at issue for the majority of patients. This is highlighted in the
supplementary affidavit of Dr. Danielle Martin, filed by the College.
Dr. Martin is the Vice President of Medical Affairs and Health
Systems Solutions at Women’s College Hospital in Toronto. She is
herself certified as a family physician and is a Fellow of the
College of Family Physicians of Canada. She deposed as follows:
The reality of health care in Ontario outside hospitals is that patients are
deeply reliant on their family physicians to connect them with the resources
they need, and the way in which that connection occurs is through a referral.
This is especially true in moments of medical and emotional vulnerability,
such as the end of life and in the case of an unwanted pregnancy.
 Dr. Martin also deposed that:
This includes rural communities and cultural/ethnic neighbourhoods with
unilingual community members, where patients do not have meaningful
choices about their primary care provider, and they cannot access specialty
care through other channels.
In most communities citizens do not have direct access to multiple different
specialists for second and third opinions; they rely on their family physicians
to refer them to a specialist whose scope of practice meets their needs, and
specialists refer to one another on the same basis.
 The evidence also bears out Dr. Martin’s observations
that, given the manner in which health care is currently practised
and made available in Ontario, effective referral is the key to
accessing health care services of all kinds, including the wide
variety of services to which some physicians have religious
 The medical procedures to which the appellants object
(an objection shared to varying degrees by the individual appellants and members of the appellant organizations) include
abortion, contraception (including emergency contraception,
tubal ligation and vasectomies), infertility treatment for
heterosexual and homosexual patients, prescription of erectile
dysfunction medication, gender re-assignment surgery and
MAiD. It is impossible to conceive of more private, emotional or
challenging issues for any patient. The evidence establishes that
these issues are difficult for patients to raise and to discuss,
even with a trusted family physician. The evidence also establishes that some of these decisions frequently confront already
vulnerable patients: patients with financial, social, educational
or emotional challenges; patients who are old, young, poor or
addicted to drugs; patients with mental health challenges
or physical or intellectual disabilities; patients facing economic,
linguistic, cultural or geographic barriers; and patients who do