I am at the Canadian Medical Association’s AGM in Montreal – and was here in time on Monday to listen to the federal Minister of Health address the doctors of Canada.
It was a speech that was remarkable not because of what was said, but because of what was left out.
Three quarters of the lengthy speech was an ideological rant about substance abuse; specifically, the safe injection site in Vancouver.
We know what the Harper government thinks about Vancouver’s Insite…they oppose it vehemently. They repeated this at the recent WHO conference. They are challenging the BC Supreme Court's favourable ruling on the matter.
The Canadian Medical Association is on record as supporting the project, because it has been shown, in clinical trials, to be an important part of a national drug strategy.
The Minister could have made a brief statement reiterating his government's position and moved on to other important matters like wait times, critical physician shortages or food safety. He could have elaborated more on mental health issues, a key topic at the CMA meeting.
Instead, Mr Clement took umbrage at the CMA's support of Insite. He then lectured physicians on what he believes should constitute appropriate clinical practice. He even used the analogy of palliative care... injecting terminally ill patients with heroin, rather than treating their cancer. To be honest, he lost me there, as I had absolutely no idea what he was talking about. The buzz in the room confirmed that no one else in the room did either.
He continued to lecture on the immorality of safe injection as a harm reduction measure. He accused physicians who participated and supported it as being unethical. He elaborated at length on the ethics of clinical treatment in general.
‘Stunned’ is the only way I could describe the reaction of the doctors and other health care professionals in the room. Was the Minister warning us all that his government will decide what care physicians should be allowed to give their patients in the future?
I always thought that diagnosis, treatment, and appropriate intervention in illness was based on internationally accepted clinical practice guidelines. I thought that medical care was decided between the doctor and the patient!
Yet, here was Big Brother getting involved…suggesting what should and should not be done within the scope of clinical practice.
There is a code of ethics under which physicians are required to practice that dates back to Hippocrates and has been cautiously and rigorously updated as scientific knowledge has expanded. Now it seems as if the Harper government wants to change that to suit their own ideology.
It is to the credit of the members of my profession, that they reacted with polite restraint to the Minister's speech.
The Chair of the ethics Committee of the CMA read a response that calmly and gently warned the Minister that ideology should not be the rationale for good public policy. Indeed, that is unethical for a government to do so.
Canadians should not be so calm. They should fear for the future of medical practice and for quality of care.
When a government, hell-bent on ideology, moves outside its scope as public policy maker and assumes the mantle of medical practitioner; moves from the Houses of Parliament and into the OR’s, ER’s and bed-sides of the patient…
It is time to be very afraid.
