Doctors Required to Make “Effective Referrals” (even if they morally object to the service)

In Ontario, if a doctor has a religious, moral or ethical objection to providing a medical service, such as abortion or medical assistance in dying, they can refuse. This is called a “

conscientious objection”. While they can deny the service, they are required to refer the patient elsewhere.

The College of Physicians and Surgeons of Ontario (“CPSO”) has a policy that explains these so-called “effective referrals”. It describes them as follows:

“a referral made in good faith, to a non-objecting, available, and accessible physician, other health-care professional, or agency. The referral must be made in a timely manner to allow patients to access care. Patients must not be exposed to adverse clinical outcomes due to a delayed referral. Physicians must not impede access to care for existing patients, or those seeking to become patients.

Doctors must provide care in an emergency, where it is necessary to prevent imminent harm, even where that care conflicts with their conscience or religious beliefs.”

The CPSO policy requiring physicians to make “effective referrals” was recently challenged by a group of doctors and organizations who argued that a referral is effectively an endorsement; for example, a family doctor would only refer a patient to a specialist if he or she thought the patient actually needed to see that specialist.  They felt that forcing doctors to make referrals they do not believe in infringes upon their rights of religion and conscience under the Canadian Charter of Rights and Freedoms. The lawsuit also involved a challenge to the CPSO’s Medical Assistance in Dying policy, which requires “effective referrals” to be made by doctors who decline to provide medical assistance in dying for reasons of conscience or religion.

In January 2018 an Ontario court released its decision, finding that the referral requirement does not infringe upon the doctors’ rights.

This case confirms that the CPSO policy continues to operate and that doctors are required to connect their patients with someone who can assist, even if they otherwise object to the treatment or service being requested.