Over the years, CPSBC has received concerns about physicians withholding the signing of the Notice of Birth from patients who are paying privately for maternity services. Patients in British Columbia may be paying privately for a variety of reasons, including lack of eligibility for public coverage. In some cases, patients may also be unable to afford the full cost of care. However, lack of payment, partial or full, should never be used as a reason to delay or deny services related to childbirth.
From both legal and ethical perspectives, all patients in BC are entitled to fair and appropriate care during childbirth.
Legal obligations
Under the Vital Statistics Act, the provider in attendance at a birth is legally required to submit a Notice of Birth in a timely manner. This requirement applies to all registrants, regardless of payment status or what may have become accepted practice. Without this, parents are unable to complete the birth registration required for receiving services. Furthermore, the CMA Code of Ethics and Professionalism states that “physicians should be aware of the legal and regulatory requirements that govern medical practice in their jurisdictions.â€
In addition, CPSBC’s Access to Medical Care Without Discrimination practice standard requires registrants to consider each patient’s unique circumstances and available resources when providing care. This standard also prohibits limiting services based on protected grounds, which can include financial status.
Ethical responsibilities
Withholding services raises serious ethical concerns. Many privately paying patients may be newcomers to Canada, including refugees, and are often unfamiliar with or unsupported in navigating the health-care system. For a postpartum patient, these additional barriers can create immediate distress and lead to longer-term challenges for both parent and child.
While it is understood that registrants are not expected to provide care without compensation, it is crucial to take a broader view of how the denial or delay of services may affect a patient’s health, well-being, and trust in the system. CPSBC expects registrants to apply an equity-informed approach and to consider the lived realities of patients when delivering care.