In this case, the effective referral provisions of the Policies guide physicians
on how to uphold their professional and ethical obligations of patient-centered
care and non-abandonment within the context of the public healthcare system
in the Province. It is reasonable to conclude that, in doing so, the Policies
will facilitate patient access to care, based on the “gatekeeper” function of
physicians in Ontario. As such, there is a rational connection between the
objective of the Policies and the means of achieving that objective.
 I agree with the Divisional Court that, as a matter of logic
and common sense, requiring objecting physicians to give an
effective referral for MAiD, abortion or reproductive health care
services will promote equitable patient access to those health
( ii) Minimal impairment
 At this step in the analysis, the College is required to
show that the Policies impair freedom of religion as little as
reasonably possible in order to achieve their objective:
RJR-MacDonald, at para. 160. As the Supreme Court observed in
Hutterian Brethren, at para. 53, this question asks “whether
there are less harmful means of achieving the legislative goal”.
The appellants say that there are less harmful means, namely,
a “generalized information” model and the means employed in
Evidence of harm
 Relying on the Supreme Court’s decision in Multani, the
appellants submit that a reasoned apprehension of harm is not
sufficient to justify an impugned measure at this stage of the
Oakes analysis. They contend that evidence of actual harm is
required and that the College did not meet this evidentiary
 The College submits that “actual harm” is not required.
The same evidentiary standard applies for every branch of the
Oakes analysis, including the minimal impairment and proportionality branches and the Divisional Court correctly found that
there was sufficient evidence at each stage to support its conclusions. There was evidence that, in the absence of the Policies,
vulnerable patients would experience harm due to interference or
delay in accessing care, shame and stigma associated with a physician’s refusal to provide care, and loss of faith in physicians and
in the health care system. These circumstances could result in
complete denial of care in some cases.
 The issue of harm must be considered in context.
 The record confirms the pivotal role of family physicians,
such as the appellants, as the key point of access to the services