Historical and Legal Context in Québec

Historical Context

Under review

The practice of medicine and surgery  was not supervised until 1788, when an ordinance was issued prohibiting any person from practicing medicine in Québec without having first obtained a permit. In 1831, the Legislative Assembly repealed this ordinance following disputes over the low representation of francophone physicians on the board of examiners. It then passed a law authorizing practitioners to elect the members of this board. The quest for a certain professional autonomy for physicians was impeded when disputes erupted over the idea of creating a pan-Canadian organization. In 1847, the Legislative Assembly voted for the incorporation of the College of Physicians and Surgeons of Lower Canada.

The legislator gave this organization the power to regulate its studies, control the admission to practice, oversee the practice of medicine and suppress its illegal practice. Thus, it was implicitly given the two-fold mandate to protect the public and control the practice of medicine. The College then had 190 members. “Still, in 1847, the Grand Charter created a precedent in North America, since no other association of physicians then had the legal status of an autonomous corporation with an exclusive right to practice.” (Free translation: Goulet, 1997, p. 30).

In the year of Confederation, the College of Physicians and Surgeons of Lower Canada adopted the name of College of Physicians and Surgeons of the Province of Québec (CPSPQ). While initially threatened in 1867 by the creation of the Canadian Medical Association, which advocated pan-Canadian structures to control the training of physicians, the College saw its role strengthened in 1876 through legislation that gave it more power in the universities and obliged physicians to register on its roll. This set the tone. For more than 100 years,  the CPSPQ would be the mainspring with respect to all legal and ethical questions concerning the medical profession (Goulet, 1997, p. 53).

Imbued with a new vitality, the medical profession restructured itself and, in 1878, adopted the code of ethics of the Canadian Medical Association, which was similar to that of the American Medical Association.  But this code did not really provide for penalties against deviant members. The creation of a council on discipline by Dr. Emmanuel Persillier-Lachapelle in 1898 marked another important milestone (Goulet, 1997, p. 57). Indeed, it was not so much the adoption of the code in 1878, but rather the quasi-legal power vested in this council that would determine its evolution. The council quickly sensed the need to specify, from among the acts derogatory to the honor of the profession, those that should  be penalized. “The creation within the professional corporation of a council on discipline invested with judicial powers established a precedent not only in America, but in most European countries.” (Free translation, Goulet, 1997, p. 80) Multiple amendments would reinforce this disciplinary power, so much so that a veritable code  was rebuilt around this specification of derogatory acts. The code of ethics used by Québec physicians until 1980 is in fact section 52 of the Regulations of the College of Physicians and Surgeons of the Province of Quebec, which was adopted in 1952 and amended many times since to include acts derogatory to the honor and dignity of the profession.

In the period from 1909 to 1960, medicine  advanced, and the medical profession gained more credibility, powers and autonomy. The Collège strengthened its role as protector of the public and consolidated  its function as the only legitimate representative of the profession. Legislation passed in 1909 increased its authority in universities and gave its council on discipline the power to compile a list of derogatory acts. Not only did the fight against charlatanism continue, but the Collège became actively involved in the development of the profession. “Professional modernity” was the watchword during this period.

From the 1970s onward, the government would play an expanding role in the field of health, proportionately weakening the medical profession and forcing the Collège to revise its policies and organization. After the institution of hospital insurance in 1960, the Collège’s influence on physicians practicing in the hospital setting also diminished. When the Castonguay-Nepveu Commission proposed the establishment of a complete health insurance system in 1970, physicians took their case to the medical unions to register their opposition to it. The Federation of General Practitioners of Québec (FMOQ) had been formed in 1963, and the Federation of Medical Specialists of Quebec (FMSQ) in 1965. Yet the crisis in the health care sector would be salutary. Despite the government’s intrusion into health care, the Professional Code and the Medical Act, adopted in 1973, would recognize the independence of physicians and confirm the roles devolved to the Collège since its inception, namely the control of medical practice and the protection of the public.

After this turbulent period, the Collège strives to give itself mechanisms whereby it could more effectively exercise its functions. Control over training and the issuance of permits was implemented with the collaboration of other Canadian bodies, whereas medical ethics in Québec pursued its own developmental path. Thus, the directors of the Collège favored a positive approach  based on promoting transparency in processing complaints, relying on preventive as opposed to corrective measures to improve practice, and developing a spirit of openness in all of its activities. The Collège chose to promote quality medicine not only to protect the public, but also to help improve the health of Quebecers.

This line of conduct would pose considerable challenges, given the breathtaking advances in medicine, the constant diversifications in medical practice and the evolution in ways of thinking, not to mention the recent developments in the health care system itself. The problems were such that physicians would have to be part of the solution, but what form this would take had yet to be articulated.

In recent years, the Collège at  all levels has ensured that its Code of Ethics would continue to provide Québec physicians  with the guideposts necessary for good practice. In 2002, the  Code  underwent an in-depth revision, taking into account professional activities and the new realities, such as, clinical research, medico-legal medicine, medical follow-up in a climate  of shortages, responsibilities toward communities, conflicts of interest, and transparency in the disclosure of health-care incidents. Many authorized groups also redefined the medical profession’s place within Québec’s professional system. Indeed, the Collège played a part in drawing up various legislative amendments adopted in recent years to promote inter-disciplinarity and to modernize professional organization in the field of health care in Québec. The Collège continues to play a key role in their application.

2012-12-19