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Extract Supporting conscientious objection and conscientious provision in the context of respecting physician autonomy is the essence of the CMA’s approach to MAID. Thus, the medical profession as a whole could participate actively throughout the drafting of the law and in the governance of medical assistance in dying. Respecting autonomy, for patients as well as for physicians, is the essential element in finding compromise to one of the most challenging question of medical ethics of our times.
Extract The CMA recognised that its policy needed to evolve: if the law were to change, the organisation would support all its members, regardless of their views, in deciding whether to participate in MAID. This was a watershed moment, enabling the association to lead national discussions and to give evidence before Canada’s Supreme Court. . . .The court referenced the CMA’s position to provide equal support for conscientious participation and conscientious objection, stating, “Nothing . . . would compel physicians to provide assistance in dying. The declaration simply renders the criminal prohibition invalid.”.
Donna Harrison, Cara Buskmiller, Monique Chireau, Lester A. Ruppersberger, Patrick P. Peung Jr.
The Linacre Quarterly
Abstract The purpose of this review was to determine whether there is evidence that ovulation can occur in women using hormonal contraceptives and whether these drugs might inhibit implantation. We performed a systematic review of the published English-language literature from 1990 to the present which included studies on the hormonal milieu following egg release in women using any hormonal contraceptive method. High circulating estrogens and progestins in the follicular phase appear to induce dysfunctional ovulation, where follicular rupture occurs but is followed by low or absent corpus luteum production of progesterone. Hoogland scoring of ovulatory activity may inadvertently obscure the reality of ovum release by limiting the term “ovulation” to those instances where follicular rupture is followed by production of a threshold level of luteal progesterone, sufficient to sustain fertilization, implantation, and the end point of a positive β-human chorionic gonadotropin. However, follicular ruptures and egg release with subsequent low progesterone output have been documented in women using hormonal contraception. In the absence of specific ovulation and fertilization markers, follicular rupture should be considered the best marker for egg release and potential fertilization. Women using hormonal contraceptives may produce more eggs than previously described by established criteria; moreover, suboptimal luteal progesterone production may be more likely than previously acknowledged, which may contribute to embryo loss. This information should be included in informed consent for women who are considering the use of hormonal contraception.
