Fiduciary nature of physician-patient relationship required physicians to act at all times in their

Provincial College of Physicians and Surgeons enacted policies that required all physicians to provide patients with effective referral for any medical services, such as medical assistance in dying and abortion, to which they had religious objections. Application by applicants, religiously objecting family doctors and associated organizations, to challenge policies as infringing ss. 2 and 15 of Canadian Charter of Rights and Freedoms was dismissed. Applicants appealed. Appeal dismissed. Policies infringed on doctors’ freedom of religion under s. 2 of Charter as doctors had sincere religious belief that required referrals would make them complicit in moral wrong which constituted interference that was neither trivial nor insubstantial. Purpose of policies was properly identified as facilitation of equitable patient access to health care services, which was pressing and substantial. As matter of logic and common sense, requiring objecting physicians to give effective referral for services would promote this objective . There was compelling evidence that vulnerable patients would suffer harm in absence of effective referral, given that services related to private, emotional and challenging issues that often required time-sensitive decisions to avoid delay preventing access altogether. Applicants’ proposed “generalized information” model placed burden on patient to self-refer through brochures, phone numbers and websites to find physician to provide services, while dealing with rejection and shame arising from loss of personal support of trusted family doctor. Minimal impairment did not require College to choose least ambitious means to protect vulnerable groups and deference was owed to choice. Generalized information and other self-referral models would minimize burden on doctors but impair equitable access to health care . Policies were minimally impairing of doctors’ religious freedom and, in context of regulated and patient-centred medical profession where patients had constitutional rights to access health care while doctors had no right to practice medicine, salutary effects outweighed deleterious effects. College presented options to insulate objecting doctors from services and doctors had option of changing to specialties without such services. Fiduciary nature of physician-patient relationship required physicians to act at all times in their patients’ interests such that policies struck reasonable compromise of not requiring objecting doctors to personally provide patients with services.

Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario (2019), 2019 CarswellOnt 7398, 2019 ONCA 393, George R. Strathy C.J.O., S.E. Pepall J.A., and Fairburn J.A. (Ont. C.A.); affirmed (2018), 2018 CarswellOnt 1135, 2018 ONSC 579, Wilton-Siegel J., Lococo J., and Matheson J. (Ont. Div. Ct.).

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