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The B.C. Human Rights Tribunal has ruled a B.C. doctor’s refusal to treat a transgender teen with a prescribed hormone blocker as discriminatory
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There’s no requirement in B.C. for doctors to inform new patients that they won’t provide certain treatments because of their religious beliefs. And, unlike in Ontario and Nova Scotia, they don’t have to refer patients to another doctor who is willing to treat them.
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This raises questions about how patients who need access to medical services that are against some doctors’ beliefs, such as abortion, medical assistance in dying, infertility treatments or transgender health care for youth, can get that care in a timely manner.
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Refusing care on moral or religious beliefs is called conscientious objection, and it’s in the spotlight after a recent B.C. Human Rights Tribunal ruling against a family doctor who refused care to a transgender patient.
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Sunrise
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What is conscientious objection, and what did the tribunal case say?
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Doctors and nurses in B.C. are allowed to refuse certain treatments based on personal or religious beliefs, but they are not required to inform new patients about treatments they won’t provide nor provide referrals. They are required, however, to be honest with patients about their options.
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The B.C. Human Rights Tribunal this month ordered a B.C. doctor to pay $28,100 for refusing to treat a transgender teen with a prescribed hormone blocker for religious reasons.
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Henry Ajaero, a doctor in Delta, told a 14-year-old girl and her mother he would not inject a puberty blocker drug because he did not feel comfortable due to “religious and cultural reasons,” according to the tribunal.
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He argued that any care related to “gender reassignment” was inconsistent with his Christian faith and was outside the scope of his practice and expertise.
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If that exists, why did the tribunal still fine this doctor?
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According to the Sept. 1 decision, his failure to administer a prescribed medication called Lupron was discriminatory. The doctor had argued he was not comfortable with gender-reassignment treatment.
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But Lupron is a hormone blocker intended to give transgender youth time to consider their options, and it must be given every three weeks. The tribunal found it was not medication for gender reassignment.
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“It does not, on its own, conflict with Dr. Ajaero’s stated religious belief that ‘God created man and woman,” the decision said.
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The teen, called Child Q in the decision, describes the day she started Lupron as “one of the best days of my life.” In the complaint, she alleges that Ajaero discriminated against her by denying her medical services based on her gender identity, thus violating B.C.’s human rights laws.
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The tribunal agreed and ruled Ajaero failed to establish a conflict between his religious beliefs and the medical services the teen was seeking.
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It also noted that throughout her treatment, Ajaero and the clinic staff continued to use he/him pronouns and her deadname, despite her mother explaining to staff that it was not OK to do so.
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Lupron is a medication used to block hormones in the body. It has been around for at least 40 years, according to the decision, and is used to treat conditions like endometriosis, cancer and early puberty.
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For Child Q, it was used to pause her puberty to give her and her care team time to figure out the “rest of her journey,” the decision said.
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What requirement is there for doctors to inform patients of treatments they won’t perform?
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This is up to the doctor, not a requirement by the College of Physicians and Surgeons.
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“It can be a major challenge because often physicians may be in the minority when they’re trying to defend those religious beliefs,” says Stephen Hoption Cann, an epidemiologist at UBC’s faculty of medicine and chair of the clinical research ethics board.
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One solution could be to inform new patients upfront about certain treatments the clinic won’t offer on religious grounds, he said, rather than refusing them later.
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“That would be a respectful thing to do if your personal beliefs don’t fit in with current medical practice or what you know the province considers current medical practice. If that’s relevant to the individual patient, you know it would be something worth discussing upfront with them,” said Hoption Cann.
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If doctors refuse treatment while the patient is already part of their practice, it could be ruled as discriminatory depending on the situation, for instance if a required medicine is delayed by the refusal.
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What about referrals?
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Doctors can’t discriminate against patients based on sexual orientation or gender, race or religion under B.C.’s human rights code, and if they refuse treatment they must discuss options with the patient in a non-judgmental and ethical manner. However, that stops at referrals.
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The College of Physicians and Surgeons of Ontario requires objecting doctors to connect patients with a willing doctor, or other health professional or agency. But B.C.’s counterpart does not have the same rule.
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Instead, B.C.’s college says if a non-urgent treatment or service conflicts with a doctor’s moral or religious beliefs, the physician is expected to manage the situation “professionally without judging, abandoning, or mistreating the patient.”
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The college refused a request for an interview, while Doctors of B.C. and the Provincial Health Services Authority referred questions about refusing care to the college.
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In an email exchange, the college said while doctors may make a personal choice not to provide a treatment or procedure based on their beliefs, they must provide patients with enough information and assistance to allow the patient to make an informed choice.
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Examples of unethical refusal would include lying, providing misinformation, or delaying care. Doctors are also not allowed to put pressure on the patients because of beliefs.
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What happened in Ontario, and do any other provinces require referrals?
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The Christian Medical and Dental Society challenged Ontario’s referral rules in court a decade ago, arguing that they violated freedom of conscience and religion under the Charter of Rights and Freedoms.
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Many religiously based medical groups argue that making a referral makes them morally complicit in a procedure they oppose. They advocate stronger government support and legal protection to allow providers to refuse certain procedures.
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In 2019, the Ontario Court of Appeal upheld the constitutionality of the college’s rules on referral, which means a referral must be made in good faith to a non-objecting, available and accessible physician.
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Nova Scotia is the other Canadian province that requires physicians to provide this type of referral.
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Should family doctors be more upfront?
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“Issues of reproductive health care, of end-of-life care, of gender care seem like natural fits for family medicine as patients will come first to their family doctor,” said Ian Bushfield, executive director with the B.C. Humanist Association, who argues the province has a duty of religious neutrality.
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“So at a very minimum we should see effective referrals at publicly funded clinics in B.C.”
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He added that clinics should be clearly communicating to patients what services they won’t provide, so that patients can make the decision to seek a different doctor.
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Postmedia asked several Christian and Muslim faith-based medical organizations for comment, but did not hear back by deadline.
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Are there legal challenges in B.C. when it comes to doctors and religion?
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Publicly funded, religiously based hospitals, such as the Catholic-run Providence Health Care (which operates St. Paul’s Hospital among other facilities), face legal challenges for refusing to provide MAID, abortion or contraception.
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For example, a case before the B.C. Supreme Court involves a challenge of St. Paul’s Hospital’s right to refuse medical assistance in dying. Dying with Dignity lawyer Robin Gage argued it’s unconstitutional to require patients to “transfer away from their care team to access a medical service” based on religious belief. Providence objects to the procedure on the basis of religion, as guaranteed in the Charter.
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What do Canadians think about health care providers refusing MAID?
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According to a ResearchCo. poll this year, Canadians are divided when it comes to whether health care providers should be allowed to refuse services to assist in dying.
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The poll suggests 41 per cent of Canadians think health-care professionals should be able to refuse if they have a moral or religious objection. Forty-two per cent of respondents disagree, while the remaining 17 per cent said they weren’t sure.
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Opposition was higher among Canadians aged 55 and over (45 per cent) than among their counterparts aged 35 to 54 (42 per cent) and aged 18 to 34 (39 per cent.)
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With files from the National Post and Susan Lazaruk
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For more health news and content around diseases, conditions, wellness, healthy living, drugs, treatments and more, head to Healthing.ca – a member of the Postmedia Network.
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