CMA policy review on abortion D.A. GEEKIE
The Canadian Medical Association's gical and dental treatment be lowered policy on abortion, discussed at this to 16 years (uniformly across Canyear's annual meeting, sparked con- ada) to permit health care profestroversy reflected in numerous letters sionals to counsel and treat young to the editor. Because so many of adults more effectively in general our readers have expressed concern health matters and in services related over this issue, we include the follow- to sexuality and contraception. active termination of a pregnancy * Where continuance of the preging summary of present CMA abor- nancy may endanger the life, physical tion policies. or mental health of the mother; The CMA defines abortion as the where there is substantial danger that active termination of a pregnancy the child may be born with a grave before 20 weeks of gestation. The as- physical or mental handicap or where sociation recognizes that the key there are reasonable grounds to beissues are not primarily medical but lieve the pregnancy resulted from a personal, social, ethical, religious and sexual offence, for example rape, financial, and that one cannot sep- incest. arate discussion of abortion from the The CMA recognizes the justifistudy of family planning and con- cation for abortion on nonmedical traception. grounds, and it believes that abortion should be considered an elective surLegal recommendations gical procedure to be decided upon by the patient and physician(s) conIn a recent policy review, the asso- cerned. Abortion procedures should ciation listed five circumstances be subject the same controls govwhere therapeutic abortion should be erning all tosurgical procedures conlawful: ducted in hospital. * When requested by the patient. The CMA recommends removing * When performed by a qual- all reference to hospital therapeutic ified, licensed medical practitioner abortion committees from the crimiwith the written consent of the pa- nal code and calls for a legal redeftient after discussion of the alterna- inition of the term "health" in the tives and medical risks involved. Criminal Code. * When performed in a public, active treatment hospital accredited No compulsion by the Canadian Council on Hospital Accreditation or approved for the The CMA is, however, opposed to conduct of abortions by the minister abortion on demand. The association of health of that province. (The holds that no hospital, physician or CMA opposes the performance of health worker should be compelled abortions in private hospitals, clinics, to participate in the provision of physicians' offices or any facility abortion services if it is contrary to other than a public, active treatment their moral or ethical principles or hospital.) policy, and it recommends that doc* When performed with the con- tors who refuse to participate in sent of the guardian in patients below induced abortions should not suffer the age of consent for medical serv- discrimination. This freedom from vices. The CMA recommends that discrimination must be stressed, parthe age of consent for medical, sur- ticularly for doctors training in ob-
stetrics, gynecology and anesthesia. The policy that sparked the recent interest and response deals with the CMA's announcement on its stand regarding the ethical responsibility of physicians with moral or religious objections to the counselling of patients seeking abortion. The CMA Code of Ethics now states that "an ethical physician, when his morality or religious conscience alone prevents him from recommending some form of therapy, will so acquaint the patient." Previously, the physicians were also obliged to advise the patient of other sources where they might obtain these services (see CMAJ 119: 61, 1978). The CMA is opposed to the principle that all publicly funded hospitals should be required to provide voluntary sterilization and abortion services because of their type of funding. The CMA does recognize the variation in the availability of therapeutic abortion facilities across Canada, however, and recommends that at least one hospital in each region should be equipped to provide these services, and that provincial hospital insurance agencies should recognize the added demands this places on such hospitals. Not an alternative The CMA stresses that abortion should not be considered as an alternative to contraception as a responsible family-planning method. The association is concerned with the large, growing number and increasing rate of abortions in Canada (Table I) and realizes that certain areas of the country are deficient in providing family planning and abortion services and information. It recommends that government health agencies cooperate with local medical societies to overcome the deficiencies in made-
CMA JOURNAL/OCTOBER 7, 1978/VOL. 119 807
Table I-Therapeutic abortions and abortion rates by province, Canada 1975-1977
Canada Newfoundland Prince Edward Island Nova Scotia New Brunswick Quebec Ontario Manitoba Saskatchewan Alberta British Columbia Yukon Northwest Territories Residence unknown Notes: 1. Rate based on estimated live births
quately serviced areas. It has also recommended that the federal government form a special commission to study all the medical, psychologic and social implications related to abortion, including patient profiles, guidelines for facilities, procedures and personnel. The CMA believes the key to solving the many problems related to the abortion issue are public educa-
1975 49 311 176 77 1 017 379 5579 24 921 1 298 1 282 4 333 10 076 77 95 1
Therapeutic abortions 1976 54 478 418 57 1 247 400 7249 26 768 1 393 1128 4 943 10 704 79 90 2
1977 57 564 493 43 1 304 426 7583 27 782 1 573 1 235 5 642 11 271 106 102 4
tion, responsible sexual behaviour and effective contraception and family planning. In order to facilitate the dissemination of information, the association recommends the following actions: * Advice and assistance on family planning should be made readily available to all residents of Canada. * The provision of advice and information on family planning
1975 13.8 1.6 4.0 7.8 3.2 6.0 19.8 7.6 8.4 13.7 27.8 18.9 8.1
Abortion rate per 100 live births 1976(') 14.9 3.7 3.0 9.4 3.3 7.6 21.4 8.1 7.2 15.0 27.7 17.6 8.1
1977(') 16.0 4.4 2.3 10.3 3.5 B.C 22.5 9.2 7.9 17.4 30.0 24.7 10.1
should be recognized as the responsibility of practising physicians. Other health professionals and health education agencies should share this responsibility within the community. * Additional family planning information facilities should be established throughout Canada in consultation with and under the supervision of the medical profession to ensure adequate medical followup.u
BCMA and ophthalmologists criticize sharp practice of vision task force Ophthalmologists in British Columbia have succeeded in bringing to the attention of the health ministry a minority opinion to the report. of the Vision Care Task Force released this spring after 2 years of study. Dr. Peter Prasloski, president of the Oto-Ophthalmological Society, a division of specialists under the BC Medical Association, said the minority report had received the support of the BCMA board of directors. As well, the BCMA board has expressed grave concerns over the conduct of the Vision Care Task Force. Dr. Prasloski said the task force report had been strongly influenced by lobbying from optometrists who have been seeking opportunities to gain inroads into medical eye care. "They (the optometrists) want to practise ophthalmology without going to medical school," he said. "They are once again looking for ways to drive in the thin edge of the wedge." Dr. Prasloski said the task force
report contained certain sections that a college of optometrists to establish ophthalmologists on the committee and regulate standards of knowledge could not agree with. However, he and competency, standards for qualsaid, their dissenting opinions were ifications to practise and standards not recorded and the report was pre- of professional conduct. Members sented as if it were agreed to by all would be licensed to practise, and members. a council of five members of the colThe minority report, which was lege plus persons appointed through drawn up by the society, points out cabinet would administer the legisits strong opposition to any exten- lation. sion of the present powers of optomeHealth Minister Robert McCleltrists and recommends against any land's advises only that his approval of university-based schools ministryoffice is studying all aspects of for optometry. reports. In the past, however, However, those who supported the the McClelland has expressed concern task force recommendations suggest about increasing costs of care in techstrongly that, in the interests of reach- nical aspects of vision care. ing more patients at less cost for preDr. Prasloski charges that the presventive care, optometrists should be given more responsibilities and better sures and lobbying to allow optometrists greater powers in preventive educational opportunities. A number of health agencies have eye care have been going on for a called for better cooperation between number of years, and that these tacophthalmologists and optometrists tics have been successful in Ontario. and said that there is room for both However, he believes that other provinces will not allow wider powers. groups of practitioners. G.Z. The task force report recommends
808 CMA JOURNAL/OCTOBER 7, 1978/VOL. 119
The Canadian Medical Association's gical and dental treatment be lowered policy on abortion, discussed at this to 16 years (uniformly across Canyear's annual meeting, sparked con- ada) to permit health care profestroversy reflected in numerous letters sionals to counsel and treat young to the editor. Because so many of adults more effectively in general our readers have expressed concern health matters and in services related over this issue, we include the follow- to sexuality and contraception. active termination of a pregnancy * Where continuance of the preging summary of present CMA abor- nancy may endanger the life, physical tion policies. or mental health of the mother; The CMA defines abortion as the where there is substantial danger that active termination of a pregnancy the child may be born with a grave before 20 weeks of gestation. The as- physical or mental handicap or where sociation recognizes that the key there are reasonable grounds to beissues are not primarily medical but lieve the pregnancy resulted from a personal, social, ethical, religious and sexual offence, for example rape, financial, and that one cannot sep- incest. arate discussion of abortion from the The CMA recognizes the justifistudy of family planning and con- cation for abortion on nonmedical traception. grounds, and it believes that abortion should be considered an elective surLegal recommendations gical procedure to be decided upon by the patient and physician(s) conIn a recent policy review, the asso- cerned. Abortion procedures should ciation listed five circumstances be subject the same controls govwhere therapeutic abortion should be erning all tosurgical procedures conlawful: ducted in hospital. * When requested by the patient. The CMA recommends removing * When performed by a qual- all reference to hospital therapeutic ified, licensed medical practitioner abortion committees from the crimiwith the written consent of the pa- nal code and calls for a legal redeftient after discussion of the alterna- inition of the term "health" in the tives and medical risks involved. Criminal Code. * When performed in a public, active treatment hospital accredited No compulsion by the Canadian Council on Hospital Accreditation or approved for the The CMA is, however, opposed to conduct of abortions by the minister abortion on demand. The association of health of that province. (The holds that no hospital, physician or CMA opposes the performance of health worker should be compelled abortions in private hospitals, clinics, to participate in the provision of physicians' offices or any facility abortion services if it is contrary to other than a public, active treatment their moral or ethical principles or hospital.) policy, and it recommends that doc* When performed with the con- tors who refuse to participate in sent of the guardian in patients below induced abortions should not suffer the age of consent for medical serv- discrimination. This freedom from vices. The CMA recommends that discrimination must be stressed, parthe age of consent for medical, sur- ticularly for doctors training in ob-
stetrics, gynecology and anesthesia. The policy that sparked the recent interest and response deals with the CMA's announcement on its stand regarding the ethical responsibility of physicians with moral or religious objections to the counselling of patients seeking abortion. The CMA Code of Ethics now states that "an ethical physician, when his morality or religious conscience alone prevents him from recommending some form of therapy, will so acquaint the patient." Previously, the physicians were also obliged to advise the patient of other sources where they might obtain these services (see CMAJ 119: 61, 1978). The CMA is opposed to the principle that all publicly funded hospitals should be required to provide voluntary sterilization and abortion services because of their type of funding. The CMA does recognize the variation in the availability of therapeutic abortion facilities across Canada, however, and recommends that at least one hospital in each region should be equipped to provide these services, and that provincial hospital insurance agencies should recognize the added demands this places on such hospitals. Not an alternative The CMA stresses that abortion should not be considered as an alternative to contraception as a responsible family-planning method. The association is concerned with the large, growing number and increasing rate of abortions in Canada (Table I) and realizes that certain areas of the country are deficient in providing family planning and abortion services and information. It recommends that government health agencies cooperate with local medical societies to overcome the deficiencies in made-
CMA JOURNAL/OCTOBER 7, 1978/VOL. 119 807
Table I-Therapeutic abortions and abortion rates by province, Canada 1975-1977
Canada Newfoundland Prince Edward Island Nova Scotia New Brunswick Quebec Ontario Manitoba Saskatchewan Alberta British Columbia Yukon Northwest Territories Residence unknown Notes: 1. Rate based on estimated live births
quately serviced areas. It has also recommended that the federal government form a special commission to study all the medical, psychologic and social implications related to abortion, including patient profiles, guidelines for facilities, procedures and personnel. The CMA believes the key to solving the many problems related to the abortion issue are public educa-
1975 49 311 176 77 1 017 379 5579 24 921 1 298 1 282 4 333 10 076 77 95 1
Therapeutic abortions 1976 54 478 418 57 1 247 400 7249 26 768 1 393 1128 4 943 10 704 79 90 2
1977 57 564 493 43 1 304 426 7583 27 782 1 573 1 235 5 642 11 271 106 102 4
tion, responsible sexual behaviour and effective contraception and family planning. In order to facilitate the dissemination of information, the association recommends the following actions: * Advice and assistance on family planning should be made readily available to all residents of Canada. * The provision of advice and information on family planning
1975 13.8 1.6 4.0 7.8 3.2 6.0 19.8 7.6 8.4 13.7 27.8 18.9 8.1
Abortion rate per 100 live births 1976(') 14.9 3.7 3.0 9.4 3.3 7.6 21.4 8.1 7.2 15.0 27.7 17.6 8.1
1977(') 16.0 4.4 2.3 10.3 3.5 B.C 22.5 9.2 7.9 17.4 30.0 24.7 10.1
should be recognized as the responsibility of practising physicians. Other health professionals and health education agencies should share this responsibility within the community. * Additional family planning information facilities should be established throughout Canada in consultation with and under the supervision of the medical profession to ensure adequate medical followup.u
BCMA and ophthalmologists criticize sharp practice of vision task force Ophthalmologists in British Columbia have succeeded in bringing to the attention of the health ministry a minority opinion to the report. of the Vision Care Task Force released this spring after 2 years of study. Dr. Peter Prasloski, president of the Oto-Ophthalmological Society, a division of specialists under the BC Medical Association, said the minority report had received the support of the BCMA board of directors. As well, the BCMA board has expressed grave concerns over the conduct of the Vision Care Task Force. Dr. Prasloski said the task force report had been strongly influenced by lobbying from optometrists who have been seeking opportunities to gain inroads into medical eye care. "They (the optometrists) want to practise ophthalmology without going to medical school," he said. "They are once again looking for ways to drive in the thin edge of the wedge." Dr. Prasloski said the task force
report contained certain sections that a college of optometrists to establish ophthalmologists on the committee and regulate standards of knowledge could not agree with. However, he and competency, standards for qualsaid, their dissenting opinions were ifications to practise and standards not recorded and the report was pre- of professional conduct. Members sented as if it were agreed to by all would be licensed to practise, and members. a council of five members of the colThe minority report, which was lege plus persons appointed through drawn up by the society, points out cabinet would administer the legisits strong opposition to any exten- lation. sion of the present powers of optomeHealth Minister Robert McCleltrists and recommends against any land's advises only that his approval of university-based schools ministryoffice is studying all aspects of for optometry. reports. In the past, however, However, those who supported the the McClelland has expressed concern task force recommendations suggest about increasing costs of care in techstrongly that, in the interests of reach- nical aspects of vision care. ing more patients at less cost for preDr. Prasloski charges that the presventive care, optometrists should be given more responsibilities and better sures and lobbying to allow optometrists greater powers in preventive educational opportunities. A number of health agencies have eye care have been going on for a called for better cooperation between number of years, and that these tacophthalmologists and optometrists tics have been successful in Ontario. and said that there is room for both However, he believes that other provinces will not allow wider powers. groups of practitioners. G.Z. The task force report recommends
808 CMA JOURNAL/OCTOBER 7, 1978/VOL. 119
