JANUARY 15, 2008


Special Report: 20 Years of Abortion Rights

MD conscientious objectors' rights safeguarded

Tug-of-war over abortion referrals persists among pro-life, pro-choice

This past year saw two major, opposing lobby groups - the pro-choice National Abortion Federation and anti-choice Canadian Physicians for Life - urge the Canadian Medical Association (CMA) to change its conscientious objection policy. At stake is physicians' right to refuse to refer patients for abortions — a right seen by pro-life groups as central to protecting doctors' autonomy, and by pro-choice ones as an impediment to women's access to abortion.

The CMA has so far rebuffed both groups' requests, but the issue is far from dead.

The CMA's policy on induced abortion, drafted in 1988 after the Supreme Court's Morgentaler decision, permits physicians to not only refuse to perform abortions but also to decline to refer patients to abortion providers, except in emergency cases. The National Abortion Federation (NAF) alleges the policy is impeding women's access to abortion services.

The CMA's position on conscientious objection delays women's consultations with gynecologists, says NAF chair Dr Pat Smith, a Hamilton gynecologist - and therefore violates another tenet of the CMA policy, that "there should be no delay in the provision of abortion services."

"We think there are flaws within the policy," she says.

The NAF sent a letter to the CMA in May to ask them to require physicians to refer patients for abortions. "By not doing so," the letter asserted, "you abdicate your moral authority to set policies regarding healthcare in Canada."

The CMA not only refused but also took issue with the claim that the policy endangers women's access to abortion. Asked his opinion in December, CMA president Dr Brian Day told NRM, "No referral is required to access abortion services in Canada" — despite the fact this is the case in New Brunswick for abortions covered by public insurance.

Canadian Physicians for Life also asked the CMA in 2007 to amend the policy. They asked the organization to clarify and strengthen physicians' right to conscientious objection. (The CMA has said no to their request as well.)

Their request came about as a result of an article in the CMAJ in 2006 that claimed, incorrectly, that physicians would be committing malpractice by refusing to refer patients for abortions. Several months after the article, and subsequent angry letters, appeared in print, Dr Jeff Blackmer, the director of the CMA Office of Ethics, had to issue a clarification to make clear that physicians have no obligation to refer patients.

Dr Will Johnston, president of Canadian Physicians for Life, says that isn't sufficient. "I think the CMA has a good position and it's being correctly upheld, but unfortunately it's vulnerable to dishonest misrepresentation."

He'd like to see government enact conscience protection laws, to reiterate physicians' right to conscientious objection. Maurice Vellacott, a Conservative MP from Saskatchwan, has expressed interest in drafting such legislation, says Dr Johnston.

Past Canadian efforts to legislate such protection have failed. In 2000, Alberta Tory MLA Julius Yankowsky proposed a conscience protection amendment to the province's Human Rights Act. The bill never made it to a second reading. Mr Vellacott's previous attempt in federal Parliament met the same result in 1999.

Interpretations of conscientious objection vary from doctor to doctor. Dr Johnston, for example, refuses to refer women to a physician who will provide an abortion. "But I also tell her she doesn't need a referral to see an abortionist," says Dr Johnston. "I'm not a roadblock to it, but I don't have to be a bridge to it."

Dr Paul Saba, the president of the left-wing Quebec-based Coalition of Physicians for Social Justice, doesn't refuse to refer, but he tells women they are making "a bad decision" before referring them to an obstetrician.

Dr Smith thinks such tactics, though technically legal, are immoral. "Physicians are forced to do all kinds of things, like ethical billing, and I don't think this falls outside of that," she says. "I'm not in favour of laws that would allow physicians to not provide a full range of services to women."



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