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 Objectives In 2 successive decades since 1967, legal accommodation of abortion has grown in many countries. The objective of this study was to assess whether liberalizing trends have been maintained in the last decade and whether increased protection of women’s human rights has influenced legal reform.
Methods A worldwide review was conducted of legislation and judicial rulings affecting abortion, and legal reforms were measured against governmental commitments made under international human rights treaties and at United Nations conferences.
Results Since 1987, 26 jurisdictions have extended grounds for lawful abortion, and 4 countries have restricted grounds. Additional limits on access to legal abortion services include restrictions on funding of services, mandatory counseling and reflection delay requirements, third party authorizations, and blockades of abortion clinics.
Conclusions Progressive liberalization has moved abortion laws from a focus on punishment toward concern with women’s health and welfare and with their human rights. However, widespread maternal mortality and morbidity show that reform must be accompanied by accessible abortion services and improved contraceptive care and information.
JE Steinauer, T DePineres, AM Robert, J Westfall, P Darney
Family Planning Perspectives
Abstract The majority of residents responding to a 1995 survey of program directors and chief residents at 244 family medicine residency programs in the United States reported they had no clinical experience in cervical cap fitting, diaphragm fitting or IUD insertion and removal. For all family planning methods except oral contraceptives, no more than 24% of residents had experience with 10 or more patients. Although 29% of programs included first-trimester abortion training as either optional or routine, only 15% of chief residents had clinical experience providing first-trimester abortions. Five percent of residents stated they certainly or probably would provide abortions, while 65% of residents stated they certainly would not provide abortions. A majority (65%) of residents agreed that first-trimester abortion training should be optional within family practice residency programs. Residents were more likely to agree with inclusion of optional abortion training and with the appropriateness of providing abortions in family practice if their program offered the training.
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 After I read the articles on abortion in CMAJ I began to wonder if ready access to abortion is the main issue. Are we faced with a Yes-No decision, or are we looking at a symptom of something deeper? . . . The world is overpopulated, yet more and more children are being born. Despite the efforts of many dedicated people (especially women) to take information on birth con- trol to the most afflicted parts of the world, little progress is being made. All the solutions are “Band-Aid” ones, and almost all – contraceptives, abortifacients and abortion itself – are directed toward women, whose reproductive capacity is certainly the root of so much trouble. To cure these ills, nothing short of a redirection of human nature is necessary. . . .the earth’s mad population increase will surely go on to a cataclysmic end. We can put this off temporarily if we follow the Chinese example (one-child or two-children families) worldwide, with strict supervision of female reproduction.
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 The Canadian Medical Association (CMA) recognizes that there is justification for abortion on medical and nonmedical socioeconomic grounds and that such an elective surgical procedure should be decided upon by the patient and the physician(s) concerned. Ideally, the service should be available to all women on an equitable basis across Canada. CMA has recommended the removal of all references to hospital therapeutic abortion committees as outlined in the Criminal Code of Canada. The Criminal Code would then apply only to the performance of abortion by persons other than qualified physicians or in facilities other than approved or accredited hospitals. The Canadian Medical Association is opposed to abortion on demand or its use as a birth control method, emphasizing the importance of counselling services, family planning facilities and services, and access to contraceptive information. . . the association also supports the position that no hospital, physician or other health care worker should be compelled to participate in the provision of abortion services if it is contrary to their beliefs or wishes. CMA also recommended that a patient should be informed of physicians’ moral or religious views restricting their recommendation for a particular form of therapy.
Extract As official spokesman for the association, your public comment is governed by association policy. Most certainly personal views that are at variance with association policy must remain exactly that – personal views that are not expressed publicly. In reality, that wasn’t a problem for me. But I do want to respond to a letter-to-the- editor published in the Aug. 15th issue of CMAJ. The letter requests a motion of censure against me for misusing the position of president to espouse my personal views on abortion . . .There was nothing of any substance in my Halifax speech that was not in keeping with CMA policy. . . the author of the letter obviously based his comment on incomplete mass media reporting of my speech or a lack of understanding.
Helen Cvejic, Irene Lipper, Robert A Kinch, Peter Benjamin
Canadian Medical Association Journal
Abstract Thirty-eight adolescents who underwent an abortion were studied by questionnaire and interview with a psychiatrist and a social worker 2 years after the abortion. Most did not regret their abortion and considered it a positive experience. Most said they would not have another abortion, although adoption was unanimously rejected as a choice for the pregnant teenager. Relations with their parents were generally good and the families were supportive in the decision-making process and in the postabortion period. The girl’s father had been absent because of death or separation in 37% of instances. A lengthy relationship with the putative father before the abortion was common, but 37% of the relationships were not able to withstand the pregnancy-abortion crisis. The proportion using contraceptives before the abortion was 2%, and 2 years after the abortion, 84%.
