Jillian Ratti, M.D., is tireless whether wearing gloves in surgery, holding a protest banner in the streets, or giving eloquent oral submissions to parliament. Ratti, a family physician and clinical lecturer at University of Calgary Medical School in Calgary, Alberta, Canada, is part of a bevy of vigilant female doctors who keep a rainbow bracelet wrapped around their stethoscope or coat. This is a signal to any LGBTQI or abortion-seeking patient: You are welcome, I am your doctor.
Over the years, she and others have offered the kind of health care that can be tricky to access in Alberta, including prescriptions for medications like the medical-abortion drug Mifegymiso (mifepristone/misoprostol). She also dedicates herself to helping transgender patients. Her conscience dictates, as she says, that everyone should have access to abortion “without judgment.”
The stakes have never been higher. According to Ratti, Alberta is the most conservative province in Canada and currently has the most anti-abortion legislature in its history. Alberta is a place where anti-abortion billboards sometimes pop up on highway advertisement poles.
It all escalated in 2019, when some lawmakers in Alberta’s legislature attempted to bring a bill (colloquially called Bill 207) that would have granted absolute protection to health care providers who morally object to medical procedures such as abortion, contraception, medical assistance in dying, gender-affirming surgery, or even a referral for these types of care. Bill 207, which ultimately collapsed in November, would have empowered a physician to refuse abortion drugs to a teenage family rape victim who has travelled 300 km across rural Alberta to seek help, based solely on their own personal faith. Defenders of Bill 207 claimed that doctors who don’t want to carry out abortion (out of faith reasons) would quit Alberta Province if the bill did not succeed. This is a claim that Ratti dismisses as “an irrelevant, fear-mongering statement with no basis in any data.”
“Fundamentalist Christian groups in Alberta funded this bill,” Ratti reveals. “One Mr. Dan Williams, the lawmaker who sponsored Bill 207, is known to hold anti-abortion views and is also affiliated with Right Now and the Wilberforce Project, which are two politically active anti-abortion groups. They helped him get elected to parliament in 2019.” Right Now and Wilberforce have refused to acknowledge exactly who they helped to win, but they boast of producing the most stridently anti-abortion parliament in the history of Alberta.
“Luckily, we do indeed have a core group of vigilant, largely female-identifying doctors, who keep an eye on government and societal trends,” Ratti says. Ratti feared that if Bill 207 succeeded, some health care providers would be empowered to turn away patients for faith reasons. Such refusals, she said, could push sexual minority patients out of critical health care, causing mental anguish to these LGBTQI patients. Ratti and activist colleagues took the fight beyond hospital wards.
She was invited to parliament to give expert testimony and passionately argued before committees weighing the bill. She stated that a conscience law will do nothing to protect the “moral distress” of Alberta religious physicians who are uneasy about providing abortion or gender-affirming surgery. While advocates for these anti-abortion laws focus on the “moral distress” of the doctor, Ratti instead thinks we should focus on the moral distress of the patient. She said, “For me, moral distress is things like hearing about a woman who attempts to fill her prescription for Mifegymiso abortion drug and faces harsh rejection from the pharmacist behind the counter.”
In fact, the consequences of Bill 207 could have literally been the difference between life and death, says Kristopher Wells, Ph.D., Canada research chair for the public understanding of sexual and gender minority youth and professor at MacEwan University. Wells blasted Bill 207 as a “dangerous slippery slope,” in an email. “Research already shows LGBTQ people already struggle to find a supportive primary care physician. Now imagine the freedom to openly discriminate.”
The bill’s attempt was misguided, adds bioethicist Cheryl Mack, head of the Ethics Committee of the Canadian Anesthesiologists’ Society. “Bill 207 was written from a very privileged perspective. It took potential for patient harm out of the equation.”
If harm was averted by the bill’s flopping, its mere attempt has galvanized fear. LGBTQI patients who have sought abortions feel like they are on the defensive again in Alberta, Ratti says. Her vulnerable patients feel less safe in Alberta lately.
“To be clear, those populations of patients are already refused referral and care, even under our current system in Alberta,” she says. “There is nonetheless a lot of anecdotal experience about patients being turned away. There is a word-on-the-street network in which ‘friendly’ and ‘unfriendly’ physicians get reputations for how well or how poorly they treat vulnerable populations.”
An anti-abortion bill is cynically a very “political thing” beyond medicine, argues Ratti. “Alberta lawmakers were funded by Wilberforce/Right Now, and those groups now expect them to legislate on behalf of their anti-abortion goals. That is what the bill was: payment for services received.”
Partly thanks to Ratti and colleagues’ continued activism, medical officers in Alberta who refuse abortion referrals based on conscience could face discipline from their regulatory bodies or professional associations, should a complaint be filed, explains Wells.
But do referrals really work in Alberta’s hospital wards? Ratti is unimpressed. “Most of the time, anecdotally at least, it seems that conscientious objectors do not meet that basic minimum. This is admittedly based on a biased sample that I hear from patients who have had bad experiences. Overall, it has been my experience that referrals in matters of conscience do not work out effectively from the perspective of patients.”
Bill 207’s attempt has been so scary for patients and demoralizing for activists that some doctors wouldn’t mind seeing drastic positions like refusing enrollment into medical school for students who cite faith to refuse abortion treatment.
“This is a hard one for me, and my opinions keep evolving,” sighs Ratti. “Originally, I had no desire to exclude anyone due to their beliefs. I am starting to believe that we should be setting stronger boundaries for the sake of patients. That includes denying admission to medical school. Is it necessary? Probably. Drastic? Probably not.”
On this, Wells is straightforward. “If you cannot agree to provide discrimination-free service, then you should not be admitted to a medical school. Bill 207 was a major black eye not only on Canada, but for our province.”
Already, Ratti and activist colleagues anticipate another punch to be swung next time. She admits: “Social conservatives are well funded. But honestly, we are tired when we use all our organizing energy to combat regression.”