Abortion: Ensuring Access
Canadian Medical Association Journal
July, 2006
In July, 2006, the Canadian Medical Association Journal published
a guest editorial
by Sanda Rodgers of the Faculty of Law, University of Ottawa, and Jocelyn
Downie, of the Health Law Institute, Dalhousie University, Halifax, Nova
Scotia. The editorial appears to have been an attempt to bully objecting
physicians who refuse to refer patients for abortion by menacing assertions
about legal and ethical obligations.
The CMAJ is a publication of the Canadian Medical Association, which,
however, asserts that its contents do not necessarily represent the views of
the Association. The CMAJ did not publish the
Project's response to the guest editorial, but did publish several
others critical of the position taken by Rodgers and Downie. Those below are
reproduced with the permission of the authors and the CMAJ. Another, by
Dr. Daniel Holmes
(University of British Columbia, Department of Pathology and Laboratory
Medicine St. Paul's Hospital Vancouver, BC) is available on the CMAJ
website, as are some letters supportive of the editorial.
As a result of the controversy, the Canadian Medical Association issued a
clarification of
its policy, which confirmed that referral by objecting physicians is not
required.
Responses to "Abortion: Ensuring Access"
Catherine Ferrier, MD, CCFP, FCFP
McGill University Health Centre (5 July , 2006 )
To the editor:
I would like to take exception to the Guest Editorial in this week's
issue of CMAJ (Abortion: ensuring access, CMAJ 175(1): July 4, 2006). . .
women who are poor, young, immigrant, disabled and so on . . . have more
difficulty accessing most health services . . .abortion has no unique status
in this regard. As for the remarks about physicians who disagree with their
position and do not refer all patients for abortion who request it, I can
only say that they reflect an impoverished "one size fits all" understanding
of physician integrity and the doctor-patient relationship.
"Response to "Abortion: ensuring access"" - eCMAJ
05-Jul-06 - In response to original article from, CMAJ 04-Jul-06; 175(1),
Page(s) 9 "Abortion ensuring access" by permission of the publisher. © 2006
Canadian Medical Association
Protection of Conscience Project
Letter to the Editor,
Canadian Medical Association Journal
10 July, 2006
Professors Sanda Rodgers and Jocelyn Downie complain that "[s]ome
physicians refuse to provide abortion services and refuse to provide women
with information or referrals needed to find help elsewhere." (CMAJ
guest editorial, 4 July, 2006)
The authors almost (but not quite) assert that physicians opposed to
abortion will "withhold a diagnosis," "delay access," "misdirect women," and
"provide punitive treatment." They insert, in the midst of this list, the
imaginary offence of "failing to provide appropriate referrals:" imaginary,
because the Canadian Medical Association does not require referral for
abortion, and none of the cases thus far proposed by some of the authors'
like-minded colleagues support such a claim.1
Nonetheless, they insist that all of these practices, refusal to
refer among them, constitute malpractice and can lead to "lawsuits and
disciplinary proceedings."
This passage does three remarkable things, all in one breath: it subtly
impugns the integrity of objecting physicians; it associates conscientious
objection with "punitive treatment" and other unethical practices; and it
envelopes conscientious objection to abortion in an atmosphere of menace. It
is a masterful symphony of accusatory innuendo, contrived connections, and
strategic omissions. An unprepared reader may overlook the lyrical niceties,
but the melody - "thou shalt refer or else" - is unmistakable.
Professors Rodgers and Downie stand in relation to their students and
medical professionals as medical professionals stand to their patients, but
their editorial fails to respect the principle of informed consent. On the
contrary: it parallels the discreditable practice of securing the consent of
a patient by manipulative and selective communication. It makes no
difference that the consent sought in this case is to a proposition and
outcomes favoured by the authors, rather than diagnosis and treatment
favoured by a physician.
The authors are free to pursue their goal of increasing access to
abortion, but they ought to do so without suppressing freedom of conscience
in another profession. They are, after all, lawyers and law professors, not
health care workers, and they will not hold in their own hands the products
of the policies they seek to impose upon others.
Sean Murphy, Administrator
Protection of Conscience Project
Notes:
1. Including
Zimmer v. Ringrose (1981), 124
Dominion Law Reports (3d) 215 (Alberta Court of Appeal);
Zimmer v. Ringrose
(1978), 89 Dominion Law Reports (3d) 657 (Alberta Supreme Court);
McInerney
v. MacDonald (1992), 93 Dominion Law Reports (4th) 415 (Supreme Court of
Canada);
Malette v. Shulman (1990), 67 DLR (4th) 321 (Ont. Court of
Appeal);
Nancy B v Hotel Dieu de Quebec (1992), 86 DLR (4th) 385 (Quebec
Superior Court);
R. v. Morgentaler (1988)1 S.C.R 95-96 (Supreme Court of
Canada). See Murphy, Sean,
Postscript for the Journal of Obstetrics and Gynaecology Canada: Morgentaler
vs. Professors Cook and Dickens.
Related Links:
Abortion Access Editorial Worrisome
Letter to the Editor, Canadian Medical Association
Journal
11 July, 2006
Williard P Johnston, MD
President, Canadian Physicians for Life (11 July, 2006)
It is disturbing that Rodgers and Downie have teaching contact with
medical students on the topic of access to abortion. It seems clear to me
that two of their central points are plainly false. . . the CMA policy on
referral for abortion is unequivocal: a physician must make his or her
position, and the right to consult another physician, clear to the patient
but is in no way obliged to provide a referral for any procedure. . . [Link
to letter]
"Abortion access editorial worrisome" - eCMAJ
11-Jul-06 - In response to original article from, CMAJ 04-Jul-06; 175(1),
Page(s) 9 "Abortion ensuring access" by permission of the publisher. © 2006
Canadian Medical Association
Balanced Journalism Needed
Letter to the Editor, Canadian Medical Association
Journal
13 July, 2006
Rene Leiva
SCO Health Centre Ottawa
To the editor:
I found the Guest Editorial in this week's issue of CMAJ to be partial
and misleading. (Abortion: ensuring access, CMAJ 175(1): July 4, 2006). One
of the main issues is the false statement by the guest editors that
physicians should refer to abortion even against their conscience: . . . [Link
to letter]
"Balanced journalism needed" - eCMAJ 13-Jul-06 - In
response to original article from, CMAJ 04-Jul-06; 175(1), Page(s) 9
"Abortion ensuring access" by permission of the publisher. © 2006 Canadian
Medical Association
Re: "Abortion: ensuring access"
Letter to the Editor, Canadian Medical Association
Journal
13 July, 2006
Dr. Philip Ney
Before definitively forming an opinion on the editorial "Abortion:
ensuring access" by Rodgers and Downie, I would like to ask them a few
questions; . . . 2) What is the scientific evidence that abortion is good
and/or essential for women? 3) How can abortion be a "constitutionally
protected right" for women, and at the same time, the practice of abortion
be "regulated like any other medical procedure"? . . . 7) I note that Rogers
and Downie think the physicians "must" or "should do" on 9 occasions. How
would members of the legal profession feel about physicians telling the
legal profession how to conduct their affairs? . . .
"Abortion: ensuring access"" - eCMAJ 13-Jul-06 - In
response to original article from, CMAJ 04-Jul-06; 175(1), Page(s) 9
"Abortion ensuring access" by permission of the publisher. © 2006 Canadian
Medical Association
Stephen J. Genuis, MD FRCSC DABOG,
Associate Clinical Professor, University of Alberta (19 July, 2006)
. . . it may be preferable to have credible physicians debating
conflict-ridden medical issues rather than sanctioning special interests
outside the profession to expound unilaterally in scientific journals. . .
The policy of coercing ethical doctors to do what they feel is unethical -
whether it is by threat of lawsuits or disciplinary action - displays
intolerance of diverse views and choice; it goes against the CMA code of
ethics . . . [Link to
letter]
"Physician Autonomy and the Ethics of Intolerance" -
eCMAJ 19-Jul-06 -In response to the original article from, CMAJ 04-Jul-06;
175(1), Page(s) 9 "Abortion ensuring access" by permission of the publisher.
© 2006 Canadian Medical Association
Moral Desensitization
Letter to the Editor,
Canadian Medical Association Journal
26 July, 2006
Renata Leong, MDcM, CCFP, MHSc
DFCM, St. Michael's Hospital; Assistant Professor, DFCM, University of
Toronto
. . . A call for the silencing of one's inner voice of conscience is not
without cost. Research on medical education has documented moral distress
and moral desensitization when trainees witness or participate in what they
perceive as unethical acts, such as making derogatory comments about
patients1,2. One can only imagine the hundredfold impact of this
phenomenon when a healthcare provider is faced with a perceived demand to
promote or participate in the taking of another's life. . . [Link
to Letter]
"Moral Desensitization" -
eCMAJ 26-Jul-06 -In response to the original article from, CMAJ 04-Jul-06;
175(1), Page(s) 9 "Abortion ensuring access" by permission of the publisher.
© 2006 Canadian Medical Association