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In June, Calgary media reported on a city doctor that was refusing to prescribe birth control at a walk-in clinic. In February, an Ottawa woman went to a walk-in clinic and was handed a letter explaining her doctor would not prescribe birth control for medical and ethical reasons. The incidents sparked intense debate over the responsibilities of doctors and the rights of patients to treatment.

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Ontario doctors will be able to deny birth control prescriptions, abortions and vasectomies to patients on the condition they refer them to another physician, according to a new policy created by the province's regulatory college.

The College of Physicians and Surgeons of Ontario will release a policy today that attempts to find a middle ground between the need to provide fair, non-discriminatory treatment while respecting the rights and beliefs of individual physicians. In addition to a referral requirement, doctors will have to treat patients in cases of emergency even if doing so goes against their beliefs. And if there is no possibility of a referral, physicians must treat the patient.

The debate over the line between a doctor's moral or religious convictions and his or her responsibility to treat erupted across Canada this year after two high-profile incidents in Alberta and Ontario, where physicians refused to provide birth control to patients.

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In June, Calgary media reported on a city doctor that was refusing to prescribe birth control at a walk-in clinic. In February, an Ottawa woman went to a walk-in clinic and was handed a letter explaining her doctor would not prescribe birth control for medical and ethical reasons. The incidents sparked intense debate over the responsibilities of doctors and the rights of patients to treatment.

Ontario's new policy is unlikely to put the discussion to rest, said Carolyn McLeod, professor of philosophy at the University of Western Ontario. Patients, particularly women, will undoubtedly find it troubling if a doctor refuses their request for birth control. Doctors who object to abortion might feel uncomfortable or complicit providing patients with a referral, but setting out a clearer policy could help connect patients to care providers who can best serve their needs, Prof. McLeod said.

"To receive abortion care from somebody who is morally opposed to abortion, I think, is harmful," she said. "I think for patients' sake, if for no one else's, there should be the ability for the provider to give the referral."

Ontario's new policy has not yet been finalized and could still be changed, depending on what the college hears during the feedback period.

Marc Gabel, former president of the College of Physicians and Surgeons of Ontario, said doctors could face disciplinary action if they do not comply with the new guidelines and cannot use unfounded medical reasons to withhold birth control, abortions, vasectomies, blood transfusions or other treatments.

"What we're trying to do, I think, is set a tone to remind physicians and the public we will act professionally in ensuring their access to care and their safety," Dr. Gabel said.

But Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba, said the policy does not go nearly far enough. He argues that doctors who allow their personal convictions to enter the conversation will alienate patients and make it difficult to have an open, honest relationship about important issues relating to health such as sexual behaviour and alcohol or drug use. Doctors have a responsibility to help prevent disease and promote safety, and allowing them to deny treatment flies in the face of good medicine, Prof. Schafer said.

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"The doctor is not supposed to be a priest or a religious figure," he said.

Editor's note: Marc Gabel is a former president of the College of Physicians and Surgeons of Ontario. An earlier version of this story identified him as the current president.

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