Human Rights in the Provision of Health Services — Consultation
Council released a draft policy for consultation that sets expectations for physicians regarding the provision of health services in a safe, inclusive, and accessible environment, in accordance with accessibility and human rights legislation.
The draft Human Rights in the Provision of Health Services policy retains the majority of the core professional expectations in the current Professional Obligations and Human Rights policy, but some important updates have been made to enhance the overall clarity of the existing expectations and to better serve the public interest with the addition of new expectations.
The updates were informed by research and feedback obtained from a preliminary consultation, public opinion polling, a Stakeholder Roundtable Discussion and the Citizen Advisory Group.
The draft policy has new positive obligations for physicians to take reasonable steps to create and foster a safe, inclusive and accessible environment where patients’ needs are met by incorporating cultural humility, cultural safety, anti-racism and anti-oppression into their practices, said Dr. Rupa Patel, a Kingston family physician and member of the Policy Working Group.
“We believe that moving from “what not to do” (e.g., do not discriminate) to “what to do” would better serve patients and is consistent with CPSO’s commitment to bring equity, diversity and inclusion into our policies. It is hoped the policy will help physicians continue to make efforts to understand power dynamics and privilege in their clinical encounters. Being more self-aware is crucial in our interactions.” said Dr. Patel.
The College, she said, recognizes the vast amount of literature that indicates a patient’s racial/ethnic/cultural background, their sexual orientation and/or gender identity, their socio-economic status, and where they live are often the primary determinants of that patient’s health. Those who are from racialized or marginalized groups are more likely to have difficulties accessing care and experience poorer health outcomes.
“The College has made a commitment to examine how we, as an organization, can better fulfill our mandate by bringing equity, diversity and inclusion to our processes and policies, and to address all forms of discrimination. Many other medical organizations have also identified EDI and anti-discrimination as priorities,” said Dr. Patel.
The draft policy has new expectations for physicians in circumstances where patients request to receive care from a physician with a particular social identity, with the companion Advice document including guidance on how to manage these types of requests.
“This is a complex issue for CPSO to address, but we felt it was important to do so given the feedback and the research in the area,” said Dr. Patel.
The draft policy also sets out expectations for physicians whose personal beliefs conflict with certain health services in a manner that would impact patient access to those services. It states that physicians must provide patients with enough information about all available or appropriate clinical options to meet their clinical needs or concerns, so patients are able to make an informed decision about exploring a particular option.
The existing “effective referral” requirement — defined as taking positive action to ensure the patient is connected to a non-objecting, available and accessible physician, other health care professional or agency — has been maintained in policy to address those situations where a physician declines to provide a particular service because of their conscience or religious beliefs.
The companion Advice document contains a new, less onerous example of an “effective referral”: providing the patient with contact information could suffice, if it is appropriate in the circumstances (e.g., where the patient does not need assistance).
Dr. Patel says the Working Group felt comfortable adding the provision of contact information to patients as an example of an effective referral that may be appropriate given that new safeguards were added to the draft policy. The safeguards require physicians to take reasonable steps to confirm a patient was connected and to take further action to provide an effective referral if they learn the patient was not connected.
The draft policy states all physicians, regardless of whether or not they have particular conscience or religious belief, must not: express personal moral judgments about patients; refuse or delay the provision of health services because the physician believes the patient’s own actions have contributed to their condition; or promote their own spiritual, secular or religious beliefs.
5 Things to Know About the Draft Policy
- Articulates new positive obligations for physicians to take reasonable steps to create and foster a safe, inclusive and accessible environment by incorporating cultural humility, cultural safety, anti-racism and anti-oppression into their practices;
- Addresses those circumstances where patients request to receive care from a physician with a particular social identity;
- Addresses those instances when physicians object to a particular service, by clarifying that physicians must provide patients with enough information about all available or appropriate clinical options, so patients are able to make an informed decision. Tying the amount of information required to the concept of valid consent was supported in the research and consultation feedback;
- Maintains the “effective referral” requirement and adds new safeguards while enabling a wider range of possible options; and
- Adds new expectations for physicians to address violence, harassment and discrimination, if they see it occurring.