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CMA PolicyBase

Policies that advocate for the medical profession and Canadians


13 records – page 1 of 2.

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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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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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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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.
Documents
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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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Examination of adverse events

https://policybase.cma.ca/en/permalink/policy11692
Last Reviewed
2019-03-03
Date
2008-08-20
Topics
Health systems, system funding and performance
Health care and patient safety
Ethics and medical professionalism
Resolution
GC08-115
The Canadian Medical Association calls on regulatory agencies, hospitals, health regions and others to utilize a non-punitive quality improvement approach to the examination of adverse events while still acknowledging individual accountability.
Policy Type
Policy resolution
Last Reviewed
2019-03-03
Date
2008-08-20
Topics
Health systems, system funding and performance
Health care and patient safety
Ethics and medical professionalism
Resolution
GC08-115
The Canadian Medical Association calls on regulatory agencies, hospitals, health regions and others to utilize a non-punitive quality improvement approach to the examination of adverse events while still acknowledging individual accountability.
Text
The Canadian Medical Association calls on regulatory agencies, hospitals, health regions and others to utilize a non-punitive quality improvement approach to the examination of adverse events while still acknowledging individual accountability.
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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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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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Prescriber profiles

https://policybase.cma.ca/en/permalink/policy589
Last Reviewed
2017-03-04
Date
1996-05-04
Topics
Ethics and medical professionalism
Resolution
BD96-08-241
That the Canadian Medical Association and the divisions continue to denounce the current inappropriate collection and use of prescriber profiles by private industry and insist that any further collection, sale and other use of prescriber profiles be conducted in an ethical and legal manner (including individual physician knowledge and consent).
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
1996-05-04
Topics
Ethics and medical professionalism
Resolution
BD96-08-241
That the Canadian Medical Association and the divisions continue to denounce the current inappropriate collection and use of prescriber profiles by private industry and insist that any further collection, sale and other use of prescriber profiles be conducted in an ethical and legal manner (including individual physician knowledge and consent).
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That the Canadian Medical Association and the divisions continue to denounce the current inappropriate collection and use of prescriber profiles by private industry and insist that any further collection, sale and other use of prescriber profiles be conducted in an ethical and legal manner (including individual physician knowledge and consent).
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Statement to the Canadian panel on violence against women Ottawa -September, 1992

https://policybase.cma.ca/en/permalink/policy11956
Last Reviewed
2019-03-03
Date
1992-09-15
Topics
Health care and patient safety
Ethics and medical professionalism
  1 document  
Policy Type
Parliamentary submission
Last Reviewed
2019-03-03
Date
1992-09-15
Topics
Health care and patient safety
Ethics and medical professionalism
Text
The CMA is pleased to have this opportunity to address the Canadian Panel on Violence Against Women. As a professional organization with a leadership role in societal issues affecting health, it is both appropriate and important for the CMA to be actively involved in addressing the problems associated with violence. The extremely high incidence of abuse, the associated severe physical, mental and psychological health problems and the significant role played by physicians in recognizing and caring for victims make this a priority for organized medicine. The CMA has significant experience and expertise in this field. In 1984, the CMA General Council passed a resolution stating: "That Health and Welfare Canada and the Provincial Ministries of Health and Education alert the Canadian public to the existence of family violence, including wife assault, child abuse, and elder abuse, and to the services available which respond to these problems, and that organized medicine (through such vehicles as professional journals, newsletters, conferences and formal medical education) alert the physicians of Canada to the problem and that all physicians learn to recognize the signs of family violence in their daily contact with patients and undertake the care and management of victims using available community resources." (Resolution #84-47) The CMA calls the Panel's attention to four major areas of concern: Recognition and Treatment, Education and Training, Protocol Development and Research. 1. Recognition and Treatment: Recognition includes acknowledging the existence and prevalence of abuse and identifying victims of violence. Violence against women is clearly a health issue and one that should be given a very high priority. Statistics indicate that nearly one in eight Canadian women will be subject to spousal violence in her lifetime and that one in five will be a victim of sexual assault. Violence against women is a major determinant of both short -and long-term health problems including traumatic injury, physical and psychological illnesses, alcohol/drug addiction and death. Furthermore, although it is critically important to recognize that abuse crosses all racial and socio-economic boundaries, there are strong indications that certain groups are particularly vulnerable to abusive acts (e.g., pregnant, disabled and elderly women). Recognition includes acknowledging and understanding the social context within which violence occurs. Violence is not an isolated phenomenon, but is part of the much broader issue of societal abuse of women. Physicians are often the first point of contact for patients who have been abused physically, sexually, mentally and/or psychologically. They have a vital role to play in identifying victims and providing treatment and supportive intervention including appropriate referral. Abuse is not always readily apparent, however, and may go undetected for extended periods of time. Numerous studies have shown that both physicians and patients often fail to identify abuse as an underlying cause of symptoms. Such delays can result in devastating and sometimes fatal consequences for patients. Even in those cases where abuse is apparent, both physicians and patients often feel uncomfortable talking openly about the abuse and the circumstances surrounding it. It is the physician's role and responsibility to create a safe and supportive environment for the disclosure and discussion of abuse. Furthermore, the lack of resources for support services or the lack of awareness of what services are available to provide immediate and follow-up care to patients in need may discourage physicians from acknowledging the existence of abuse and identifying victims. It is clear that improvement in the ability and the degree to which victims of abuse are recognized and given appropriate assistance by physicians and other caring professionals in a non-threatening environment is urgently required. Individuals who are abused usually approach the health care system through primary contact with emergency departments or other primary care centres. The care available in such settings is acute, fragmented and episodic. Such settings are not appropriate for the victims of violence. The challenge that we, as physicians, recognize is to be able to provide access in a coordinated way to medical, social, legal and other support services that are essential for the victim of violence. This integration of services is essential at the point of initial recognition and contact. The CMA has been involved with eight other organizations in the Interdisciplinary Project on Domestic Violence (IPVD), the primary goal of which is to promote interdisciplinary co-operation in the recognition and management of domestic violence. 2. Education and Training: The spectrum of abuse is complex; the victims are diverse; expertise in the field is developing. The current system of medical education neither provides health care personnel with the knowledge or skills nor does it foster the attitude to deal adequately with this issue. Some of CMA's divisions have played an active role in this area. For instance, the Ontario Medical Association has developed curriculum guidelines and medical management of wife abuse for undergraduate medical students. It is ,important that there be more involvement by relevant medical groups in developing educational and training programs and more commitment from medical educators to integrate these programs and resources into the curriculum. Programs must be developed and instituted at all levels of medical education in order that physicians can gain the requisite knowledge and skills and be sensitive to the diversity of victims of violence. The CMA believes that the educational programs must result in: 1) understanding of the health consequences of violence; 2) development of effective communication skills; and, 3) understanding of the social context in which violence occurs. Understanding of the social context in which violence occurs will require an examination of the values and attitudes that persist in our society, including a close consideration of the concepts of gender role socialization, sexuality and power. This is required in order to dispel the pervasive societal misconceptions held by physicians and others which act as barriers to an effective and supportive medical response to patients suffering the effects of violence. 3. Development of Protocols: The CMA recognizes the need for more effective management and treatment of the spectrum of problems associated with violence against women. Health care facilities, professional organizations and other relevant groups are challenged to formulate educational and policy protocols for integrated and collaborative approaches to dealing with prevention of abuse and the management of victims of violence. The CMA and a number of its divisions have been active in this area:
In 1985, the CMA prepared and published Family Violence: Guidelines for Recognition and Management (Ghent, W.R., Da Sylva, N.P., Farren, M.E.), which dealt with the signs and symptoms, assessment and management, referral assistance and medical records with respect to wife battering, child abuse and abuse of the elderly;
The Ontario Medical Association published Repons on Wife Assault in January 1991. This document, endorsed by the CMA, examines the problem of wife assault from a medical perspective and outlines approaches to treatment of the male batterer and his family;
The Medical Society of Nova Scotia has developed a handbook entitled Wife Abuse: A Handbook for Physicians, advising on the identification and management of cases involving the battering of women;
The New Brunswick Medical Society has produced a series of discussion papers on violence and in conjunction with that province's Advisory Council on the Status of Women, has produced a graphic poster depicting physical assault on pregnant women as a way of urging physicians to be alert for signs of violence against women; The Medical Society of Prince Edward Island has worked cooperatively with the provincial Department of Health and Social Services and the Interministerial Committee on Family Violence to produce a document entitled Domestic Violence: A Handbook for Physicians. The CMA encourages continued involvement by the medical profession in the development of initiatives such as these and welcomes the opportunity to work in collaboration with other professionals involved in this area. 4. Research The CMA has identified violence against women as a priority health issue. Like rriany other areas in women's health, there is a need for research focusing on all aspects of violence and the associated problems. More specifically, the CMA maintains that there should be more research on the incidence of abuse (particularly as it relates to particular groups), on ways to facilitate the disclosure by victims of abuse and on the effectiveness of educational and prevention programs. The CMA recognizes that the medical profession must show a greater commitment to ending abuse of women and providing more appropriate care and support services to those who are victims of violence. The CMA possesses unique skills and expertise in this area and welcomes the opportunity to work with the Panel on this challenging social and health problem.
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13 records – page 1 of 2.