Politicians aren’t doctors, and they shouldn’t pretend to be.
Danielle Smith recently announced sweeping changes restricting transgender healthcare across Alberta. I’d argue all of these changes deserve condemnation, but I want to direct particular focus to Smith’s decision to directly interfere in the physician–patient relationship.
Whether you consider yourself a trans ally or not, this should set off alarms for you, no matter where you live in Canada, as there are serious downstream consequences for both the practice of medicine and quality of healthcare, nationwide.
In flagrant disregard of international best practices and rigorously developed clinical protocols, Smith and her government are banning puberty blockers and hormone replacement therapy for all youth under 16, and banning gender-affirming surgeries for everyone under 18. Of note: gender-affirming genital-related surgeries were already banned prior to this announcement. Top surgeries, which involve the removal of breast tissue, are exceedingly rare, and subject to significant preoperative roadblocks and ultimately, physician approval.
I am not a physician, nor am I any kind of expert on the nuances of prescription, diagnosis, or surgery. But I am a social worker—one specifically trained in Carleton’s structural social work model, and taught to examine how policy shapes the experiences of my clients. Through my training, I learned to be wary of ideological or politically motivated interference in healthcare. As soon as I saw Premier Smith’s announcement, I knew this was a case of such interference, and a dangerous precedent for the practice of evidence-based healthcare in Canada.
Let’s give some context to this. Firstly, Danielle Smith’s continued premiership is more precarious than those of most Canadian premiers—her party is new and her predecessor was ousted because of organized far right groups within the Alberta UCP. Second, many far right groups in Canada take their cues from groups in the U.S. that have, for a while now, had their sights set on trans people, and on rolling back our relatively recent gains of inclusion in both education and healthcare. Finally, with two Canadian provinces already jumping on the “parental rights” wedge issue, Smith was undoubtedly pressured to follow suit—and go further. Doing so signals that she’s ready to play ball on social issues to the far right base whose approval her continued political success is dependent on.
Now, provincial governments obviously play an integral role in healthcare, but the specifics of clinical protocol, standards and practice are regulated by professional bodies like the College of Physicians and Surgeons of Alberta. Why? Because politicians are not qualified to understand the intricacies of medicine, medical research or medical ethics. One of the strongest quality checks on Canadian healthcare is that our health professionals are self-regulating. What happens if government overreach is allowed to encroach upon and erode professional autonomy? If we open this door and permit politicians to dictate the practice of medicine, it will lead to interference in other areas far outside the realm of trans healthcare
In my view, this isn’t actually about gender-affirming care at all, but about breaking new ground in social conservatives’ fight to ban abortion. Take the Campaign Life Coalition, the most powerful pro-life lobby in Canada. They’ve put their weight behind banning gender-affirming care. Why? Because if they can spin controversy and misinformation to turn the public against gender-affirming care, it sets a precedent, making it easier to ban other things, while normalizing political interference in healthcare at the expense of both patients’ freedoms and physicians’ professional autonomy.
Perhaps, the best way to support effective care for trans youth isn’t for politicians to put themselves between physicians and their patients, but to work with physicians and hospitals to ensure they have well resourced gender-affirming care programs able to provide every patient—and their families—with the wraparound services and supports they need. Gender-affirming care clinics in Canada often have years-long wait lists and lack sustainable funding. While they do their best, they’re chronically under-resourced, making it harder for every patient to get the quality care they deserve. If Premier Smith’s concern had been genuine, rather than rooted in political self-interest, she’d work with physicians to improve care, instead of dictating radical changes to their established best practices.
At the end of the day, we all deserve a healthcare system based on evidence, with policies and protocols crafted with care. We must guard our health systems from ideologically-motivated interference, because such interference threatens the very bedrock and scientific integrity of Canadian healthcare. Premier Smith’s changes are not in the best interest of children, youth and families, or medical practitioners. If changes are needed to the established approach to gender-affirming care and youth, such changes must be determined by the guiding bodies of physicians, not politicians, and they must center the needs of young trans people and their families. For the sake of our health system’s integrity and the vulnerable youth in question, Premier Smith must go back to the drawing board.
Fae Johnstone is the Executive Director of Queer Momentum