Protection of Conscience Project Library

Prenatal diagnosis and female abortion: a case study in medical law and ethics

Bernard M Dickens

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.

Will the “Conscience of an Institution” Become Society’s Servant?

Joan Mclver Gibson, Thomasine Kimbrough Kushner

Extract
(Overview of accomplishments and future direction of hospital ethics committees) Overall, there is a modest sense of satisfaction with present mechanisms for dealing with ethical dimensions of patient care decisions, and a cautious optimism about the future. This is tempered by a growing, though as yet unfocused concern that emerging issues of cost, access, and quality of care will press ethics committees, now the “consciences” of institutions, into service on behalf of the community at large. . .

Gibson JM, Kushner TK. Will the “Conscience of an Institution” Become Society’s Servant? Hastings Cent. Rep. 1986 Jun;9-11.

Retention of products of conception after therapeutic abortion

Ellen R Wiebe

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Failure to remove all the products of conception during a therapeutic abortion is an acknowledged complication whose incidence increases with increased gestational age. In the following case, symptoms of an incomplete abortion were experienced for 2 1/2 years after the abortion.

Wiebe ER. Retention of products of conception after therapeutic abortion. Can Med Assoc J. 1986 Mar 1;134(5):505.

The abortion of thinking

Paul de Bellefeille

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.

(Correspondence) “The Silent Scream”: setting the record straight

Carlos Del Campo

Extract
A newsbrief in CMAJ 1985;132:1301) criticizing the videotape “The Silent Scream” failed to report the opinion of a highly qualified expert. Dr. Ian Donald, the original developer of diagnostic ultrasonography, former Regius professor of obstetrics at the University of Glasgow and honorary research consultant at the National Maternity Hospital in Dublin, spent 4 years filming fetal activity at various stages of gestation. Donald, in a sworn affidavit, wrote: “I have now studied Dr. Nathanson’s video-tape film entitled ‘The Silent Scream’ not less than four times and affirm that I am of the opinion that the fetal activities depicted by ultrasound real- time scanning in this film are not faked [or] the result of artefact intentional or otherwise”.

Campo CD. (Correspondence) “The Silent Scream”: setting the record straight. Can Med Assoc J. 1985 Sep 15;133(6):556-557.

Professions as the conscience of society

Paul Sieghart

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.

(Correspondence) “The Silent Scream”: setting the record straight

J Kohari

Extract
No doubt several Ottawa gynecologists were shocked by the stark reality of the ultrasound images of abortion shown in “The Silent Scream”. The film can be called propaganda, but since there is no proof that it is a fake it is called a documentary. The gynecologists never questioned the reality of the procedure, so why do they label it dishonest?

Kohari J. (Correspondence) “The Silent Scream”: setting the record straight. Can Med Assoc J. 1985 Sep 15;133(6):557.

Abortion (Policy Statement)

Canadian Medical Association

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.

Conscientious objection: a constitutional right

Frederick L Brown, Stephen M Kohn, Michael D Kohn

Brown FL, Kohn SM, Kohn MD. Conscientious objection: a constitutional right. New England Law Review. 1985;21: 545-569

Conscience, good character, integrity, and to hell with philosophical medical ethics?

Raanan Gillon

British Medical Journal, BMJ — British Medical Journal

Extract
. . .A recurring theme throughout medical discussion of medical ethics, typified by the British Medical Association’s Handbook of Medical Ethics,’ is the importance of recourse to conscience. In addition to this positive attitude to the importance of good conscience, good character, and integrity, doctors often have a distinctly negative attitude to philosophical discussion, argument, and criticism concerning medical ethics. . .

Gillon R. Conscience, good character, integrity, and to hell with philosophical medical ethics? Br Med J. 1985 May 18;290(6480):1497-1498.