Regulação das profissões de saúde em Ontário: autorregulação com accountability pública baseada em estatutos legais
| Autor | Trudo Lemmens, Kanksha Mahadevia Ghimire |
| Cargo | Doutor em Direito Civil pela Faculty of Law; mestre especializado em bioética, pela McGill ? Faculty of Law; mestre em Direio pela Faculdade de Direito da KULeuven University. Professor de Direito Sanitário na Faculdade de Direito da University of Toronto. Toronto. |
| Páginas | 124-204 |
Tema em Debate/ Artigo Original
R. Dir. sanit., São Paulo v.19 n.3, p. 124-204, nov. 2018/fev. 2019
DOI: http://dx.doi.org/10.11606/issn.2316-9044.v19i3p124-204
Trudo Lemmens1
Kanksha Mahadevia Ghimire1
REGULATION OF HEALTH PROFESSIONS
IN ONTARIO: SELF-REGULATION
WITH STATUTORY- BASED PUBLIC
ACCOUNTABILITY
accountability
Received: 11/29/2019. Approved: 04/03/2019
1University of Toronto. Toronto, Canada.
Correspondence: Trudo Lemmens. E-mail: trudo.lemmens@utoronto.ca
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Model of regulation of health professionals in Ontario
R. Dir. sanit., São Paulo v.19 n.3, p. 124-204, nov. 2018/fev. 2019
ABSTRACT
e paper explores the model of regulation of health professionals in Ontario, Canada; a self-
-regulation model built around a detailed statutory scheme.e core of the paper consists of a
discussion of Ontario’s Regulated Health Professions Act and of the key components of 26 specic
health profession acts that have been enacted under its umbrella. e paper explores the role of the
regulatory colleges, the role of the Ministry of Health in determining scope of practice and other
components of medical practice, and the disciplinary and appeal procedures. Some other specic
issues are also briey touched upon, such as the integration into the profession of internationally
trained physicians, and the government’s role in ensuring access to specialists across the province.
A nal section looks at the challenges and the limitations of the Ontario model, through a number
of health professions-related controversies that revealgaps in self-regulation, including: failure to set
and enforce proper educational and practice standards in specic areas; failure to conduct timely
investigations into potential misconduct by professionals; and failure to question professionals in
a position of power. e paper also discusses briey the implications of recognizing through legal
regulation some alternative and complementary medical practices, and the challenge ofregulating
indigenous health care practitioners. It concludes that the primary limitations of the regulatory
model arise on account of professional self-interest and power-relations impacting procedural
issues, and the complexity of the regulatory model that may potentially undermine quality control.
Keywords:
Canada; Health Professions; Health Work Regulation; Public Accountability.
RESUMO
Este artigo explora o modelo de regulação dos prossionais de saúde em Ontário, Canadá, um
modelo de autorregulação construído em torno de um regime estatutário especíco. O foco central
do trabalho é a discussão sobre a Lei de Regulamentação das Prossões de Saúde de Ontário e os
principais componentes de 26 leis foram promulgadas sob sua égide para regulamentar prossões
de saúde especícas. O artigo explora a função dos colegiados regulatórios, o papel do Ministério
da Saúde na determinação de escopos de prática e de outros elementos da atividade médica, e os
procedimentos disciplinares e de recurso. Outras questões especícas também são brevemente
abordadas como a adequação prossional de médicos treinados no exterior e a atribuição do
governo de garantir o acesso a especialistas em toda a província. A seção nal analisa os desaos e
as limitações do modelo, levantando uma série de controvérsias relacionadas às prossões de saúde
que revelam lacunas na autorregulação, incluindo: incapacidade de estabelecer e aplicar padrões
educacionais e práticos adequados em áreas especícas; falha na condução de investigações em
tempo hábil sobre possíveis desvios de conduta por parte dos prossionais; e falha em questionar
prossionais em posições de poder. O artigo também discute brevemente as implicações de reco-
nhecer, por meio de regulamentação legal, algumas prossões alternativas e complementares de
saúde; e o desao de regular os prossionais de saúde indígenas. Conclui-se que as principais
limitações do modelo regulatório surgem em razão de interesses prossionais individualistas e
de relações de poder que afetam questões processuais, bem como da complexidade do modelo
regulatório, que pode potencialmente prejudicar o controle de qualidade.
Palavras-Chave:
Accountability; Canadá; Prossões de Saúde; Regulação das Prossões de Saúde.
126
Lemmens T., Ghimire K. M.
R. Dir. sanit., São Paulo v.19 n.3, p. 124-204, nov. 2018/fev. 2019
Introduction
As in several other industrialized countries, the regulation of the health
professions in Canada has undergone significant changes in the last decades.
These changes often occurred in conjunction with others in the health care
system itself. The changes indicate a growing recognition of the need for a pub-
licly accountable regulatory system, in line with the crucial role of the health pro-
fessions in Canada’s publicly funded health care system. Yet, reflecting political
realities, the health professions have largely retained their autonomy and been
allowed to organize, albeit under closer state guidance, their own professional
regulatory system.
e regulation of professionals in Canada falls under the provincial gov-
ernments jurisdiction with respect to health care1. Provincial governments and the
territories determine which health professions to regulate and the manner of their
regulation2. is paper explores the model of regulation of health professionals in
Ontario, Canada’s most populated province. Ontario was at the forefront in the
early 1990s when it developed a detailed model of health professions regulation.
e Ontario model has oen been seen as an interesting model of self-regulation
built around a detailed statutory scheme. e paper aims at sketching a picture of
the model of self-regulation that Ontario embraced, and at identifying certain key
issues pertaining to its regulatory model.
I. Background leading up to statutory regulation in 1991
Health professions regulation in Ontario underwent a number of changes
over the 19th and 20th century3. The early 19th century began with increasing
control by the medical profession (primarily physicians) over the division of
labor in health care4. Through state regulation, medicine became a monopoly
that controlled other ‘non-physician’ health services (such as laboratory tech-
nicians)5. After the failure of a ‘free market’ for health care during the Depres-
sion of the 1930s, Canadian provinces started introducing doctor and hospital
insurance plans6.
1HEALTH Law in Canada.
, 2014. Available at:
. Available at:
2ALDRIDGE, Stephanie. The regulation of health professionals: an overview of the British Columbia experience.
, v. 39, n. 1, p. 4, 2008.
3
the Ontario case. , v. 37, n. 7, p. 841-842, Oct. 1993
4Id. Ibid., p. 842.
5Id., loc. cit.
6Id., loc. cit.
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