President's Letter: NLMA Supports the AMA Call to Remove Government Interference from Medical Decision-making

President’s Letter: NLMA Supports the AMA Call to Remove Government Interference from Medical Decision-making

Dear Colleagues:

The NLMA wishes to offer its support for the Alberta Medical Association (AMA), the AMA Section of Pediatrics and the AMA Section of Child and Adolescent Psychiatry positions that gender-affirming treatments are a medical decision that should not involve political interference.

Earlier this month, the Government of Alberta announced plans to restrict access to gender affirming treatments for pediatric Transgender, Two-Spirit, and Gender Diverse (TTGD) youth. All gender-affirming surgeries for minors aged 17 and under will be prohibited. The use of gender affirming puberty blockers and hormone therapies for medical transition will not be permitted for those under the age of 16, and those aged 16-17 will require physician and psychologist approval and parental consent to treatment.

While the Alberta government maintains that the intention of its policies is to protect children from making decisions that may have irreversible impacts on their body, these policies will have unintended consequences, including putting the health and safety of TTGD youth at risk. As the AMA notes, TTGD youth experience significant minority stress and barriers in the world on the basis of their gender identity, which results in higher rates of mental illness, addictions, suicidality, and poorer quality of life. Puberty blockers offer a temporary, reversible pause that allow youth to explore their gender identity without experiencing the distress of pubertal changes that don’t align with their sense of self. Gender-affirming genital surgery in Canada is already limited to patients aged 18 and over.

Decisions to provide medical intervention to treat gender dysphoria are not taken lightly. They are based on medical evidence, diagnostic criteria, comprehensive biopsychosocial assessments and extensive consultations about the risks and benefits with the patient, their family and a team of medical and allied health professionals. Physicians work collaboratively to ensure that TTGD youth who do engage in gender-affirming care are engaged in the complete assessment process and have the capacity to provide informed consent.

During the press conference announcing the new policies, Alberta Premier Danielle Smith was asked by the Globe and Mail if there will be penalties for physicians who assist TTGD youth and their families who travel to other provinces to receive gender-affirming health care. The premier would not definitively answer the question and alluded that the province was determining what issues need to be legislated or put into regulation to implement its policies.

This over-reach by the Alberta government is very concerning for the medical community. Government must not interfere in the doctor-patient relationship by limiting access to evidence-based medical treatments. The NLMA supports the AMA’s call for the Alberta government, and other provincial governments that have taken similar positions, to stop interfering in health care decision making with mandates that run contrary to the evidence and integrity of established medical practice.

The position of the AMA Section of Pediatrics is available here and the statement from the AMA Section of Child and Adolescent Psychiatry is available here.