this paper explores the tensions experienced by christian physicians in ontario as they navigate the effective referral requirement. physicians in ontario are currently required by law to provide an effective referral should they conscientiously object to medical assistance in dying, also referred to as maid (cpso, 2015). this paper will consider the relationship christian physicians in ontario have with the effective referral requirement and the ways in which they manage their competing values within their profession and their faith. ultimately this paper will aim to answer the following research question, “how do christian physicians in ontario understand the tension between their professional and religious obligations when considering maid?”. to answer this question structured-qualitative interviews were conducted with eight physicians who a.) identify as christian, b.) are in a position to receive requests for maid, and c.) practice medicine within ontario with a license. thematic analysis was used to analyze the interview data. participants suggested several alternatives that they feel would adequately address their concerns with the effective referral requirement such as the implementation of a self-referral system and changing the requirement from providing a referral to requiring the provision of a phone number to patients instead.