If we don't uphold the first article in the Charter of Rights and Freedoms, the freedom of belief and expression of belief, we will become a dictatorship. Doctors must not be forced to participate in actions that they believe are morally wrong, that will harm their patients. "Effective referrals" are, in essence, participation in the act. If someone wants to buy a gun to commit a terrorist attack and I, knowing their intention, tell them where to get the gun, am I not guilty of participating in the act?