Child Q v. Ajaero (No. 2), 2026 BCHRT 189

Date Issued: September 1, 2026
File: CS-005114

IN THE MATTER OF THE HUMAN RIGHTS CODE,
RSBC 1996, c. 210 (as amended)

AND IN THE MATTER of a complaint before
the British Columbia Human Rights Tribunal

BETWEEN:

Child Q
COMPLAINANT

AND:

Henry Ajaero
RESPONDENT

REASONS FOR DECISION

Tribunal Member: Devyn Cousineau
Counsel for the Complainant: Adrienne S. Smith
Counsel for the Respondent: Scott Marcinkow and Aynsley Severide

Date of Hearing: May 4-7, 2026
Closing submissions: July 15, 2026
Location of Hearing: Via videoconference

I        INTRODUCTION

[1]             Child Q is a brave, sensitive, kind transgender girl. This complaint is about a visit to her family doctor, Henry Ajaero, when she was 14 years old.

[2]             In late 2020, Child Q had come out as transgender and was struggling with puberty. Her mental health was very poor. At her mother’s request, Dr. Ajaero referred Child Q to the BC Gender Clinic. There, an endocrinologist prescribed Child Q a medication called Lupron, to pause her puberty and give her some time to decide her next steps. Child Q describes the day she started Lupron as “one of the best days of my life”.

[3]             Lupron is taken as an injection every three to four weeks. Though Child Q had the option to administer the injection herself, she preferred to have the injection done by a doctor. Mother Q booked an appointment with Dr. Ajaero on March 5, 2021, for Child Q to receive an injection. On the day of the appointment, while Mother Q and Child Q were waiting, Dr. Ajaero learned what the injection was for. He decided he did not feel comfortable administering it. He told Mother Q privately that he would not administer the injection for “religious and cultural reasons”. He said there was no one else at the clinic who could do it. Mother Q and Child Q were forced to leave without receiving the injection.

[4]             In this human rights complaint, Child Q alleges that Dr. Ajaero discriminated against her by denying her medical services based on her gender identity, in violation of s. 8 of the Human Rights Code. She asks for remedies including lost wages, expenses, and compensation for injury to her dignity, feelings, and self-respect.

[5]             Dr. Ajaero offers two explanations for his refusal to give Child Q her injection. First, he says that it is inconsistent with his religious beliefs to administer any care related to “gender reassignment”. Second, he says that administering Lupron was outside the scope of his practice and expertise. In these circumstances, he argues that Child Q was not denied a service that he provides and, in any event, any denial was justified. He asks for the complaint to be dismissed.

[6]             I heard this complaint over four days. I am grateful to the parties, witnesses, and counsel for their respectful and professional conduct throughout a difficult proceeding.

[7]             For the reasons that follow, I find that the complaint is justified. In reaching this conclusion, I acknowledge that Dr. Ajaero’s decision arose in the context of a busy practice in the middle of a pandemic. It was not malicious or intended to hurt Child Q. But the Code is concerned with impacts and not intent. In this case, the impact of Dr. Ajaero’s decision was that Child Q was denied access to medical services because of her gender identity. I am not persuaded that this was justified by his religious beliefs or lack of medical expertise. I find that Dr. Ajaero violated s. 8 of the Code, and I order remedies.

[8]             There is an order in this case prohibiting the publication of information that could identify Child Q, her mother, or her gender affirming care providers in connection with this complaint: letter decision dated February 25, 2026.

[9]             I caution the reader that these reasons refer to self-harm by a young person.

II      PRELIMINARY ISSUES

[10]         I begin with two preliminary issues: Dr. Ajaero’s application to limit publication, and my decision not to admit evidence from Dr. Ajaero’s proposed expert witness.

A.    Application to limit publication

[11]         By letter dated March 24, 2026, I granted Dr. Ajaero’s application to limit publication of information that could identify him or the name of his clinic in connection with the complaint. My order was effective up until the final decision, at which point I indicated that the balancing of Dr. Ajaero’s privacy interests and the public interest in publication may change.

[12]         Dr. Ajaero applies to limit publication of his name and the name of his clinic in this final decision. Child Q opposes the application.

[13]         The general principles are not in dispute. Complaints at the Tribunal are presumptively public: Mother A obo Child B v. School District C, 2015 BCHRT 64 at para. 7. The Tribunal has discretion to limit publication of identifying information where a person can show their privacy interests outweigh the public interest in full access to the Tribunal’s proceedings: Tribunal Rules of Practice and Procedure, Rule 5(6); Stein v. British Columbia (Human Rights Tribunal), 2020 BCSC 70 at para. 64(a). The Tribunal may consider factors like the stage of the proceedings, the nature of the allegations, private detail in the complaint, harm to reputation, or any other potential harm: JY v. Various Waxing Salons, 2019 BCHRT 106 at para. 30.

[14]         Dr. Ajaero argues, and there is no dispute, that this is a case likely to attract the public’s “prurient” attention. Cases involving medical treatment for transgender youth have garnered media and online attention. Doctors who provide gender affirming care have faced threats and incitements to violence: C.D. v Provincial Health Services Authority, 2019 BCSC 603 at paras. 26-36 and 44-50. Dr. Ajaero argues that, if his name is published in this decision, his name will be widely circulated and it is reasonable to anticipate that he will “be the subject of online opinions and criticisms, which could include threats of harm”.

[15]         The difficulty I have with this argument is that there is no evidence to suggest that Dr. Ajaero may face threats because he refused to give Child Q gender affirming care. The cases that address threats against doctors are about doctors who give gender affirming care. I am not prepared to assume that the public response is the same to doctors on both sides of the issue.

[16]         That said, I appreciate that Dr. Ajaero may face online opinions and criticisms. I acknowledge this has the potential to affect his professional reputation. I accept, as Dr. Ajaero argues, that “professional reputations are the product of much dedication, time, and effort, and can suffer greatly from a single complaint alleging a human rights violation”. In the cases that he has cited, the Tribunal has erred on the side of protecting doctors’ reputations in the face of unproven allegations: e.g. KS v DR. O Corp and another, 2018 BCHRT 273; EC v. Dr. GL, 2015 BCHRT 121; Mr. S v. Dr. M and another, 2023 BCHRT 239.

[17]         In this complaint, the allegations against Dr. Ajaero are no longer unproven. The case has been heard, and this is my final decision. I have found that Dr. Ajaero discriminated against Child Q. This distinguishes the cases cited by Dr. Ajaero and is consistent with them. For example, Dr. Ajaero cites Pharmacist v. Doctor, 2019 BCHRT 176, where the Tribunal anonymized the name of the respondent doctor during the interim stages of its process. However, in its final decision finding that the doctor had violated the Code, the Tribunal denied the doctor’s request to continue to limit publication of her name: The Pharmacist v. College of Pharmacists of British Columbia and another, 2024 BCHRT 291 atpara. 25.  

[18]         There is a public interest in publishing the names of respondents who have violated the Code: The Sales Associate v. Aurora Biomed Inc. and others (No. 3), 2011 BCHRT 5 at para. 14; Basic v. Esquimalt Denture Clinic and another, 2020 BCHRT 138 at para. 9. To the extent Dr. Ajaero experiences consequences from publication, they flow from his conduct which I have found discriminated against Child Q: Basic at para. 12; The Sales Associate at para. 14; cited in Pharmacist at paras. 20-21.

[19]         Finally, Dr. Ajaero argues that his “personal religious beliefs are not a matter of public record, and he is entitled to privacy with respect to such matters”. I accept that any litigant in a public legal process faces some loss of privacy, as the cost of an open legal system. Dr. Ajaero has not persuaded me that his privacy interests in his religion outweigh the presumption of full public access to this proceeding. His evidence was that he is an active member of his church and has been his whole life. He did not suggest that he makes efforts to keep his religion private, and it is not the sort of information that I might assume engages a high level of privacy interest.

[20]         I am not persuaded to limit publication of Dr. Ajaero’s name in this final decision. The application is denied.

B.    Admissibility of expert evidence

[21]         During the hearing, Dr. Ajaero sought to qualify Gary Goldsand as an expert in medical ethics in Canada, including conscientious objections, and to admit his opinion about three questions:

1. If Dr. Ajaero was unfamiliar with using Lupron for blocking puberty in a young transgender patient, was it reasonable for him to refuse to inject the medication during the visit?
2. Please explain the concept of conscientious objection, which is referenced in the College Practice Standard titled Access to Medical Care [Without Discrimination].
3. If Dr. Ajaero felt that injecting Lupron to block puberty in a young transgender patient was inconsistent with his religious beliefs, was it reasonable for him to refuse to inject the medication during the visit?

[22]         Child Q objected to the admissibility of this expert evidence. Professor Goldsand testified, and was cross-examined, about his qualifications. Both parties made submissions. I found that Professor Goldsand’s evidence was not admissible, with reasons to follow. These are my reasons.

[23]         The Tribunal has discretion to admit evidence that it considers “necessary and appropriate, whether or not the evidence or information would be admissible in a court of law”: Code, s. 27.2. Though its discretion to admit expert evidence is broader than a court’s, the Tribunal is mindful of the well-known dangers of expert evidence, including that it can “distort the fact finding process”, create a risk that a decision maker relies on “junk science” or “unproven material not subject to cross-examination”, and “lead to an inordinate expenditure of time and money”: White Burgess Langille Inman v. Abbott and Haliburton Co., 2015 SCC 23 at para. 18; R. v. Mohan, [1994] 2 SCR 9 [Mohan] at p. 21. The Tribunal will decline to admit expert evidence where it is clear that the evidence could not assist in resolving the complaint: Somers v. Surrey Pretrial Services Centre, 2025 BCHRT 70 at para. 11.

[24]         To decide the admissibility of expert evidence, the Tribunal follows the analysis laid out by the Supreme Court of Canada in Mohan and White Burgess.  First, the party seeking to introduce the evidence – here, Dr. Ajaero – must establish the threshold requirements of admissibility: relevance, necessity in assisting the trier of fact, the absence of any exclusionary rule, and a properly qualified expert: Mohan, at para. 17; White Burgess at para. 23. Second, the Tribunal balances the potential risks and benefits of admitting the evidence: White Burgess at para. 24. The Tribunal may modify the application of any of these criteria where it is satisfied that the evidence is “necessary and appropriate”: Code, s. 27.2; Oger v. Whatcott (No. 5), 2018 BCHRT 229 at para. 22; Campbell v. Vancouver Police Board (No. 2), 2019 BCHRT 128 at para. 5.

[25]         In this case, I acknowledge Professor Goldsand’s interesting and specialized practice in the area of medical ethics, where he has no doubt acquired working expertise over his 25-year career. However, Dr. Ajaero has not persuaded me that Professor Goldsand’s evidence is necessary to assist the Tribunal.

[26]         Expert evidence is necessary where it “provides information ‘which is likely to be outside the experience and knowledge of a judge’”: Mohan at p. 23, quoting R. v. Abbey, [1982] 2 SCR 24. Its purpose is to provide “a ready-made inference which the judge and jury, due to the technical nature of the facts, are unable to formulate”: R. v. Abbey, 1982 CanLII 25 (SCC) at p. 42. It is not enough that expert evidence may be relevant or helpful: R v. D.D., 2000 SCC 43 at para. 46.

[27]         Dr. Ajaero argues that Professor Goldsand’s evidence is necessary to assist the Tribunal to understand how ethical principles apply in a busy clinical setting. He argues this is beyond the ordinary knowledge of the Tribunal. Respectfully, I disagree.

[28]         There is no question that some cases about medical services may raise unique and specialised considerations requiring expert evidence. However, this is not such a case.

[29]         Professor Goldsand is not a doctor. He has a masters’ degree in Comparative Religious studies. He began, but did not complete, doctoral studies at the University of Toronto in bioethics and religion. His proposed expertise is grounded in his experience working as a clinical ethicist in a health care setting, in Alberta and Saskatchewan. His proposed evidence is:

1. It was “reasonable and consistent with practice standards” for Dr. Ajaero to refuse to administer Lupron to Child Q.
2. Conscientious objection is “a well-established concept in clinical caregiving, emerging from the recognition that some clinical interventions are at odds with the fundamental belief of a provider”, and Dr. Ajaero complied with the College’s “practice standard on Access to Medical Care”.
3. Dr. Ajaero’s refusal to administer Lupron was “a reasonable expression of conscientious objection” and “would not have put his patient in any clinical danger”.

These opinions do not arise in a technical area that this Tribunal could not understand based on the facts presented.

[30]         First, the Tribunal regularly considers allegations of discrimination in a variety of professional settings, including in the delivery of medical services. In this case, Dr. Ajaero testified about the pressures that he was under, including a significant and varied workload, short appointment times, and the stress and uncertainty of practicing medicine during the pandemic. Understanding these pressures does not require technical expertise.

[31]         Second, Professor Goldsand’s opinion about conscientious objection is not grounded in any technical expertise beyond the knowledge of the Tribunal. Professor Goldsand explains that conscientious objection emerges from the “recognition that some clinical interventions are at odds with the fundamental beliefs of a provider”. The Tribunal, and courts, are deeply familiar with the tensions that can arise from conflicting rights and interests. Taking guidance from Supreme Court of Canada caselaw, the Tribunal regularly navigates the tension between religious beliefs and the rights of equity seeking groups: see e.g. Smith and Chymyshyn v. Knights of Columbus and others, 2005 BCHRT 544 [Knights of Columbus]; Oger v. Whatcott (No. 7), 2019 BCHRT 58.

[32]         Third, Professor Goldsand’s opinions, on their face, are not derived from academic or expert study in a field of expertise. Though he refers to “practice standards”, he only cites one. I appreciate, as Dr. Ajaero argues, that expertise does not have to be derived from academia and can be based in an expert’s “working knowledge”: Pinch (Guardian ad litem of) v. Morwood, 2016 BCSC 75 at para. 16. However, Professor Goldsand’s proposed evidence does not bridge any technical gap in this Tribunal’s knowledge. Rather, it rests on his assessment of the limited facts he has been presented with. This is not necessary for any issue I must decide.

[33]         I can just as readily make findings of fact and draw inferences and conclusions without assistance from Professor Goldsand: Northern Interior Woodworkers’ Assn. obo Souter v. Pacific Island Resources, 2011 BCHRT 294 at para. 62, citing “The Law of Evidence in Canada” at p. 456. In doing so, I have the benefit of a complete record, including evidence that has been tested through cross-examination.

[34]         In contrast, Professor Goldsand’s opinion is based on an incomplete record, including some facts and assumptions that are inconsistent with the evidence before me and my findings. For example, Professor Goldsand speculates “it is possible that the doctor had some uncertainty about whether [Mother Q and Child Q] carried a deep appreciation of potential risks” and “[h]ad the meeting not ended abruptly, it is highly likely that the next steps would have been the main topic of discussion – about where she might go to receive the injection”. Neither of these speculations were borne out in the evidence before me. Elsewhere, Professor Goldsand describes Lupron as a “relatively new” treatment, while the evidence before me established that it is not. Finally, Professor Goldsand’s opinion about Dr. Ajaero’s compliance with practice standards does not address the findings of the College of Physicians and Surgeons of BC, and is inconsistent with them.

[35]         I appreciate that these are the sort of concerns that may, in many cases, be addressed as a matter of weight rather than admissibility. However, in this case, they affirm my determination that Professor Goldsand’s evidence would not have been helpful, let alone necessary.

[36]         I am grateful that Professor Goldsand took the time to prepare a report, and testify about his qualifications. However, it was clear to me during the hearing that his evidence could not assist in resolving the complaint. For that reason, I found it was inadmissible.

III    EVENTS GIVING RISE TO THE COMPLAINT

[37]         Most of the facts underlying this complaint are not in dispute. They are set out in documentary evidence and in the testimony of Mother Q, Child Q, and Dr. Ajaero. I have also benefited from the expert evidence of Dr. Elizabeth Saewyc, a Professor, Distinguished University Scholar, and the Director of the School of Nursing at the University of British Columbia. Dr. Saewyc was qualified as an expert in (1) barriers to accessing health care for transgender children and youth, (2) consequences of withholding or interrupting gender affirming care for transgender youth, and (3) the medical uses of Lupron and the experience of survey respondents accessing it. Finally, the events giving rise to this complaint were also the subject of an investigation by the College of Physicians and Surgeons of BC [College], which made findings and issued a reprimand to Dr. Ajaero for failing to comply with its practice standard called Access to Medical Care Without Discrimination [Practice Standard]. I refer to these findings throughout my decision.

[38]         Dr. Ajaero is from Nigeria. He went to medical school in Nigeria, and has practiced medicine in Nigeria, South Africa, and rural BC before coming to his current clinic in 2014. He is Christian. He was baptised, confirmed, and married in the Anglican church. All his children are baptised in church. He goes to church every Sunday with his family. His religion is an important part of his life.

[39]         During the period of this complaint, Dr. Ajaero worked in a busy primary medical clinic, practicing general family medicine. He became Child Q’s family doctor in 2017, when she was ten years old.

[40]         Child Q came out as trans in the spring of 2020, when she was 13. In this hearing, she described herself as an “early bloomer”. As her endocrinologist later noted, she was “dramatically affected by her progression through puberty”. In her evidence, Child Q put it this way:

I had begun puberty fairly early on, so I was already feeling a lot of the effects of testosterone and what testosterone was doing to my body … I can’t describe in words the amount of pain that caused me.

[41]         Throughout this period, Child Q was supported by a psychiatrist specialising in gender, and a child psychologist. Even with this support, by the fall of 2020, Child Q’s mental health was worsening.

[42]         Child Q’s psychiatrist recommended that she be referred to the Gender Clinic at BC Children’s Hospital. On October 29, 2020, Mother Q had a telephone appointment with Dr. Ajaero to ask him to make the referral. Dr. Ajaero’s chart notes reflect that Mother Q wanted Child Q “referred to Gender therapy clinic” and the referral was recommended by Child Q’s pediatrician. Dr. Ajaero wrote: “A: ?Gender issues”. A few days later, Dr. Ajaero called back for more information, and spoke to Mother Q. In his chart notes, he recorded:

[Child Q] is going through gender therapy.

[Her] psychiatrist wants referral to the clinic

Psychiatrist will do his own referral …

A: Gender issues

[43]         Dr. Ajaero agreed to make the referral. In doing so, he did not say anything to Mother Q about being uncomfortable about issues relating to Child Q’s gender identity. In the referral form, Dr. Ajaero wrote that the reason for referral was “gender dysphoria as per [her] clinical counsellor”.

[44]         I pause here to note that, throughout his treatment of Child Q, Dr. Ajaero and the clinic staff continued to use he/him pronouns and her deadname. This continued after Mother Q told the clinic that Child Q used she/her pronouns and had a different name. Though this is not the alleged discrimination that I am asked to consider in this complaint, I note that it demonstrates a lack of care, understanding, and sensitivity towards a vulnerable trans child. In this decision, I have corrected Dr. Ajaero’s chart notes to properly reflect Child Q’s gender.

[45]         Child Q’s mental health continued to worsen. She was self-harming. She had suicidal thoughts, with a plan. She was hoarding Tylenol. In November 2020, just before Child Q’s 14^th birthday, Mother Q found her suicide note.

[46]         On December 8, Mother Q had another telephone appointment with Dr. Ajaero. She told Dr. Ajaero that she was worried about Child Q’s mental health. She told him about the suicide note and Tylenol. Dr. Ajaero’s chart notes reflect that Child Q had been “doing self-harm” and “also having gender issues”. At Mother Q’s request, he wrote a prescription for Ativan. The College was later critical of Dr. Ajaero’s failure to conduct an urgent assessment and ensure that Child Q’s suicidality was being addressed with another professional.

[47]         On January 14, 2021, Child Q was seen at the Gender Clinic. There, a pediatric endocrinologist prescribed her Lupron, a puberty suppressant.

[48]         Lupron is a medication used to blocks hormones in the body. It has been around for at least 40 years, and is used to treat conditions like endometriosis, cancer, and precocious puberty. For Child Q, it was used to pause her puberty to give her and her care team time to figure out the “rest of her journey” (as Mother Q put it). Dr. Saewyc testified that this is very important for trans youth, whose mental health and long-term wellbeing may be negatively affected if they are required to go through endogenous puberty. The endocrinologist continued to oversee Child Q’s treatment throughout the time she was taking Lupron.

[49]         Lupron needs to be injected with a shot, every 3-4 weeks. This timing is important. A delay can cause testosterone to come back into the body. Child Q had the option to learn how to administer the injection herself, but she and her family preferred it was done by a health care professional.

[50]         Child Q’s first shot was on February 4, 2021. Mother Q called Dr. Ajaero’s clinic to try to make the appointment there, but was told Dr. Ajaero was away. They went instead to a walk-in clinic. Child Q had a small seizure after the injection. Despite this, Child Q says that getting that first Lupron injection was “one of the best days of my life”.

[51]         Mother Q made an appointment with Dr. Ajaero for the second shot. When she called to make the appointment, she told the medical office assistant that the purpose of the visit was for Child Q to receive an injection of Lupron.

[52]         The appointment was on March 5, 2021. I accept Dr. Ajaero’s evidence that this was a busy and stressful time for him. His practice is extremely busy at the best of times, and the pandemic was a uniquely challenging time to practice medicine. In March 2021, Dr. Ajaero had recently returned from a six-week trip to Nigeria, and was catching up with a high volume of work that waited for him on his return.

[53]         Child Q and Mother Q arrived for her appointment and checked in. Mother Q told the medical office assistant Child Q’s name and pronouns. She testified, and I accept, that she was very diligent about doing this to try to ensure Child Q’s safety and wellbeing in any setting. From her perspective, Child Q’s mental health was precarious. She was worried that “any little hit could push her over the edge”. Despite these efforts, the medical office assistant repeatedly used Child Q’s deadname and wrong pronouns, at times projecting loudly across the room. Child Q testified that she was hurt by this but assumed it was just a mistake in the system. At the same time, she says – and I accept – that it can be dangerous to be publicly outed as trans. Mother Q and Child Q waited in the reception for a long time; Child Q estimates it was about 1.5-2 hours.

[54]         In the meantime, Dr. Ajaero says that he was learning for the first time that the purpose of Child Q’s appointment was to receive a Lupron injection. He understood – wrongly – that this was part of a process for “gender assignment therapy”. He says that he had never had any experience with that branch of medicine. He testified that, because of his religion, he finds it “conflicting and difficult” to be involved in any part of “gender reassignment”.

[55]         Dr. Ajaero says that he spoke to another doctor at the clinic, who counselled him that he had the right not to provide any medical procedure that he was not comfortable with. He testified that the doctor told him that, as a Muslim, he would not do it either. I note that this is different than what it appears the doctor later told the College. Dr. Ajaero did not call this doctor to testify. For the purpose of this decision, I do not have to decide what the doctor said to Dr. Ajaero, or whether/why the doctor would not administer the injection. Rather, I accept that Dr. Ajaero spoke to another doctor and resolved not to administer the injection.

[56]         The medical office assistant came out and called Mother Q in. She said, using the wrong pronouns, that Child Q should stay in the waiting room. Mother Q reached to get the Lupron, but the assistant said she should leave it.

[57]         Mother Q met privately with Dr. Ajaero. Using Child Q’s deadname, Dr. Ajaero told her that he would not be administering the shot. He explained this was for religious and cultural reasons, and he hoped that was ok. Mother Q said it was not ok, and they needed to get the shot that day. Mother Q asked if there was someone else who could do it, and Dr. Ajaero said no. Mother Q stormed out. She told Child Q that they were leaving, and they left. They never spoke to Dr. Ajaero again, outside legal proceedings.

[58]         Dr. Ajaero’s chart notes from that day say:

MOA made this appointment without consulting me

[She] is here for Lupron injection

No prior information about the nature and reason for the injection

I noticed that the injection is for gender re-assignment as patient is already in the waiting room with [her] mother

I called mother into the room and explained to her that I would not be able to give the injection

Based on my religious belief and cultural background

[Her] mother was angry and said that today was four weeks since the last injection and [she] had to get [her] injection today.

I told her: I am sorry, I cant do it.

She stormed out of the room saying, “No, this is not OK”

[59]         Dr. Ajaero says that Mother Q left before he could offer her other options. He blamed his medical office assistant for not telling him earlier what the injection was for. If he had known, he says he could have called the family earlier to let them know he would not do it.

[60]         Both Mother Q and Child Q testified about their shock and upset at being turned away by their family doctor. Mother Q put it this way:

Mental health-wise for [Child Q], when she was able to get her shot – because she could finally see some progress and she was getting somewhere – it felt like a bit of a lifeline. And telling her she couldn’t get that shot felt like … she was drowning and I had the lifeline, and I just wasn’t going to give it to her.

[61]         Child Q says she was shocked at first and did not know what to do. Then she felt scared about what to do next. She and Mother Q felt a sense of urgency. It had already been four weeks plus one day since the last injection, and they could not delay further.

[62]         It was late Friday afternoon. Mother Q called a walk-in clinic and explained the situation. She says she was “slightly hysterical”. The walk-in clinic agreed to squeeze them in. Child Q received the injection later that day. Only after this was done did Child Q feel like she could more fully process her feelings. She felt angry and upset. I return to this below.

[63]         After this, Child Q went exclusively to walk-in clinics to receive her injection. Mother Q would take the day off work, and they would go first thing in the morning. Mother Q would always explain the situation, to ensure there was no problem. There never was. Mother Q testified that none of the doctors they saw had ever administered a Lupron shot before. She describes it as a “weird shot”. It comes in two pieces, in a box with instructions. She says the doctors would look at it, read the instructions, and “figure it out”.

[64]         Dr. Ajaero never formally ended his relationship with Child Q and her family. However, Mother Q and Child Q never returned to him. From Mother Q’s perspective, it was not safe and they no longer trusted him as a family doctor. Eventually, around December 2021, they found a new family doctor.

[65]         Mother Q made a complaint about Dr. Ajaero to the College. In a disposition letter dated November 7, 2023, the College found that Dr. Ajaero had failed to comply with the Practice Standard. The College advised:

Pursuant to section 36(1.1) of the [Health Professions Act], we confirm that Dr. Ajaero has been issued a formal reprimand for refusing to provide care related to gender transition to a patient on the basis of conscientious objection, without offering assistance to this patient in order that they could receive this care from another provider, in contravention of the College’s Access to Care and Discrimination practice standard …

[66]         On September 23, 2021, Mother Q filed this human rights complaint on behalf of Child Q.

IV    ISSUES

[67]         The human rights analysis proceeds in two well-known stages.

[68]         First, the burden is on Child Q to prove that she was denied a service that Dr. Ajaero customarily provides to the public, and her gender identity was a factor in that denial: Moore v. BC (Education), 2012 SCC 61 at para. 33.

[69]         Second, the burden shifts to Dr. Ajaero to justify the denial based on a bona fide andreasonable justification: British Columbia (Superintendent of Motor Vehicles) v. British Columbia (Council of Human Rights), 1999 CanLII 646 (SCC) [Grismer] at para. 20.

[70]         In this case, I must also address a third issue raised by Dr. Ajaero: whether a finding of discrimination would be a disproportionate limit on his right to freedom of religion under s. 2(a) of the Charter of Rights and Freedoms.

[71]         I consider each of these issues in turn.

V      COMPLAINANT’S CASE

[72]         I have no difficulty finding that Child Q has proven the elements of her case. Dr. Ajaero denied her medical services on March 5, 2021, and her gender identity was a factor in that decision.

[73]         Dr. Ajaero makes two arguments about the elements of Child Q’s case.

[74]         First, Dr. Ajaero argues that Child Q was not denied any service that he customarily provides to the public, so as to engage the protection of s. 8 of the Code. He says that he does not provide the service of injecting Lupron. He analogizes to the decision in Yaniv v Various Waxing Salons, (No. 2), 2019 BCHRT 222, where the Tribunal found that the respondents did not provide the specific service that the complainant was seeking. He argues that doctors must be able to define their own services, to ensure they practice medicine safely. Otherwise, he argues that “physicians may feel compelled to provide services they do not offer in order to avoid complaints of discrimination under the Code”.

[75]         I agree that the Code does not compel doctors to offer medical services they are not qualified to provide. However, in my view, Dr. Ajaero’s proposed definition of his services is too narrow.  

[76]         Section 8 of the Code is interpreted expansively to “breathe life, and generously so” into the protection, and advance the Code’s broad public purposes: Gould v. Yukon Order of Pioneers, 1996 CanLII 231 (SCC); British Columbia Human Rights Tribunal v. Schrenk, 2017 SCC 61 at para. 31. To this end, the Tribunal must be cautious not to define a service too narrowly, which risks obscuring, and perpetuating, barriers which impede equal access to public life: Moore at paras. 27–31.

[77]         In Moore, for example,the school district closed a program that provided intensive services and individualized help to students with severe learning disabilities. As a result, the district was unable to offer Jeffrey Moore, a child with dyslexia, sufficient remediation supports. An issue in the case was how to define the “service” provided by the school district. The majority of the BC Court of Appeal defined the service as “special education” and concluded that, because Jeffrey was treated the same as other students with disabilities, he was not denied this service. The Supreme Court of Canada rejected this narrow approach. It found that the service was education generally. Justice Abella explained that defining the service narrowly as “special education” would immunize the District from having to justify its decisions which adversely impact students with disabilities and, in doing so, “[risk] perpetrating the very disadvantage and exclusion from mainstream society the Code is intended to remedy”: para. 31, quoting Rowles JA. In my view, the same risks are present if I were to accept Dr. Ajaero’s narrow definition of service in this case.

[78]         I accept that, as a family doctor, Dr. Ajaero does not provide all medical services that other family doctors may provide. For example, he testified that he does not deliver babies, see patients in hospitals, provide cosmetic procedures, do sports medicine, work in the emergency department, give surgical assistance, do minor surgical procedures, prescribe methadone, deliver medical assistance in dying, or do abortions. However, the service that Child Q was seeking, in my view, did fall within his scope of practice and services.

[79]         Dr. Ajaero delivers primary medicine services. As a family doctor, his practice is broad. I find it reasonable to infer his services include giving patients intramuscular injections. When Mother Q made the appointment, she said it was for an injection and there was no suggestion that may not be part of Dr. Ajaero’s services. There was no further inquiry about the medication to determine whether it formed part of Dr. Ajaero’s services. The clinic made the appointment, and Dr. Ajaero was prepared to administer the injection until he learned what it was for. Though I appreciate different doctors may scope their practices differently, I also note that Child Q was able to consistently receive the injection through walk-in clinics. This supports my finding that the injection was not a specialized procedure or outside the everyday services of a family doctor. Indeed, it was something Child Q could have elected to do herself. This is not like Yaniv, where the complainant was plainly and intentionally seeking a different kind of waxing service than the respondents provided.

[80]         Second, Dr. Ajaero argues that Child Q did not experience any adverse impacts because she was able to receive the Lupron injection at a walk-in clinic later the same day. Respectfully, this argument is untenable.

[81]         Section 8(1)(a) of the Code says that a person must not “deny to a person” a service customarily available to the public because of their protected characteristic. Under the legislation, the denial of service is, by definition, an adverse impact. Where it is connected to a protected characteristic, it must be justified. In this case, Dr. Ajaero denied Child Q a service because of her gender identity. The fact that she was able to mitigate the impact by going to another clinic may be relevant to remedy, but it is not relevant to liability: Knights of Columbus at para. 125; SK v. Dr. F (No. 2), 2025 BCHRT 105 at para. 22.

[82]         I find that Child Q has established the elements of her case.

VI    JUSTIFICATION

[83]         The heart of this case is whether Dr. Ajaero has established a bona fide and reasonable justification for denying services to Child Q. If the denial is justified, it is not discriminatory.

[84]         The justification analysis is well established and not in dispute. It examines the “standard” that Dr. Ajaero was applying. In this case, Dr. Ajaero says he was applying two standards:

1. He does not administer Lupron because doing so would go against his religious beliefs [Religion Standard]; and
2. He does not administer Lupron because it is outside his scope of practice and expertise [Expertise Standard].

[85]         There is no dispute that Dr. Ajaero developed these standards for the first time when confronted with the reason for Child Q’s appointment. However, this Tribunal has recognized that “it is not unusual for a standard not to be articulated until the issue presents itself”: Knights of Columbus at para. 57. I accept that these were the standards that Dr. Ajaero was applying.

[86]         These standards must be justified under the human rights analysis. This requires Dr. Ajaero to prove:

1. A valid purpose: The standard was adopted for a purpose rationally connected to Dr. Ajaero’s function.
2. Good faith: The standard was adopted and enforced in an honest and good faith belief that it was necessary to fulfil its valid purpose.
3. Reasonable necessity and accommodation: The standard was reasonably necessary to accomplish its purpose. To prove reasonable necessity, Dr. Ajaero must establish that he could not do anything else reasonable or practical to avoid the negative impact on Child Q, without incurring undue hardship. This is the concept of reasonable accommodation.

Grismer at para. 20

[87]         Child Q disputes that Dr. Ajaero has proven any of the elements of this defence. I consider each in turn.

A.    Valid purpose

[88]         At this stage of the analysis, I must consider the general purpose of the impugned standard and determine whether it is rationally connected to the function Dr. Ajaero was performing, that is providing medical services as a family doctor: Meiorin at para. 57; Grismer at para. 20. The focus is “not on the validity of the particular standard that is at issue, but rather on the validity of its more general purpose”: Meiorin at para. 59.

[89]         Dr. Ajaero argues, and I accept, that the purpose of the Religion Standard is to allow him to practice medicine in a way that does not violate his sincerely held religious beliefs. This is consistent with the principle of “conscientious objection”, which is well recognized in health care. The College’s Practice Standard allows registrants to “make a personal choice not to provide a treatment or procedure based on their values and beliefs”. Courts have likewise recognized that doctors may make decisions about whether to participate in medical treatments that conflict with their religious beliefs: Carter v. Canada (Attorney General), 2015 SCC 5 at para. 132; R. v. Morgentaler, 1988 CanLII 90 at pp. 95-96. This purpose is rationally connected to Dr. Ajaero’s services as a family doctor.

[90]         Next, I accept that the purpose of the Expertise Standard is to ensure that Dr. Ajaero delivers medical services competently. This is rationally connected to Dr. Ajaero’s services as a family doctor. As the Ontario Human Rights Tribunal has explained:

For professionals, knowledge of the limits of one’s own expertise and skills is an important part of good practice, fulfilling professional obligations, and serving the public adequately.

Finan v. Cosmetic Surgicentre (Toronto), 2008 HRTO 47 at para. 30

[91]         I am satisfied that both the Religion Standard and the Expertise Standard have a valid purpose, which is rationally connected to Dr. Ajaero’s function as a family doctor.

B.    Good faith

[92]         At this stage, Dr. Ajaero must prove that he “adopted the particular standard with an honest and good faith belief that it was necessary to the accomplishment of its purpose, with no intention of discriminating against the claimant”: Meiorin at para. 60. This is a subjective test, which examines whether Dr. Ajaero was acting based on a discriminatory animus. Though intent is not required to find discrimination, a standard cannot be bona fide and reasonably justified if it is intended to discriminate. I find that Dr. Ajaero has satisfied this part of the test.

[93]         I accept Dr. Ajaero’s evidence about his intentions. He made a quick decision in the context of a busy day, with incomplete information.

[94]         Throughout this complaint, Dr. Ajaero has emphasised the pressures he is under as a family doctor in a busy practice. He estimates he has around 2,800-2,900 patients. He works five days per week, seeing about 50 patients per day. Patients are booked for ten-minute appointments. On Saturdays, he works at a different walk-in clinic. He estimates that, every day, he receives about 200-300 reports about his patients, including lab results, specialist reports, and requests for prescription refills. He has other paperwork to complete, including chart notes, referrals, care plans, insurance forms, disability forms, and tax forms. After March 2020, he faced the additional pressures arising from practicing medicine during a global pandemic.

[95]         On the day of Child Q’s appointment, Dr. Ajaero was still catching up from a six-week trip to Nigeria. He testified that he had never interacted with a trans person (to his knowledge) or been involved in any “gender therapy”. He had never administered Lupron for any purpose. It was apparent from his evidence that, in all the circumstances, he felt uncomfortable and unprepared. I accept that these feelings motivated his decision to deny services to Child Q, and were not based on an intention to discriminate against her.

[96]         I accept that Dr. Ajaero has proven this element of the justification analysis.

C.    Reasonable necessity

[97]         Finally, Dr. Ajaero must prove that denying service to Child Q, in the way that he did, was reasonably necessary to achieve the purposes of the Religion Standard and the Expertise Standard. This includes proving that he did everything reasonable and practical to accommodate Child Q and could not have done anything else for her without incurring undue hardship. This is where his defence fails.

[98]         In my respectful view, Dr. Ajaero has not established that either the Expertise Standard or the Religion Standard was reasonably necessary to achieve their purposes, or that he could not have done anything further for Child Q short of denying her services.

1.     The Standards were not reasonably necessary

[99]         A standard is reasonably necessary where the service provider could not accomplish its purpose while accommodating the complainant, without incurring undue hardship. Standards “must be as inclusive as possible”, incorporating “every possible accommodation to the point of undue hardship”: Grismer at paras. 22 and 32.

[100]      Above I have accepted that the purposes of Dr. Ajaero’s standards were:

1. to allow him to practice medicine in a way that does not violate his sincerely held religious beliefs (Religion Standard), and
2. to ensure that Dr. Ajaero delivers medical services competently (Expertise Standard).

[101]      I am not persuaded that, in order to achieve these purposes, it was reasonably necessary for Dr. Ajaero to refuse to give Child Q her injection.

[102]      A standard may be unreasonable where it is based on “impressionistic assumptions”: Grismer at para. 31. I find that is the case here. Dr. Ajaero’s assessment that he could not give Child Q her Lupron injection because of his expertise was based on incomplete and inaccurate information. He testified:

… I asked my [medical office assistant] to confirm what the injection was. And then she came back and told me it was for Lupron. Which I don’t have any expertise or experience with. And she also told me it was for gender assignment therapy. And which also I don’t have any experience with. And also because of my religious background and I was very very uncomfortable with that kind of that branch of medicine …

[103]      Dr. Ajaero’s conduct was based on his misunderstanding that Lupron was for “gender assignment therapy” and that it required him to have experience in that branch of medicine. In fact, although Lupron was part of gender affirming care for Child Q, it was not a treatment for “gender assignment”. Further, Dr. Ajaero was not being asked to practice in a different branch of medicine. Child Q was under the care of specialists at the Gender Clinic, who had prescribed the medication and were monitoring her treatment. All she needed from Dr. Ajaero was the injection. The injection was simple enough that she could have done it herself, but she preferred to have it done by a medical professional.

[104]      Dr. Ajaero made no attempt to correct his misunderstandings or better inform himself about what he was being asked to do.  He did not ask any questions about the injection, including to confirm that it had been prescribed by Child Q’s endocrinologist, who was continuing to oversee her care. He did not review the information pamphlet that accompanied the shot, to see whether it might have answered any of his concerns. There were numerous resources available to him, including Mother Q, the Gender Clinic, and other online resources. Dr. Saewyc testified that, in 2021, doctors had access to a “Rapid Access Consultative Services”, which they could call to speak to a specialist who could support in the provision of gender affirming care. Dr. Ajaero did not avail himself of any of these options and instead denied care based on impressionistic assumptions about the treatment Child Q was seeking from him.

[105]        I distinguish Finan. In that case, the Human Rights Tribunal of Ontario accepted evidence that the respondent doctor “was not qualified to offer the medical services that were requested by the complainants”: para. 30. In contrast here, the medical service being requested was administering an intramuscular injection. Dr. Ajaero was not asked to prescribe the medication, or monitor its effects on Child Q. That was all being done by the Gender Clinic. He simply had to give an injection that she could have elected to give herself. There is no evidence before me that, as a family doctor, he was not qualified to do that.

[106]      Dr. Ajaero argues that his decision not to administer Lupron to Child Q was based on his clinical judgement regarding his own expertise, in the context of “his hundreds of competing demands on the day of the Visit”. He argues that the Tribunal must “exercise significant caution in interfering with such a decision”. He cites McDonald v. O’Malley and BC (Min of Public Safety and Solicitor General), 2005 BCHRT 154, where the Tribunal held:

…The question of the standard of medical care when a doctor is exercising her or his best medical judgment is not an issue for the Tribunal to decide, as long as that judgment is exercised in a non-discriminatory manner, and as long as Mr. McDonald’s disabilities were accommodated.  I note that other medical practitioners prescribed anti-depressants and pain medication to Mr. McDonald.  Differences in opinion can arise when doctors, exercising their best medical judgment, decide upon the best course of treatment. [para. 33]

[107]      I accept these principles, and I agree with Dr. Ajaero that it is not this Tribunal’s role to direct “the practice of medicine”. However, I do not agree that this is a complaint – like McDonald – which is about standards of medical care or differences in opinion about how to treat a patient. Rather, it is a case where a doctor accepted an appointment to administer an injection, without asking for any information about what it was for, and then refused to do it when they learned it was related to gender affirming care for a trans girl. This is a case, unlike McDonald, where I find that Dr. Ajaero’s medical judgment was in fact exercised in a discriminatory manner. This engages Child Q’s rights under the Code, and is the proper purview of the Tribunal.

[108]      Dr. Ajaero has not persuaded me that administering Child Q’s injection fell outside the scope of his expertise, and that it was reasonably necessary to deny her care in order to ensure he was delivering his services competently. This argument is not a basis to justify the adverse impacts on Child Q.

[109]      Nor, in my respectful view, has Dr. Ajaero persuaded me that it was reasonably necessary to deny Child Q care in order to practice medicine in a way that does not violate his sincerely held religious beliefs.

[110]      I have no difficulty accepting that Dr. Ajaero is Christian and his religion is an important part of his life, and the life of his family. He gave ample evidence about his upbringing and his life in the church.

[111]      However, it is not enough for Dr. Ajaero to say he is Christian and therefore justified in refusing to provide medical services to a patient based on their gender identity. He must establish, as a matter of fact, that there is a conflict between his religious beliefs and the medical services that Child Q was seeking. In other words, he must establish that his sincere religious practices or beliefs call for a particular line of conduct, either by being subjectively or objectively customary or by subjectively engendering a personal connection with the divine: Syndicat Northcrest v. Amselem, 2004 SCC 47 [Amselem], at para. 56. The conflict between religious beliefs and medical services should be rooted in evidence, and not the subject of inference or judicial notice. Here, the evidence does not establish that refusing to administer medication whose purpose is to suppress puberty in trans youth is a particular line of conduct called for by Dr. Ajaero’s religious custom or connection to God.

[112]      Dr. Ajaero’s evidence about the specific religious practice or belief underlying his conduct towards Child Q was minimal, and limited to the following exchange:

A: I’m a Christian and … Christian religion is important to me. I believe in God created man and woman. And I find it difficult to be involved anything against that. And mostly, like I said, I don’t have the experience and expertise in that … branch of medicine.

…

… I find it difficult to be involved in anything against that belief, that goes against that belief.

Q: How was this – to your understanding – going against this belief?

A:  This [started to do] gender reassignment. I find it conflicting and difficult for me to be involved in it. [emphasis added]

[113]      In my respectful view, this evidence is not enough to establish that it was reasonably necessary for Dr. Ajaero to deny services to Child Q based on her gender identity, in order to allow him to practice medicine consistently with his religious beliefs.

[114]      First, as I have said, Dr. Ajaero made his decision not to give Child Q her injection based on incomplete and impressionistic information about what he was being asked to do. While it is true that Lupron was prescribed through the Gender Clinic, and was intended to give Child Q time to consider options relating to her gender identity, it is not medication for gender reassignment. It does not, on its own, conflict with Dr. Ajaero’s stated religious belief that “God created man and woman”.

[115]      Second, Dr. Ajaero does not explain the point at which his religious beliefs come into conflict with providing medical services to a trans child. It is not clear to me when or how they do. Child Q put it this way in her argument: “he has not set out the scope or substance of his religious belief”. I agree. Here I have considered that Dr. Ajaero had previously supported some of Child Q’s gender affirming care, including by referring her to the Gender Clinic. I have also considered that, after Mother Q complained to the College, Dr. Ajaero registered for a course on “Gender-Affirming Primary Care” and told the College that he “intended to review further resources with regard to gender affirming care”. These steps are laudable. And I appreciate the possibility that Dr. Ajaero’s religious beliefs allow him to deliver some gender affirming services and not others. However, the evidence before me is that Dr. Ajaero is prepared to deliver some gender affirming medical services without compromising his religious beliefs. Dr. Ajaero has not explained why administering an injection of Lupron – a medication prescribed and overseen by another doctor to pause puberty – crosses the line.

[116]      Finally, Dr. Ajaero’s evidence is not that providing Child Q with services would interfere with his ability to act in accordance with a sincerely held religious belief. It is that he would find it “difficult and conflicting” to do so. He testified that, more than a religious belief, the issue was “mostly” his “experience and expertise”. On its face, this undermines the argument that it was reasonably necessary to deny Child Q services based on her gender identity. It distinguishes this case from others where decision makers have considered evidence that doctors will not deliver certain medical services because those services are sinful and to participate in them is sinful: Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2019 ONCA 393 [Christian Medical]at para. 66.

[117]      Dr. Ajaero has not established that either the Religion Standard or the Expertise Standard were reasonably necessary to achieve their purposes. This is likely because they were developed quickly, in the context of a busy and stressful day, with incomplete information. This context is an explanation for Dr. Ajaero’s decision, but it does not justify his decision to deny medical services to a vulnerable trans youth because of her gender identity.  

[118]      This is enough to find that Dr. Ajaero violated s. 8 of the Code. However, for the sake of completeness I will go on to consider the issue of accommodation. Even if I had found that Dr. Ajaero could not have achieved the valid purposes of the Religion Standard and Expertise Standard while administering the injection himself, I am not satisfied that Dr. Ajaero fulfilled his duty to accommodate Child Q.

2.     Dr. Ajaero could have taken further steps to ensure Child Q’s needs were met

[119]      The concept of reasonable accommodation requires service providers to do “whatever is reasonably possible” to remove Code-related barriers preventing a person’s equitable access to their services: Council of Canadians with Disabilities v. VIA Rail Canada Inc., 2007 SCC 15 [VIA Rail] at para. 121. The concept of “undue hardship” sets the limit for the lengths that service providers are required to go to, and the point at which further efforts become unreasonable. Inherent in the concept is the recognition that there may be some hardship in accommodating a person’s Code-related needs. Accommodation is not always easy, convenient, or cost-effective. Service providers are required to consider options that may result in some hardship:  VIA Rail at para. 122. It is only when the hardship becomes “undue” that the duty ends.

[120]      These principles are reflected in the College’s Practice Standard, which sets out the “minimum standard of professional behaviour and ethical conduct” for doctors to ensure their services are provided without discrimination. Under that Standard, doctors (registrants) are required to:

Take reasonable steps to create and foster a safe, inclusive, and accessible environment for patients up to the point that would subject to the registrant to undue hardship and recognizing certain circumstance are out of a registrant’s control …

Consider the patient’s unique circumstances and available resources when providing care.

Where a doctor chooses “not to provide a treatment or procedure based on their values and belief”:

… they must provide patients with enough information and assistance to allow the patient to make an informed choice for themselves. This includes advising the patient that other health-care providers may be available to see them. Where needed, registrants must offer assistance and must not abandon the patient.

[121]      Dr. Ajaero argues that, short of providing the injection, there is nothing further he could have done to accommodate Child Q. He says that he had already provided a referral to the Gender Clinic, and Mother Q knew she could receive the injection at a walk-in clinic, and did so. I disagree. I am not satisfied that Dr. Ajaero took all reasonable and practical steps to avoid the negative impact on Child Q: Meiorin at para. 38.

[122]      Before March 5, 2021, Dr. Ajaero was aware that Child Q’s mental health had been poor, and she had been suicidal. He knew she was struggling with “gender issues”. He knew he had referred her to the Gender Clinic. The cover of the referral form that he completed included the following information:

If your patient is seeking medical treatment [puberty blockers/hormones], a readiness assessment must be completed by a trans-competent mental health assessor prior to seeing a pediatric endocrinologist.

While he denies seeing them, Dr. Ajaero was copied on reports from Child Q’s endocrinologist, setting out her medical history and treatment plan, including Lupron.  Finally, he knew that her March 5 appointment was for an injection.

[123]      In this context, I cannot accept that there was nothing further that Dr. Ajaero could have done, short of denying Child Q medical care on a Friday afternoon, after nearly two hours of waiting. Among other things, he could have proactively considered how he was prepared to be involved in Child Q’s medical care, and communicated any limits on the scope of practice to Child Q and Mother Q in advance. He could have taken time to gather any information he felt he was missing to accurately assess his qualifications and religious concerns about administering the injection. As I have said, there were numerous resources available to him, including Mother Q, the information pamphlet included with the injection, the medical reports his office had received, the Gender Clinic, the Rapid Access Consultative Services hotline, and other online resources. Dr. Ajaero did not avail himself of any of these options before denying care. Nor did he undertake any effort to mitigate any impacts on Child Q of denying service. Aside from talking to the other doctor at the clinic, he did not turn his mind to other reasonable or practical options to support Child Q’s access to important medical services. He did not offer Mother Q or Child Q any assistance or options to ensure that Child Q could receive her injection that day. Dr. Ajaero says that Mother Q stormed out before they could discuss other options. At the same time, however, he acknowledges that he did not have any other options to suggest. Nor did he make any attempt to follow up after the fact. In my respectful view, Dr. Ajaero did not fulfill his human rights obligations towards Child Q.

[124]      This is consistent with the findings of the College. In its disposition letter on behalf of the Inquiry Committee, dated November 7, 2023, the author reported:

The Committee took particular note of Dr. Ajaero’s interview with College staff, in which Dr. Ajaero was asked to explain his approach to responding to patients who ask him to provide care that he is not comfortable with. The Committee felt that it was clear from the interview that Dr. Ajaero did not have any formal process in place, and that he did not demonstrate an understanding of how he could have ensure that this patient had access to care that he declined to provide. The Committee agreed that Dr. Ajaero’s responses during the interview indicated that he had not made any clear arrangements for referrals when this situation arises with similar patients in the future. The Committee stated that all physicians should have a clear strategy about what they will do when faced with a request for care they are not comfortable providing themselves, and that it was clear from Dr. Ajaero’s interview that he did not have a strategy in place. The Committee noted that it would have been easy for Dr. Ajaero to have made arrangements in advance, and that there was a significant gap in his knowledge of the College’s expectations regarding conscientious objection. [p .5] 

[125]      As I have said, the Committee reprimanded Dr. Ajaero for “refusing to provide care related to gender transition to a patient on the basis of conscientious objection, without offering assistance to this patient in order that they could receive this care from another provider”, in contravention of the Practice Standard. From a human rights perspective, this represents a finding from Dr. Ajaero’s professional regulator that there were other steps he should have taken to ensure Child Q’s equitable access to medical services. This undermines Dr. Ajaero’s position in this forum that there was nothing he further he could have done for Child Q.

[126]      Child Q was entitled to receive medical services without discrimination based on her gender identity. Given her age, mental health, and vulnerability as a trans person, this right was critical to ensuring her mental, psychological, and physical wellbeing. She went to see her trusted family doctor for help administering an important injection. I find that Dr. Ajaero did not consider Child Q’s needs at all when he denied her care. This falls short of conduct that can be justified under the Code. I find that Dr. Ajaero discriminated against Child Q based on her gender identity, in violation of s. 8 of the Code.

VII  BALANCING FREEDOM OF RELIGION WITH PROTECTIONS AGAINST DISCRIMINATION

[127]      Dr. Ajaero argues that a finding of discrimination would represent a disproportionate limit on his right to freedom of religion, under s. 2(a) of the Charter.

[128]      To consider this argument, I must first decide whether my decision “engages the Charter by limiting Charter protections — both rights and values”: Trinity Western University v. Law Society of British Columbia, 2018 SCC 32 [TWU] at para. 58. If so, then I must ensure my decision reflects a proportionate balancing of the Charter protections and the purposes of the Code: TWU at para. 58; Doré v. Québec (Tribunal des professions), 2012 SCC 12, at para. 58. A proportionate balancing “is one that gives effect, as fully as possible to the Charter protections at stake given the particular statutory mandate”: Loyola High School v. Quebec (Attorney General), 2015 SCC 12 at para. 39. This is a highly contextual exercise, which allows for more than one possible outcome: Loyola at para. 41.

[129]      The right to freedom of religion encompasses “the right to entertain such religious beliefs as a person chooses, the right to declare religious beliefs openly and without fear of hindrance or reprisal, and the right to manifest religious belief by worship and practice or by teaching and dissemination”: R. v. Big M Drug Mart Ltd., 1985 CanLII 69 (SCC) at p. 336. It is engaged where a person (here, Dr. Ajaero) can show that:

1. They sincerely believe in a practice or belief that has a nexus with religion; and
2. A finding of discrimination would interfere, in a manner that is more than trivial or insubstantial, with their ability to act in accordance with that practice or belief.

TWU at para. 63; Amselem at para. 56

[130]      These are questions of fact. If s. 2(a) is not engaged, “there is nothing to balance”: TWU at para. 63.

[131]      I have set out Dr. Ajaero’s evidence about his religious belief above. I accept that Dr. Ajaero sincerely believes that “God created man and woman”, and this belief has a nexus with his Christian religion. However, for the same reasons that I was not persuaded it was reasonably necessary to deny Child Q medical services based on this religious belief, I am not persuaded that a finding of discrimination would interfere with Dr. Ajaero’s ability to act in accordance with that practice or belief. Any interference would, in my view, be trivial or insubstantial because it would “not threaten actual religious beliefs or conduct”: Alberta v. Hutterian Brethren of Wilson Colony, 2009 SCC 37at para. 32.

[132]      Even if Dr. Ajaero’s religious rights were engaged, I would find that my decision represents a proportionate balancing of his Charter right and the purposes of the Code.

[133]      The freedom to hold religious beliefs has always been broader than the freedom to act on them: Trinity Western University v. British Columbia College of Teachers, 2001 SCC 31 at para. 36. Religious freedoms must co-exist with other rights and values, in particular the right of equality-seeking groups to be treated as “human beings equally deserving of concern, respect and consideration”: Andrews v. Law Society of British Columbia, 1989 CanLII 2 (SCC) at p. 171 para. 15; Saskatchewan (Human Rights Commission) v. Whatcott, 2013 SCC 11 at para. 161; Amselem at para. 63. In Big M, the Court was clear that the freedom to manifest religious beliefs stops at the point where those manifestations “injure his or her neighbours or their parallel rights to hold and manifest beliefs and opinions of their own”: para. 123; see also Multani v. Marguerite-Bourgeoys, Comm. Scolaire, 2006 SCC 6 at para. 26; Oger (No. 7) at para. 131.

[134]      This case is about the right of a young trans person to access publicly funded medical services without discrimination. This right is guaranteed to her by s. 8 of the Code. The Code is quasi-constitutional legislation, whose protections are “fundamental to our society”: Zurich Insurance Co. v. Ontario (Human Rights Comm.), 1992 CanLII 67 (SCC) at para. 18; Schrenk at para. 31. Like s. 15 of the Charter, the Code protects and promotes substantive equality in a multicultural and diverse society: Oger (No. 7) at para. 87. Its purposes are set out in s. 3:

(a) to foster a society in British Columbia in which there are no impediments to full and free participation in the economic, social, political and cultural life of British Columbia;

(b) to promote a climate of understanding and mutual respect where all are equal in dignity and rights;

(c) to prevent discrimination prohibited by this Code;

(d) to identify and eliminate persistent patterns of inequality associated with discrimination prohibited by this Code;

(e) to provide a means of redress for those persons who are discriminated against contrary to this Code.

[135]      These purposes, and the protection of the Code, are especially resonant for trans youth. The Supreme Court of Canada has recognized that trans people “occupy a unique position of disadvantage in our society”: Hansman v. Neufeld, 2023 SCC 14at paras. 83-89; see also Oger (No. 7) at paras. 60-65. Trans and gender diverse youth are “especially vulnerable to expression that reduces their worth and dignity in the eyes of society and questions their very identity”: Hansman at para. 9. They are “more likely to report nearly every type of violence and discrimination than their heterosexual and cisgender peers in school”: Chilliwack Teachers’ Association v. Neufeld (No. 10), 2026 BCHRT 49 at para. 58.When the BC government amended the Code to add the ground of “gender identity and expression” as a protected characteristic, then-Attorney General Suzanne Anton expressed the Legislature’s clear intention to foster a society in which trans people are equal in dignity and rights:

There is no question that transgender persons can face challenges. They face violence. They face discrimination. They may be refused tenancies. They may be refused employment for no other reason than that they are transgender. They may be fired. It is important for transgender persons to know that they are protected, to know that government is with them.

It is important for all of us in society to know that we may not discriminate against a person based on their gender identity or expression. …

[British Columbia, Debates and Proceedings (July 25, 2016), p. 1425]

[136]      Despite this protection, Dr. Saewyc’s evidence establishes that trans youth continue to face barriers to timely and effective medical services, and that the consequences of delaying or denying medical care can be very serious: Expert report dated January 27, 2026 (Ex 3, tab 6) [Saewyc Report].

[137]      Trans youth report higher rates of discrimination in health care compared to their cisgender peers: Saewyc Report, p. 6. This includes being misgendered and deadnamed, and being unable to access gender affirming care: Saewyc Report; Christian Medical at para. 140. Many trans and nonbinary youth do not seek necessary medical care because of “fear of what the doctor might say or do, and previous negative experiences”: Saewyc Report, p. 5.  As Dr. Saewyc explains, the impacts of discrimination can be lifelong:

Negative experiences in health care often lead to avoiding further health care, even when it is urgent or necessary. Trans and nonbinary young people may miss out on the needed screening for cancer, heart disease, mental health and substance use disorders, and sexually transmitted infections, as well as preventative education and recommended vaccines. They may delay care for injuries or illnesses until the symptoms are more severe. All of these can mean they face more serious health conditions, at an advanced stage that becomes harder to treat, due to delays in care. [Saewyc Report, p10]

[138]      Although transgender health care for adolescents has been available in Canada for more than 30 years, young people still face “extended wait times” to access it: Saewyc Report, p. 6. These delays “increase the distress and urgency of gender diverse young people”, and “may prolong or worsen dysphoria”: Saewyc Report, p. 7. Conversely, early access to care is linked to lower levels of “depressive symptoms and mental health challenges”: Saewyc Report, p. 7. For adolescents facing an endogenous puberty, time is especially of the essence. A trans youth who is forced to go through a puberty that does not align with their gender identity may face increased distress and poorer mental health, including depression and suicidal ideation. In the long term, they may find it more difficult to align their physical appearance with their gender identity, worsening gender dysphoria and making “future health care more complicated”: Saewyc Report, p. 8.

[139]      These are the interests that must be balanced against Dr. Ajaero’s asserted right to manifest and practice his sincerely held religious belief that God created man and woman, by refusing to administer an injection without notice or alternative care plans for a vulnerable trans youth.

[140]      As a doctor, Dr. Ajaero is a member “of a regulated and publicly funded profession”, which is “subject to requirements that focus on the public interest, rather than [his] interests”: Christian Medical at para. 187. He has elected to practice in a profession “devoted to the service of the public”, which “necessarily gives rise to moral and ethical choices”: Christian Medical at para. 187. In navigating those choices, the Code imposes on him an obligation to ensure his services are provided without discrimination. He must consider the Code-related needs of his patients, and do everything reasonable and practical to meet those needs up to the point of undue hardship. This is an obligation properly placed on him as a provider of public services. His religion does not exempt him from it. As the Ontario Court of Appeal put it, his patients “should not bear the burden of managing the consequences of [his] religious objections”: Christian Medical, at para. 185. In this decision, I have found that Dr. Ajaero denied Child Q medical services based on her gender identity, without considering or addressing her needs at all.

[141]      In my view, a finding that Dr. Ajaero did not fulfill his obligations to Child Q represents a proper and proportionate balancing of his freedom of religion and Child Q’s right (also grounded in the Charter)to equitable access to “lawful and provincially funded health care services”: Christian Medical at para. 166. It reflects that “minor limits on religious freedom are often an unavoidable reality of a decision-maker’s pursuit of its statutory mandate in a multicultural and democratic society”: TWU at para. 100.

VIII         REMEDY

[142]       I have found Child Q’s complaint of discrimination justified. I declare that Dr. Ajaero’s conduct, as set out in this decision, was discrimination contrary to s. 8 of the Code.I order him to cease the contravention and refrain from committing the same or similar contraventions: Code,s. 37(1)(a) and (b).

[143]      In addition to these orders, Child Q seeks orders that Dr. Ajaero compensate her for Mother Q’s lost wages, as well as expenses incurred by the discrimination, and injury to her dignity, feelings and self respect. Finally, Child Q seeks an order that Dr. Ajaero post the Tribunal’s decision prominently in any place he practices medicine. I address each of these in turn.

A.    Mother Q’s lost wages

[144]      Mother Q filed this complaint on Child Q’s behalf, when Child Q was 14 years old.  She has represented Child Q throughout this proceeding. In doing so, she incurred $1,535.29 as lost wages. Child Q asks for this amount to be compensated, under s. 37(2)(d)(ii) of the Code.

[145]         Section s. 37(2)(d)(ii) gives the Tribunal discretion to compensate the person discriminated against for wages lost by the contravention. The object of an award for wage loss is to put the person in the position they would have been in had the discrimination not occurred: Gichuru v. Law Society of British Columbia (No. 2), 2011 BCHRT 185 [Gichuru] at para. 300 (upheld in 2014 BCCA 396). Section 37(2)(d)(ii) says:

(2) If the member or panel determines that the complaint is justified, the member or panel

(d) if the person discriminated against is a party to the complaint, or is an identifiable member of a group or class on behalf of which a complaint is filed, may order the person that contravened this Code to do one or more of the following:

(ii) compensate the person discriminated against for all, or a part the member or panel determines, of any wages or salary lost, or expenses incurred, by the contravention; [emphasis added]

[146]      On its face, s. 37(2)(ii) applies to wages lost by the “person discriminated against”. In this case, that is Child Q, not Mother Q. I raised this during the parties’ closing submissions. In response, counsel for Child Q argued that s. 37 should be given a large and liberal interpretation to achieve the ameliorative purposes of the Code. They analogize to cases where the Tribunal has ordered a respondent to make a donation to a group other than the complainant, without referring to any specific examples.

[147]      Notwithstanding the Code’s broad remedial purposes, this Tribunal does not have “license to ignore [its] words”: University of British Columbia v. Berg, 1993 CanLII 89 (SCC) at para. 27. Based on the limited evidence and argument before me, I am not satisfied that s. 37(1)(d)(ii) permits me to award wage loss to a person who has not been discriminated against – in this case, Mother Q. I deny this request.

B.    Expenses

[148]        Section 37(2)(d)(ii) of the Code empowers the Tribunal to make an order to compensate Child Q for expenses incurred by Dr. Ajaero’s contravention of the Code. The purpose of such an order is to, as much as possible, place the complainant in the position they would have been in but for the discrimination: Gichuru at para. 388.

[149]      Child Q seeks compensation in the amount of $8,100 for the expense of obtaining Dr. Saewyc’s expert evidence. In his Response to Remedy Sought Form, Dr. Ajaero asserted that this was not a necessary expense and should not be awarded. He made no submissions about this request in his closing argument.

[150]      I am satisfied that Dr. Saewyc’s evidence was useful, especially to understand what Lupron is and the social context of this complaint. It is appropriate to compensate Child Q for the expense of her evidence. In Gichuru,the Tribunal explained:

The Tribunal, and its predecessors, has long ordered compensation for the expense of expert reports, where such expert evidence is necessary to establish a contravention of the Code. The basic rationale is that, if an expert report is necessary to establish the contravention, then it is compensable as an expense incurred by the contravention. Compensation is necessary to make the successful complainant whole … [at para. 389]

This rationale applies here.

[151]      I order Dr. Ajaero to pay Child Q $8,100 as compensation for expenses incurred by discrimination.

C.    Injury to dignity, feelings, and self-respect

[152]      A violation of a person’s human rights is a violation of their dignity. That is why s. 37(2)(d)(iii) confers discretion on this Tribunal to award damages to compensate a complainant for injury to their dignity, feelings, and self-respect. The purpose of these awards is compensatory, and not punitive. In exercising this discretion, the Tribunal generally considers three broad factors: the nature of the discrimination, the complainant’s social context or vulnerability, and the effect on the complainant: Torres v. Royalty Kitchenware Ltd., 1982 CanLII 4886 (ON HRT); Gichuru at para. 260. The quantum is “highly contextual and fact-specific”, and the Tribunal has considerable discretion to award an amount it deems necessary to compensate a person who has been discriminated against: Gichuru at para. 256; University of British Columbia v. Kelly, 2016 BCCA 271 at paras. 59-64. In this case, Child Q seeks an award of $50,000.

[153]      At the outset, I note that several of Dr. Ajaero’s submissions about remedy focus on the circumstances of his decision making, including his religious beliefs, his busy and stressful practice, the COVID-19 pandemic, and his perception that there was no medical emergency. I have addressed these circumstances elsewhere in my decision. At this point, however, the focus is not on Dr. Ajaero but on Child Q. The exercise is to bring the remedial power of the Code to offer Child Q some compensation for how she was impacted by the violation of her dignity.

[154]      The nature of the discrimination in this case is the refusal of service by a family doctor on one occasion. Though it was a single incident, it is significant that the service at issue was health care. Equitable access to publicly funded health services engages a person’s right to life, liberty, and security of the person under s. 7 of the Charter: Christian Medical at paras. 48 and 166. At the same time, the discrimination was aggravated by the additional circumstances that Child Q faced while she was waiting for an extended period in the waiting room. During that time, she was publicly misgendered and deadnamed by the medical office assistant, notwithstanding Mother Q’s proactive efforts to correct her. Trans people are “entitled to recognition of, and respect for, their gender identity and expression” in public services: Nelson v. Goodberry Restaurant Group Ltd. dba Buono Osteria and others, 2021 BCHRT 137 at para. 80. Throughout her time at Dr. Ajaero’s clinic that day, Child Q’s gender identity was not respected. Her dignity was not upheld.

[155]      The social context of the complaint and Child Q’s vulnerability exacerbated the impact of discrimination on her. I have set out that context above, including that trans people continue to face oppression, marginalization, and discrimination and that trans youth are uniquely vulnerable to those harms: see also Nelson at para. 132.

[156]      Within this broader social context, Child Q was uniquely vulnerable. She was still a child at just 14 years old. The onset of her endogenous puberty had been distressing for her, to the point that she contemplated ending her own life. In her suicide note, she expressed that she could not keep going through male puberty. Lupron, and the time it afforded her, was a lifeline. But her mental health was still precarious when she went to see Dr. Ajaero.

[157]      As a family doctor, Dr. Ajaero exercised power over Child Q. Family doctors are “‘gatekeepers’ in a publicly funded health care system”: Christian Medical at para. 102. Their patients turn to them for advice and access to medical care for issues that are intensely private and difficult, and may be stigmatizing: Christian Medical at paras. 121-124. This was true of Child Q, who came to Dr. Ajaero expecting discrimination-free assistance administering what, for her, felt like a life-saving medicine.

[158]      It is not surprising, then, that the impact on Child Q was significant. I fully accept the evidence from Mother Q and Child Q about this impact.

[159]      In the immediate aftermath of Dr. Ajaero’s denial of service, the focus was on ensuring that Child Q could receive her injection that day. Despite Dr. Ajaero’s view that there was no medical emergency, in fact I find that there was urgency for Child Q to receive her injection that day. They were already one day past the four-week mark, and any significant delay in receiving the injection could mean that Child Q would experience the effects of testosterone. Mother Q was able to mitigate some of the immediate impact on Child Q by acting quickly to get her into the walk-in clinic for an injection that day. But this was stressful. The stakes were raised by the fact that it was a Friday afternoon, and walk-in services were less available on the weekend. Child Q, as a child, felt helpless and scared. She could see that her mother was also scared and upset, and she felt guilty about that.

[160]      After Child Q received the injection, and the immediate urgency had passed, she had more time to process the event. She felt angry. In her own words, Child Q described the experience as “shattering”:

…I had a lot of pride and I was very happy to have had that shot. And to be told that … I was not going to be able to have it – at least not under Dr. Ajaero’s care, and presumably there was a chance that I would not be able to get the shot, considering walk ins and wait times and all that kind of stuff, we didn’t know where to go next.

It was shattering for me to hear. I had felt as though … a pause was exactly what I needed at that time. I remember in the suicide note that my mum had mentioned earlier, I had talked about how I couldn’t wait any more for myself to …. experience male puberty and to keep going through that. And that was something I wasn’t able to handle anymore. I couldn’t. … Male puberty had begun to set in. I was starting to experience body hair and starting to hear my voice and it was a lot of things I just wasn’t able to handle at that time. I had begun to self-harm around that same time. Around January to March was when it was at its worst and it had proceeded to get worse after this particular encounter.

So it was shattering in that moment to hear that I was not going to be able to receive the shot.

[161]      Mother Q testified that this was the first time Child Q had experienced “blatant discrimination” from someone they had trusted. Because of her health needs, Child Q needs to interact with the medical system a lot. The discrimination in this case affected the family’s faith and trust in the medical system.

[162]      In sum, I find that Child Q experienced a significant impact to her dignity, feelings, and self-respect. The next issue is the quantum of my award.

[163]      Child Q argues that an award of $50,000 would appropriately compensate her for the harms of discrimination in this case, and “serve to protect other person[s] from discrimination… by making discrimination against transgender children in healthcare expensive”. She cites cases where the Tribunal has awarded between $5,000 and $30,000 for discrimination relating to gender identity, health care, and services: e.g. Client v. Spruce Hill Resort & Spa, 2021 BCHRT 104 [Spruce Hill] ($15,000 for a complainant who was denied services because they had cancer); Waters v. BC Medical Services Plan, 2003 BCHRT 13 ($6,500 for a complainant who was denied MSP coverage for a phalloplasty); Dawson v. Vancouver Police Board (No. 2), 2015 BCHRT 54 ($15,000 for a complainant who was misgendered, deadnamed, and denied access to medical treatment while incarcerated); Nelson ($30,000 for a complainant who was harassed and then terminated from their employment). She notes that the trend for the Tribunal’s damages award is upwards.

[164]      Dr. Ajaero argues that any award should be in the range of $10,000 to $15,000. He cites cases involving a single denial of service where the Tribunal has awarded $7,500 and $15,000: Belusic v. Yellow Cab of Victoria, 2018 BCHRT 81 ($7,500 for a blind complainant who was denied taxi service with his guide dog) and Spruce Hill ($15,000 for a complainant who was denied services because they had cancer). He argues that the circumstances of this case are less egregious than in Nelson (loss of employment)or Dawson (multiple incidents), and that Child Q has not cited any cases supporting an award of $50,000.

[165]      In all the circumstances, I exercise my discretion to award Child Q $20,000. In my view, this amount recognizes the serious impact that the discrimination had on a vulnerable trans youth, while she was seeking important and publicly funded medical services from her family doctor. I appreciate this is less than Child Q asked for, but in my view $50,000 would not be commensurate with the Tribunal’s awards in other similar cases. In that regard, I find Spruce Hill most analogous. I award slightly more in this case in recognition of Child Q’s unique vulnerability. The purpose of the award is to compensate Child Q, and in my view $20,000 is appropriate for that purpose.

D.   Order to post the decision

[166]      Finally, Child Q seeks an order that Dr. Ajaero “post the Tribunal’s decision prominently in any place he practices medicine”. She argues that this is necessary to ensure current or prospective patients know that he may not treat them, and can make an informed decision about whether to continue in his care. Dr. Ajaero opposes this order, arguing that it would serve no purpose other than to punish him. I agree.

[167]      The purposes of the Code are remedial, not punitive. The public interest is sufficiently served by publishing this decision, and ordering Dr. Ajaero to cease the contravention and refrain from committing the same or similar contraventions. I am not persuaded that any further purpose would be served by requiring Dr. Ajaero to post the decision. I deny this request.

IX    CONCLUSION

[168]      I have found that Dr. Ajaero discriminated against Child Q based on her gender identity, in violation of s. 8 of the Code.I make the following orders:

1. I declare that Dr. Ajaero’s conduct contravened s. 8 of the Code: Code, s. 37(2)(b).
2. I order Dr. Ajaero to cease the contraventions and refrain from committing the same or similar contraventions: Code, s. 37(2)(a).
3. I order Dr. Ajaero to pay Child Q $8,100 as compensation for expenses incurred by discrimination: Code, s. 37(2)(d)(ii).
4. I order Dr. Ajaero to pay Child Q $20,000 as compensation for injury to her dignity, feelings, and self-respect: Code, s. 37(2)(d)(iii).
5. I order Dr. Ajaero to pay post-judgement interest on the damage award until paid in full, based on the rates set out in the Court Order Interest Act.

Devyn Cousineau
Vice Chair