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Treatment of Self, Family Members, and Others Close to you

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Approved by Council: November 2001;
Reviewed and Updated: November 2006, February 2016, June 2017, May 2018, September 2019, May 2025

 

Policies of the College of Physicians and Surgeons of Ontario (“CPSO”) set out expectations for the professional conduct of physicians practising in Ontario. Together with the Essentials of Medical Professionalism and relevant legislation and case law, they will be used by CPSO and its Committees when considering physician practice or conduct.

Within policies, the terms ‘must’ and ‘advised’ are used to articulate CPSO’s expectations. When ‘advised’ is used, it indicates that physicians can use reasonable discretion when applying this expectation to practice.

Additional information, general advice, and/or best practices can be found in companion resources, such as Advice to the Profession documents.

 

Definitions

Treatment: Anything that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic, or other health-related purpose. This includes but is not limited to performing any controlled act; ordering and performing tests (including blood tests and diagnostic imaging); providing a course of treatment, plan of treatment, or community treatment plan.

Emergency Treatment: Treatment that is necessary in a timely manner to prevent significant harm, suffering and/or deterioration.

Minor Condition: A health condition that can be managed with minimal, short-term treatment and usually does not require ongoing care or monitoring.

Family Member: An individual with whom the physician has a familial connection and with whom the physician has a close and/or personal 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, or sibling.

Others Close to Them: Individuals who have a close and/or personal relationship with the physician where the nature of the relationship could reasonably affect the physician’s professional judgment.

Policy

Treating Yourself, Family Members and Others Close to You

  1. Physicians must not provide treatment for themselves, family members, or others close to them except for:
    1. Treatment for minor conditions;
    2. Emergency treatment; or
    3. Other treatment permitted by Provisions 5 to 7 of this policy.
  1. Where additional or ongoing treatment is necessary, physicians must make every reasonable effort to transfer care to another qualified health-care professional as soon as is practical.
  1. Physicians must not provide recurring episodic treatment to themselves, family members, or others close to them for the same disease or condition, or provide ongoing management of a disease or condition, even where the disease or condition is minor.

Treating Spouses or Sexual/Romantic Partners

  1. 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 relationship such that the sexual abuse provisions of the Regulated Health Professions Act, 1991 would apply. For more information, see the Legal Requirements: Treatment of Sexual and/or Romantic Partners document.

Practising in Communities with Limited Treatment Options

  1. CPSO recognizes that in some small communities, there may be family members or others close to the physician who do not have alternative options for treatment. When determining if a person does not have alternative options for treatment, physicians must consider:
    1. Whether the treatment is within another available qualified health-care professional’s scope of practice;
    2. The geographical distance and/or the person’s ability to travel to other treatment options;
    3. Whether virtual care can be used to provide treatment; and
    4. Any personal factors that would present a significant barrier to obtaining treatment  from another available qualified health-care professional.
  1. If a person does not have alternative treatment options and is not a physician’s sexual or romantic partner, the physician may provide treatment beyond emergency treatment or treatment for minor conditions and must document the circumstances in the patient’s medical record, including why treatment was provided.
  1. Despite Provision 6, physicians must not:
    1. Provide intimate examinations outside of emergency treatment to family members; and/or
    2. Provide psychotherapy to family members.

Prescribing or Administering Drugs

  1. Physicians must not prescribe or administer narcotics and/or controlled drugs and substances for themselves, family members, or others close to them except if providing emergency treatment.

Facilitating Continuity of Care

  1. If a physician provides treatment under this policy, they must take reasonable steps to facilitate continuity of care where necessary.
 

Endnotes

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

  2. This definition is adapted from the Health Care Consent Act.

  3. For information about why close relationships may affect a physician’s professional judgment, see the Advice to the Profession: Treatment of Self, Family Members, and Others Close to You companion document.

  4. The Health Professions Procedural Code and O. Reg. 260/18 under the Regulated Health Professions Act only allows physicians to treat their sexual or romantic partners in emergency circumstances or where the treatment is minor in nature, and only when the physician has taken reasonable steps to transfer care or where there is no reasonable opportunity to transfer care.

  5. This includes Indigenous communities who may have a deep and pervasive mistrust of the medical profession. Further guidance on this provision’s application to Indigenous communities can be found in the Advice to the Profession: Treatment of Self, Family Members and Others Close to You document.

  6. For examples of personal factors that would present a significant barrier to obtaining treatment, please see the Advice to the Profession: Treatment of Self, Family Members, and Others Close to You document.

  7. Intimate examinations include breast, pelvic, genital, perineal, perianal and rectal examinations of patients.

  8. 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.

  9. 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.

  10. 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. 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.