On June 7, Ontario voters elected Doug Ford and gave the Conservatives a majority in the provincial parliament. While Ford is a controversial and polarizing figure, many Ontario physicians were glad for the change in government.
They were enthused about Ford stating during his campaign that he'd "work with our frontline health care workers," as this represents a change from the palpable disdain the incumbent Liberal government seemed to have for physicians in particular.
Many took these statements to mean Ford would listen to doctors about important issues in health care. After feeling unheard by the Kathleen Wynne government for so long on LHIN dysfunction, hospital cutbacks, unemployed doctors, ever growing waitlists and a multi-year contract dispute, physicians felt eager to have a leader respectful of health care providers and their knowledge.
And yet it's puzzling that during the campaign, Ford more than once took a strong stance that directly opposed the common consensus among doctors, namely his harsh condemnation of safe injection sites, his plans to scrap the updated sex-ed curriculum and his anti-choice views on abortion. These contradictions highlight key concerns about how Ford plans to manage Ontario's health care.
Since reproductive rights are human rights, Ford's comments on abortion represent nothing less than an attack on the fundamental right to choice and self-determination. And while some have dismissed his statements as empty pandering to his socially conservative base, those of us who have been watching the slow degradation of reproductive rights in the United States know that anti-choice rhetoric is rarely toothless.
Examples in the U.S. include legislation such as mandatory waiting periods, age of consent laws, forced ultrasounds and bogus "safety" rules for abortion clinics, which have created significant barriers to an otherwise legal procedure. It's worth noting, too, that these barriers disproportionately affect people marginalized by poverty or race, who already have the most to lose by being forced to carry an unwanted pregnancy.
Don't be fooled by the argument that abortion is federally mandated and thus untouchable by the provinces. There is plenty that a Premier could do to hinder access, something the anti-choice advocacy group Campaign Life Coalition (CLC) touched on in its survey of candidates conducted prior to the election.
Conservatives winning a majority government gives Ford a mandate to enact policies sought after by his socially conservative base
One of the questions on the survey concerned delisting abortion as OHIP-covered service, something well within the purview of a Premier. This one simple change would erect a sharp financial barrier to abortion access, disenfranchising low income women and creating a two-tier system of reproductive health care.
The CLC produced a list of anti-choice "green-light" candidates as a voting guide prior to the election, which was largely based upon the results of their survey, a series of questions designed to determine a candidate's willingness to effect legislative change on issues of reproductive choice.
Of the 12 Conservative party members green-lit by the CLC, nine were elected. A second list of eight "educable" candidates was also put out by the CLC. Of these, four were elected, one being Ford himself. This is a significant concern, as the Conservatives winning a majority government gives Ford a mandate to enact policies sought after by his socially conservative base.
From a medical perspective this is not simply a reproductive choice issue. Ford's statements in his interview with the anti-choice publication Right Now indicate a complete lack of understanding about patient autonomy in medical decision making. He stated that "most procedures in this province require a minor to have the consent of a parent," and later elaborated during a campaign stop that parents have to approve even getting their tonsils out.
This is a completely uninformed and ignorant understanding of how health care is delivered to adolescents. A teenager with a solid grasp on their medical condition who understands the available treatment options does not require parental approval, even for a surgical procedure like tonsillectomy. When parents are involved in their teenager's medical care it' s with the consent of the teenager, not the other way around.
Ford's statements demonstrate he is willing to ignore the many reasons why a teenager might not want her parents involved in her abortion. A girl who will be punished or kicked out if her family learns she is sexually active or who is pregnant as the result of sexual abuse from a family member would face significant risk if forced to ask for parental consent or even disclose her pregnancy at all.
Our health care system recognizes that patient self-determination is an inherent right, achieved through access to available services and autonomy over one's medical decisions. We don't offer those rights selectively based on age and anatomy, so consequently we don't restrict teenagers with uteruses from having the same rights to bodily autonomy as everyone else.
Ford has also framed his pledge to allow Members of Provincial Parliament to craft bills on abortion as a free speech issue, saying that he will not "muzzle" his party and would "welcome any member who wanted to bring [abortion] forward in the Legislature." This framing is not new from the perspective of anti-choice lobbying, but it highlights another area where Ford needs education on health care.
Abortion in Canada is considered primarily a medical issue between physician and patient, meaning the government largely stays out. Introducing legislation on abortion would represent the government inserting itself into the physician-patient relationship, something not many doctors would support. Bureaucratic interference in health care was, in fact, a much complained about fault of the Wynne government, a political weakness seized upon by Ford.
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Physicians will hold the Ford government to account on its pledge to listen to us. Moreover, we expect our Premier to be well versed in the core principles of health care, which enshrine patient autonomy as essential.
Reproductive health is not a separate entity from the rest of medicine; it's bread and butter primary care, in addition to being a basic human right. If Ford is serious about his image as a leader "committed to frontline health care," he will keep his personal beliefs on abortion out of his legislative duties.
Ford should consider this an excellent opportunity to listen to doctors and learn about reproductive health in the province he now governs. Physicians stand ready to give him the education he needs.
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