Approved by Council: November 2001
Reviewed and Updated: November 2006, February 2016, June 2017; May 2018

Companion Resources: Advice to the Profession

Other References:

• "Treating Those Closest to You," Dialogue, Issue 1, 2016
• Results from the most recent consultation

Definitions

Family member: An individual with whom the physician has a familial connection and with whom the physician has a personal or close relationship, where the relationship is of such a nature that it would reasonably affect the physician’s professional judgment. This includes, but is not limited to: the physician’s spouse or partner, parent, child, sibling, members of the physician’s extended family, or those of the physician’s spouse or partner (for example: in-laws).  

Others close to them: Any other individuals who have a personal or close relationship with the physician, whether familial or not, where the relationship is of such a nature that it would reasonably affect the physician’s professional judgment. This may include, but is not limited to, friends, colleagues, and staff.¹

Treatment: Anything that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health-related purpose. This includes: the performance of any controlled act;² ordering and performing tests (including blood tests and diagnostic imaging); providing a course of treatment, plan of treatment, or community treatment plan.³

Minor condition: A non-urgent, non-serious condition that requires only short-term, episodic, routine care and is not likely to be an indication of, or lead to, a more serious condition, or a condition which requires ongoing clinical care or monitoring.⁴

Emergency: an “emergency” exists where an individual is apparently experiencing severe suffering or is at risk of sustaining serious bodily harm if medical intervention is not promptly provided.

Policy

1. In order to meet their professional obligations to practise medicine safely and effectively, physicians must only provide treatment for themselves and family members in limited circumstances, as set out in this policy.

Providing Treatment

2. Physicians must not provide treatment for themselves or family members except:
   1. For a minor condition, or in emergency situations;
      and
   2. When another qualified health-care professional is not readily available.
3. Physicians must not provide recurring episodic treatment to themselves or family members for the same disease or condition, or provide ongoing management of a disease or condition, even where the disease or condition is minor.
4. As the same risks of compromised objectivity and meeting the standard of care may arise when providing care to others close to them, physicians are advised to carefully consider whether it would be appropriate to provide treatment in these instances.
   1. Where the relationship would reasonably affect the physician’s professional judgement, physicians must not provide treatment to an individual close to them, except in accordance with the circumstance set out in provision 2 of this policy.
5. When the nature of the relationship with family members or others close to them has changed, physicians must re-evaluate the nature of their relationship to determine whether they can still be objective.
   1. If the physician’s professional judgment has been reasonably affected by changes in the relationship, physicians must transfer care of the individual to another qualified health-care professional as soon as is practical.

Scope of Treatment and Transfer of Care

6. Physicians must always act within the limits of their knowledge, skill and judgment.⁵
7. Providing treatment in accordance with this policy is limited to addressing the immediate medical needs associated with treating a minor condition or emergency. Where additional or ongoing care is necessary, physicians must transfer care of the individual to another qualified health-care professional as soon as is practical.

Expectations about Documenting Care and Maintaining Confidentiality

8. Physicians must advise the individual receiving care to notify their primary health-care professional of the treatment that the physician has provided.
9. Where the individual does not have a primary health-care professional, physicians are advised to explain to the individual the importance of informing their next health-care professional, where practical, of the treatment received from the physician.
10. Where it is impractical for the individual receiving treatment to inform their own primary health-care professional of the treatment the individual received (e.g., children), physicians are advised to inform the individual’s primary health-care professional, with the individual’s consent, of the treatment they provided.
11. Physicians must maintain the confidentiality of the personal health information of any individual they treat.⁶

Spouses or Sexual/ Romantic Partners

12. Physicians must be mindful that providing treatment to a spouse, partner, or anyone else with whom they are sexually or romantically involved may give rise to a physician-patient relationship and that providing treatment that exceeds the circumstances set out in this policy may give rise to a physician-patient relationship⁷ such that the sexual abuse provisions⁸ of the Regulated Health Professions Act, 1991 would apply.
13. Physicians must not provide treatment to a spouse, partner, or anyone else with whom they are sexually or romantically involved, beyond the circumstances of a minor condition or emergency, and where no other qualified health-care professional is readily available.

Prescribing or Administering Drugs

14. If prescribing drugs is required as part of providing care in accordance with this policy, physicians must comply with the College’s Prescribing Drugs
15. Physicians must not prescribe or administer the following for themselves, family members, or others close to them:
    1. narcotics^9,10,
    2. controlled drugs or substances^11,12,
    3. monitored drugs¹³,
    4. cannabis for medical purposes¹⁴, or
    5. any drugs or substances that are addicting or habituating.
16. Physicians must not prescribe or administer the drugs or substances set out in provision 15 even when another health-care professional is in charge of managing the treatment of the disease or condition.

Endnotes

^1. Physicians are advised to contact the College’s Physician Advisory Services or the Canadian Medical Protective Association (CMPA) for further guidance as to which individuals may be included in this term.

^2. Controlled acts for physicians, as set out in s. 4 of the Medicine Act, S.O. 1991, c. 30.

^3. The definition of “treatment” has been adapted, and modified, from the definition of “treatment” as set out in the Health Care Consent Act, 1996, S.O. 1996, c. 2, Schedule A, at Section 2(1); the exceptions to “treatment” under the Health Care Consent Act do not apply to this policy.

^4. For the purposes of this policy, “minor condition” does not include providing sick notes or completing insurance claims for themselves, family members, or others close to them.

^5. Sections 2(1)(c), 2(5), O. Reg. 865/93 (Registration), enacted under the Medicine Act, 1991, S.O 1001., c.30.

^6. Physicians must abide by their legal obligations under the Ontario Personal Health Information Protection Act, 2004, S.O. 2004, c. 3 Sched. A (PHIPA), as well as the expectations set out in the College’s Confidentiality of Personal Health Information policy.

^7. Patient criteria, O. Reg. 260/18, under subsection 1(6) of the Health Professions Procedural Code, Schedule 2 of the Regulated Health Professions Act, 1991, S.O. 1991, c.18 (hereinafter HPPC). For more information, see the College’s Maintaining Boundaries and Preventing Sexual Abuse policy section “Determining Whether a Physician-Patient Relationship Exists”.

^8. Legislative provisions relating to sexual abuse are set out in Sections 1(3) to (6) and Sections 51(1) to (3) and (4.1) to (9) of the HPPC. This includes the amendments to the HPPC contained in Bill 87 (Protecting Patients Act, 2017) in force as of May 1, 2018. It does not include any other requirements that may be developed in regulation. Physicians are advised that the passing of Bill 70, the Regulated Health Professions Amendment Act (Spousal Exception), 2013, has not changed the law with respect to physicians, as the College has not opted to exempt physicians who treat their spouses from the sexual abuse provisions. For more information, see the College’s Maintaining Boundaries and Preventing Sexual Abuse policy.

^9. Narcotics are defined in s. 2 of the Narcotic Control Regulations, C.R.C. c. 1041, enacted under the Controlled Drugs and Substances Act, S.C. 1996, c. 19 (hereafter the CDSA)  CDSA: the term ‘narcotics’ includes opioids.

^10. While these drugs or substances may be a legitimate treatment, regulations under the CDSA prohibit physicians from prescribing or administering narcotics, or controlled drugs or substances for anyone other than a patient whom the physician is treating in a professional capacity. There are no exceptions under the CDSA for prescribing or administering these drugs or substances to non-patients, even in emergencies. See s. 53(2) of the Narcotic Control Regulations C.R.C. c. 1041, and s. 58 of the Benzodiazepines and Other Targeted Substances Regulations, SOR/2000-217, under the CDSA.

^11. Controlled drugs and substances are defined in s. 2(1) of the CDSA and mean a drug or substance included in Schedule I, II, III, IV or V of the Act.

^12. Please see footnote 10.

^13. The Ontario Ministry of Health and Long-Term Care (Ministry) monitors a number of prescription narcotics and other controlled substance medications as part of its Narcotics Strategy. A list of monitored drugs is available on the Ministry’s website http://health.gov.on.ca/en/pro/programs/drugs/monitored_productlist.aspx. See also s. 2 of the Narcotics Safety and Awareness Act, 2010, S.O. 2010, c. 22 for a definition of ‘monitored drug’.

^14. See the College’s Cannabis for Medical Purposes policy for more information.