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Moral distress and the ethics of involuntary treatment

• Canadian Medical Association Journal

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On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham examine the issues raised in a recent CMAJ commentary on Alberta’s Compassionate Intervention Act, which explores the ethical and clinical implications of this approach to involuntary treatment. As governments across Canada turn to coercive measures in response to the overdose crisis, the episode considers what these policies mean for patient autonomy, clinical practice, and the role of physicians in enforcing care.

Dr. Bonnie Larson, a family physician and addictions medicine specialist at the University of Calgary, joins the conversation to unpack the legislation. She explains how the Act allows individuals to be detained and treated even when they are deemed capable of making their own medical decisions. Dr. Larson describes how this represents a substantial departure from established principles of consent and autonomy, placing physicians in ethically complex positions and reshaping their role in care.

The discussion then turns to Massachusetts, where involuntary treatment for substance use has existed for decades under Section 35. Dr. Keren Ladin, a bioethicist and health services researcher at Tufts University, reveals the experiences of clinicians working within this framework. Drawing on her research, she describes how Section 35 has shaped clinical practice, contributed to moral distress among healthcare providers, and often resulted in people being treated in carceral rather than therapeutic settings.

Together, the guests reflect on what these policies reveal about how societies respond to addiction, the limits of coercive care, and the risks of prioritizing control over evidence-based, patient-centred treatment.

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Dr. Mojola Omole:

Hi, I'm Mojola Omole.

Dr. Blair Bigham:

I'm Blair Bigham. This is the CMAJ Podcast.

Dr. Mojola Omole:

So I don't remember if this was our producer, greatest producer in the world, who came out for us to do this topic, but when the editorial came across, I thought this was such a fascinating topic to look at.

Dr. Blair Bigham:

It's fascinating. It's infuriating. It's confusing. It's really something that I'm excited to get into today and talk about. Across Canada right now, there is a wave of legislation that is trying to damage the ability of a physician to have a therapeutic relationship with their patients, right? And we're seeing that in Alberta around involuntary treatment. And today we're going to get into it. We're going to talk about a very critical commentary that was published in CMAJ that gets into the weeds of what this legislation means for physician practice and for that physician-patient relationship that all of us hold so sacred.

Dr. Mojola Omole:

And then our second guest is actually a bioethicist and a research researcher from Boston, where they've actually been implementing what they call their form of this legislation, Section 35, for the last few decades. And we'll talk about what has happened there and what the impact on clinicians has been.

Dr. Bonnie Larson is the family physician and addictions medicine specialist at the University of Calgary. She's co-author of the commentary in CMAJ titled, “Involuntary treatment for substance use:

application of Kass's ethical framework to Alberta's Compassionate Intervention Act”. Bonnie, welcome to the podcast.

Dr. Bonnie Larson:

Thanks for having me.

Dr. Blair Bigham:

So this is a pretty critical commentary you've written. Let's back up. Tell me about your reaction when this legislation was first introduced.

Dr. Bonnie Larson:

Yes, our reaction when this legislation was passed back in May 2025 was one of initial confusion, I guess, I would say, and recognition that healthcare colleagues were also very confused, had a lot, a lot of questions about how the legislation would be implemented, on what timeline, how it was all going to work for clinicians. And I think seeing that made myself and the co-authors realize that we needed a way to think about this kind of change to current legislation. So we decided to take an ethical lens to it.

Dr. Blair Bigham:

You use the word confused. I want to work through that. Let's start at the beginning. What mechanisms currently exist under the previous legislation, the Mental Health Act, for a physician to be able to intervene when somebody is at a severe addiction risk?

Dr. Bonnie Larson:

Okay, so I'll give you an example, like a clinical example from my practice would look something like I have a patient who has severe depression and plus or minus substance use disorder. And I'm seeing a deterioration to the point that I feel like they are at risk of harm to themselves or to someone else. I'm seeing escalating suicidality or intent to harm. And I'm worried that there maybe there are mental health issues, including or not, the substance use could be putting them in a place where they're also not able to make a voluntary decision like on their own. And in which case, I can use a mechanism in the Mental Health Act as a community family doc called a Form 1. And I give evidence on that form, document why I think that they are at risk and how I think that treatment could benefit them and, you know, why they can't access care other than involuntarily. So and then I do that. I fill out the documentation and call EMS or police who are going to convey my patient to care. So to a hospital where they are, they must be assessed by a psychiatrist within 24 hours of that apprehension and conveyance. Then there is a whole very robust system of checks and balances in place where that person can reject care, can say, I don't want to be here. And then it requires a stepwise approach for physicians and then a panel of healthcare providers and legal people to continue that if it's deemed that person. But they have to do a proper capacity assessment, like full capacity assessment to treat somebody either in hospital or in the community without that patient's consent. This legislation changes all of that right from who is eligible to actually make an application for someone to be apprehended and conveyed all the way through to the aftercare, to treatment, to aftercare, all of the lengths of time, the intervals that people can be held or detained without their consent are very significantly increased or potentially increased. And the input from physicians is quite minimal. And the input from law enforcement is elevated. So there are a lot of spots in the new legislation that really expand the scope and decrease sort of the checks and balances compared to the current legislation that we have.

Dr. Blair Bigham:

Let's start with one of the biggest changes, and that's in who can actually initiate apprehension. Tell us how the new act contrasts to the old act.

Dr. Bonnie Larson:

OK, the change now is that adult family members or guardians, in addition to a judge or a physician, are also now able to initiate an application. And one of the issues that we're seeing with the family member designation is that it's not well defined who that person could be. And so adding that as well as unregulated professionals. So folks that do amazing work, however, are not regulated. For example, addictions counselors or caseworkers can now initiate those applications.

Dr. Mojola Omole:

I just wanted to clarify. So basically, we are taking the role of physicians initiating a Form 1, is what we're talking about, right? To now, being anyone that is within this very large perimeter can initiate this. Not saying that you shouldn't listen to those people that you've named, but if they're not necessarily mental health, like professionals who are treating addictions or severe mental health, I'm not quite understanding why they've been given the authority or the power to do this.

Dr. Bonnie Larson:

Absolutely. I guess it begs the question, what is this legislation's purpose? And what was it meant for? What was the policy written for? You can see how maybe they were thinking more along the lines of public safety and law enforcement, maybe drug policy, rather than public health policy per se. And that was exactly the confusion, puzzlement, fear that I heard from colleagues when the legislation was passed, like, how exactly and who is going to do this work? And quite frankly, a lot of people saying I don't want to be involved with this. And so, there are implications for clinical practice, physician autonomy, moral distress added, especially to the care providers that are already doing this very frontline difficult work on the frontlines of the drug poisoning crisis, for example, and the housing crisis, to be further asked to do care that they're conscientiously not aligned with. So, yeah, the answer is, those are the very good questions.

Dr. Mojola Omole:

Wait, sorry, just to clarify something for me. So, if someone, like, let's say you're your disgruntled, separated partner, and you're brought into the hospital because they're saying of concern. Does this then mean that the treating physicians will have to follow through on this?

Dr. Bonnie Larson:

Yeah, like, not only that, but all of the power for decision making and enforcement lies with a single government-appointed commission. There's no judicial process involved.

Dr. Mojola Omole:

I'm so sorry. This is crazy. Sorry. This is, like, actual crazy. What are we talking about here? It is what it looks like, Majola.

Dr. Blair Bigham:

It is what it looks like. They've also changed what can be brought to a patient's life, even if they have capacity. You were talking about how under the traditional system, a capacity assessment is really important. But this new act kind of disrupts that.

Dr. Bonnie Larson:

Yes, disrupts that completely, because it's not required anymore at all. So a patient can be treated regardless of their capacity to make their own decisions. So they can actually decline treatment and have the capacity to do so, but still be forcibly treated.

Dr. Mojola Omole:

I think what I'm struggling to understand is, we have long established that mental health substance abuse is a medical issue. I can't forcibly treat my patient who needs surgery for their cancer, who needs chemo for their cancer, and they refuse it. How can we as healthcare professionals justify treating patients against their own will for a health disorder, like, for a health problem? I don't understand.

Dr. Bonnie Larson:

We suspect that you're very much not alone in not being able to justify that. This legislation was never—it's not written by healthcare providers, and we feel that the consultation process wasn't adequately done to involve healthcare providers or patients.

Dr. Blair Bigham:

But doesn't it all fall apart when someone ends up at a physician? Like, this unregulated person triggers their apprehension, and someone says, oh, they have capacity, but they still need treatment against their will. But a physician or a nurse practitioner would ultimately have to order that treatment. Can't they just say no?

Dr. Bonnie Larson:

Yeah, ultimately, there is a physician, a psychiatrist on that commission. So it's a lawyer, a psychiatrist, and a member of the public on the commission that pretty much has power over the entire process. So yes, you're right. Eventually, a physician, that psychiatrist needs to say, yes, they agree that this person is eligible for the program, needs some kind of intervention and or possible treatment, and they establish a care plan. So yes, there needs to be one physician who is a psychiatrist that is saying yes. But the legislation is vague in terms of these intervals of detainment without opportunities to ask for a review. And the length to assessment, some estimates digging around in the legislation itself, if you account for all the places that it says may be extended to five days, may be extended to 10 days, that it could potentially be up to 17 days before the physician ever lays eyes on that individual, which we know is highly risky.

Dr. Mojola Omole:

So where would this individual be in this time frame?

Dr. Bonnie Larson:

So Alberta is currently building two centers, facilities, brand new, spending $180 million on two centers, one in Calgary and one in Edmonton, 150 beds each. They're called Compassionate Intervention Centers, and that's where folks will be taken. In the meantime, there's a lot of questions about if those are built not for two or three years, in the meantime, where will people be taken? And there's a lot of speculation about that. We've been told various things, you know, doctors asking, are they going to be brought to a hospital? And then we are required, just like with a secure psychiatric unit, will it be like that? Or will they be put in into remand, into jails, incarcerated? And you can't quite pin down where folks will be taken, but it will be a secure facility of some kind.

Dr. Blair Bigham:

So this is clearly polarized. I appreciate that for many families, they would find that this hampers trust or is flatly unhelpful. But other families have advocated for involuntary treatment. Some have said that they think their children or their loved ones would be alive had they been able to get them into a treatment program. And even some physicians have said there's a role for involuntary treatment. Let me ask, can the CIA be fixed? Are you advocating for changes to it to improve how it's applied? Or do you think we need to go in a different direction altogether?

Dr. Bonnie Larson:

I wouldn't say a different direction. I would say we need to look at the root causes of what has landed us here in the first place. We know that families are often driven by desperation and sometimes false hope that there is something that can be done. And it can temporize, give families a break for that stabilization period where they're not as worried about their loved one. So I can completely understand, as a mom, I can completely understand if you're thinking give me just a breather so I just want to be able to talk to my child. And so I totally understand the desperation that drives the support for like, can't you just hang on to them for a little while so they can stop using? That is fair. The problem is that we don't know that it's effective for the outcome that families want, which is to keep their loved one safe and well and alive. And what we do know is that it actually increases their risk, probably because they lose tolerance to the substance and then they're at higher risk. So what we could do instead of spending hundreds of millions of dollars on really building new law enforcement facilities is focus on investing again in what the things that we know work that are evidence-based, evidence-supported, culturally appropriate, collaborative with families. We know that there are solutions to the drug poisoning crisis, if that's what we're really intending to address. That work, voluntary treatment, expanded safe withdrawal or detox, housing first, permanent supportive housing, OAT, harm reduction, and trauma-informed care.

Dr. Blair Bigham:

Bonnie, thank you so much for joining us today. Thanks for having me. Dr. Bonnie Larson is a family physician and addictions medicine specialist at the University of Calgary.

Dr. Mojola Omole:

While Alberta's Compassionate Intervention Act is new to the province, involuntary commitment for addiction treatment is not a new approach. Massachusetts has been running one of the largest and longest running programs of its kind in the United States for over 50 years. It's called Section 35.

Dr. Keren Ladin has studied Section 35, focusing specifically on the moral distress clinicians experience working within this system. Dr. Ladin is a bioethicist and health service researcher at Tufts University. She's the co-author of a research paper in the International Journal of Drug Policy titled “Clinicians' experience with involuntary commitment for substance use disorder:

A qualitative study of moral distress”. Thank you so much, Keren, for joining us today.

Dr. Keren Ladin:

Sure. Happy to be here. Thanks for having me.

Dr. Mojola Omole:

Okay. So what exactly is Section 35?

Dr. Keren Ladin:

So Section 35 is a program that essentially allows for involuntary commitment of people who are deemed as a potential harm to themselves or others. It allows for clinicians, family members, or concerned others to petition a court to have a person involuntarily committed against their will.

Dr. Mojola Omole:

So what led to the creation of this in Massachusetts?

Dr. Keren Ladin:

So in Massachusetts, as the opioid crisis intensified, there was increasing homelessness, increasing use of emergency services by people with substance use disorders. And so the legislature was attempting to address this crisis by using this section to divert people who were coming for medical care through the emergency room to a rehabilitation process. So that was the nature of it. And they devised this commission to evaluate the efficacy. And I think that it remains controversial in terms of how effective it is at serving its goal, which is reducing, you know, improving access to care for people with substance use disorder and also reducing the service needs.

Dr. Mojola Omole:

So what did they find in this commission? What was their results?

Dr. Keren Ladin:

So their results was largely to look at the utilization of Section 35. At that time in 2018, the number of petitions in Massachusetts were 10,770. The number of evaluations conducted were 7,244. And that resulted in 5,716 involuntary commitments. And I think that some of the issues that were raised both by the report and by clinicians concerned about Section 35 are that there's not enough actual rehabilitation facilities to support all of the people who are sectioned. And so as of 2025, the most recent data that I could find was that three out of four men who are sectioned in Massachusetts end up receiving services in a carceral setting. Despite not being convicted of a crime. So, yeah. And we know there is evidence that receiving substance use disorder services or withdrawal services in the context of carceral setting is not as clinically or therapeutically effective, obviously, as in a rehabilitation setting and often contributes to essentially somebody having the identical situation as prior to their sectioning. So I think that there is concern among clinicians and among advocates, given how Section 35 has been rolled out, about its effectiveness and whether or not it's serving its clinical and therapeutic purpose in terms of rehabilitation or whether it's more serving as a punishment-based approach or an approach to clean the streets.

Dr. Mojola Omole:

So if the majority of people are receiving treatment in a carceral setting, how are physicians who are supposed to be the one managing substance use disorder, how are they interacting with this process?

Dr. Keren Ladin:

Yeah. So the Section 35 essentially allows for interested parties or qualified people, and that can include a police officer, a physician, a spouse, a blood relative, a guardian, or a court official, to ask a court to involuntarily commit someone for addiction treatment. And so the process, what happens is that prior to the hearing, a judge orders an exam by a qualified clinician, which is not the clinician, obviously, that requested the sectioning, and they ask them to assess whether the person has a substance use disorder and whether the person presents a likelihood of serious harm as a result of their addiction. And if serious risk is established, then the judge can send the person to addiction treatment for up to 90 days. And so I think your question is kind of both a logistics question, but also an ethical one, like how is it that clinicians who are obligated to do no harm, how are they seeing their role? I think that's what you're asking. Is that right, Jola?

Dr. Mojola Omole:

Yeah, because I'm just like, I'm confused in the sense of if the majority of people are getting treatment in a carceral setting, which then makes me concerned about what kind of facilities are people going to to get this involuntary treatment? And then how are you getting treatment in jail, proper treatment for substance use disorder in jail when you have not committed a crime?

Dr. Keren Ladin:

Yeah. Yeah. So it's a really complicated, very thorny issue, right? And I think that there is some disconnect between, you know, these kind of quote-unquote qualified person who's requesting care and intervention for the person with substance use disorder and what happens to that person next. We asked a little bit in our study about whether or not clinicians knew what happened, what were the next steps for folks, and whether they were sent to carceral settings or rehabilitation centers. I think they often don't know, but they know. We noticed a distinction in approaches and perceptions between substance use clinicians, so those who really are experts in this area who see these patients all the time, who are better versed in harm reduction strategies, and emergency room clinicians, who I think bear the brunt of, for lack of better, kind of putting a Band-Aid on the situation and addressing these frequent flyer patients who come in routinely overdosing, really struggling. And so I think that clinicians really feel a tension, like you want to do something that you feel like will have lasting impact and benefit for the person. On the other hand, this may not be the approach that, you know, contributes to that. And I don't think that there is a great understanding among emergency room clinicians about that.

Dr. Mojola Omole:

So in your research, you did focus on moral distress. Why did you choose that to focus on?

Dr. Keren Ladin:

Yeah, so I guess first I want to distinguish moral distress from general kind of ethical distress. So people can feel, you know, ethical distress when they see something that's disturbing and they're unsure what to do. But moral distress, particularly for professionals, so thinking about for clinicians in a medical setting, is characterized by a feeling that you know what the right thing to do is, but you are compelled to do something else owing to your institutional structure. And so one of the things that we were really interested in was, you know, do people act outside of what they would think is the best thing for the patient? Is there some conflict or tension between what you feel is your fiduciary obligation versus your institutional policies or your state policies, given the intense reliance on Section 35? And in particular, some of the formative discussions that were occurring here in Massachusetts were that there was a real spectrum of opinions, again, between folks who were clinicians, who were in the substance use field and very familiar and very amenable to a harm reduction approach, and emergency room physicians and nurses and social workers who I think were, you know, were bearing the brunt of this and less, I don't know if less familiar, but maybe were less compelled by harm reduction approaches and were more familiar and more had higher levels of enforcement of Section 35.

Dr. Mojola Omole:

And so they felt lower distress over, moral distress over this? They did, yes. Did that change? Like, I don't know if you studied this, but I guess what I'm like, I guess what I'm asking is like, maybe at the moment when you do something, you're like, OK, we're doing something, we're getting this person the help that they need. But then retrospectively, when you see that same person 100 days later with another overdose, does that change their level of moral distress?

Dr. Keren Ladin:

Yeah, so it's a really interesting question. And I think that's what, that's the reason we were focused on moral distress, which is to say, do clinicians, are clinicians acting in this way because they feel like they have to, but they don't feel it's the right thing? Or do they feel it's the right thing and they're acting in this way? And so what we found in this group of low moral distress is that they did not express the inability to act in accordance with their best clinical judgment. So there was an alignment between what they thought was the best clinical route and their use of Section 35. They described appreciating the ability to help patients and remove them from high-risk situations. They had few reservations towards petitioning a patient as long as they met the severity criteria. And I think that part of this is the biases and heuristics of decision-making, right, that we all are kind of reliant on these salient stories that are memorable to us. And so they very often describe to us salient success stories instead of focusing on the ones that… Can you share some of those? Yeah. So, yeah. And like I said, they were mostly emergency room clinicians. So one clinician said to us, from a moral standpoint, you know, I feel I would almost feel bad if I wasn't doing something. Another said to us, I don't feel badly when I section somebody. I feel that it's done for the right reasons and that it is to protect them since they do not have the emotional and mental capacity in their chronic intoxicated states to make good decisions. And so people…

Dr. Blair Bigham:

That's a loaded statement.

Dr. Keren Ladin:

It is. I'm like so shocked because I'm like, are we God? I… Yes. I mean, I agree with you. We were very surprised to hear this. But I do think that it is… It's not uncommon in other areas of medicine where we allocate resources that clinicians are in a situation of determining who gets what, right? So I'm thinking about my own area in transplant, organ transplantation. This very often happens, right? But yes, I think you're raising real shock that we also had as a research team to hear this. But I will say these were strongly held beliefs and people anchored on these success stories, like the one or two that they remember that got better after sectioning.

Dr. Mojola Omole:

And then what did the physicians who had high distress, what were some of the things that they were talking about?

Dr. Keren Ladin:

Yeah, so high distress, high moral distress clinicians were more often substance use experts. They described deep discomfort with section 35 that was exacerbated when clinicians had limited alternatives and utilized the policy when they did not believe that it was the best clinical option. These clinicians actually rarely used section 35. They emphasized alternative options and they understood section 35 to be associated with poor patient outcomes. And for them, they really held as salient cases, negative experiences from involuntary commitment. So I can give you kind of two examples. One said, this is a mental health clinician who said, I hate doing it. I hate it. It's an ugly, very ugly process, especially in this state because police literally come and take someone out who has committed no crime. It's hard and it hurts and I don't like it. And another clinician said to us, I worry about it. I think it frequently causes ruptures in family relationships and treatment relationships. It can cause patients to come out the exact opposite of what you would want.

Dr. Mojola Omole:

So I'm just a little bit like, in shock about the whole entire process and the landscape of what different physicians see. I think that, like, you know, Blair's an emergency room doc. And so even just having this conversation, I'm like, you're right in the sense of like, sorry, I'm like finding it hard to talk because I'm like, I just assume that we all saw things from the same perspective, right? I assume that we all thought harm reduction. I'm not, I'm a surgeon, but I just assume that harm reduction, that's what I tell my patients. Okay, you're smoking, you're drinking, you're doing this, got to pick one to let go of if you want this cancer not to come back. I don't say you have to quit everything, right? So I think that's what I'm struggling with is how there's such a divide in the spectrum of how clinicians address this.

Dr. Keren Ladin:

Yeah. I think, I think it's a really good point. And the only thing I can say to illustrate it is one of the social workers described to us that they considered sectioning similar to issues with discharge. So they said, one quote is, we would also think about folks who are at risk for falls. They come in needing medical interventions, significant testing or medical treatment as a result of being found down or falling, having injuries that are sustained when using alcohol. So they're thinking about, there are often circumstances in hospitals where we don't discharge a patient to home, even though a patient really wants to go home, right? It's in their best interest to go to rehabilitation. It's not safe for them to go home. And they're thinking about section 35 in this kind of analogous way. We understand, we know that you're in dire straits right now. We know that you need a break from your, your normal setting. And so we are going to try to have a window in which you can be removed from this setting and focus on other things in order to try to give you a fresh start.

Dr. Mojola Omole:

Does section 35 actually work?

Dr. Keren Ladin:

I think that there's very limited evidence. There are certainly cases where it has worked, but overall the data is mixed. And I don't think that there is a lot of evidence that it is, you know, would meet the threshold for an evidence-based policy that we hold other medical interventions to.

Dr. Mojola Omole:

Wow. This has been, I don't know, this has been, I'm so riled up because I'm just like, what are we doing here? But thank you so much. Is there anything you feel like we've missed, Keren?

Dr. Keren Ladin:

I mean, I will say that I think many people see section 35 as a last resort and even people who use it, nobody enjoys using it. So I would say I definitely wouldn't want to paint a picture here that any clinicians thought that this was like a, an ideal public health or medical strategy. I think that it's understood in the context of a very severe public health epidemic in which emergency rooms and cities and social services are overwhelmed and people were throwing all kinds of things at the wall. And with the passage of time, we may have a better understanding about whether or not this was really an appropriate and effective approach.

Dr. Mojola Omole:

But it's still being used.

Dr. Keren Ladin:

It is still being used. Yeah, it is still being used. And I guess that's the only other point that I would make is that, you know, in the context of in Canada, of your own considerations of these types of approaches, I think that the critical factor is really around capacity to absorb patients who are sectioned in supportive rehabilitative settings, right, and avoiding carceral settings as much as possible.

Dr. Mojola Omole:

Thank you so much, Keren, for being part of the podcast. Thank you.

Dr. Keren Ladin:

Yeah. Thanks so much for having me.

Dr. Mojola Omole:

Dr. Keren Ladin is a bioethicist and a health service researcher, and she joins us today from Tufts University.

Dr. Blair Bigham:

So Jola, let's take a step back because I'm pretty fired up here. You are pretty fired up. There is a change in Canadian society, and I think it happened in American society first, where we're starting to see political ideologies that used to be mostly bluster, mostly one side, the other side, blah, blah, blah, now taking root in legislation. And now that legislation is forcing you and I, well, not you and I, we don't work in Alberta, but it's forcing us down a certain road.

Dr. Mojola Omole:

I would say that before we get there, we also need to recognize that, especially when we talk about this policy, it is a response to what communities are facing, what people are seeing and trying to find solutions to a problem, the problem being substance use disorders and just the rampant of overdoses and the fracturing of families. I disagree, obviously, because of how fired up I am about this legislation, but I don't think that we can just say that it's purely political and not put into the fact that families and communities are wanting a solution.

Dr. Blair Bigham:

So the drive for a solution, the need for a solution is critical, right? Like there's no doubt that addiction is a massive and generational crisis in Canadian society. So, Jola, OK, so let's bring it back to what's happening in Alberta with involuntary treatment. What is a physician to do?

Dr. Mojola Omole:

I feel that as physicians, whether you're emergency, whether you're mental health, all of us took an oath to do no harm, in my opinion, and I probably am assuming from a legal perspective, this does do harm. We do need a solution to helping people with substance use disorder. But legislating involuntary commitment by non-clinicians and non-substance use clinicians is doing harm. The data from Massachusetts has shown that A, it is not effective for a patient and B, it leads to physician moral distress. Even from like when we did the COVID vaccines, we see the downstream effects of that now where people are wanting to have measles party because they've lost trust in the health care system. So what is this going to do further? It's going to worsen our profession in terms of what people view us at, which is kind of low already for what it should be. So my opinion is that as physicians, we do need to stand up and say, no, we are we are trained in this. Not me, but some of us are trained in this. We should stand up and say we need to do what's best for our patients.

Dr. Blair Bigham:

Well, I have no doubt that there are Alberta physicians probably getting ready to do just that and challenge this legislation. I'm sure we haven't heard the last of it. That's it for this episode of the CMAJ Podcast. If you can, please like or share or rate our podcast or leave a comment wherever it is you download your audio. It really helps us get the message out. The CMAJ Podcast is produced by Neil Morrison at PodCraft Productions. Our editor of the podcast is Deputy Editor at CMAJ, Catherine Varner. I'm Blair Bigham.

Dr. Mojola Omole:

I'm Mojola Omole. Until next time, be well.