Whether it's kirpans in a Montreal schoolyard, turbans on a Milton job site, polygamists in a B.C. town or lesbians in a Winnipeg doctor's waiting room, opposing cultural and religious rights are giving a rough ride to Canada's cherished multiculturalism.

"The groups are clashing like never before," says Robert Mundle, chaplain at Toronto's Rehabilitation Centre. Mundle, an expert on the ethics of religion in medicine, says Canada can expect to see many more faith-based confrontations.

The latest involves a lesbian couple in Winnipeg who complained to Manitoba's human rights commission and College of Physicians and Surgeons that family doctor Karmeila Elias refused to accept them as patients because of their sexual orientation.

"It was like a kick in the stomach," says Andrea Markowski, who recently moved to the city from the Northwest Territories with her spouse of 18 years, Ginette. "I have a really hard time understanding how her religion affects her ability to care for me as a human being."

Thor Hansell, lawyer for Egyptian-born Elias, denies she refused care, saying the doctor felt she had a responsibility to explain her "personal religious views" so the couple could decide for themselves whether to become her patient.

Canada's doctor shortage means such confrontations will occur more often, says Dr. Bill Pope, head of Manitoba's College of Physicians and Surgeons, as doctors recruited from abroad bring their cultural and religious beliefs with them.

"Often their basic knowledge is good, but it's all in the way in which you operationalize it for a culture that might be quite different."

That's why the college requires a four-week orientation course before foreign-trained doctors can practise in Manitoba. Pope made a special visit to the course this week, where 25 doctors from the Middle East and Asia were wrapping up.

"Needless to say, I spent some time with them to explain this issue to them. A lot of them were terrified," he says. "They will be beginning practice very soon."

This isn't the first time religion and medicine have clashed in Winnipeg. Last year, doctors at Grace Hospital resigned rather than accept a court order to keep a patient on life support after a brain injury.

The family of 84-year-old Samuel Golubchuk said removing life support would constitute a sin under their Orthodox Jewish beliefs because it would hasten his death. Golubchuk died before his case could be resolved in the courts.

Mundle says the ongoing challenge facing Canada is to balance opposing rights. In both the Golubchuk and Markowski cases, the issue was complicated by the expenditure of public money.

Golubchuk's doctors argued it was a waste of resources to keep him on life support when there was no chance of survival. Andrea Markowski says Elias has a responsibility to care for her and Ginette, whatever her personal feelings.

"She is a doctor who is paid with public funds," Markowski says.

It's the sort of case the Ontario College of Physicians and Surgeons had in mind last year when it passed a policy paper warning doctors they could face human rights complaints if they refuse care to a patient on the basis of their personal religious beliefs.

"In our society, we all pay taxes for this medical system to receive services" said then college president Preston Zuliani.

Both the Ontario and Manitoba colleges say doctors should help patients in such cases find another physician. Beyond medicine, the issue of clashing rights is also playing out in construction sites, small towns and schoolyards:

Sikh security guard Deepinder Loomba was before the Ontario Human Rights Tribunal complaining he was discriminated against when ordered to remove his turban and don a hard hat at a Home Depot store construction site, saying his job patrolling the outside of the site made the hard hat unnecessary.

In Bountiful, B.C., leaders of the Fundamentalist Church of Jesus Christ of Latter Day Saints face charges of polygamy.

In a controversial decision two years ago, the Supreme Court of Canada ruled Montreal teenager Gurbaj Singh Multani could take his ceremonial dagger to school.

With files from the Star's wire services