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HUMAN RIGHTS AND HEALTH SERVICES: A GUIDE FOR PATIENTS

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The content in this resource is based on the College of Physicians and Surgeons of Ontario’s (CPSO)’s Human Rights in the Provision of Health Services policy ("Policy"). Additional guidance for physicians can be found in the Advice to the Profession: Human Rights in the Provision of Health Services ("Advice") companion document.

 

CPSO has committed to bringing equity, diversity, and inclusion (EDI) into our processes and policies. As part of this commitment, the Policy sets out expectations for doctors in providing safe, inclusive, and accessible health services, in a manner that respects patients’ rights, autonomy, dignity and diversity. It also sets expectations for doctors when they limit the health services they provide because these services conflict with their conscience or religious beliefs.

This Guide for Patients and Caregivers (“Guide”) provides you with an overview of what you can expect from your doctor. Each section of the Guide sets out a list of things your doctor is responsible for and a list of things you can do to help support your own health care experience

For definitions of key terms and concepts related to this Guide, see CPSO’s Equity, Diversity, and Inclusion Glossary.

Providing Safe, Inclusive and Accessible Health Services

Your doctor is responsible for providing you with safe, inclusive, and accessible health services. However, it is important that you provide the information necessary so that your doctor can create a safe, inclusive, and accessible environment that accommodates your needs and addresses any potential barriers to care.

What to anticipate from your doctor

What you can do
  • A safe, inclusive, and accessible environment where you can communicate your concerns to your doctor.
  • Health services that are free from personal moral judgments and stereotypes.

 
  • If you are comfortable doing so, you can speak to your doctor about your lived experience, cultural background, values, beliefs, and any other personal characteristics you feel may apply to the health care services you are considering.
    • This will help your doctor work together with you to personalize your treatment plan and achieve the best possible health outcomes.
  • Health services that are free from discrimination.
    • This means that decisions about health care services – including whether to accept a new patient, whether and how to provide health care information and services, and whether to end the doctor-patient relationship – are expected to be free from discrimination.  
  • If you are concerned that a health care decision is potentially discriminatory, and if you are comfortable doing so, you may want to talk to your doctor about your concerns. 
  • Accommodate your needs up to the point of undue hardship .
  • Examples of accommodations may include:
    • Allowing a service dog to join you into an exam room.
    • Using forms that reflect the diversity of patients’ gender identities and expression.     
  • You can talk to your doctor about your needs and any accommodations you may require. 
    • It is important to have an open and honest discussion with your doctor so that they can work with you to make accommodations, where possible.
  • If your doctor is not able to accommodate your specific request, you can discuss other possible accommodation options that may be put in place instead.
  • Accommodate requests to receive care from a doctor from a particular identity, where the request is reasonable and a doctor with that identity may be accessible.
    • An example of a request may include a patient from a racial or ethnic minority group requesting a physician of the same race or ethnicity based on a history of discrimination or other negative experiences within the health-care system.
  • If you feel comfortable doing so, you can discuss with your doctor the reason behind your request to see a doctor from a particular identity.
  • In some cases, you may not feel comfortable explaining the reason behind the request (for example, if the request for a female doctor is due to a history of sexual assault). In these cases, your doctor will use their professional judgment to determine if they can carry out your request, where resources are available. 
  • Take necessary and reasonable steps to address acts of violence, harassment, and discrimination against patients and others.
    • This includes stopping and/or otherwise addressing these acts (e.g., requesting assistance from the appropriate authority and providing support) in a manner that does not compromise the safety of themselves, patients and/or others.
  • Consider voicing any concerns you may have about violent, harassing, or discriminatory behaviour you have experienced while receiving care to your doctor or another member of your care team so that they may take appropriate action.  
 

Health Services that Conflict with Doctors’ Conscience or Religious Beliefs

CPSO has expectations for doctors who have a conscientious or religious objection to the provision of certain health services. These expectations accommodate the rights of objecting doctors to the greatest extent possible while ensuring that patients’ access to healthcare is not impeded. For example, doctors are not required to perform abortions or provide medical assistance in dying (MAID), if doing so would be against their conscience or religious beliefs.

If a specific health care service conflicts with your doctor’s conscience or religious beliefs in a manner that could impact your ability to access that service, your doctor is expected to take positive action to ensure that you are connected to a non-objecting, available and accessible health care provider or agency that can provide the service you are requesting. This is called an “effective referral”.

There are a range of ways that your doctor can make an effective referral. What the effective referral will look like will depend on your specific circumstances, including the service being requested, your specific needs, and level of vulnerability (e.g., depending on the resources available in your area, your ability to navigate the health-care system, and/or the nature of your health condition).

Can my doctor end our doctor-patient relationship because my care options/ choices conflict with their conscience or religious beliefs?

No. Your doctor will need to continue managing other aspects of your care, even if they provide an effective referral for a specific service. For example: if your family doctor is not comfortable providing you with advice on terminating a pregnancy, they can partially transfer your care to another doctor who can manage this aspect of your care while your family doctor continues to provide care for your other needs.   

What to anticipate from your doctor

What you can do
  • Provide you with an effective referral if they do not provide the service, treatment, or procedure you are requesting because the service conflicts with their conscience or religious beliefs. 
  • The effective referral must be made:
    • to a non-objecting doctor, health-care professional or agency that is available and accessible to you. 
    • in a timely manner so that you do not experience an adverse clinical outcome due to delay. 
  • An example of an effective referral includes connecting you with an agency charged with facilitating referrals for the service, treatment, or procedure, and arranging for you to be seen at that agency (e.g., in the context of MAID, contacting Ontario’s care coordination service, which would connect you with a willing provider of MAID-related services.).  
  • If your doctor is unable to provide the service, treatment, or procedure you are requesting, you can ask for more information on how you can be connected with another doctor, health-care professional, or agency that can perform the service, treatment, or procedure you are requesting.

 
  • Take into consideration your specific circumstances when considering how to make the effective referral. 
  • Your doctor will need to use their professional judgment to determine what specific action to take in making an effective referral, as some patients may need more help than others because of their specific needs and vulnerability.
  • If you are comfortable doing so, consider sharing your unique circumstances with your doctor, including the reason(s) behind the service you are requesting and any problems you may be facing to accessing that service.
  • This will help your doctor figure out what level of support you will need to be appropriately connected to another health care provider or agency.

 

Endnotes

  1. Undue hardship refers to the potential excessive cost, limited outside sources of funding, and/or health and safety concerns that may be imposed on the doctor if they try and implement a specific accommodation. In many cases, it is not difficult to accommodate a person’s disability. For more information, see Undue Hardship – Ontario Human Rights Commission.