Alberta’s Bill 26, which restricts gender-affirming treatments, has provoked strong opposition from the province’s clinicians. Though officials have presented the law as a means of protecting children during a vulnerable time, many clinicians see it as an intrusion into their practice and a rejection of internationally recognized standards of care.

Alberta’s Bill 26 “will enable government to implement policies to preserve choice for minors identifying as transgender while continuing to refocus the healthcare system,” according to the provincial government. It aims to support children in preserving their fertility until they are old enough to make decisions with possibly life-changing consequences, Justice Minister Mickey Amery said in a statement.

Under the bill, Alberta Health Services will transition to an acute care service delivery provider. The bill also enables provincial health agencies to establish a process for resolving patient concerns.

Bill 26, which was passed in December 2024, prevents patients younger than 18 years from accessing gender-affirming treatments such as puberty blockers and hormone therapy. It also specifies when and how these medications can be used. The Canadian Medical Association (CMA), along with three Alberta doctors, has launched a constitutional challenge to the law.

CMA Speaks Out

Bill 26 restricts the practice of evidence-based gender-affirming medical care, resulting in patient distress, according to the CMA. “These patients are going through a critical period in their healthcare journey,” Margot Burnell, MD, president of the CMA, told Medscape News Canada. “They often have anxiety, depression, and suicidal ideation, so it’s critically important that we support them and their loved ones in this process.”

Opponents of the legislation point out its repercussions not only for transgender patients but also for physician and patient autonomy overall. A patient who visits a physician can discuss the clinical evidence with respect to his or her illness and engage in shared decision-making. “With this bill, the government is imposing itself in medical clinics, and that’s why we felt it was important as an organization to speak out on this matter,” said Burnell.

Bill 26 signifies a major change to Alberta healthcare legislation, Jake Donaldson, MD, family physician in Calgary, told Medscape News Canada. “It prevents physicians from providing treatments that are considered the standard of care internationally, replacing clinical judgment with political decision-making. My concern is that the bill undermines patient safety, interferes with physician-patient relationships, and puts vulnerable youth at increased risk by removing care that is recommended by every major medical organization in North America.”

Donaldson noted that the bill sets a precedent for government intervention in matters of patient care. “It’s quite concerning that politicians are trying to insert themselves in healthcare, when they have no training or expertise,” said Donaldson.

“Bill 26 really did put the government in the patient’s examining room,” Brian Wirzba, MD, president of the Alberta Medical Association, told Medscape News Canada. The parents he has spoken to have expressed a lot of concern, he said, and the law may mean that patients must seek care in other provinces. “This measure is a further demonstration that Alberta isn’t necessarily a welcoming place for patients who have gender dysphoria or who are struggling with gender identity,” said Wirzba.

“There is a social stigma for people seeking gender-affirming care. Not all Alberta physicians are necessarily in favor of the treatment. The Alberta Medical Association’s position is that even if there is a controversial therapy or differences of opinion, the courts and the province’s politicians should not be weighing in on that,” Wirzba added.

Loss of Trust

In November, the CMA surveyed 447 doctors on their views of Alberta’s Bill 26 and other matters. About 76% of Alberta doctors responded that they don’t feel trusted or respected.

Doctors also foresee ripple effects that extend well beyond their own experience. Approximately 8 in 10 doctors believe that growing government oversight of medical practice will make it harder to recruit and retain physicians in their province. “Recruitment and retention are foundational to access. If the workforce becomes harder to maintain, there are serious reasons to believe patients will feel it, too,” the report stated.

When asked about the direct consequences of government policy for care, physicians expressed serious concern. Two thirds (66%) said these political decisions will worsen patient quality of care. Only 13% believe such decisions will improve care. The report concluded that doctors see these changes not as incremental adjustments but as decisions that could reshape how care is delivered in ways that leave patients worse off.

Burnell, Donaldson, and Wirzba reported having no relevant financial relationships.

Evra Taylor is a widely published freelance medical writer and reporter with 20 years’ experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.