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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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Patient bill of health information rights

https://policybase.cma.ca/en/permalink/policy9498
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Health care and patient safety
Health information and e-health
Ethics and medical professionalism
Resolution
GC09-17
The Canadian Medical Association and provincial/territorial medical associations call on governments to engage patients and the public in the development of a patient bill of health information rights that sets out a vision for the governance of patient health information.
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Health care and patient safety
Health information and e-health
Ethics and medical professionalism
Resolution
GC09-17
The Canadian Medical Association and provincial/territorial medical associations call on governments to engage patients and the public in the development of a patient bill of health information rights that sets out a vision for the governance of patient health information.
Text
The Canadian Medical Association and provincial/territorial medical associations call on governments to engage patients and the public in the development of a patient bill of health information rights that sets out a vision for the governance of patient health information.
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Pay for performance and quality measures in family medicine

https://policybase.cma.ca/en/permalink/policy9511
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Health human resources
Ethics and medical professionalism
Physician practice/ compensation/ forms
Resolution
GC09-32
The Canadian Medical Association will develop a discussion paper on international experience and research related to pay for performance and quality measures in family medicine.
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Health human resources
Ethics and medical professionalism
Physician practice/ compensation/ forms
Resolution
GC09-32
The Canadian Medical Association will develop a discussion paper on international experience and research related to pay for performance and quality measures in family medicine.
Text
The Canadian Medical Association will develop a discussion paper on international experience and research related to pay for performance and quality measures in family medicine.
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Training and support for physicians in addiction medicine

https://policybase.cma.ca/en/permalink/policy9524
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Health human resources
Pharmaceuticals/ prescribing/ cannabis/ marijuana/ drugs
Ethics and medical professionalism
Resolution
GC09-78
The Canadian Medical Association calls on national and provincial/territorial medical education and licensing bodies to expand training and support for physicians in addiction medicine, including formal recognition of special skills and improved training and support opportunities for primary care physicians.
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Health human resources
Pharmaceuticals/ prescribing/ cannabis/ marijuana/ drugs
Ethics and medical professionalism
Resolution
GC09-78
The Canadian Medical Association calls on national and provincial/territorial medical education and licensing bodies to expand training and support for physicians in addiction medicine, including formal recognition of special skills and improved training and support opportunities for primary care physicians.
Text
The Canadian Medical Association calls on national and provincial/territorial medical education and licensing bodies to expand training and support for physicians in addiction medicine, including formal recognition of special skills and improved training and support opportunities for primary care physicians.
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Immunization of physicians and other health care providers

https://policybase.cma.ca/en/permalink/policy9530
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Population health/ health equity/ public health
Ethics and medical professionalism
Health human resources
Resolution
GC09-95
The Canadian Medical Association encourages all physicians and other health care providers to be immunized for influenza annually.
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Population health/ health equity/ public health
Ethics and medical professionalism
Health human resources
Resolution
GC09-95
The Canadian Medical Association encourages all physicians and other health care providers to be immunized for influenza annually.
Text
The Canadian Medical Association encourages all physicians and other health care providers to be immunized for influenza annually.
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Pets on airplanes

https://policybase.cma.ca/en/permalink/policy9532
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Ethics and medical professionalism
Health care and patient safety
Resolution
GC09-97
The Canadian Medical Association supports the Canadian Lung Association's call for the House of Commons Standing Committee on Health to study the health impacts of federally regulated airline policies that allow pets to travel in the cabin of airplanes.
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Ethics and medical professionalism
Health care and patient safety
Resolution
GC09-97
The Canadian Medical Association supports the Canadian Lung Association's call for the House of Commons Standing Committee on Health to study the health impacts of federally regulated airline policies that allow pets to travel in the cabin of airplanes.
Text
The Canadian Medical Association supports the Canadian Lung Association's call for the House of Commons Standing Committee on Health to study the health impacts of federally regulated airline policies that allow pets to travel in the cabin of airplanes.
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Electronic health records

https://policybase.cma.ca/en/permalink/policy9543
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Ethics and medical professionalism
Health information and e-health
Health care and patient safety
Resolution
GC09-47
The Canadian Medical Association will work with provincial/territorial medical associations to demand that governments recognize that the flow of information from the patient record to the electronic health records is the professional responsibility of physicians.
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Ethics and medical professionalism
Health information and e-health
Health care and patient safety
Resolution
GC09-47
The Canadian Medical Association will work with provincial/territorial medical associations to demand that governments recognize that the flow of information from the patient record to the electronic health records is the professional responsibility of physicians.
Text
The Canadian Medical Association will work with provincial/territorial medical associations to demand that governments recognize that the flow of information from the patient record to the electronic health records is the professional responsibility of physicians.
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Change initiatives in health care

https://policybase.cma.ca/en/permalink/policy9544
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Health human resources
Resolution
GC09-51
The Canadian Medical Association will incorporate in its Toward a Blueprint for Health Care Transformation: A Framework for Action a call on all levels of governments to ensure that change initiatives in health care be clinically driven from inception to implementation and include appropriate physician representation from practising physicians who are representative of and accountable to their colleagues.
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Health human resources
Resolution
GC09-51
The Canadian Medical Association will incorporate in its Toward a Blueprint for Health Care Transformation: A Framework for Action a call on all levels of governments to ensure that change initiatives in health care be clinically driven from inception to implementation and include appropriate physician representation from practising physicians who are representative of and accountable to their colleagues.
Text
The Canadian Medical Association will incorporate in its Toward a Blueprint for Health Care Transformation: A Framework for Action a call on all levels of governments to ensure that change initiatives in health care be clinically driven from inception to implementation and include appropriate physician representation from practising physicians who are representative of and accountable to their colleagues.
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Impact of health care transformation

https://policybase.cma.ca/en/permalink/policy9545
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Resolution
GC09-53
The Canadian Medical Association will work with provincial/territorial medical associations, affiliates and associates to examine the impact of health care transformation on all aspects of physicians' practices, in a diverse range of settings; primary and specialty care, including the relationship between them; undergraduate and postgraduate education and continuing professional development; and health and health care services for patients.
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Resolution
GC09-53
The Canadian Medical Association will work with provincial/territorial medical associations, affiliates and associates to examine the impact of health care transformation on all aspects of physicians' practices, in a diverse range of settings; primary and specialty care, including the relationship between them; undergraduate and postgraduate education and continuing professional development; and health and health care services for patients.
Text
The Canadian Medical Association will work with provincial/territorial medical associations, affiliates and associates to examine the impact of health care transformation on all aspects of physicians' practices, in a diverse range of settings; primary and specialty care, including the relationship between them; undergraduate and postgraduate education and continuing professional development; and health and health care services for patients.
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Improved practice and patient management techniques

https://policybase.cma.ca/en/permalink/policy9547
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC09-55
The Canadian Medical Association, in collaboration with provincial/territorial medical associations, will incorporate in its Toward a Blueprint for Health Care Transformation: A Framework for Action a call on governments to ensure that resources and training are made available to adequately support physicians' adoption of improved practice and patient management techniques aimed at increasing access and quality.
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC09-55
The Canadian Medical Association, in collaboration with provincial/territorial medical associations, will incorporate in its Toward a Blueprint for Health Care Transformation: A Framework for Action a call on governments to ensure that resources and training are made available to adequately support physicians' adoption of improved practice and patient management techniques aimed at increasing access and quality.
Text
The Canadian Medical Association, in collaboration with provincial/territorial medical associations, will incorporate in its Toward a Blueprint for Health Care Transformation: A Framework for Action a call on governments to ensure that resources and training are made available to adequately support physicians' adoption of improved practice and patient management techniques aimed at increasing access and quality.
Less detail

32 records – page 1 of 4.