In 2021, Ontario MPP Suze Morrison introduced Bill 17, the Gender Affirming Health Care Advisory Committee Act. The Bill was sent to be studied by the Standing Committee on Social Policy, but did not make it past committee stage due to the Ontario election in June 2022.  On November 16, 2022, four NDP MPPs re-introduced the Gender Affirming Health Care Advisory Committee Act, 2022, now listed as Bill 42.

What is Bill 42?

The main purpose of the bill is to establish a committee that will advise the Minister of Health regarding “improving access to and coverage for gender-affirming health care.” Upon receiving recommendations from the Committee, the Minister of Health would make recommendations to the government. Some of the language in this bill can be confusing, but it goes on to define gender-affirming health care as “procedures, medical treatments and referral processes that align a patient’s body and physical presentation with their gender identity.”

Bill 42 clarifies that members of the committee would include members of transgender, two-spirit, non-binary, intersex, and other diverse communities (making up the majority of the committee), as well as health care providers who have experience working with these groups and any others that the Minister of Health thinks might be helpful to have on the committee. Further, the committee would be required to consult with stakeholders such as health care providers, LGBTQ and transgender health associations, and addiction and mental health centres.

Intended recommendations of the committee would include how to increase coverage, access, and availability of gender-affirming health care, expanding OHIP coverage for gender transition procedures that are not currently covered, how to reduce referral requirements for access to care, and “how to define gender-affirming health care procedures as life-saving procedures.”

What Does This Mean for Ontarians?

The Gender Affirming Health Care Advisory Committee Act is concerning on multiple levels. First, it encourages gender transition (or sex-change procedures and treatments) as something that is ultimately good and beneficial to Ontarians struggling with their identity. Some people struggle with gender dysphoria, a deep sense that their gender is different from their biological sex. When this happens, our society often tries to encourage them to change the appearance of their biological sex with no questions asked. This bill seeks to remove various impediments to sex-change procedures. However, there is no mention in the bill of biological sex and its importance when discussing ‘gender-affirming health care.’

Of course, it is important that those who struggle with gender dysphoria have access to health care in general. They are human beings made in the image of God and should be cared for like anyone else. But, as the definition of ‘gender-affirming health care’ shows, Bill 42 has nothing to do with what we think of when we hear the term ‘health care.’ Rather, it is specifically focused on procedures that align a patient’s body with their gender identity. We need to unpack that to understand what is proposed here: to ‘align’ a body with their gender identity means to biochemically or surgically modify or remove healthy functioning body parts in order to make a biological male or female appear like the opposite sex. The sponsor and supporters of the bill are pushing a deeply religious – not scientific – view of anthropology (what it means to be human) that privileges the feelings of the internal self or soul over the physical body. This religious idea is rooted in ancient Gnosticism.

Citizens and governments should not simply affirm and support these transitions by funding elective surgeries and procedures through OHIP. We must recognize the harms that gender transitions cause and seek to come alongside those who struggle with these deep existential questions. Rather than affirming gender identity at the expense of biological sex, we can focus on affirming biological sex and helping those who struggle with the biological aspect of their identity. The victims of this kind of legislation are often children who become confused by ‘gender-affirming care,’ instead of being helped to understand what is best for them. Sex-change procedures have harmful short- and long-term effects, and many people regret them later in life. Instead of trying to help a patient with their changeable understanding of gender, this bill advocates for helping patients access changes to their biological sex that are often irreversible.   

Bill 42 would also seek to reduce referral requirements for access to care. The idea behind this would again be to allow patients to access ‘health care’ quicker. In other words, they would not be required to go through various referral processes to ensure that they understand what is involved in the process for sex-change procedures or that they are mentally competent to make that decision. When the former iteration of this bill was debated in the Legislature, the bill’s sponsor stated in the debate at the Legislature: “When we met over coffee, this constituent said, ‘I have to prove I’m mentally well for surgery, but I’m mentally unwell because I can’t get surgery.’ This catch-22 in terms of accessing transition-related health care has cost lives.” It’s this kind of focus that seeks to fast-track sex-change procedures while failing to consider the implications of such procedures.

At the same time, this will become a greater concern for doctors who cannot in good conscience provide these treatments. Currently, doctors and other health care providers who have a conscientious objection to various controversial procedures are required to refer the patient to another health care professional who will provide the treatment. But the door to conscientious objection may become narrower as a result of this legislation. Defining gender-affirming health care as a lifesaving procedure will have a detrimental effect on doctors who oppose the practice. After all, why should we permit doctors to refuse to save someone’s life? On the other hand, if it is framed as an elective procedure, there may be more room for objection and disagreement.

Bill 42 has a focus on improving access to gender-affirming surgeries and procedures, including removing any difficulty for the patient trying to access those procedures. Yet, these procedures cause harm to Ontarians. If this bill is passed, these harms will increase. Bill 42 not only presents sex-change procedures as good and helpful but also as necessary, critical, and life-saving procedures. This is concerning, but we can also counter this perspective with biblical truth, showing the importance of caring for all people in a way that affirms the importance of the body and seeks to help people through their existential struggles.

The Ontario Legislature often returns from their summer break in mid-September and continues with the work they had started before the break. But, with the federal election in full swing this September, the government chose to prorogue the legislature (end the current session) and return on October 4^th with a new session. So, following the extended break, with the provincial election in June 2022 coming into sight, the Ontario Legislature has been quite busy over the past month. Some of this activity is particularly worth noting.

Every new session of the Legislature begins with a speech from the throne. In the speech, where the government can share their priorities, the government once again emphasized the importance of prioritizing health and long-term care moving forward. The opposition is also keen to share their priorities leading up to the election and many of their private members’ bills also have a focus on health and long-term care. Over 35 bills have been introduced in the past few weeks. Some of these prioritize important policies which align with various recommendations in ARPA Canada’s recent elder care policy report. Others focus on more concerning policy options.

Long-Term Care

When a legislature is prorogued, all bills that have not been passed need to start the process over. This was the case with the More Than a Visitor Act. MPP Lisa Gretzky has re-introduced this bill which recognizes the value of care from family and friends for residents in a formal care setting. This bill, if passed, would allow designated caregivers to visit residents in congregate care settings, to provide physical and tangible support – even during a pandemic. The More Than a Visitor Act has been reintroduced as Bill 19. As when this bill was first introduced, we encourage you to send an EasyMail to your MPP in support of this legislation.

Another of ARPA’s elder care recommendations is that governments work with care homes to develop minimum staffing requirements for long-term care. Bill 14, the Time to Care Act, seeks to ensure that long-term care residents have at least four hours a day of nursing and personal support services. Last year, the government committed to having this in place by 2024-25 and shows the same priority in recent long-term care legislation. Last year, the Ontario Long-Term Care COVID-19 Commission also provided recommendations to the government, many of which were in line with ARPA Canada’s recommendations on Elder Care. Another private member’s bill, Bill 4, seeks to ensure that the Ontario government implements those recommendations and reports on the progress being made.

Vaccinations

Bill 6, the Jobs and Jabs Act, is another private member’s bill that many Ontarians have been paying attention to. This bill would prohibit employers from intimidating or dismissing employees based on their vaccination status or their refusal to disclose vaccination status. On the surface, the intent of the bill is helpful, with its desire to ensure that employees are not penalized based on their personal medical decisions. However, we also ought to be concerned when the government tells private businesses who they can and cannot fire. Because the legislature randomly draws ballots for when private members’ bills will be discussed, this bill will not be on the agenda for 2^nd reading until March 2022.

Protests

There are also two different private members bills that seek to ban COVID-19 protests outside of hospitals and other health facilities. This is concerning because Ontarians should be allowed to protest if they choose, as long as they are not breaking existing laws around obstruction, trespassing, or other misbehaviours. You can read some further commentary on this topic here. If you are concerned about this, you can also send an EasyMail to your MPP here.  

Gender

Another bill of concern is Bill 17, the Gender Affirming Health Care Advisory Committee Act. This bill seeks to create an advisory committee that would make recommendations to the Minister of Health with regards to “improving access to and coverage for gender-affirming health care.” The bill goes on to define gender-affirming health care as “procedures, medical treatments and referral processes that align a patient’s body and physical presentation with their gender identity.” Recommendations from the committee would likely include things like improving access and coverage for procedures related to gender transition, expanding OHIP coverage for various sex-change treatments, and how to “define gender-affirming health care procedures as lifesaving procedures.”

Bill 17 explicitly promotes and normalizes sex-change surgeries and other medical procedures and treatments for gender dysphoria, instead of supporting body-affirming counselling for those who struggle with their gender and sexuality. The Gender Affirming Health Care Advisory Committee Act has already passed second reading with all-party support and has been forwarded to the Standing Committee on Social Policy for further study.

Stay Tuned

We mention just a few of the current bills on the Ontario agenda to look at some of the priorities that MPPs have been promoting with the return of the Legislature. We can continue to encourage our elected representatives to promote positive elder care, including prioritizing the involvement of family caregivers and ensuring adequate staffing ratios in long-term care homes. At the same time, we can point out areas of concern where our MPPs do not view the role of the government correctly, or where they have an improper understanding of healthcare and its purposes. As some of these bills progress, we will provide updates and action items as necessary.