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CPSO’s Effective Referral Requirement Affirmed by Superior Court


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In a unanimous decision released today, the Superior Court of Justice (Divisional Court) supported patients’ rights to access health services and the CPSO’s effective referral requirement in relation to its Professional Obligations and Human Rights and Medical Assistance in Dying policies. The Court decision is a win for patient access to health services in Ontario.

The decision also affirmed that the emergency provision in the CPSO’s Human Rights policy represents reasonable limits on religious freedom, demonstrably justified in a free and democratic society. The Applications were dismissed in their entirety.

The goal of ensuring access to healthcare, in particular equitable access to healthcare, is pressing and substantial. The effective referral requirements of the Policies are rationally connected to the goal. The requirements impair the Individual Applicant’s right of religious freedom as little as reasonably possible in order to achieve the goal,” states the decision.

CPSO President Dr. Steven Bodley welcomed the decision. “This is a win for vulnerable patients,” he said. “We are pleased that the Court affirmed our concern that the alternatives proposed by the Applicants would compromise the goal of ensuring access to healthcare, in many situations, often involving vulnerable members of our society.”

The CPSO’s Professional Obligations and Human Rights policy articulates physicians’ professional and legal obligations to provide health services without discrimination and sets expectations of physicians who limit the health services they provide because of their personal values and beliefs. The policy establishes the duty to provide an effective referral if a physician has a conscientious or religious objection to providing a service; and the duty to provide the service in an emergency despite any objection.

The CPSO’s Medical Assistance in Dying policy advises of the legal framework and professional expectations of physicians with respect to medical assistance in dying, as shaped by federal legislation, provincial legislation, and relevant CPSO policies. The MAID policy also provides that where a physician declines to provide medical assistance in dying for reasons of conscience or religion, the physician must not abandon the patient, and an effective referral must be provided. The MAID policy does not require physicians, in any circumstance, to provide MAID or conduct assessments for MAID contrary to their conscientious or religious beliefs.

The goal of these provisions is to protect the public, prevent harm to patients and facilitate access to care for patients in our multicultural, multi-faith society, by guiding all physicians on how to uphold their professional and ethical obligations of non-abandonment and of patient-centred care within the context of Ontario's public health-care system. They aim to protect all Ontario patients, with an emphasis on ensuring that the most vulnerable are not exposed to harm when their physician objects to providing an otherwise appropriate and available medical service.

CPSO defence of patient access to health services was backed by a number of interveners including the Attorney General of Ontario and Dying with Dignity Canada.

Read the complete decision.