general motions in order of debate · pdf filegeneral motions . in order of debate. the order...

General Motions In order of debate

The order of debate for general motions has been established by the Resolutions Committee in relation to relevance, fit and focus to the CMA’s strategic objectives and priorities.

1. GM5 - 21 2. GM5 - 5 3. GM5 - 13 4. GM5 - 14 5. GM5 - 8 6. GM5 - 3 7. GM5 - 19 8. GM5 - 1 9. GM5 - 15 10. GM5 - 26

150th GENERAL COUNCIL – Québec 2017 GENERAL MOTIONS

IN ORDER OF DEBATE

Confidential│Page 1 of 2

MOTION GM 5-21 MOVER Dr. Ruth Vander Stelt SECONDER Dr. Frantz-Daniel Lafortune The Canadian Medical Association will develop a national guide on levels of medical intervention for use across the continuum of care. MOTION GM 5-5 MOVER Dr. Jessica Otte SECONDER Dr. Bradley Fritz The Canadian Medical Association supports fulfillment of advance requests for medical assistance in dying in cases in which a person who was competent at the time an advance request was legally completed subsequently becomes incompetent. MOTION GM 5-13 MOVER Dr. Andrew Clarke SECONDER Dr. Barbara Blumenauer The Canadian Medical Association supports a review of Canada’s medical liability system and an evaluation of alternative models, including no-fault systems. MOTION GM 5-14 MOVER Dr. Janice Wong SECONDER Dr. Mark Corbett The Canadian Medical Association supports a policy of opt-out rather than opt-in for disability insurance protection offered to medical students and residents in all Canadian jurisdictions. MOTION GM 5-8 MOVER Dr. Barbara Blumenauer SECONDER Dr. David May The Canadian Medical Association calls for mandatory labelling, warnings and a recall system for prescription pharmaceuticals sold in Canada that contain gluten and/or priority allergens.

150th GENERAL COUNCIL – Québec 2017 GENERAL MOTIONS

IN ORDER OF DEBATE

Confidential│Page 2 of 2

MOTION GM 5-3 MOVER Dr. Nitasha Puri SECONDER Dr. Vanessa Brcic The Canadian Medical Association recommends that MD Financial Management Inc. utilize a socially responsible investing approach in managing all of its investment portfolios. MOTION GM 5-19 MOVER Dr. Andrew Clarke SECONDER Dr. Jesse Kancir The Canadian Medical Association will work with stakeholders in medical education to encourage awareness of the difference between non-commissioned financial/insurance advisers employed by national and provincial/territorial medical associations and commissioned financial/insurance advisers employed by banks and other corporations. MOTION GM 5-1 MOVER Dr. Charles Webb SECONDER Dr. Eric Cadesky The Canadian Medical Association will create an electronic portal to allow locally led and potentially politically active medical organizations to upload their contact information. MOTION GM 5-15 MOVER Dr. Eric Cadesky SECONDER Dr. Charles Webb The Canadian Medical Association will expand its provincial and territorial medical association PolicyBase to include submissions from grassroots medical organizations across the country. MOTION GM 5-26 MOVER Dr. Hasan Sheikh SECONDER Dr. Danyaal Raza The Canadian Medical Association will support new projects and mechanisms to facilitate the expansion and increase the scale of innovative health system pilot projects in Canada.

General Motion: GM5-21 Mover: Dr. Ruth Vander Stelt

Seconder: Dr. Frantz-Daniel Lafortune

Motion: The Canadian Medical Association will develop a national guide on levels of medical intervention for use across the continuum of care.

Existing policy check x The motion does not duplicate an existing motion. The motion is not an immaterial variation of an existing motion.

1. Why is a policy needed on this issue at this time and what supportive evidence exists that requires policy development in this area?Recent legislative changes and debates concerning medical assistance in dying have served to highlight the principles of patient dignity and shareddecision making. Differences in end-of-life care practices and tools—such as those used to determine levels of medical intervention (LMI)—cancause substantial discomfort for physicians and disparities in health care options for patients. This is why the Quebec Medical Association, togetherwith the Institut national d’excellence en santé et services sociaux, conducted a field study on the matter (the only study of its kind in NorthAmerica). The results were conclusive: LMIs must be standardized in order to ensure consistency and continuity of care. A distinction must also bedrawn between drafting a LMI—considered a medical procedure—and an advance medical directive, which is left up to the patient.

2a. Please describe how the criteria of relevance, fit and focus, as described below, support the consideration of your motion: Relevance (The issue resonates with CMA members and solves their problem(s) and makes their lives easier) Fit (The CMA is in the best position to make a significant impact on this and there is no other organization whose primary mandate relates to the issue) Focus (The issue and scope is clearly defined and there is a niche area within this issue) CMA can leverage its national influence and leadership to make provinces/territories and their institutions aware of the importance of LMI use and standardization. The process not only recognizes the concept of the patient as partner by facilitating dialogue between patients, relatives, physicians and care teams in the early stages of an illness, but it also optimizes patient intake at health care facilities, the work of pre-hospital care providers, the consistency of the continuum of care and, of course, the practice of medicine.

2b. What other organization, apart from the CMA, would be best positioned to advance this issue? Physicians and managers in health and social services institutions.

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General Motion: GM5-5 Mover: Dr. Jessica Otte

Seconder: Dr. Bradley Fritz

Motion: The Canadian Medical Association supports fulfillment of advance requests for medical assistance in dying in cases in which a person who was competent at the time an advance request was legally completed subsequently becomes incompetent.

Existing policy check x The motion does not duplicate an existing motion. x The motion is not an immaterial variation of an existing motion.

1. Why is a policy needed on this issue at this time and what supportive evidence exists that requires policy development in this area? Advance directives were recommended by both the provincial/territorial expert advisory group and a joint House-Senate Committee that examined assisted dying in Canada. There is general agreement that if requests are to be allowed in advance, the individual must be competent at the time the advance request is drafted. The report of the Special Joint Committee on Physician-Assisted Dying recognized that an advance request could be considered in the following situations: - where a person’s request has been accepted but the individual loses competence before medical assistance in dying (MAiD) takes place; - where a person has been diagnosed with a grievous and irremediable condition but is not yet experiencing enduring and intolerable suffering; - […] Advance requests prevent the suffering of someone who has been approved for MAiD but then loses competence and must continue to suffer. It also prevents individuals from ending their lives earlier than they would otherwise in order to avoid losing competence before the suffering becomes intolerable, something which was a major factor in the Carter case.

2a. Please describe how the criteria of relevance, fit and focus, as described below, support the consideration of your motion: Relevance (The issue resonates with CMA members and solves their problem(s) and makes their lives easier) Fit (The CMA is in the best position to make a significant impact on this and there is no other organization whose primary mandate relates to the issue) Focus (The issue and scope is clearly defined and there is a niche area within this issue) End-of-life care and medical assistance in dying is one of the topics for this year's General Council meeting. CMA is well positioned to lead a discussion on advance requests for MAiD.

2b. What other organization, apart from the CMA, would be best positioned to advance this issue? National and provincial/territorial Colleges, provincial/territorial medical associations, federal and provincial/territorial governments, medical schools.

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General Motion: GM5-13 Mover: Dr. Andrew Clarke

Seconder: Dr. Barbara Blumenauer

Motion: The Canadian Medical Association supports a review of Canada’s medical liability system and an evaluation of alternative models, including no-fault systems.


1. Why is a policy needed on this issue at this time and what supportive evidence exists that requires policy development in this area? The Canadian Medical Protective Association (CMPA) premium rates have risen significantly over the last few years with no clear limit on future costs and a lack of clarity as to whether provincial/territorial governments will continue to subsidize the majority of the professional liability fee. There are significant differences in CMPA premiums by region and specialty. Current premium rates are substantially higher for certain specialties, including orthopedics, obstetrics and gynecology, and neurosurgery. Current costs may be a barrier to continued physician supply especially in rural areas or for certain specialties. No-fault insurance models may offer benefits including streamlined processes, and avoidance of lengthy litigation. As such, there should be a review of the Canadian medical liability system and an evaluation of alternative models, including “no-fault systems”.

2a. Please describe how the criteria of relevance, fit and focus, as described below, support the consideration of your motion: Relevance (The issue resonates with CMA members and solves their problem(s) and makes their lives easier) Fit (The CMA is in the best position to make a significant impact on this and there is no other organization whose primary mandate relates to the issue) Focus (The issue and scope is clearly defined and there is a niche area within this issue) Medical liability insurance rates impact all physicians. CMPA premium rates have risen significantly over the last few years and there are differences in rates by region and specialty in Canada. CMA is well positioned to call for a review of the Canadian medical liability system and an evaluation of alternative models, including “no-fault systems”.

2b. What other organization, apart from the CMA, would be best positioned to advance this issue? Canadian Medical Protective Association, provincial/territorial medical associations, provincial/territorial governments.

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General Motion: GM5-14 Mover: Dr. Janice Wong

Seconder: Dr. Mark Corbett

Motion: The Canadian Medical Association supports a policy of opt-out rather than opt-in for disability insurance protection offered to medical students and residents in all Canadian jurisdictions.


1. Why is a policy needed on this issue at this time and what supportive evidence exists that requires policy development in this area? While most provincial and territorial medical associations offer appropriate disability insurance plans to medical students and residents, a small proportion of the most vulnerable trainees remain unprotected because they postpone making a decision about purchasing disability insurance until they are uninsurable. CMA recommends that all medical schools and all provincial/territorial members of Resident Doctors of Canada adopt a choice architecture that sees trainees automatically enrolled in a basic disability insurance plan until such time as they make a conscious choice to obtain alternative coverage.

2a. Please describe how the criteria of relevance, fit and focus, as described below, support the consideration of your motion: Relevance (The issue resonates with CMA members and solves their problem(s) and makes their lives easier) Fit (The CMA is in the best position to make a significant impact on this and there is no other organization whose primary mandate relates to the issue) Focus (The issue and scope is clearly defined and there is a niche area within this issue) CMA has identified physician health as a growing priority. Ensuring all medical students and residents have appropriate disability insurance plans will protect those who are in training and vulnerable. As such, CMA is well positioned to support a policy that ensures all medical students and residents have appropriate disability insurance plans.

2b. What other organization, apart from the CMA, would be best positioned to advance this issue? CMA, medical schools, Resident Doctors of Canada, provincial/territorial medical associations.

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General Motion: GM5-8 Mover: Dr. Barbara Blumenauer

Seconder: Dr. David May

Motion: The Canadian Medical Association calls for mandatory labelling, warnings and a recall system for prescription pharmaceuticals sold in Canada that contain gluten and/or priority allergens.


1. Why is a policy needed on this issue at this time and what supportive evidence exists that requires policy development in this area? Celiac disease is a life-threatening disease present in 1 in 130 Canadians requiring complete avoidance of gluten. Current food labelling regulations make it easier for those with Celiac disease to select safe food and be warned if undeclared gluten is present. However, no such laws exist for prescription medications, making it difficult if not impossible to determine if medication is free of gluten or other priority allergens. Mandatory labelling of gluten and other priority allergens in prescription pharmaceuticals is necessary so Celiac patients can receive safe and timely care, and be warned if medications are inadvertently found to contain gluten or other priority allergens. Additionally, a warning and recall system should be in place for gluten and other priority allergens present in prescription pharmaceuticals, similar to the recall systems in place for food in Canada.

2a. Please describe how the criteria of relevance, fit and focus, as described below, support the consideration of your motion: Relevance (The issue resonates with CMA members and solves their problem(s) and makes their lives easier) Fit (The CMA is in the best position to make a significant impact on this and there is no other organization whose primary mandate relates to the issue) Focus (The issue and scope is clearly defined and there is a niche area within this issue) In order for physicians to provide the most effective and safe care to Celiac patients, there must be warnings if medications are inadvertently found to contain gluten. CMA is well positioned to encourage stakeholders to work together to address this particular issue.

2b. What other organization, apart from the CMA, would be best positioned to advance this issue? Health Canada, federal and provincial/territorial governments, provincial/territorial and national pharmacy associations.

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General Motion: GM5-3 Mover: Dr. Nitasha Puri

Seconder: Dr. Vanessa Brcic

Motion: The Canadian Medical Association recommends that MD Financial Management Inc. utilize a socially responsible investing approach in managing all of its investment portfolios.


1. Why is a policy needed on this issue at this time and what supportive evidence exists that requires policy development in this area? Money plays an important part in our society. However, the flow of money doesn’t always serve the health of citizens in an optimal way. Physicians should be supported to ensure that our investment practices align with supporting social determinants of health, including poverty reduction, protecting the environment, promoting education, housing, and food security, as these factors all contribute to population health and wellness. Socially responsible investing is not new and is gaining momentum. More people are paying attention to the types of companies they invest in—what business activities those companies undertake, and the health and environmental impact of their actions. In this approach, institutional investors apply a screen for various environmental, social or governance (ESG) factors, and if a company doesn’t meet the specified ESG obligations, they won’t invest in that company. In August 2015, CMA General Council delegates voted at the annual meeting to have CMA divest its reserves from fossil fuel companies. CMA asked that MD Financial Management investigate investment opportunities in renewable energy solutions and in May 2016, MD Financial Management released its Fossil Fuel Free Funds. This is a great start, but we need to go further. Socially responsible investing is a way to align one’s values with their investments.

2a. Please describe how the criteria of relevance, fit and focus, as described below, support the consideration of your motion: Relevance (The issue resonates with CMA members and solves their problem(s) and makes their lives easier) Fit (The CMA is in the best position to make a significant impact on this and there is no other organization whose primary mandate relates to the issue) Focus (The issue and scope is clearly defined and there is a niche area within this issue) As stated above, CMA has already asked that MD Financial Management investigate investment opportunities in renewable energy solutions. CMA is well positioned to encourage MD Financial Management to take the next step and utilise a socially responsible investing approach to all of its investment portfolios. Socially responsible investing is a way to align one’s values with their investments, where not only the return on investment is important, but also the health of people and the planet.

2b. What other organization, apart from the CMA, would be best positioned to advance this issue? MD Financial Management Inc.

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General Motion: GM5-19 Mover: Dr. Andrew Clarke

Seconder: Dr. Jesse Kancir

Motion: The Canadian Medical Association will work with stakeholders in medical education to encourage awareness of the difference between non-commissioned financial/insurance advisers employed by national and provincial/territorial medical associations and commissioned financial/insurance advisers employed by banks and other corporations.


1. Why is a policy needed on this issue at this time and what supportive evidence exists that requires policy development in this area? In the past two years, faculties of medicine across the country have begun restricting and, in many cases, prohibiting both CMA and provincial/territorial medical association (PTMA) representatives from speaking with medical students and residents about how to ensure their long-term financial health and security. This restriction is part of a broader policy with the worthy aim of preventing commercial (primarily pharmaceutical company) bias in medical education. Where this policy errs, however, is in its failure to differentiate the stakeholders that these two kinds of representatives serve. While banks and other financial services providers are trying to make money from doctors, the advisers employed by PTMA and CMA companies are trying to make money for doctors, including members who are trainees. Formal curricula focus on helping trainees understand that different sources of information about therapeutic modalities can be biased in different ways, and help them uncover those sources of bias. We should accord the same degree of thoughtful differentiation to our sources of financial advice. CMA and PTMAs are member-governed, not-for-profit organizations. Their advisers have a duty to give advice that is in their members’ best interests. Other salespeople serve themselves, or the shareholders of the organizations who employ them.

2a. Please describe how the criteria of relevance, fit and focus, as described below, support the consideration of your motion: Relevance (The issue resonates with CMA members and solves their problem(s) and makes their lives easier) Fit (The CMA is in the best position to make a significant impact on this and there is no other organization whose primary mandate relates to the issue) Focus (The issue and scope is clearly defined and there is a niche area within this issue) This is a timely and sensitive issue that needs to be addressed in order to ensure the long-term financial health and security of medical students and residents of Canada. CMA is well-positioned to work with stakeholders including the Association of Faculties of Medicine of Canada, Canadian Federation of Medical Students and Resident Doctors of Canada to encourage ethical differentiation of the non-commissioned financial/insurance advisers employed by PTMAs and CMA, from the commissioned salespeople employed by financial and for-profit institutions.

2b. What other organization, apart from the CMA, would be best positioned to advance this issue? Association of Faculties of Medicine of Canada, Canadian Federation of Medical Students, Resident Doctors of Canada, provincial/territorial medical associations.

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General Motion: GM5-1 Mover: Dr. Charles Webb

Seconder: Dr. Eric Cadesky

Motion: The Canadian Medical Association will create an electronic portal to allow locally led and potentially politically active medical organizations to upload their contact information.


1. Why is a policy needed on this issue at this time and what supportive evidence exists that requires policy development in this area? It is important for CMA to be apprised of issues occurring at grassroots/local levels where physicians are engaged in advocacy work. Local physician-led organizations serve to educate, communicate, and advocate for medical communities. These grassroots physician-led organizations can be a resource in identifying themes/issues that are important for discussion at a national level and that are relevant to CMA’s aims and objectives. Examples of these types of organizations include: Vancouver Medical Association, Victoria Medical Society, BC medical staff associations, Alberta zone medical staff associations, and Ontario medical staff associations.

2a. Please describe how the criteria of relevance, fit and focus, as described below, support the consideration of your motion: Relevance (The issue resonates with CMA members and solves their problem(s) and makes their lives easier) Fit (The CMA is in the best position to make a significant impact on this and there is no other organization whose primary mandate relates to the issue) Focus (The issue and scope is clearly defined and there is a niche area within this issue) It is important for CMA to be apprised of issues occurring at grassroots/local levels where physicians are engaged in advocacy work. Local physician-led organizations serve to educate, communicate, and advocate for medical communities. These grassroots physician-led organizations can be a resource in identifying themes/issues that are important for discussion at a national level and that are relevant to CMA’s aims and objectives. Examples of these types of organizations include: Vancouver Medical Association, Victoria Medical Society, BC medical staff associations, Alberta zone medical staff associations, and Ontario medical staff associations.

2b. What other organization, apart from the CMA, would be best positioned to advance this issue? n/a

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General Motion: GM5-15 Mover: Dr. Eric Cadesky

Seconder: Dr. Charles Webb

Motion: The Canadian Medical Association will expand its provincial and territorial medical association PolicyBase to include submissions from grassroots medical organizations across the country.


1. Why is a policy needed on this issue at this time and what supportive evidence exists that requires policy development in this area? As the only national organization representing Canadian doctors, CMA can continue its leadership by opening its central repository for guidelines, policies and initiatives so that CMA members and the organizations they work with can learn from each other to share and accelerate innovation and learning from local, regional, provincial/territorial and national groups.

2a. Please describe how the criteria of relevance, fit and focus, as described below, support the consideration of your motion: Relevance (The issue resonates with CMA members and solves their problem(s) and makes their lives easier) Fit (The CMA is in the best position to make a significant impact on this and there is no other organization whose primary mandate relates to the issue) Focus (The issue and scope is clearly defined and there is a niche area within this issue) Canada is often called the land of 10,000 pilot projects. CMA is perfectly positioned to open its repository of policies to local, provincial/territorial and national organizations so that members can teach and learn from each other's work and minimize duplication while scaling up work done elsewhere in our country.

2b. What other organization, apart from the CMA, would be best positioned to advance this issue? CMA is best positioned as it is the only organization advocating for all Canadian doctors and already has an online, searchable database of policies. Expanding it to include the policies and projects of other organizations fits with CMA's advocacy role.

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General Motion: GM5-26 Mover: Dr. Hasan Sheikh

Seconder: Dr. Danyaal Raza

Motion: The Canadian Medical Association will support new projects and mechanisms to facilitate the expansion and increase the scale of innovative health system pilot projects in Canada.


1. Why is a policy needed on this issue at this time and what supportive evidence exists that requires policy development in this area? The Canadian health care system is often described as a patchwork of pilot projects. Innovation in our system is not lacking, but successful projects often fail to spread and/or scale in size. The Health Council of Canada (HCC) was a national, independent, public reporting agency that was intended to disseminate information on best practices and innovation across the country, including a ‘Health Innovation Portal’ featuring practices, policies, programs and services that could be scaled up or adopted. However in 2014, after 2 years of funding, the federal government ended its funding. CMA’s Joule has partially filled the void, catalyzing new innovations. However, it lacks a robust mechanism for the knowledge translation of existing projects and an ability to help connect individuals who have successfully implemented existing innovations with those interested in replicating them. This is a key area where CMA can show national leadership.

2a. Please describe how the criteria of relevance, fit and focus, as described below, support the consideration of your motion: Relevance (The issue resonates with CMA members and solves their problem(s) and makes their lives easier) Fit (The CMA is in the best position to make a significant impact on this and there is no other organization whose primary mandate relates to the issue) Focus (The issue and scope is clearly defined and there is a niche area within this issue) Relevance: CMA members across the country are looking for innovative solutions to provide better quality and more efficient care to their patients. The creation of this database will help health care leaders across the country implement innovative solutions to advance work flow and the patient care experience. Fit: As physicians' national health care organization, CMA is ideally positioned to create this database and ensure it is up to date. Focus: The focus of this motion is narrow and centers on the creation of a database to the benefit of physicians and patients across the country.

2b. What other organization, apart from the CMA, would be best positioned to advance this issue? The federal government would also be positioned to advance this issue, as was previously done with the HCC.

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