Morning-after pill poses moral dilemma for some MDs

The woman, who did not want to be identified for reasons of privacy, was told by a nurse the doctor was morally opposed to the pill, which prevents pregnancy after sex, and would not prescribe it.

The recent incident raises several questions about the controversial issue of doctors refusing to administer a drug based on personal beliefs.

The issue set off a debate when the drug Preven, known as the morning-after pill, was approved by Health Canada late last year. It is now sold in some pharmacies.

"As far as a physician is concerned they can decide to give treatment or withhold depending on his moral feeling,'' said Dr. Ashok Sharma, chief of staff at the St. Catharines site of the Niagara Health System.

As long as doctors are upfront with their patients, give them sufficient information or alternatives and fall within the province's Regulated Health Professions Act, they have the right to limit their medical practice, said Jill Hefley, spokeswoman for the College of Physicians and Surgeons of Ontario.

"It is up to physicians to define the parameter of their practice,'' said Hefley.

Of the 10 doctors who rotate shifts in St. Catharines General hospital's emergency room, only one will not prescribe the emergency contraceptive pill on moral grounds, said Sharma. The hospital would not release the name of the physician and said the doctor did not wish to talk publicly about his beliefs.

If a doctor is morally opposed to a medical treatment, it is his or her obligation to provide the patient with alternatives, said Sharma.

In a non-emergency situation where contraception was not used during sex or it failed, a doctor at St. Catharines General can recommend a woman go to a walk-in clinic, a birth control centre or another hospital emergency room.

In a case of sexual assault, the circumstances change, said the chief of staff.

"There is a standing order that they (doctors) have to give the pill in any emergency,'' he said.

The Sexual Assault Treatment Centre, which serves the region, is located at the hospital.

Women who fear an unwanted pregnancy have 72 hours after intercourse to take the drug.

"It is not uncommon for people to come to get the morning-after pill,'' said Maria Vuono, program manager of the hospital's critical care unit.

The emergency room gets a handful of non-emergency requests each month for the treatment, she said.

"ER is not the right place for contraceptive care,'' said Sharma. "We are too busy.''

The emergency room can't provide sufficient counselling or follow-up care. Family doctors or walk-in clinics provide more appropriate care, said Sharma.

In the recent case of the St. Catharines woman, she was told by the nurse on duty she had the option of either waiting until another doctor came on duty or go to the St. Catharines birth-control centre or a walk-in clinic to get the pill. She went to a centre.

Niagara Region runs three birth-control centres. If a woman goes to a centre looking for the morning-after pill, she can't get it without a doctor.

"Emergency contraception is always prescribed by a physician,'' said Alan Spencer, program manager of sexual health with the Region's public health department. "People can access it through the clinic.''

The clinics in Welland and Niagara Falls are only open during the afternoon. The St. Catharines clinic is open all day but doctors are not on-duty at the three clinics at all times. If a physician is not available, the woman will be referred to a family doctor or walk-in clinic, said Spencer.

A person would only be denied the emergency contraceptive on a medical and not a moral basis, he said.

"We believe in non-judgmental health treatment,'' said Spencer. "We want people to be healthy.''

At Hotel Dieu Hospital, the decision to prescribe the drug is left to the emergency room physician, said Rick Mauro, the hospital's spokesman.

The Catholic hospital would prefer to refer a woman to the city's other hospital because it is better equipped to deal with such cases, said Mauro.

However, administering the drug is still a decision each doctor must make, said Mauro.