Abstract The legal approach to abortion is evolving from criminal prohibition towards accommodation as a life-preserving and health-preserving option, particularly in light of data on maternal mortality and morbidity. Modern momentum for liberalization comes from international adoption of the concept of reproductive health, and wider recognition that the resort to safe and dignified healthcare is a major human right. Respect for women’s reproductive self-determination legitimizes abortion as a choice when family planning services have failed, been inaccessible, or been denied by rape. Recognition of women’s rights of equal citizenship with men requires that their choices for self-determination be legally respected, not criminalized.
Extract Conclusion The trend of hospital mergers between religious and non-religious hospitals may continue to threaten access to reproductive health services, especially for patients who already have limited access because they live in rural areas or have low incomes.l” However, as this essay suggests, there are several avenues that concerned citizens and activists can take to try to prevent the loss of these vital services.l ” The creativity and determination of those who commit themselves to ensuring that reproductive health services will continue to be available to all who desire them has resulted in several viable legal and practical methods of intervention. Although I believe it is important to respect the religious rights and beliefs of others. when the expression of these beliefs encroaches on patients’ rights to access basic health services, intervention is appropriate and necessary. I hope that public outcry, in the forms of legal and grassroots action, will persuade state actors, legislatures, hospital administrators, and clergy to properly acknowledge patients’ rights and participate in the creation of acceptable solutions to the financial problems that hospitals increasingly face. We need solutions that do not deny essential health services to any group of people.
Extract After Roman Catholic leaders issued strong criticism about its trampling of religious freedom, the American Medical Association approved a watered-down measure supporting continued community access to a full range of reproductive services following hospital consolidations. The AMA’s amended resolution stopped short of saying Catholic hospitals should have to perform all reproductive health procedures. . . The AMA instead upheld its policy that physicians and hospitals not be forced to perform services that violate their moral principles. . .
Abstract In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to “sensitive” services like abortion, family planning , HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers’ right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White’s analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients’ right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal “bypass” legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts.
Abstract An Alberta woman recently won a lawsuit against the government of Alberta for wrongful sterilization that took place when she was a 14-year-old ward at the Provincial Training School for Mental Defectives. It was the first time the province has been held accountable for actions taken under the Sexual Sterilization Act, a 1927 law that promoted the theory of eugenics and led to the sterilization of more than 2800 people. It has since been repealed. A physician who served on the province’s Eugenics Board said the decisions were based on the best scientific advice and medical techniques available at the time. Today, she added, eugenics is being practised in a different way through prenatal diagnosis and therapeutic abortion..
Extract The wave of abortion-on-demand legislation sweeping the world has reached our shores. The first blows to the concept of the sanctity of human life are being dealt at a time when health care in South Africa is undergoing tremendous upheaval. This concept may be irreparably damaged if the present Abortion and Sterilisation Act of 1975 is changed. . . Health professionals should be guided in their decisions and proposals by health values and by scientific evidence. Unfortunately these are not the only prerequisites, since moral and religious considerations are always subconscious realities. Enormous moral and ethical pressures already confront those making decisions about the provision of medical and health care in developing countries. . . The ‘unwanted’ child . . .is therefore victimised, not because of his or her own shortcomings but because society attempts to solve its socio-economic and broader health problems through the sacrifice of its children. . . To avoid abortions, fertility regulation (family planning)should be aggressively propagated in South Africa with specific emphasis on female education and counselling regarding contraceptive information, services and supplies and sterilisation. Contraception saves the lives of thousands of women around the world owing to avoidance of unwanted pregnancies.
Extract Conclusion When President Bush successfully thwarted passage of the Emergency Chinese Immigration Relief Act of 1989 and implemented his own order insisting upon “careful consideration” of victims who plead for political asylum because of coercive population control measures in their homelands, he unwittingly illustrated the need for a change in the statutory language. The Executive Order unwisely forces the issue of coercive population control policies into statutory language designed to protect victims of discrimination. Such manipulations would not be necessary if the Refugee Act of 1980 were amended to encompass the Handbook’s interpretation of the U.N. Protocol.
The interpretative guidelines to the U.N. Protocol, and derivatively to the Convention, call for a “conscientious objector” exception to military service. The grant of refugee status to individuals who prove “valid reasons of conscience,” even reasons distinct from religious claims, recognizes that fitting an individual within the protections of the refugee definition requires a judgment on the means other nations use to implement their policy ends, not just the ends themselves. Rather than relying solely on the five narrow grounds for granting asylum that were developed in response to the atrocities of World War II, the U.N. Protocol, as interpreted by the Handbook, also advocates protection for the individual persecuted by virtue of mandatory participation in a military service with which he morally disagrees. Because the debate regarding coercive population control considers the legitimacy of means employed in achieving governmental policy objectives, the logic of the conscientious objector exception also applies to claims such as that of Chang.
Abstract In busy hospitals the increasing numbers of abortions must be performed without disturbing other hospital functions. Local anesthesia, vaginal tubal ligation and the use of outpatient beds are the operative and administrative adaptations described. Of 1545 abortions performed in Victoria Hospital, London, in 1971, 428 (32%) were done under local anesthesia; 14 of these patients also had vaginal tubal ligation under local anesthesia. There were 405 sterilizations (26.2%) among this group of patients, of which 390 (96.3%) were vaginal tubal ligations. Of the total number, 891 (57.7%) were dealt with as outpatients and these comprised 62.0% of patients having therapeutic abortion only, and 46.7% of patients having tubal sterilization as well as abortion.
A David Clayman, John R Wakeford, John MM Turner,Brian Hayden
Canadian Medical Association Journal
Abstract The number of therapeutic abortions performed at the Vancouver General Hospital in 1969 was double the average number for the previous four years and in 1970 the total reached 1465. The more liberal attitude towards abortion has resulted in a decided reduction in the number of children available for adoption in the community. This policy has required a streamlining of the duties of the Therapeutic Abortion Committee and an alteration in the pattern of bed and operating-room utilization. By far the greatest number of abortions were performed on psychiatric-social grounds. The complication rate of 17% was influenced chiefly by the advanced duration of the gestation in a high proportion of cases. Gynecologists and hospitals must be prepared to assume their altered role in providing abortion and sterilization in today’s society.
Extract It is difficult for the ordinary doctor like myself to understand the role of the G.M.C. as regards medical ethics. Its change in attitude over abortion would suggest that the law of the land takes precedence over medical ethics, for the present law permits abortion for non-medical reasons. Does this mean that the G.M.C. will maintain only those medical ethics which do not conflict with the law, and that laws permitting euthanasia and sterilization of the unfit would receive similar sanction ? There is surely a conflict here not only between the G.M.C. and individual doctors but between the G.M.C. and those medical ethics which have international recognition..
