After reading the updated practice standards it is apparent that contradictory language is used. A physician cannot give details that are against his/her conscience without having the patient question what they think. These would clearly be controversial care elements with high stakes outcomes. Restricting their ability to discuss this with a patient in an honest and forthright way undermines the patient - physician relationship of trust and transparency not to mention the hippocratic oath that they are expected to adhere to. There has been a plethora of information / advertising and media coverage on these controversial procedures so that the patient can easily access any one with a google search and self referral to such a clinic or program. Asking physicians to become involved in any way when it is in conflict with their conscience is not ethical and undermines the profession. It should not be more than a statement like “I do not provide that service but my secretary will give you a pamphlet to direct your inquiry” or a similar statement that will not require an opinion or discussion thereby also protecting the physician from moral / personal stress. Patients have rights to chose but physicians also must have their rights and health protected. Forcing referral is not protecting their right of conscience or their mental health.