Full Text

Position on Induced Abortion (1988)

The CMA's position on induced abortion is as follows:

* Induced abortion is the active termination of a pregnancy before fetal viability.

* The decision to perform an induced abortion is a medical one, made confidentially between the patient and her physician within the confines of existing Canadian law. The decision is made after conscientious examination of all other options.

* Induced abortion requires medical and surgical expertise and is a medical act. It should be performed only in a facility that meets approved medical standards, not necessarily a hospital.

Induced abortion, as interpreted by the CMA, is the active termination of a pregnancy before fetal viability. In this context viability is the ability of the fetus to survive independently of the maternal environment. According to current medical knowledge viability is dependent on fetal weight, degree of development and length of gestation; extrauterine viability may be possible if the fetus weighs over 500 g or is past 20 weeks' gestation,* or both.

In January 1988 the Supreme Court of Canada struck down Section 251 of the Criminal Code of Canada. The CMA's position is that there is no need for this section to be replaced. The following are the CMA's positions in other matters related to induced abortion.

* Induced abortion should not be used as an alternative to contraception.

* Counselling services, family planning services and information on contraception must be readily available to all Canadians.

* The provision of advice and information on family planning and human sexuality is the responsibility of practising physicians; however, educational institutes and health care agencies must share this responsibility.

* The patient should be provided with the option of full and immediate counselling services in the event of unwanted pregnancy.

* Since the risks of complications of induced abortion are lowest in early pregnancy, early diagnosis of pregnancy and determination of appropriate management should be encouraged.

* There should be no delay in the provision of abortion services.

*Gestation begins at conception.

* A physician should not be compelled to participate in the termination ofa pregnancy.

* No patient should be compelled to have a pregnancy terminated.

* A physician whose moral or religious beliefs prevent him or her from recommending or performing an abortion should inform the patient of such so that she may consult another physician.

* No discrimination should be directed against doctors who do not perform or assist at induced abortions. Respect for the right of personal decision in this area must be stressed, particularly for doctors training in obstetrics and gynecology, and anesthesia.

* No discrimination should be directed against doctors who provide abortion services.

* Abortion services should meet specific standards in the areas of counselling, informed choice, medical and surgical procedures, nursing and follow-up care.

* Induced abortion should be uniformly available to all women in Canada.

* Health care insurance should cover all the costs of providing all medically required services relating to abortion including counselling

The CMA stresses the importance of considering fetal viability when active termination of a pregnancy is being discussed by a patient and her doctor. It must be remembered that when the fetus has reached the stage where it is capable of an independent existence, termination of pregnancy may result in the delivery of a viable fetus. Elective termination of pregnancy after fetal viability may be indicated under exceptional circumstances.