[19] The Human Rights Policy was the evolution of Policy
Statement #5-08, entitled “Physicians and the Ontario Human
Rights Code”, adopted by the College in 2008 to address its
expectations for physicians who, for moral or religious reasons,
refused to accept certain patients, refused to provide medical
services, or terminated the physician-patient relationship. While
that document did not contain the current effective referral
requirement, it did provide that objecting physicians were
expected to “[a]dvise patients or individuals who wish to become
patients that they can see another physician with whom they can
discuss their situation and in some circumstances, help the
patient or individual make arrangements to do so”.
[20] In 2014, the College undertook a review of the policy and
engaged in a consultation process with its membership and other
interested parties, revising the policy in March 2015 to include
the effective referral requirement.
[21] The stated purpose of the Human Rights Policy is to set “out
the legal obligations under the [Human Rights] Code for physicians
to provide health services without discrimination, as well as the
College’s professional and ethical expectations of physicians in
meeting those obligations . . . [The] policy outlines physicians’
rights to limit the health services they provide for legitimate reasons
while upholding their fiduciary duty to their patients.”
[22] After the release of the decision of the Supreme Court of
Canada in Carter v. Canada (Attorney General), [2015] 1 S.C.R.
331, [2015] S.C.J. No. 5, 2015 SCC 5, striking down portions of
the Criminal Code, R.S.C. 1985, c. C-46, prohibiting assisted
suicide, the College undertook a consultation process, which led to
the adoption of a policy to provide guidance to physicians in com-
plying with the legislation permitting MAiD. The stated purpose of
the policy, adopted in June 2016, is to articulate “the legal
obligations and professional expectations for physicians with respect
to medical assistance in dying, as set out in federal legislation,
provincial legislation, and relevant College policies”.
[23] This was Policy Statement #4-16, entitled “Medical
Assistance in Dying” (the “MAiD Policy”), which contained the
following effective referral requirement:
Where a physician declines to provide medical assistance in dying for reasons
of conscience or religion, the physician must not abandon the patient. An
effective referral must be provided. An effective referral means a referral
made in good faith, to a non-objecting, available, and accessible physician,
nurse practitioner or agency. The referral must be made in a timely manner
to allow the patient to access medical assistance in dying. Patients must not
be exposed to adverse clinical outcomes due to delayed referrals.
(Emphasis added)
