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Members were requested to provide comment as to whether it was appropriate for consultants to refuse to accept patients on the basis that they are from another region. Some responded that they felt their first priority was to patients in their local community. Council has also been aware that, even in relatively urgent circumstances, physicians in some communities have to put considerable time and effort into trying to transfer their patient to appropriate care. While it is understood that geography and other factors will mean that particular specialty services may not be available locally, the net result is that it may be denied outright to some patients on the basis of the location of the referring physician. In reviewing this, Council is acutely aware of the significant resource and workload issues involved in this matter. Nevertheless, the fact that a patient can to be precluded from specialty access, on this basis, should not be considered acceptable, either ethically, legally, or politically. Council bases this opinion on the following provision of the Code of Ethics:

7. In providing medical service, do not discriminate against any patient on such grounds as age, gender, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, sexual orientation or socioeconomic status. This does not abrogate the physician's right to refuse to accept a patient for legitimate reasons.

More specifically, the commentary in that Code states the following:

The categories of discrimination are not closed. It is also improper to deny access to the other "classes" of patients. Examples might include current and former patients of a particular physician or physicians, or a class based on some other factor such as place of residence. Similarly, the right to deny access may be limited according to availability of alternate care.

On this basis, Council feels it appropriate to challenge physicians, Regional Health Authorities, and other interested parties to develop processes, procedures, and initiatives to avoid placing physicians in possible ethical conflict.

06/04