Like it or not, sex-selective abortion
has arrived in Canada.
The topic made headlines in August
because of a protest in Surrey, BC against advertisements
placed in South Asian-targeted newspapers. The ads were
paid for by an American private ultrasound clinic owner,
Dr John Stephens, who was offering sex-determination
testing to BC's Indian community. Local community activists
accuse him of providing scans at 12 weeks to parents
who go on to terminate female fetuses because of a preference
for boys.
Dr Stephens is furious about the
brouhaha. "There is nothing unethical about the medical
relationship between a patient and her doctor such that
there may be a decision — made by the patient —
that results in her electing to not continue her pregnancy,"
says Dr Stephens. "It's nobody's business — it's
none of my business to even ask that question of the
patient."
Dr Stephens says there's no evidence
linking his exams to sex-selective abortions. However,
circumstantial proof does exist: conservative magazine
Western Standard published an article last year that
examined the abnormal gender ratios of some BC and Ontario
communities that have large proportions of Indian residents.
In Surrey, where over 10% of the population is of Indian
descent, there were 111 boys under the age of five per
100 girls in 2000. (The ratio should be 105:100 at that
age.)
Dr Stephens says the statistics
don't prove a thing. He calls the accusations against
his patients "paternalistic" and "racist," and those
against his practice unfair and untrue.
Dr Stephens complains he's been
unfairly targeted. There are indeed similar clinics,
offering similar services based in Canada that have
not been singled out. One clinic, See3D, based in North
York, ON, advertised their $65, 18-week sex-determination
test in the August 17 edition of CanIndia News on the
very same page as an article about Dr Stephens' ad being
pulled.
One private company called UC Baby,
however, refuses to do sex-determination testing before
20 weeks. (After 20 weeks most physicians will not perform
elective abortions because of the risk to the mother's
health.) "We don't want our service used for sex-selective
abortion," says president Dr Tina Ureten.
PUBLIC
POLICY
Sex-selective abortion presents bioethicists and clinicians
with a difficult ethical conundrum. Is it permissible
to limit access to abortion services in order to combat
systemic gender discrimination?
Canada's answer thus far has been
no, despite the general public's opposition to sex-selective
abortion and the majority of doctors' and hospitals'
refusal to provide sex-determination testing to women
who express a desire to abort a fetus based solely on
gender.
The 1994 Royal Commission on Reproductive
Technology recommended that prenatal sex determination
for the purpose of sex-selective abortion "not be available
for use," but the Assisted Human Reproduction Act, passed
in 2004 as a follow-up to the Commission report, only
restricts sex-selection in vitro, not in utero.
At the United Nations Commission
on the Status of Women meeting in March, Canada helped
force the withdrawal of a US-sponsored resolution against
sex-selective abortion. "The bottom line was that some
countries, including Canada, didn't want to put any
limits on abortion," says former George H W Bush speechwriter
and Christian activist Janice Shaw Crause, who attended
the UN meeting.
CLINICAL
ETHICS
Kerry Bowman, PhD, a clinical bioethicist at Mt Sinai
Hospital in Toronto, says his physician colleagues refuse
to provide sex-determination testing if the patient
says they don't want the baby if it's a boy or a girl.
However, such patients inevitably go elsewhere —
like to the private sector. "Many people learn not to
mention it," he says.
"The arguments for it are that
this is simply a matter of choice, that our healthcare
system is built on autonomy," he says. "But others say
we'd be colluding with extreme discrimination, and that
is my opinion as well. It really goes against the ethos
of the society. In the medical world, we should stand
together."
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