The College’s By-laws include a Code of Ethics. The Code of Ethics reaffirms the duty of an optometrist to treat all patients with respect, not to discriminate against patients, and to make efforts to provide individuals in need with optometric care.
Optometrists should keep in mind their ethical obligations under the Code of Ethics in all of their patient care decisions.
The purpose of the Policy Guidelines is to assist optometrists in understanding their legal and ethical obligations to provide services to the public without discrimination on prohibited grounds.
Patients are entitled to access optometry and other health care services in a way that respects their human rights. Optometrists must comply with the Ontario Human Rights Code (the “Human Rights Code”)1 when making decisions on accepting patients, providing care, and ending the optometrist–patient relationship.
Optometrists are not obligated to provide or continue to provide optometric services if the reason is not prohibited by the Human Rights Code. However, optometrists must ensure that patients and potential patients are always treated with dignity and respect, and that services are only discontinued in accordance with the College’s regulations and policies.
The Human Rights Code requires optometrists to treat all patients and potential patients equally, regardless of the patient’s race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, age, marital status, family status, or disability. It is discriminatory to refuse to accept, treat, or continue to treat a patient for any of these reasons.
The Human Rights Code requires optometrists to accommodate the needs of patients and potential patients with disabilities, as well as any needs of patients relating to family status and other grounds set out in the Human Rights Code. Accommodations must be made to the point of “undue hardship.” The term “undue hardship” is not defined in the Human Rights Code. However, in determining whether an accommodation would cause undue hardship, the Human Rights Code requires individuals to consider cost, outside sources of funding, if any, and health and safety requirements.2 This means that optometrists are expected to accommodate patients’ needs at their own expense, and to incur some hardship in doing so.
The Ontario Human Rights Commission’s Policy and guidelines on disability and the duty to accommodate provides guidance on how optometrists can meet the duty to accommodate and what undue hardship means, as follows:
“The Human Rights Code prescribes three considerations in assessing whether an accommodation would cause undue hardship. These are:
- outside sources of funding, if any
- health and safety requirements, if any.
The Supreme Court of Canada has said that, “one must be wary of putting too low a value on accommodating the disabled. It is all too easy to cite increased cost as a reason for refusing to accord the disabled equal treatment”. The cost standard is therefore a high one.
Costs will amount to undue hardship if they are:
- shown to be related to the accommodation; and
- so substantial that they would alter the essential nature of the enterprise, or so significant that they would substantially affect its viability.”
For more information on “undue hardship,” please visit: http://www.ohrc.on.ca/en/policy-and-guidelines-disability-and-duty-accommodate/5-undue-hardship.
Optometrists should also keep in mind the requirements of the Accessibility Standards for Customer Service,3 a regulation to the Accessibility for Ontarians with Disabilities Act.4 These requirements are explained in the College’s publication regarding the Accessibility Standards.
The Human Rights Code does not prevent optometrists from making clinical decisions or from accepting or refusing to continue to treat a patient on non-prohibited grounds. For example, the Human Rights Code does not require the optometrist to provide uninsured service free of charge. If an optometrist does not feel competent to treat a person, the Human Rights Code does not require the optometrist to do so.
1 R.S.O. 1990, c. H. 19
2 See subsections 11(2) and 17(2) of the Human Rights Code.
3 O. Reg. 429/07
4 Accessibility for Ontarians with Disabilities Act, 2005, S.O. 2005, c. 11
Approved by Council – January 14, 2013