 by moving the procedures listed under “Prohibited Activities” (sections 5-9) to “Controlled Activities” and adding the words “except in accordance with the regulations and a licence” to each of the provisions in sections 5-9. Consistent with this recommendation we consider that the regulatory agency should be established as soon as possible and be given as much authority as possible over the matters that Bill C-13, section 65, reserves to regulations of Governor in Council. We hope that the agency will build upon the experience and expertise of existing organizations and structures in the field of assisted reproduction that deal with practice standards, education, certification and accreditation. Conclusion To summarize, we strongly support government efforts to regulate assisted human reproduction and related activities, including the prohibition of certain practices either temporarily or permanently. However, like others who have appeared before this Committee, we do not believe that criminalizing the medical and scientific activities named in the bill is an appropriate way to achieve those objectives. We consider that the objectives could be as well achieved by far less drastic means than criminalization and, moreover, that criminalization would create major obstacles to legitimate medical and scientific progress in the treatment of infertility. We recommend that the proposed agency be empowered to regulate these practices and that the criminal power be invoked when controlled activities are performed without authority of a licence from the agency or in defiance of the licensing conditions established by the agency. Thank you, Madame Chair and members of the Committee. We will be pleased to respond to your questions.
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