Medical Matters: Balancing freedom of expression and professional responsibilities

Read time: 3 minutes

By Dr. Scott McLeod, CPSA Registrar & CEO and Dr. Jaelene Mannerfeldt, CPSA Council Chair

Unsurprisingly, there has been a lot of media coverage on the future of health care in Alberta as of late and one such topic that has been heavily debated is freedom of expression as it relates to regulated professionals. While we can’t speak for all health professionals, we thought it was important to share CPSA’s perspective as draft legislation is debated.

There seems to be an impression that we at CPSA have a desire to limit physicians’ freedom of speech. The reality is that we support physician’s freedom of speech, and we encourage physicians to express their opinions and share their thoughts. As physicians we are taught the value of advocacy early in our careers. In fact, “medical advocate” is a core competency outlined in the CanMEDS framework for the competencies needed for medical education and practice.

So why then is there a perception that the regulator is intent on limiting physicians’ freedom of speech? We can’t guess what others may be thinking; however, the most obvious would be related to recent cases where complaints have been made against physicians who spoke out during the pandemic. Whether that was related to comments about public health protocols or treatment options for COVID-19, there were a handful of physicians that had complaints submitted against them based on comments they made.

It’s important to note that as a regulator, we are obligated by law to address each complaint that comes forward. Our job is to collect the evidence and determine if there is sufficient evidence to demonstrate the physician failed to meet a Standard of Practice or the Code of Ethics and Professionalism.

Since this is November and we have just passed Remembrance Day, it is important to recognize that Canada is a country that enjoys significant freedoms that many countries around the world don’t have. However, the reality is that freedom is not free. Many thousands of Canadians have given their lives for the freedoms we enjoy today and therefore we all have a responsibility to maintain our freedoms. That is why Canada’s Charter of Rights and Freedoms has limitations in it.

Physicians hold a position of trust in society and that trust must be maintained to ensure all physicians can practise effectively. That is why the Code of Ethics and Professionalism advises physicians to “provide opinions consistent with the current and widely accepted views of the profession when interpreting scientific information to the public; clearly indicate when you present an opinion that is contrary to the accepted views of the profession.”

Note that the Code does not actually limit a physician from providing an opposing position, rather it states that you must clearly state your opinion is in opposition to the consensus of others. This is important because new ideas must be shared. The whole principle of the scientific method is to come up with new theories. However, the scientific method is not about public debate of the theories. The second and most important part of the scientific method is the research required to safely assess those theories. Randomly trying treatments on sick patients is inappropriate experimentation that can put people in harms way.

One other key statement from the Code of Ethics and Professionalism that’s important to reflect on is “A humble physician acknowledges and is cautious not to overstep the limits of their knowledge and skills or the limits of medicine, seeks advice and support from colleagues in challenging circumstances, and recognizes the patient’s knowledge of their own circumstances.”

It is impossible for a physician to have expertise in all areas of medicine. That is why an undergraduate MD degree is followed by specialty training. Physicians are expected to practise medicine within their area of expertise. Making public comments about specialties we are not qualified to practise is dangerous. This leads to confusion for Albertans at times when they look to medical professionals for their expertise. A cardiologist making comments about the prevention and treatment of heart disease is what we should expect, but that same cardiologist should likely not be making comments about the value of joint replacement surgery.

Just as we continuously review our Standards of Practice, with input from our regulated members, health care partners, government, and Albertans, to ensure CPSA is providing reasonable and up-to-date expectations, reviewing legislation can be a good thing. For example, we do see our complaints process used inappropriately at times, such as complaints made against physicians who are expressing their opinions that fall outside clinical responsibilities. As mentioned above, we still have an obligation to address the complaint under current legislation. Having some freedom to automatically dismiss some complaints could help CPSA in the work we do.

For that reason, we look forward to finding language that strikes the right balance of allowing physicians the freedom to express their opinions with their responsibilities as a professional to protect the public. Finding the correct balance will be tricky and it will take considerable consultation prior to any final legislation.

As we mentioned, this has been a highly debated topic as of late and we think it’s important to share and hear others’ perspectives—including yours. Regulated members, please keep an eye on your inbox in the coming days for a chance to share more feedback on this topic.

We have also included some recent opinion pieces below to offer a broader perspective on this topic.

• Opinion: Better balance needed between free speech and professional regulation by Collin May
• Opinion: Legislation a ‘sledgehammer’ for professional regulators by James T. Casey
• Free speech and reasonable limits by Gregory D. Sim