Alberta Regulator Affirms Doctors Can Decline Referral for Morally Objectionable Services

The College of Physicians and Surgeons of Alberta (CPSA) is updating its Standards of Practice to address worries about compelling healthcare professionals to endorse morally objectionable medical services such as abortion, medical assistance in dying (MAID), and gender-affirming care. The draft document reveals the elimination of the term “effective referral,” which mandates physicians who conscientiously object to a service to refer patients to a willing practitioner.

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

“Forcing a doctor to make an ‘effective referral’ is to force them to participate in a procedure against their medical judgment and their conscience,” Pete Baklinski, communications director of Campaign Life Coalition, said in a Jan. 12 news release.

“In essence, many doctors of conscience see making an effective referral as them being the first domino in a series of events that result in what they view as a negative outcome for their patient.”

The Campaign Life Coalition (CLC) voiced approval of this alteration, highlighting concerns about the potential violation of doctors’ conscience rights.

“Now, more than ever before, it’s time for Alberta healthcare professionals to unite and demand that their Charter-guaranteed right to ‘freedom of conscience’ be respected and protected in provincial law,” CLC National President Jeff Gunnarson said.

The CLC advocates for legal measures to safeguard the conscience rights of healthcare workers, stressing the importance of Alberta professionals coming together to assert and secure Charter-guaranteed “freedom of conscience” within provincial law.

Pete Baklinski, Communications Director of CLC, emphasized that numerous doctors view the requirement for an effective referral as a compromise to their medical judgment and conscience, potentially leading to outcomes they consider unfavorable for patients. Recognizing grassroots initiatives in Alberta, Baklinski pointed out a November resolution advocating protection against third-party interference and the preservation of doctors’ rights to refrain from prescribing treatments they find disagreeable.

“Last November, grassroots members of the UCP passed a resolution (Policy proposal 16) at the party’s AGM calling for protection for Alberta physicians from ‘undue third-party interference,’ while, at the same time, calling for protections for doctors from being compelled to ‘prescribe treatments’ with which they disagreed,” he said. “Albertans want to protect the conscience rights of doctors. Now is the perfect time.

The choice to eliminate the “effective referral” clause aligns with the broader Canadian context, where discussions about extending Medical Assistance in Dying (MAID) services to individuals with mental illness are ongoing. Initially restricted to terminally ill patients after legalization in 2016, amendments in 2020 expanded eligibility to those with deaths not deemed “reasonably foreseeable.”

Parliament further adjusted eligibility in 2021, temporarily excluding individuals with mental illness until March 2024. In December 2023, Justice Minister Arif Virani hinted at assessing information from medical experts, parliamentary committees, and stakeholders to determine whether to proceed or pause the expansion of MAID for mental illness by March 17.

“We’ll evaluate all of that comprehensively to make a decision whether we move ahead on March 17, or whether we pause,” he told The Canadian Press in a wide-ranging interview.Both options are “on the table,” he added.

The CPSA’s choice to eliminate the term “effective referral” corresponds with ongoing discussions about conscience rights and controversial medical services in both Alberta and Canada.