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
"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
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
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."