Human Rights Policy

Approved: December 10, 2024
Effective Date: Immediately
Version #: 1.00

Purpose:

The purpose of this policy is three-fold:

  1. To articulate the College’s expectations of pharmacy professionals to meet the legal and ethical requirements to provide pharmacy products and services in a respectful, inclusive, and non-discriminatory manner in accordance with accessibility and human rights legislation.
  2. To clarify the College’s expectations of pharmacy professionals if they experience discriminatory behaviour from a patient or a member of the pharmacy team.
  3. To articulate the College’s expectations regarding effective referral that balances the pharmacy professional’s rights to conscientious objection, while confirming patients’ rights to access pharmacy products and services in a respectful and timely manner.
Scope:

This policy applies to all pharmacy professionals, regardless of practice setting or registration classification, and upholds existing legislation, and the College’s Standards of Practice and practice policies.

Definitions:

Designated Manager (DM): The Part A pharmacist designated by the owner(s) and reported to the College as responsible for managing the pharmacy. The DM carries the same liability for the operation of the pharmacy as the owner(s). (DPRA, Standards of Operation)

Discrimination: An act, communication, or decision that results in the unfair treatment of an individual or group, for example, by excluding them, imposing a burden on them, or denying them a right, privilege, benefit, or opportunity enjoyed by others. Discrimination may be direct and intentional; it may also be indirect and unintentional, where rules, practices, or procedures appear neutral but have the impact of disadvantaging certain groups of people. (Ontario Human Rights Commission’s glossary of terms, CPSO Human Rights in the Provision of Health Services policy)

Effective Referral: Taking action to ensure a patient is connected with another registrant, other health-care professional, or agency that is available and accessible to the patient, in a timely manner so that the patient does not experience an adverse clinical outcome. (CPSO Human Rights in the Provision of Health Services policy, Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2019 ONCA 39)

Hospital Pharmacy Administrator (HPA): The person with oversight of the hospital pharmacy operation who is accountable for ensuring that all systems required to provide safe and effective pharmacy services are in place. The Administrator is not required to be a registrant of the College. (Standards of Operation)

Pharmacy Professional: Pharmacy professional refers to a pharmacist and/or a pharmacy technician. For the purposes of this policy, where the term ‘pharmacist’ is used, it is inclusive of pharmacy interns and students, and subject to any terms, conditions and limitations on their certificates of registration. Where this is not the case, it will be clearly identified.

Protected grounds under the Human Rights Code: The Ontario Human Rights Code prohibits actions that discriminate against people based on protected grounds in protected social areas (including goods, services, and facilities, such as hospitals and health services). The protected grounds include age; ancestry, colour, race; citizenship; ethnic origin; place of origin; creed; disability; family status; marital status; gender identity, gender expression; receipt of public assistance; record of offences; sex (incl. pregnancy); and sexual orientation. [1]

Policy:

Pharmacy professionals are required to act in their patients’ best interests and provide an environment where the rights, autonomy, dignity, and diversity of all people are respected.

All expectations articulated within this policy flow from the fundamental freedoms protected within the Canadian Charter of Rights and Freedoms (the Charter), the human rights that are protected within the Ontario Human Rights Code and the duties outlined in the Accessibility for Ontarians with Disabilities Act, 2005.

The Standards of Practice for Pharmacists and Pharmacy Technicians require pharmacy professionals to treat others with sensitivity, respect, and empathy and to demonstrate a caring, empathetic, and professional attitude when practicing their profession.

Providing Pharmacy Services

Patients can expect that their human rights will be upheld when accessing pharmacy services. This includes feeling safe and respected within the registrant-patient relationship to optimize the trust necessary to effectively provide care to patients.

To facilitate building and maintaining trust, registrants must not:

  1. express personal moral judgments in a manner that is demeaning towards patients’ identity, beliefs, expression, or characteristics, the patient’s condition, or the pharmacy services that patients are considering;
  2. rely on or promulgate stereotypes[2] associated with one or more aspects of the patient’s identity or condition to determine their needs or make treatment/service decisions;
  3. refuse or delay the provision of health services because the registrant believes the patient’s own actions or inactions have contributed to their condition; or,
  4. promote or impose their own spiritual, secular, or religious beliefs when interacting with patients.

The Duty to Provide Services Free from Discrimination

Discrimination in pharmacy care violates human rights and accessibility legislation, the principles of beneficence, respect, non-maleficence as outlined in the Code of Ethics, and presents a risk of harm to patients. The College recognizes that discriminatory behaviour can encompass a broad continuum, ranging from unintentional behaviour that negatively affects a patient, to conduct taken without regard for the dignity of the patient, to deliberate discriminatory behaviour.

Registrants have a duty to provide pharmacy services to patients that is free from discrimination. Registrants are expected to comply with the relevant legal requirements stipulated in the Ontario Human Rights Code and the Accessibility for Ontarians with Disabilities Act, 2005.

  • The Human Rights Code has primacy over all other provincial legislation, including the Substitute Decisions Act, 1992; Health Care Consent Act, 1996; Mental Health Act; and the Accessibility for Ontarians with Disabilities Act, 2005. This means that if there is a conflict between the Human Rights Code and another provincial law, the Human Rights Code prevails unless the other law includes a specific exception.
  • Section 1 of the Ontario Human Rights Code reads: Every person has a right to equal treatment with respect to services[3], goods and facilities, without discrimination because of race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex (incl. pregnancy), sexual orientation, gender identity, gender expression, age, marital status, family status or disability.

Registrants must not discriminate, either directly or indirectly, based on a patient’s condition or a protected ground under the Human Rights Code when making decisions relating to the provision of pharmacy services, including when:

  1. deciding to accept or refuse a patient;
  2. deciding to provide information to a patient;
  3. deciding to provide or limit a pharmacy service[4], including dispensing a drug or product according to a valid prescription;
  4. deciding to provide a clinical or effective referral; or,
  5. deciding to end the registrant-patient relationship[5].

Should a registrant be advised that through their words or actions they are unintentionally perpetuating bias or discrimination, it is the College’s expectation that the registrant will cease the behaviour immediately upon being informed of it.

Registrants also have a right to equal treatment with respect to employment or practice without discrimination.

  • Section 5 (1) of the Ontario Human Rights Code reads: Every person has a right to equal treatment with respect to employment without discrimination because of race, ancestry, place of origin, colour, ethnic origin, citizenship, creed/religion, sex, sexual orientation, age, record of offences, marital status, family status or disability.

Should a registrant find themselves in a situation of experiencing discrimination or harassment[6], as defined by the Ontario Human Rights Code, while providing pharmacy services, it is the College’s expectation that:

  • the registrant follows the policies in place at the location where they are practising, including the procedure to follow if the discrimination or harassment being experienced is due to another member of the pharmacy team.
  • if the registrant decides to end the registrant-patient relationship due to discrimination or harassment from a patient, that the registrant follows existing policy. 5

The Duty to Accommodate

Registrants must comply with their legal duty to accommodate[7] the needs of patients arising from protected grounds under the Human Rights Code in a manner that respects the patient’s dignity, autonomy, privacy, and confidentiality.

In so doing, registrants must explore and implement accommodation measures up to the point where these measures would:

  1. subject the registrant to undue hardship (e.g., excessive cost, health or safety concerns); or
  2. significantly interfere with the legal rights of others.

Managing Conscientious Objections

The College acknowledges that registrants have the right to limit the products and services they provide in their practice for reasons of conscience or creed/religion6. The Court of Appeal for Ontario has confirmed that where an irreconcilable conflict arises between a physician’s interest and a patient’s interest, the interest of the patient prevails as a result of the professional obligations and fiduciary duty physicians owe to their patients. [8] The basis of this decision rests on health professionals having a fiduciary responsibility to their patients, which thereby extends the application of this ruling to the pharmacy profession.

  • While the Charter entitles a health care professional to limit the health products and services they provide for reasons of conscience or creed/religion, this choice cannot directly or indirectly impede access to these products or services for existing patients, nor those seeking to become patients. [9]
  • Limiting access to pharmacy products and services on the basis of conscience or creed/religion does not permit registrants to discriminate on the basis of a patient’s condition or a protected ground under the Human Rights Code when deciding whether to provide a product or service to a patient that they would normally provide to other patients.

The Code of Ethics (the Code) outlines the ethical principles and standards that pharmacy professionals are accountable to in practice. In a circumstance where a registrant declines to provide a product or service due to a conscientious objection, they are required to meet the expectations outlined in standard 2.13 of the Code.

2.13: Registrants must, in circumstances where they are unwilling to provide a product or service to a patient on the basis of moral or religious grounds, ensure the following:

  1. That the registrant does not convey (directly or indirectly) their conscientious objection to the patient.
  2. That the registrant participates in a system designed to respect the patient’s right to receive products and services requested.
  3. That there is an alternative provider available to enable the patient to obtain the requested product or service, which minimizes inconvenience or suffering to the patient.

The Duty to Respect Health Care Access Rights

Designated Managers (DM) in community pharmacies and Hospital Pharmacy Administrators (HPA) must ensure that there is a procedure in place that enables patients to access products and services in a timely manner if a member of the pharmacy team has a conscientious objection to providing a product or service to a patient.

  • Objecting pharmacy professionals have a responsibility to inform their Designated Manager/Hospital Pharmacy Administrator or other appropriate manager of their conscientious objection and follow the procedure that is in place to respect a patient’s right to receive pharmacy products and services.

When objecting to provide a pharmacy product or service on the basis of conscience or creed/religion, registrants must:

  1. inform their DM/HPA/Manager of their conscientious objection;
  2. participate in the procedure that the DM has put in place that provides a timely effective referral to a non-objecting, available and accessible provider;
  3. make reasonable efforts to ensure continuity of patient care when the registrant is unable or unwilling to provide the requested pharmacy products or services;
  4. ensure that a patient’s right to receive pharmacy products and services is respected; and,
  5. provide respectful and effective care in an emergency, where it is necessary to prevent imminent harm, even where the care conflicts with their conscience or religious beliefs.

Objecting registrants must not:

  1. impede a patient’s access to care;
  2. convey or impose any personal moral judgement about a patient’s identity, beliefs, expression, or characteristics; or,
  3. withhold information about the existence of any treatment because it conflicts with their conscience or religious beliefs.
Legislative References:
Additional References:
Implementation

College Contact: Pharmacy Practice

Revision History

Version # Date Action
1.00 December 10, 2024 New; Incorporates Professional Obligations when Declining to Provide a Pharmacy Product or Service due to Conscience or Religion Guideline

 

  1. For more information on the protected grounds and protected social areas under the Human Rights Code, see the Ontario Human Rights Commission’s website. ↑
  2. See Ontario Human Rights Commission’s glossary of terms ↑
  3. The Ontario Human Rights Commission has clarified that services include health services – https://www.ohrc.on.ca/en/social_areas/goods_services_facilities ↑
  4. Pharmacy Act s. 3, 4. ↑
  5. See the College’s Ending the Pharmacists-Patient Relationship guideline ↑
  6. See Ontario Human Rights Commission’s Glossary of Human Rights Terms – https://www3.ohrc.on.ca/en/teaching-human-rights-ontario-guide-ontario-schools/appendix-1-glossary-human-rights-terms ↑
  7. See. Ontario Human Rights Commission policies – https://www.ohrc.on.ca/en/our_work/policies_guidelines ↑
  8. See para. 187 Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2019 ONCA 393. ↑
  9. See para. 187 Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2019 ONCA 393. ↑
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