The ethical code of the profession protects this right when the act violates ethical, moral or religious principles or when the doctor feels that their professional judgment is being pressured; in such cases, they must provide a written reason to the clinical management of the health facility.

This point is made clear in an opinion published by the College of General and Family Medicine and included in the same report, since evaluating a person's fitness to drive involves assessing the risks to third parties in complicated social situations.

There is an inherent ethical and professional conflict involved in refusing or imposing conditions on the award of a certificate, as this could damage the long-standing relationship of trust and confidence between the patient and their doctor; for this reason, the Medical Association states that doctors should not be required to give out such certificates without exception.