B.C. Human Rights Tribunal overreach threatens patient safety and physician autonomy

The B.C. Human Rights Tribunal recently ordered family physician Dr. Henry Ajaero to pay $28,100 for not administering an injection of the gonadotropin-releasing hormone agonist leuprolide (Lupron) to forestall puberty in a 14-year-old child, known as “Child Q” in 2020. Previously, Dr Ajaero had referred Q to a specialist clinic for gender dysphoria, where Q had been prescribed leuprolide and given the option of returning to Dr. Ajaero every three to four weeks for the injection or self-administering. Q went to Dr. Ajaero, who declined on the basis that administering leuprolide as a puberty blocker conflicts with his religious beliefs, and later cited unfamiliarity with the medication as a reason for not administering it. Q went to a walk-in clinic to have the injection that same day, and Q’s mother started a process against Dr. Ajaero under the B.C. Human Rights Code. The Human Rights Tribunal is a quasi-judicial body whose members handle discrimination complaints under the Human Rights Code, and decided on Sept. 1, 2026 that Dr Ajaero discriminated against “Q” on the basis of Q’s transgender statusI do not intend to relitigate whether Dr. Ajaero illegally discriminated against Q, though there are certainly areas for criticism in the decision. The decision opens with a series of personal compliments about Q, which calls the tribunal member’s objectivity into question. The tribunal member allowed only the complainant to submit expert witness testimony; the medical ethics expert whom Dr. Ajaero hired was not allowed to testify. Rather, I am concerned that this decision opens the door to significant hazards to patient safety.As physicians, patients entrust us to make an independent assessment of their condition and to advise a plan based on our expertise. We are not healthcare technologists who uncritically enact the orders of others. Because of this, if a physician is not familiar with the indications, contraindications, side effects and monitoring parameters of a treatment, the physician must not be compelled by law to administer a treatment. This is doubly so when there is another doctor in the circle of care who could be administering the treatment instead. You can bet that if the patient suffered negligent harm from the treatment, the administering physician would not be cleared of all responsibility by saying he was “just following orders.”Dr. Ajaero’s other justification for declining to administer leuprolide was religious belief. Conscientious objection is the last line of defence patients have against suffering harm from the medical system. The history of medicine includes unethical human experimentation and forced sterilization, sometimes endorsed by governments and there is no reason to believe that the present and future of medicine are immune from such troubling practices. Even though it may have side-effects some of us find undesirable, doctors must be able to listen to their hearts when they are told to do something they think is wrong, especially in a non-emergent situation where alternative care is available. Conscientious objection is the right of a physician to protect a patient in a flawed world. If it is disregarded, one could imagine a physician being compelled by law to perform cardiopulmonary resuscitation (CPR) on a patently unsuitable patient, or to administer medical assistance in dying (MAiD) to a patient when the doctor believes treatment options have not been exhausted. Conscientious objection is a right that we thankfully need to exercise rarely. Similar to freedom of speech, though we may not always like how people exercise it, the consequences of taking away a physician's right not to do something is far worse.I wrote my concerns to the College of Physicians and Surgeons of British Columbia (CPSBC) as well as to Doctors of BC. The state of physician regulation in B.C. is in flux: by legislative fiat, as of earlier this year, the government now appoints all board members of the CPSBC (previously, half were elected by physicians). We are no longer self-regulating, and I am concerned that the Human Rights Tribunal is further infringing on the CPSBC’s authority to set medical practice standards. The CPSBC's Practice Standard on Consent to Treatment requires that physicians “not provide the treatment until they are assured that valid consent has been obtained” and “be assured that, if delegating the act of obtaining consent . . . the (delegate) healthcare provider has the knowledge, skill, and judgment required to obtain consent.” Neither of these conditions would hold if a physician were asked to administer an unfamiliar drug prescribed by someone else, so the orders of the Human Rights Tribunal appear to infringe on the practice standards of the CPSBC.I call on the CPSBC to make a public statement on this important matter of protecting patients from potential harms that could befall them in the medical system, and to set clear boundaries on the authority of the Human Rights Tribunal to modify the practice standards of physicians. And to physicians: this could be you. It might not be a matter of gender-affirming therapy, but the law can compel you to administer a treatment against your judgment, even in non-emergent situations where alternative care is available.Dr. Nicholas Steinberg is a family physician in Vancouver and a clinical instructor at the University of British Columbia and Simon Fraser University.

B.C. Human Rights Tribunal overreach threatens patient safety and physician autonomy

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