Appendix "A"

POHR

Human Rights 2022

Project Recommendation

§1. Physicians must act in their patients’ best interests.

a) In doing so, physicians must strive to create and foster an environment in which the rights, autonomy, dignity and diversity of all patients,or those seeking to become patients, are respected.

§2. Physicians must comply with the Ontario Human Rights Code (the “Code”) . . .

§1. Physicians must take reasonable steps to create and foster a safe, inclusive, and accessible environment in which the rights, autonomy, dignity, and diversity of all patients are respected, and where patients’ needs are met, by:

a. complying with the relevant legal requirements under the Accessibility for Ontarians with Disabilities Act, 2005 and the Human Rights Code (the Code); and

b. incorporating cultural humility, cultural safety, anti-racism, and anti-oppression into their practices.

§1. Physicians must take reasonable steps to create and foster a safe, inclusive, and accessible environment in which the rights, autonomy, dignity, and diversity of all patients are respected, and where patients’ needs are met, by complying with the relevant legal requirements under the Accessibility for Ontarians with Disabilities Act, 2005 and the Human Rights Code (the Code).

POHR

Human Rights 2022

Project Recommendation

§11. In the course of communicating their objection, physicians must not express personal moral judgments about the beliefs, lifestyle, identity, or characteristics of existing patients, or those seeking to become patients.

§2. In discharging provision 1, physicians must not:

a. express personal moral judgments about patients’ beliefs, lifestyle, identity, or characteristics or the health services that patients are considering;

§2. In discharging provision 1, physicians must not:

a. criticize or demean patients’ beliefs, lifestyle, identity, or characteristics. This does not preclude respectful discussion of beliefs or habits that may adversely affect a patient's health.

a) Furthermore, physicians must not promote their own religious beliefs when interacting with patients, or those seeking to become patients, nor attempt to convert them.

c. promote their own spiritual, secular, or religious beliefs when interacting with patients

Human Rights 2022

Project Recommendation

§4. Where a patient requests to receive care from a physician with a particular social identity (e.g., race, ethnicity, culture, sexual orientation and/or gender identity, spiritual/secular/religious beliefs, etc.), physicians must:

§4. A patient may request to receive care from a physician with a particular social identity (e.g., race, ethnicity, culture, sexual orientation and/or gender identity, spiritual/secular/religious beliefs, etc.). The duty to accommodate normally applies to requests related to a patient’s protected characteristics. [P]hysicians must:

a. with appropriate consent, provide any emergent or urgent medical care the patient requires; and

a. with appropriate consent, provide any emergent or urgent medical care the patient requires; and

b. where non-emergent or non-urgent care is required,

b. where non-emergent or non-urgent care is required,

take reasonable steps to accommodate the patient’s request if the physician believes that the request is ethically or clinically appropriate (e.g., patient would like to receive care from a physician who speaks the same language to facilitate communication); or

i) take reasonable steps to accommodate requests directly or indirectly motivated by patient beliefs about services or procedures;

ii) in other cases, if the physician believes that the request is ethically or clinically appropriate (e.g., patient would like to receive care from a physician who speaks the same language to facilitate communication), take reasonable steps to accommodate the request; or

c. tell the patient that their request will not be accommodated if the physician believes that the request is discriminatory (e.g., racist, sexist, ageist, heterosexist, etc.) and determine whether it is safe and in both parties’ best interest to provide any non- emergent or non-urgent care required.

iii) if the physician believes that the request is discriminatory (e.g., racist, sexist, ageist, heterosexist, etc.) tell the patient that their request will not be accommodated.

c. when a request is refused under (b)iii, advise patients that they are free to contact other health care practitioners or services for assistance, and, if need be, indicate how that can be done.

An argument by law professor Amir Attaran suggests that if EAS practitioners provide euthanasia/assisted suicide to someone who is eligible, human rights law requires them to provide the service to anyone legally eligible. He also asserts that they cannot escape the obligation by making an effective referral.

The Project does not accept Prof. Attaran’s claim that an effective referral must be construed as evidence of discrimination, nor does it accept his argument in relation to objecting practitioners who refuse to provide a contested service to anyone. However, his argument may apply to practitioners willing to provide EAS for some eligible patients but not others. It thus seems appropriate to include guidance on this issue in Human Rights 2022.

POHR

Human Rights 2022

Project Recommendation

§6. Physicians must provide patients with quality health care in a safe manner. If physicians feel they cannot appropriately meet the health-care needs of an existing patient, or those who wish to become patients, they are not required to provide that specific health service or to accept that person as a patient. However, physicians must:

a) comply with the Code, and College expectations, in so doing; and

b) make any decision to limit the provision of health services on the basis of clinical competence in good faith.

§6. Physicians must make any decisions to limit the provision of health services for reasons of clinical competence and/or scope of practice in good faith, and in accordance with the Code and College expectations.

a. In making this decision, physicians must consider the risks and benefits of limiting the provision of health services and the impact it would have on patients (e.g., if they would have difficulties accessing the services elsewhere in a timely manner due to a lack of resources).

§6. Physicians must make any decisions to limit the provision of health services for reasons of clinical competence and/or scope of practice in good faith, and in accordance with the Code and College expectations.

POHR

Human Rights 2022

Project Recommendation

§12. Physicians must provide information about all clinical options that may be available or appropriate to meet patients’ clinical needs or concerns.

§8. Physicians must provide patients with enough information about all available or appropriate clinical options to meet their clinical needs or concerns so that patients are able to make an informed decision about exploring a particular option.

§8. Physicians must provide patients with enough information about all available or appropriate clinical options to meet their clinical needs or concerns so that patients are able to make an informed decision about exploring a particular option. Physicians must use their professional judgement to determine if, when and how to discuss particular treatment options with their patients.

§11. Physicians must not

§11. Physicians must not

b. provide false, misleading, confusing, coercive, or incomplete information about available or appropriate clinical options;

§15. Physicians must not impede access to care for existing patients, or those seeking to become patients.

c) impede access to information and/or care, or

b) interfere with access to information and/or care, or

Human Rights-Advice 2022

Project Recommendation

[333] Does the expectation to provide patients with an effective referral apply in faith-based [334] hospitals and hospices?

[335] Yes. Physicians are required to comply with the expectations set out in the College’s [336] policy. This means that physicians would be required to provide patients with access to [337]information and care, including an effective referral, for the services, treatments, and [338] procedures that are not provided in the faith-based hospital or hospice.

The CPSO should delete the direction to physicians working in faith-based institutions.