Protection of Conscience Project Library
Service, not Servitude
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The CMA will establish an ad hoc committee to review the association’s abortion policy in the wake of the Supreme Court of Canada’s Jan. 28 ruling that over- turned Criminal Code restrictions on abortion.
Blair L. (News) New committee will review CMA’s abortion policy, board decides. Can Med Assoc J. 1988;138(7):643.
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The adjectives range from “bloody outrageous” to “appalling and disgusting”, for just about no one is satisfied with a therapeutic abortion service that annually prompts hundreds of Newfoundland women to leave the province to get abortions. . . many women cannot get abortions in Newfoundland, in part because most of the province’s doctors won’t perform them, and in part because community standards are conservative. . . Dr. Carl Robbins, medical director of the General Hospital, thinks local doctors are unwilling to perform abortions because of personal conviction and the influence of values developed while training.
Yaffe B. The abortion issue in Newfoundland: a province divided. Can Med Assoc J. 1987 Apr 15;136(8):865-866.
Abstract
A case is presented in which a registered nurse caring for a 63-year-old patient in severe pain from terminal cancer disagrees with the attending physician’s order of morphine for fear that it will hasten the patient’s death. The nurse finds herself on duty alone one night when the patient and her daughter request more morphine. Bernal and Hoover contend that, because the nurse apparently took no prior action to explore alternative courses of pain relief for the patient or to make other arrangements for care, her duty of care overrides her appeal to conscience in the immediate situation. Aroskar believes that the nurse in this situation must give the injection, find someone else who can, or contact the physician. She holds, however, that nurses should be allowed to refuse to carry out particular procedures based on an appeal to personal conscience if the decision is founded on accurate information, acceptance of consequences, and advance planning.
Bemal EW, Hoover PS. The Nurse’s Appeal to Conscience. Hastings Cent Rep. 1987;25-26. Available from:
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Dr. Carl Robbins finds the fact that abortions are not available in his province “disgraceful, bordering on the unethical” (Can Med Assoc J 1986; 135: 910). He must be a young man, because it wasn’t long ago that it was disgraceful for a doctor to do abortions – besides which, it was a crime. As for Dr. Robbins’ call to ethics, I wonder what he is using for the basis of his code. Certainly not the Judeo-Christian formula. It must be the new “situation ethics”, which as applied to our general conduct is producing frightening results.
Aubé LA. (Correspondence) Newfoundland has no legal abortion services. Can Med Assoc J. 1987;136(4):324.
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I have, as I am sure do many doctors, a framed version of the Hippocratic Oath prominently and proudly displayed in my waiting room. . . I had a very busy general medical and surgical practice, and during that time it was understandably considered ethical to do a truly therapeutic abortion when this very occasional truly medical necessity arose. . . .Times have changed, but there are some things that cannot change if we are to retain our self-respect as professionals.
Johnson EA. (Correspondence) Abortion: an issue that won’t go away. Can Med Assoc J. 1986 Nov 15;135(10):1062-1064.
Abstract
Alarm over the prospect that prenatal diagnostic techniques, which permit identification of fetal sex and facilitate abortion of healthy but unwanted female fetuses has led some to urge their outright prohibition. This article argues against that response. Prenatal diagnosis permits timely action to preserve and enhance the life and health of fetuses otherwise endangered, and, by offering assurance of fetal normality, may often encourage continuation of pregnancies otherwise vulnerable to termination. Further, conditions in some societies may sometimes render excusable the inclination to abort certain healthy female fetuses. In places where abortion for fetal sex alone is recognised as unethical, however, medical licensing authorities already possess the power to discipline, for professional misconduct, physicians who prescribe or perform prenatal diagnosis purely to identify fetal sex, or those who disclose fetal sex when that is unrelated to the fetus’s medical condition.
Dickens BM. Prenatal diagnosis and female abortion: a case study in medical law and ethics. J Med Ethics 1986 Sep; 12(3): 143-144.
Extract
The Canadian Medical Association’s policy summary on abortion must be questioned. Although the summary may represent the consensus of some people at the executive level, it does not correspond to the views of the majority of CMA members. . . . medical problems require medical solutions; and when an expectant mother has medical difficulties the medical solution in good contemporary obstetrics is almost never termination of the pregnancy. The solution to socioeconomic problems must also be socioeconomic. To propose medical solutions for socioeconomic problems, and destructive ones at that, is illogical and shows a sad lack of confidence in our society’s ability to care for its own.
de Bellefeille P. The abortion of thinking. Can Med Assoc J. 1986;134(2):115-117.
Abstract
Ethics is no less of a science than any other. It has its roots in conflicts of interest between human beings, and in their conflicting urges to behave either selfishly or altruistically. Resolving such conflicts leads to the specification of rules of conduct, often expressed in terms of rights and duties. In the special case of professional ethics, the paramount rule of conduct is altruism in the service of a ‘noble’ cause, and this distinguishes true professions from other trades or occupations. If professional ethics come into conflict with national laws, the professional today can test the legitimacy of such laws by reference to internationally agreed legal standards in the field of human rights, and so help to perform the role of ‘professions as the conscience of society’.
Sieghart P. Professions as the conscience of society. J Med Ethics. 1985 Sep;11(3):117-122.
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.
Canadian_Medical_Association. Abortion (Policy Statement). Can Med Assoc J. 1985 Aug 15;133(4):318.
Abstract
This essay explores some of the conceptual and moral issues raised by illegal actions in health care. The author first identifies several types of illegal action, concentrating on civil disobedience, conscientious objection or refusal, and evasive noncompliance. Then he sketches a framework for the moral justification of these types of illegal action. Finally, he applies the conceptual and normative frameworks to several major cases of illegal action in health care, such as “mercy killing” and some decisions not to treat incompetent patients.
Childress JF. Civil disobedience, conscientious objection, and evasive noncompliance: a framework for the analysis and assessment of illegal actions in health care. J Med Philos. 1985 Feb 01;10(1):63-83.