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(Correspondence) Therapeutic abortion

WF Baldwin

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
I support Dr. Roseborough’s stand that most therapeutic abortions are essential, remedial and generally humane (Can Med Assoc J 111: 645, 1974) and I see no advantage in debating the issue further. . . . It has been my experience that sympathetic counselling combined with a few days’ delay results in a certain number of unwise or unwanted terminations being avoided. I do not deny (or mind) that some patients suffer anxiety from delay, but if termination of pregnancy in ambivalent patients is avoided, I believe the checks are valuable. . .My personal approach is that we must return to some form of sensible and responsible morality. Sex has now become one of the most discussed subjects of modern times. The Victorians pretended it did not exist at all, whereas the so-called moderns pretend nothing else exists. We have discarded the first attitude as being unrealistic and it is now time that we discarded the second.

Baldwin W. (Correspondence) Therapeutic abortion. Can Med Assoc J. 1974;111(12):1299, 1301.

Hill-Burton Hospitals After Roe and Doe: Can Federally Funded Hospitals Refuse to Perform Abortions?

Eugene L Berl

Extract
Conclusion
Public hospitals, by reason of the mandate of Roe and Doe, cannot categorically refuse to perform abortions. Similarly, under the state action doctrine, hospitals receiving federal funds pursuant to the Hill-Burton Act cannot refuse to perform abortions, notwithstanding the Health Programs Extension Act of 1973. The inter-relationsip of state and the hospital in the Hill-Burton program, with all the rights, duties and obligations incidental thereto, and the fact that the state and the hospital are joint participants in a state project undertaken for the benefit of the public, support the finding of state action. The Roe prohibition against state interference in a woman’s abortion decision, to be more than a mere cipher, must extend beyond state abortion statutes to the unwarranted refusal to perform abortions by hospitals with which the state is intimately involved.

Berl EL. Hill-Burton Hospitals After Roe and Doe: Can Federally Funded Hospitals Refuse to Perform Abortions? New York U Rev Law & Social Change. 1974;4(1):83-97.

Uterine injuries complicating hypertonic saline abortion

JJ Willems

Author Summary
Two cases of uterine injury complicating midtrimester abortion induced by hypertonic saline are described, one with an extensive laceration of the cervix and the other with a rupture of the lower uterine segment extending into the vault of the vagina. The etiology, diagnosis and possible obstetric sequelae are discussed. With the increasing number of therapeutic abortions being performed in North America there is a concomitant increase in associated complications being reported in the literature. This report describes two of the more uncommon and potentially more important complications encountered when amnioinfusion is employed for the induction of midtrimester abortion. [Details of 19 year old and 15 year old patients at 16 and 18 weeks gestation respectively].

Willems J. Uterine injuries complicating hypertonic saline abortion. Can Med Assoc J. 1974 Dec 07;111(11):1223-1226.

(Editorial) Wilful exposure to unwanted pregnancy?

Carol A Cowell

Extract
The WEUP syndrome (otherwise known as “Wilful Exposure to Unwanted Pregnancy”) has been well documented in a number of psychiatric publications. . .

. . . Abortion is not an emergency procedure and the lowering of the legal age of consent has had virtually no effect on the availability of the operation to the adolescent patient. . . .

. . . .does the “open approach” and provision of effective contraception mean to young people that you personally endorse premarital sexual experimentation and does this influence their behaviour? My answer is an unequivocal “No”; they make their own choice with or without your approval, and whether or not they are “outfitted” beforehand with effective contraception.

. . To the question “What was your main reason for having an abortion?” the following answers were given: “too young” (55%), “wanted to finish school” (15%), “wanted a child but couldn’t keep it” (12%), “pressure advice from parents (7%), “don’t want the kid (child)” (7%), other (4%). From our follow-up data regarding the girls’ assessment of what for them was the best solution (i.e. term delivery or abortion), 93.3% said that abortion was the best solution, with some 4.3% saying that it was not and 2.4% providing no answer. . .

Cowell CA. (Editorial) Wilful exposure to unwanted pregnancy?. Can Med Assoc J. 1974 Nov 16;111(10):1045, 1047.

The unwanted pregnancy

Sharon H Stone, Kenneth E Scott

Authors’ Summary
A questionnaire was submitted to the mothers of 200 consecutively delivered infants; 15% of mothers were unmarried. The results showed a high prevalence of unwanted pregnancy, most accounted for by well educated, married women having their first or second baby, and despite access to contraceptive agents. Most of the married women and over 50% of the unmarried who had not wanted to become pregnant wanted the baby after its birth.

Stone SH, Scott KE. The unwanted pregnancy. Can Med Assoc J. 1974;111(10):1093-1097.

(Correspondence) CMA policy on abortion

CMAJ

Extract
While the CMA has recommended the removal of the requirement for hospital therapeutic abortion committees from the Criminal Code, it has supported the retention of the balance of sections 251 and 252. The purpose of this stand is to retain the more serious implications of a violation of the Criminal Code as compared with a violation of provincial medical acts regarding the performance of abortions by non-qualified persons or by qualified physicians outside approved hospitals. This policy also reflects the association’s opinion that some provincial medical acts, and the means of enforcing them, are less than adequate.

CMAJ. (Correspondence) CMA policy on abortion. Can Med Assoc J. 1974 Nov 02;111(9):905.

(Correspondence) CMA policy on abortion

Wendell W Watters

Extract
The recent special report “Abortion: a review of CMA policy and positions” by D. A. Geekie (Can Med Assoc J ill: 474, 1974) has left many members of the CMA and many other Canadians with a feeling of confusion and a deep sense of betrayal. If this idiosyncratic interpretation of the CMA policy on abortion does reflect the official views of the organization, many physicians will seriously question their association with and participation in the activities of that body. . . .. We categorically reject Mr. Geekie’s interpretation of the CMA position on abortion, and demand that the executive of the organization repudiate this document and reissue a statement that clearly puts forth a rational statement of policy on abortion.

Watters WW. (Correspondence) CMA policy on abortion. Can Med Assoc J. 1974 Nov 02;111(9):900-902.

(News) CFPC discusses changing world of the family physician

David Woods

Extract
Dr. Doran said that there are now 12 centres in Canada where genetic amniocentesis is performed, including his own group in Toronto which has done 195 in less than three years. The overall goal of the technique, he said, is to reduce genetic disease by therapeutic abortion (technically illegal under the present Criminal Code) and eventually by prevention.

Woods D. CFPC discusses changing world of the family physician. Can Med Assoc J. 1974 Oct 05;111(7):717-719.

Constitutional Law: Private Hospital May Refuse to Perform Abortion

Betty Berger

Extract
Conclusion
It is evident that the abortion question in relation to private hospitals is being fought on two grounds. One ground is state action. The other is freedom of religion and moral conviction. Decisions are beginning to indicate that public hospitals may have to perform abortions if they have the facilities. On the other hand, decisions such as Bellin, indicate that courts may not find sufficient state action when a private hospital is involved even if that hospital has received public funds. Even if they do, Bellin indicates that the right of conscience may protect the private hospital which is also sectarian and opposed to abortion on religious and moral grounds.’ Furthermore, the United States Congress has established a policy that receipt of funds from Hill-Burton or any other programs covered by the Health Services Extension Act of 1973 should not force a hospital to provide personnel and facilities for abortions. In addition, the first amendment protects the rights of individuals and groups to refuse to do what their religion prohibits. Abortions are generally a convenience and not a matter of life and death if not performed in the private hospital. In the balance of convenience versus first amendment freedoms, courts are unlikely to let convenience prevail. Private hospitals have sold neither their rights nor their private status..

Berger B. Constitutional Law: Private Hospital May Refuse to Perform Abortion. Saint Louis U Law J. 1974;18(3): 440-460.

(Correspondence) Inquiry into British law on abortion

PE Shea

Extract
Alan Massam’s article “Abortion Act gains outweigh drawbacks – British inquiry” (Can Med Assoc J 110: 1301, 1974) is a disturbing example of slanted journalism, aimed at further poisoning the minds of the bulk of doctors who sit on the fence in the abortion issue. . . .Mr. Massam, and apparently the inquiry, attempt to subtly convince us that abortion is a socially, morally, legally acceptable fact of life and we need only concern ourselves with its details. . . . Surely all our human rights are secondary to the right to life. This is the basic principle that the inquiry and Mr. Massam choose to ignore.

Shea P. (Correspondence) Inquiry into British law on abortion. Can Med Assoc J. 1974 Sep 7;111(5):388.