feature
Referrals: The Central Debate
supportive
Opposed
“Patients should
Freedoms entitles physinot be impacted by
cians to limit the health
an individual physiservices they provide for
cian’s conscience or
reasons of conscience or
religious beliefs.”
religion, the policy emphasizes that doing so
must not impede, either
“Referrals are
directly or indirectly, panecessary to ensure
tients’ access to care.
access to care for
The policy requires that
patients.”
physicians, who choose to
limit the health services
they provide for reasons
of conscience or religion, do so in a manner that
respects patient dignity, ensures access to care and
protects patient safety. As part of ensuring access to
care, the policy requires that physicians provide their
patients with an ‘effective referral’ for those services
the physician chooses not to provide for reasons of
conscience and religion. An ‘effective referral’ means
a referral that is made in good faith with a view to
supporting, not frustrating or impeding, access to
care.
In a submission, Barbara Hall, Chief Commissioner
of the Ontario Human Rights Commission, commended the College for effectively balancing patient
and physician rights. According to the Commissioner, the policy recognizes that no right is absolute; the
core of a right is more protected than the periphery;
rights can be limited by the rights and freedoms of
others; and that the aim is to respect the importance
of both sets of rights.
Below are some commonly asked questions about
the policy.
“Physicians should
not have to provide
care that conflicts
with their
conscience &/or
religious beliefs.”
The policy states that
‘clinical competence’ is
a legitimate reason for
physicians to refuse to
treat patients. What
does this mean?
This section of the policy
“A referral is
reflects the College’s genmorally equivalent
eral expectation that phyto providing the
sicians will always practise
care in question”
within the limits of their
own knowledge, skill and
judgment.
Any decision made on the basis of clinical competence must, however, be made in good faith. Clinical
competence must not be used as a means of unfairly
refusing to treat patients (or individuals who wish
to become patients) who have complex health-care
needs or who are perceived to be difficult.
The policy discusses physicians’ legal duty to accommodate the needs of patients up to the point
of undue hardship. When would an accommodation be considered to impose undue hardship?
An accommodation is considered to cause undue hardship if it imposes excessive costs, or gives rise to health
or safety concerns.
Determinations of whether the duty to accommodate has been satisfied and whether an accommodation
imposes an undue hardship are made by the Ontario
Human Rights Tribunal and the Courts. The Commission has stated that:
• costs’ include the actual, present financial cost of car‘
rying out an accommodation measure, as well as any
External Consultation
Dates held
Dec 10, 2014–
Feb 20, 2015
9287
Respondents
12
Breakdown of
Respondents
89%
Public
6%
physicians
4%
.4%
other
organizations
Changes Made in
Response to Feedback
YES
NO
Dialogue Issue 1, 2015
Issue1_15.indd 12
2015-03-19 11:18 AM