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The current CPSO policy on Anabolic Steroids states “This policy articulates the College’s expectations of physicians regarding the use of anabolic steroids and other substances and methods for the purpose of performance enhancement in sport (i.e., doping)”
Please note, the current policy addresses prescribing concerns for anabolic steroids in SPORT… nothing else.
I have a concern about this. Why does the College feel it’s necessary to involve itself by making a policy to enforce other organizations regulations? Moreover, the majority of the anti-doping organizations are not even Canadian. What happened to allowing physicians to self-regulate and do what’s best for their patients? The College should focus its resources on fixing real issues like physician shortages, physician burnout, physician advocacy and improving quality patient care in a timely manner in an already overstretched healthcare system rather than being the enforcer of other non-Canadian, non-medical organization’s regulations.
Our mandatory dues continue to increase year after year while CPSO resources are wasted on over-regulation by compartmentalizing medicine with policies like this. These policies continue to drive a wedge between physician’s and the College.
Regarding the Anabolic steroid policy. It would be helpful to have a comment on harm reduction. many doctors are asked by patients using steroids (not prescribed by the doctor) to monitor them with respect to cbc, psa etc. This puts the doctor in an awkward position Re: harm reduction vs running afoul of the policy (Ie, is this “providing support”?).
I ran a very unscientific twitter poll recently asking whether docs would agree to monitor vs “wash their hands”, and over 90% said they would agree to monitor for harm reduction.
So lets get this straight. A woman can have an abortion with no questions asked whatever the reason. But if she wants to take her body and go have an ultrasound to find out the sex of the child that is forbidden. Rather paternalistic I’d say.
I have tried to reply to the questions. But I cannot find where in the communication from you to enter my answers.
In short, I do not practise in Ontario. I am a practising pathologist. I do not prescribe anything. I do not get consultations from people who want medications of any sort. I do not get requests related to female genital mutilation which I completely disapprove of. I do not get requests for referral for prenatal imaging for any reason and I am aware of the reasons why I should not cooperate in helping people get this imaging done.
I hope this is a satisfactory response for your request. I apologise for not being able to find a place on your communication to respond there. I have limited IT capability.
These three policies provide normative, objective guidance about 3 disparate issues that superficially have nothing to do with one another. I question the wisdom of consulting on all three as a combined whole.
I have profound concern, however, that the College may be getting out of the business of making normative judgements altogether. Certainly, these three policies speak to a powerful interaction between the profession of medicine and social norms. They reflect our society’s rejection of 3 types of behaviours: cheating in sport, mutilation (especially for the purpose of increasing a woman’s sexual value), and sex-based discrimination manifesting as female-selective abortions. In these cases, the College policies declare that the profession of medicine, as a constituent element of society but also as an independent stakeholder with wisdom to impart on the society, affirms society’s rejection of these behaviours and the values that motivate them.
By eliminating this sort of policy, I fear the College is signalling that medicine has no role, as a profession, in informing the common public morality. This is consistent with the radical autonomist perspective in which physicians are not to make any specific moral judgements but simply be “service providers” who unthinkingly facilitate any legal request made by the patient. As a physician I reject this perspective in the strongest possible terms. Physicians are moral agents and the profession as a whole must likewise be a moral agent if we are not to strip the word “profession” of all meaning.
There is a moral right and wrong and I expect the CPSO to provide a moral standard of practise. For if we are only providers of care rather than professional physicians offering the most appropriate and best care for our patients, then we have lost the essence of our profession. We must DO NO HARM in of itself a moral standard lived for hundreds of years. If now, we acknowledge that maybe under some circumstances it is licit for physicians to refer for female genital cutting… what are we saying? Have we become amoral service providers at the call of medically untrained patients? Or are we still physicians trained to do no harm and to help alleviate ailments with the CPSO as our moral guide.
It’s not related to my practice
The policies in question remain valuable and should be retained, as they reflect some of the last remnants of a professional commitment to the existence and importance of an objective moral order. In short, fetal ultrasound for sex discrimination is wrong; anabolic steroid use for performance enhancement is wrong; and female genital mutilation (FGM) is wrong. The College gains nothing and loses much credibility by withdrawing its on-the-record opposition to these practices.
All three matters in question receive varying levels of support and condemnation in the broader society, and all three can and do implicate the medical profession in different ways. While support or condemnation from doctors is not the sole voice on such issues, it is nevertheless an important factor in shaping public opinion. Unfortunately, the recent trend has been for the College to retreat from decisive stands on such contentious issues in favour of an autonomy-first approach. Eliminating the policies on fetal ultrasound for sex determination, anabolic steroids and FGM would represent a further instance of the profession abrogating its role as an important source of wisdom and authority in the shaping of social and moral values.
An analogy can be drawn with the amoral foreign policy currently being pursued by the Trump administration in the United States. Mr Trump has been steadily withdrawing the USA from its previous role as a defender of certain inalienable values, preferring instead to maintain benign (or malignant) neutrality towards the actions of rogue regimes, so long as they do not directly impact his interests. The result has been the weakening of the international moral order and a victory for those sowing chaos. One must hope that the CPSO does not pursue a similar policy of amoral disengagement by withdrawing its important condemnation of discrimination-oriented fetal ultrasounds, anabolic steroids, and FGM. Doing so would only strengthen those who would push these practices towards mainstream acceptance.
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