January 10, 2009

Canada's three major airlines will now require a doctor's note from disabled or obese passengers seeking a second seat free of charge, a requirement that the Canadian Medical Association calls an undue pressure on the country's doctors.

As of today, Air Canada, Air Canada Jazz and WestJet require medical certification for access to the "one person, one fare" program, which took effect this month after a Canadian Transportation Agency ruling early last year. The program guarantees a second free seat for those who require a personal attendant while travelling, or whose obesity functionally disables them from travelling.

These people will now need to have doctor's notes. Such doctor visits are paid for by the patient.

"In order for us to be sure we implement it properly and with due regard to the Agency's intentions, we have to know who truly requires accommodation so that all eligible people are covered and receive the benefit of this policy," Air Canada spokesman Peter Fitzpatrick wrote in a statement to The Globe and Mail.

The requirement for a note certifying obesity is what has the CMA up in arms.

"The majority [of applicants] would be people who are just too large to fit in one seat. You don't need a medical opinion to know that," said Briane Scharfstein, a long-time family doctor who is now the director of professional affairs at the CMA.

"It is to some extent an abuse of physicians' time, when they're already a bit overwhelmed ... to be writing notes to, in essence, police entitlement to a benefit."

The transportation-agency-defined group that is eligible for the "one person, one fare" program includes "those determined to be functionally disabled by obesity for purposes of air travel," but excluded are "persons who are obese but not disabled as a result of their obesity."

Air Canada's policy, which took effect yesterday, requires of passengers "a doctor's certificate of their disability." If that disability is obesity, the airline will consider the doctor's note valid for two years. It can be renewed by a nurse, physical therapist or occupational therapist.

WestJet requires one doctor's note for each flight booking, with no renewal process. Its policy takes effect today.

Both airlines have processes for refunds of seats booked before yesterday for coming flights. Dr. Scharfstein is hoping the airlines will meet with the CMA to discuss a more suitable process.

Laurie Beachell, national co-ordinator of the Council of Canadians with Disabilities, suggested that may involve expanding the types of professionals who are able to certify the benefit, but said it shouldn't be left up to the airlines.

"The challenge around disability always is: Who is the gatekeeper on determining eligibility? And for a lot of processes, medical evidence, or a doctor's note, is required. ... It isn't a good use of doctors' time," Mr. Beachell said last night.