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Notes

1. Lewis, C.S., Screwtape Proposes a Toast and Other Pieces. London and Glasgow: Collins (Fontana Books) 1974, p. 18, 25

2. Stein, Rob,"Health Workers' Choice Debated: Proposals Back Right Not to Treat." Washington Post, 30 January, 2008. Accessed 2008-11-28.

3. Miller, Jennifer,"Bioethics, objection of conscience & clinician autonomy." Bioethics International, 30 November, 2007. Accessed 2008-11-28.

4. Submission to the College of Physicians and Surgeons of Ontario Re: Physicians and the Ontario Human Rights Code. Protection of Conscience Project, 12 September, 2008.

5. Smith, Wesley J, Second Hand Smoke,"Speaking Truth to Power: European Cases Presage Huge "Conscience Rights" Bioethics Fights to Come." 18 November, 2008. Accessed 2008-11-18.

6. Canning, Cheryl,"Doctor's faith under scrutiny:Barrie physician won't offer the pill, could lose his licence."The Barrie Examiner, 21 February, 2002.

7. "State of Victoria, Australia demands referral, performance of abortions." Protection of Conscience Project.

8. Golde, Polo Black,"California Court Comes Out: The Bioethics of Benitez." Bioethics Forum, 22 August, 2008. Accessed 2008-11-28.

9. Deibert, "Dave,"Sask. doctors resign over tubal ligation policy." Victoria Times Colonist, 21 December, 2006. Accessed 2008-11-28.

10. "Woman given settlement after being denied tubal ligation." CBC News, 13 September, 2007. Accessed 2008-11-28.

11. French, Janet,"Region to control Humboldt hospital." The Star Phoenix, 20 September, 2007. Accessed 2008-11-28.

12. Maputo Plan of Action for the Operationalisation of the Continental Policy Framework for Sexual and Reproductive Health Rights, 2007-2010. African Union, Special Session of the African Union Conference of Ministers of Health, Maputo, Mozambique 18-22 September, 2006. Accessed 2008-11-28.

Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa. African Union, 2nd Ordinary Session of the Assembly of the Union, Maputo, 11 July, 2003 Accessed 2008-11-28.

13. "Progress made in mainstreaming gender equality into Poland's national legislation, women's anti-discrimination committee told." UN General Assembly WOM1591, Dept. Of Public Information, 16 January, 2007. Accessed 2008-11-28.

14. "Portugal moves to legalize abortion." Catholic Culture, Catholic World News Feature Stories, 12 March, 2007. Accessed 2008-11-28.

15. Hoffman, Matthew Cullinan,"Portuguese Government Orders Doctors to Remove Anti-Abortion Restrictions from Code of Ethics: Portuguese Bar Association denounces decision as 'arrogant and overbearing.'" LifeSiteNews.com, 22 October, 2007. Accessed 2008-11-28. Almeida, Henrique,"Portugal doctors stand by anti-abortion principles." Reuters, 15 November, 2007. Accessed 2008-11-28.

16. Hoffman, Matthew Cullinan,"Portuguese Government to Prosecute Doctors Group Over 'Illegal' Anti-Abortion Ethics Policy." LifeSiteNews.com, 22 November, 2007. Accessed 2008-11-28.

17. Hoffman, Matthew Cullinan,"Portuguese Physicians Capitulate to Pressure to Change Ethical Code to Allow Abortions."LifeSiteNews.com, 11 July, 2008. Accessed 2008-11-28.

18. "Spanish Party Platform Challenges Abortion Conscience Clause." Catholic Culture, Catholic World News Feature Stories, 28 February, 2008. Accessed 2008-11-28.

19. "Church in India Condemns Judge's Sterilization Order." Zenit, 23 February, 2006. Accessed 2008-11-28.

20. "Catholic nurses under pressure to assist abortions." Spero News, 18 May, 2006. Accessed 2008-11-28.

21. Wilkinson, Isambard,"Nurse raped for refusal to carry out abortions." The Telegraph, 27 February, 2006. Accessed 2008-11-28.

22. "Hospitals must provide euthanasia." Expatica, 18 April, 2007. Accessed 28 November, 2008.

23. Murphy, Sean,"Belgium: mandatory referral for euthanasia." Protection of Conscience Project, December, 2003.

24. R Sparrow, Right of the living dead? Consent to experimental surgery in the event of cortical death. J. Med. Ethics, Oct 2006; 32: 601 - 605.
S Curry, Living patients in a permanent vegetative state as legitimate research subjects. J. Med. Ethics, Oct 2006; 32: 606 - 607.
H Draper, Research and patients in a permanent vegetative state. J. Med. Ethics, Oct 2006; 32: 607.
J Thompson, Relatives of the living dead. J. Med. Ethics, Oct 2006; 32: 607 - 608.
N Levy, A Ravelingien, J Braeckman, F Mortier, E Mortier, and I Kerremans, Respecting rights ... to death. J. Med. Ethics, Oct 2006; 32: 608 - 611.

25. "Sister Frances described Mr Wallis as "delightful, intelligent and aware young man". "I know that some people will say 'You are a Christian foundation. What are you thinking about?'. But we are here for all faiths and none," she said. "It is not our job to make moral decisions for our guests. We came to the conclusion that it was our duty of care to support Nick emotionally and to help ensure his physical safety." Payne, Stewart,"Hospice helped dying man lose his virginity." The Telegraph, 31 January, 2007. Accessed 2008-11-28.

26. Choy, Heather Low,"Sex visits organised for disabled men." news.com.au, Tasmania News, 28 September, 2005.

27. Dooley, D. "Conscientious refusal to assist with abortion" (Editorial). BMJ 1994;309:622-623 (10 September) Accessed 2008-11-30.

28. The Spanish pro-life group Provida reported that, a year after abortion was legalized in Spain, only 2 out of 100 gynaecologists in a Madrid hospital were willing to perform them. By 2004, abortions had been performed by only one doctor at the largest hospital in Valencia."96% of gynecologists in Spain refuse to perform abortions". Catholic News Agency. Accessed 2006-06-13.

29. "Abortion-Care Education Is Deficient in U.S. Health Professional Training". Joint Announcement from Ibis Reproductive Health, the National Abortion Federation, and the Abortion Access Project, 9 May, 2006. Accessed 2006-07-02.

Finer, Lawrence B., and Henshaw, Stanley K., "Abortion Incidence and Service in the United States in 2000." Perspectives on Sexual and Reproductive Health, Vol. 35, No. 1 January/February, 2003

Ceci Connolly , Ceci,"Number of Abortion Providers At Its Lowest in Three Decades." Washington Post, 22 January, 2003. Accessed 2006-07-02.

30. What constitutes a late term abortion is a somewhat subjective question. If we take fetal viability as a marker for what constitutes a 'late term' abortion, statistics in the United Kingdom show that as many as 50 babies survive abortions each year in the United Kingdom. Rogers, Lois, "Fifty babies a year are alive after abortion." The Sunday Times, 27 November, 2005. Accessed 2006-06-13.

Consider what is implied in the following resolution: "That this Meeting calls upon the MSC and BMA to work with the GMC, NHS and appropriate Royal Colleges to ensure that babies born alive as a result of termination of pregnancy procedures receive the same full neonatal care as that available to other babies."BMA Annual Representative Meeting, 2004. Accessed 2006-06-13.

31. A survey conducted in 1998, years afer legalization of abortion in the United States, found that most of the 1,200 nurses surveys wanted as little to do with abortion as possible. Poggenpoel, M., Myburgh, C., & Gmeineer, A., (1998, September). "One voice regarding the legislation of abortion: Nurses who experience discomfort." Curationis, pp. 2-7. Cited in Marek, Marla J., "Nurses' Attitudes Toward Pregnancy Termination in the Labor and Delivery Setting." JOGNN, 33, 472-479; 2004

32. The reluctance of Scots physicians to provide abortions after 15 weeks gestation has resulted in women travelling to England for the procedure. "Ian Jones, chief executive of the BPAS . . . admitted that it could be difficult to find doctors and nurses, particularly in the west of Scotland, who were prepared to work at the clinic. He said the fact that so many women needed to travel to England for late abortions reflected the fact that medical staff in Scotland do not want to perform them." Templeton, Sarah Kate,"Private firm plans Scottish abortion clinic." The Sunday Herald, 19 January, 2003. Accessed 2006-06-13. On the other hand, abortions can be obtained in some locations very late into pregnancy. Foster, Kate,"Hospital Admits Abortion At 34 Weeks." Scotland on Sunday, 10 April 2005. Accessed 2006-06-13.

A shortage of willing Canadian physicians caused women from Ontario and Quebec to go to the United States for late term abortions. Quebec Health Minister Philippe:"'In Quebec, our doctors at the present time don't feel comfortable doing abortions later than 22 weeks. From 20 to 22 weeks they're all done in Sherbrooke, after that we still don't have the capacity to do them here.'""Quebec hopes to offer late-term abortions." CBC News, 10 September, 2004. Accessed 2006-06-13.

By 2002 there had been a 578 percent increase in the numbers of abortions performed at 20 to 21 weeks gestation in Canada."Discovery of birth defects leads to abortions: study." CBC News, 28 March, 2002. Accessed 2006-06-13. The news report, drawing on Statistics Canada figures, noted that 96.7% of abortions in 2001 were performed before the 16th week. Since there were 105,154 abortions in 2001, about 3,480 abortions were performed after the 16th week: about nine per day. The Daily, 11 February, 2005. Accessed 2006-06-13.

Two to three abortions performed up to and beyond 24 weeks gestation were reported to be occurring each week in an Alberta hospital, many resulting in live births of infants. [Ko, Marnie,"Down the Slope to Infanticide: Nurses At Foothills Hospital Rebel Over The Horrifying Results Of Late-Term 'Genetic Terminations.'" Alberta Report Newsmagazine. May 3, 1999.

And, for the same reason, a district health board in New Zealand has decided to subsidize travel to Australia for women who want second trimester abortions. ["Royal College calls for conscience decision on second trimester abortions." Radio New Zealand,11 March, 2006. Accessed 2006-03-11.

33. Doctors at a hospital in Lyon, France, resigned en masse when administrators instructed them to implement a new law raising the gestational limit for abortion from 10 to 12 weeks. A study by the Jérôme Lejeune Foundation of the situation in Lyon found "intense reluctance" among doctors to carry out the later term abortions."French Doctors Rethinking Abortions in Face of New Law: At One Hospital, Physicians Quit en Masse." Zenit, 7 November, 2001. Accessed 2006-06-13.

34. "Consultants opposed to the killing of the twin, who had been diagnosed with a serious but operable heart defect, have threatened to bring a legal action for unlawful killing against the Royal Victoria Infirmary in Newcastle." "Doctors Revolt over Last-Minute Abortion of Twin." British Nursing News On Line, 10 November, 2002. Accessed 2006-06-13.

35. Dr. Ward's survey of Western Cape physicians found that half would not do abortions for non-lethal congenital abnormalities. More important was his finding that 46% would refuse to perform abortions for socio-economic reasons; less than a third were willing to do so. Ward, Harvey, Are State Doctors in the Western Cape willing to implement the Choice of Termination of Pregnancy Act of 1996? An opinion survey conducted in the Western Cape in November 1997. In fulfillment for the requirements of the FCOG (S.A.) part 2.

95% to 99% of nurses surveyed in the California study I have mentioned would refuse involvement in sex selective abortion; the rate of objection to selective reduction in multifetal pregnancies ranged from 71% to 92%. Marek, Marla J., "Nurses' Attitudes Toward Pregnancy Termination in the Labor and Delivery Setting." JOGNN, 33, 472-479; 2004. The range in both cases reflects responses that differed according to gestational age.

36. For example: a study in the United Kingdom found that nurses developed increasingly negative attitudes to abortion the longer they worked in units where it was provided. Marshall, S.L., Gould, D. & Roberts, J. (1994) "Nurses' attitudes towards termination of pregnancy." Journal of Advanced Nursing, 20, 567-576. Cited in Marek, Marla J., "Nurses' Attitudes Toward Pregnancy Termination in the Labor and Delivery Setting." JOGNN, 33, 472-479; 2004.

Abortion had been legal in Britain for over a generation when a third of junior doctors were reported to be conscientious objectors to the procedure. Barratt, Helen,"Conscientious Objection to Abortion." Triple Helix, Winter, 2001.

A survey by RN magazine disclosed that the number of nurses who refused to work in a unit where abortions were performed had increased over ten years from 48% to 61%.
Ventura, M.J. (1999) "Where nurses stand on abortion." RN, 62(3), 44-48. Cited in Marek, Marla J., "Nurses' Attitudes Toward Pregnancy Termination in the Labor and Delivery Setting." JOGNN, 33, 472-479; 2004.

Recent Californian research found rates of conscientious objection among nurses ranging from 23% to 99%, depending upon the reasons for the procedures. Moreover, two hospitals declined to participate in the survey because of fear that it would "stir up negative feelings" among staff: this, thirty years after the legalization of abortion in the United States. Marek, Marla J., "Nurses' Attitudes Toward Pregnancy Termination in the Labor and Delivery Setting." JOGNN, 33, 472-479; 2004.

On the other hand, other researchers have noted that experience has led to the development of more positive attitudes toward the procedure. See Meta Hammarstedt, Lars Jacobsson, Marianne Wulff and Ann Lalos, Views of midwives and gynecologists on legal abortion - a population-based study. Acta Obstetricia et Gynecologica Scandinavica, Volume 84 Page 58 - January 2005 doi:10.1111/j.0001-6349.2005.00695.x Volume 84 Issue 1: "The more experience of working with legal abortion, especially current experience, the less restrictive gynecologists and midwives are in their views. Compared with previous studies, staffs have become more liberal in their attitudes toward abortion and the relevant legislation."

37. Sometimes this collision is unintended. In England, for example, the Royal College of Nursing general secretary has suggested an expanded role for nurses in abortion. She stated that the organization wants to increase access to abortion in the early stages of pregnancy "and allow nurses greater involvement in providing services." While the general secretary affirmed the right of nurses to refuse to participate, she does not appear to have recognized that expecting more nurses to participate in abortion will increase the probability of pressure on conscientious objectors."RCN Says No Need for Change in Abortion Law." RCN News Release, 30 June, 2005. Accessed 2006-06-12.

38. The Center for Reproductive Rights secret policy - exposed by CFAM, despite threats of civil action - is based on this.

39. Planned Parenthood, Refusal Clauses: A Threat to Reproductive Rights Accessed 2006-06-13. National Abortion Rights Action League, Refusal to Provide Medical Services. Accessed 2006-06-13.

40. The Contraception Report: A State by State Review of Access to Contraception. NARAL Foundation, 2001, p. 11 (Available through http://www.popline.org/docs/274304).

41. Quoting Nancy Yanofsky of the ProChoice Resource Center. Good, Regan,"Pharmacies New Reproductive Rights Battleground." Wenews, 13 August, 2002. Accessed 2006-06-27.

42. "Pro-Choice Michigan's executive director, Rebekah Warren, said 'these big, blanket conscience clauses really could deny patients access to the medical care that they need, to the information that they need and to referrals that they need.'" Komp, Catherine,"'Conscience Clauses' Could Usher Healthcare Access Crisis." New Standard, 29 March, 2006. Accessed 2006-03-30.

43. The executive director of the New York affiliate of the National Abortion and Reproductive Rights Action League, Ms. Kelli Conlin, said she wanted to be sure that all of New York's mayoralty candidates were "committed to ensuring that medical residents at city hospitals were trained in abortion procedures." Bumiller, Elisabeth,"Abortion Rights Leader Mulling Endorsement in Mayoral Race." New York Times, 6 April, 2001. Accessed 2006-06-13.

"Joyce Arthur, a spokesperson for the Pro-Choice Action Network in Vancouver, says all students, including pro-life ones, should be compelled to learn about abortions and refer patients to pro-choice doctors, whether they like it or not. 'It's sort of an obligation that they learn about this basic and very common medical procedure,' she says. She adds that if prolifers cannot stomach this, then 'they shouldn't be a doctor,' and they'd have to find a different profession." O'Neill, Terry,"Should doctors be forced to abandon their faith?" Western Standard Magazine, 2004

A trustee of the Center for Reproductive Rights stated: "Abortion is a medical procedure and all medical students who are in the OB/GYN specialty should be required to learn the procedure. Medical school curricula must address this." The Center for Reproductive Rights: Summary and Synthesis of Interviews (E2545) (See note 53)

A journalist researching Medical Students for Choice noted that its brochure outlined the goal of having "all medical students train to be abortionists." Edwards, Greg J.,Medical Students for Choice: Pro-choice group at UBC hard to locate, unless you're a fan.

Medical Students for Choice encourages medical schools to include the following in their curriculum for all students (emphasis added):
• didactic instruction on the public health, social and historical context of abortion
• medical and surgical abortion techniques
• pre- and post-abortion management
• pregnancy-options and contraceptive counseling.
Medical Students for Choice Policy on Abortion Training. Accessed 2006-06-13

44. McLeod, Carolyn, "Demanding Referral in the Wake of Conscientious Objection to Abortion." In Cohen, JC and Keelan, JE (Eds.) M C I S B R I E F I N G S: Comparative Program on Health and Society, Lupina Foundation Working Papers Series 2004-2005 (January, 2006). Munk Centre for International Studies, University of Toronto. Accessed 2006-04-07.

45. The Abortion Non-Discrimination Act (USA) was added to an omnibus spending bill, which passed the House of Representatives in November, 2004. The amendment was attacked by ostensibly 'pro-choice' groups, including Planned Parenthood, the National Organization for Women (NOW) and the National Abortion Rights Action League (NARAL). 'Pro-choice' groups attack freedom to choose: NARAL, NOW and Planned Parenthood (November, 2004). Protection of Concience Project.

46. During a CTV News interview on 2 June, 2001, the executive director of Planned Parenthood in Calgary, Alberta, claimed that physicians who object to abortion for reasons of conscience are ethically obliged to refer patients for abortion. The assertion was false. Murphy, Sean,"Planned Parenthood and "Anti-Choice" Rhetoric." Protection of Conscience Project.

47. Toneguzzi, Maria, "Planned Parenthood Targets 'Anti-choice' Docs." Calgary Herald, 19 August, 2004.

Planned Parenthood Alberta, Be Aware of Anti-Choice Doctors and Radiologists. Accessed 2004-08-28.

"Abortion groups are launching a campaign to name doctors who refuse to help women seeking terminations. . . In an even more aggressive move, patients are being urged to report to the General Medical Council (GMC) doctors who refuse to play any role in terminations." Templeton, Sarah Kate,"Abortion lobby in campaign to expose pro-life doctors." The Sunday Times, 17 July, 2005. Accessed 2006-06-13.

Foster, Charles, "Conscientious objection to abortion - ethics, polemic and law." Triple Helix, Autumn, 2005.

48. For example, the Center for Reproductive Rights Board of Directors includes:

Executive Committee Members
Nicki Nichols Gamble (Vice Chair), Former President and CEO, Planned Parenthood of Massachusetts
Francis W. Hatch, III (Vice Chair), Chairman, The John Merck Fund
Betsy K. Karel (Chair), Board Chair, Trellis Fund
Nancy J. Northup (Ex-Officio 1/13/03), President, Center for Reproductive Rights

General Members
Laurie G. Campbell (Treasurer and Chair of Finance Committee)
Jane E. Hodgson, MD, MS, FACOG, Founding Fellow, America College of Obstetricians
and Gynecologists
Sylvia A. Law, Elizabeth K Dollard Professor of Law, Medicine and Psychiatry, New
York University Law School
Marcie J. Musser, Vice President and Treasurer of the Board, General Service Foundation
Nafis Sadik, MD, Special Envoy for United Nations, Secretary General for HIV/AIDS
in Asia and Pacific
Sheldon J. Segal, PhD, MD, FRCOG (Secretary), Distinguished Scientist, The Population Council
Marshall M. Weinberg, Board Member, American Jewish Joint Distribution Committee
The Center for Reproductive Rights Board of Directors - Primary Affiliation Information (E2547) (See note 30)

In Canada, the following individuals are among those active against freedom of conscience in health care:

Rebecca Cook, J.S.D. 1994, LL.M. 1988 (Columbia University, School of Law); J.D. 1982 (Georgetown University Law Center); M.P.A. 1973 (Harvard University, Kennedy School of Government) M.A. 1972 (Tufts University, Fletcher School of Law and Diplomacy); A.B. 1970 (Barnard College, Columbia University); Attorney 1983 (Washington, D.C. Bar)

• Faculty of Law Professor in International Human Rights, University of Toronto
  Co-Director, International Programme on Reproductive and Sexual Health Law
  Professor, Faculty of Medicine, Department of Health Policy, Management and Evaluation
• 1999 Fellow, Royal Society of Canada
  1998 Ludwik and Estelle Jus Memorial Human Rights Prize, University of Toronto
  1997 Certificate of Recognition for Outstanding Contribution to the Promotion of Women's Health, awarded by the International Federation of Gynecologists and Obstetricians
  Accessed 2008-12-02

Sanda Rodgers, B.A. (Case Res.), LL.B. (McGill), B.C.L. (ibid.), LL.M. (Mtl.), of the Bar of Ontario, Full Professor

• Professor and former Dean of the Faculty of Law, University of Ottawa; Shirley Greenberg Professor in Women and the Legal Profession; recipient of the Women Lawyers Association Award for Outstanding Contribution to the Legal Profession and the Ottawa Women's Choice Award for Outstanding Contributor to Gender Equity.
• In 2000 she was an Elected Bencher: Law Society of Upper Canada .She is an expert in Canadian health law, more particularly in women's reproductive health; an Adjudicator under the Grandview Agreement between Ontario and the Grandview Survivors Group and was the sole Adjudicator of the Agreement for Compensation for the Sir James Whitney School for the Deaf.
• She was a Commissioner, Ontario Law Reform Commission and a Consultant to the Royal Commission on New Reproductive Technologies and the Krever Commission on Confidentiality of Health Information, among others. She is a member of the Board of Directors of the Court Challenges Programme.
  Accessed 2008-12-02

49. ". . . hospital boards should never have been allowed a choice in the matter. The Government should . . . require hospitals which receive public grants to establish abortion committees." Globe and Mail, 18 January 1974. Quoted in de Valk, Alphonse, Morality and Law in Canadian Politics: The Abortion Controversy. Dorval, Quebec: Palm Publishers, 1974, p. 137

A Chinese doctor testifying before an Australian Senate Committee in 1999 stated that conscientious objection to the state's "one-child-policy"was not allowed, and that doctors who refused to perform abortions would go to jail. Chinese health care workers and the 'one-child' policy:China (1983-1999) Protection of Conscience Project.

"Feminist organizations in Equador have set up tribunals operating within the legal framework of the government which will investigate violations of 'gender rights' including the 'refusal to perform legal abortions.'" (Inter Press Service, December 17 1999) Accessed 2006-06-13.

While visiting East Timor in 2000, Dr. Robert Walley of MaterCare International was alarmed by the conduct of officials from the World Health Organization and CNRT, and "struck by how aggressive they were in imposing their views and their values on the people." He found that Timorese doctors felt "oppressed," and were concerned about the secrecy of WHO and CNRT activities. "They asked for help in developing a separate Catholic system which would provide care in accordance with the values of the Timorese people.""Urgent letter from Dr. Robert Walley for help". Catholic Insight, October, 2000, Vol. VIII, No. 8, p. 4.

Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba, asserted that conscientious objectors who refuse "legal services" (ie., the 'morning after pill') to patients who have nowhere else to go should leave the profession, apparently settling an ethical problem by appealing to law. Jacobs, Mindelle, "Pharmacists want right of refusal," Edmonton Sun, 16 April, 2000

In 2001 the French senate passed a law to compel French Polynesia to publicly fund abortions, despite objections from the Polynesian government that the law was contrary to the territory's religious traditions. The law was affirmed by the French Constitutional Council."Parish court rules French Polynesia must pay for abortion." LifeSiteNews.com, 6 July, 2001. Accessed 2008-11-30

Consider an article in The Guardian newspaper in Britain. None of six women interviewed had had medical reasons for abortion, and not one of them said that she had encountered any difficulty obtaining an abortion, but the author asserted that physicians opposed to abortion are "able to block access to services on the basis of moral opposition." Shabi, Rachel,"One in Three." The Guardian, 12 October, 2002. Accessed 2006-06-13.

In 2005 a group of European experts demanded that physicians who object to abortion for reasons of conscience should be compelled to refer patients to someone who will provide the procedure. Their opinion concerned a concordat between the Slovak Republic and the Holy See that would have protected freedom of conscience in the Republic.
Opinion No. 4-2005: The Right to Conscientious Objection and the Conclusion by EU Member States of Concordats with the Holy See. EU Network of Independent Experts on Fundamental Rights, 14 December, 2005, p. 20. Accessed 2008-11-30.

50. The progression is neatly illustrated by the name changes of a prominent American abortion advocacy group: from the "National Association for the Repeal of Abortion Laws" (1969) to the "National Abortion Rights Action League" (1973) to the "National Abortion and Reproductive Rights Action League" (1993).Key Moments in NARAL Pro-Choice America's History. Accessed 2006-06-22.

51. Similarly, in Canada, Toronto's Globe and Mail, advocated legalization of abortion "to enable doctors to perform their duties according to their conscience and their calling."
"Free the Doctor",Globe and Mail, 18 May, 1965. Quoted in de Valk, Alphonse, Morality and Law in Canadian Politics: The Abortion Controversy. Dorval, Quebec: Palm Publishers, 1974, p. 18]. Two years later the Globe argued that, in the case of abortion, "where religious moralities conflict, the State should support none, but leave the choice to individual conscience." "Now the job is to be done, let it be done right", Globe and Mail, 21 December, 1967. Quoted in de Valk, supra, p. 56

52. The assurance given by a Canadian M.P. to a parliamentary committee studying her private member's bill to legalize abortion. Quoted in de Valk, supra, p. 44-45

Similar assurances came from the Canadian Welfare Council: "At the risk of labouring the obvious, no woman will be required to undergo an abortion, no hospital will be required to provide the facilities for abortion, no doctor or nurse will be required to participate in abortion." Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence, Appendix "SS": Canadian Welfare Council Statement on Abortion to the House of Commons Standing Committee on Health and Welfare. February, 1968, p. 707.

Nor was the Catholic Hospital Association concerned: "We note that there is no question of [our hospitals] being obliged to change their present norms of conduct. On the contrary, proponents of a 'liberalized' abortion law admit that it should exempt those who object to being involved in procuring abortions." Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence, Appendix "QQ": Brief submitted by the Catholic Hospital Association of Canada . . . on the Matter of Abortion. February, 1968, p. 8058-8059]

Canadian Prime Minister John Turner rejected a protection of conscience amendment to the government bill legalizing abortion because, he said, the proposed law imposed no duty on hospitals to set up committees, imposed no duty on doctors to perform abortions, and did not even impose a duty on doctors to initiate an application for an abortion. Hansard- Commons Debates, 28 April, 1969, p. 8069

53. CRR documents obtained by the Catholic Family and Human Rights Institute (CFAM) were entered in the United States Congressional Record (p. E2535 to E2547) on 8 December, 2003, to forestall efforts by the Center to suppress dissemination of the documents through litigation. They are available on the Protection of Conscience Project website.

The documents cited herein are:
International Legal Program Summary of Strategic Planning: Through October 31, 2003 (E2535)
ILPS Memo # 1- International Reproductive Rights Norms: Current Assessment (E2535-E2538);
ILPS Memo #2- Establishing International Reproductive Rights Norms: Theory of Change (E2538-E2539).

Domestic Legal Progam Summary of Strategic Planning Through October 31, 2004 (E2539)
DLPS Memo #1- Future of Traditional Abortion Litigation (E2539-2540);
DLPS Memo #2- Report to Strategic Planning Participants From Systematic Approach Subgroup (E2540-E2541).
DLPS Memo #3- Report to Strategic Planning Participants From "Other Litigation" Subgroup (E2541-E2542).

Program Strategies and Accomplishments (E2543)
The Center for Reproductive Rights: Summary and Synthesis of Interviews (E2543-2546)
The Center for Reproductive Rights Board of Directors - Primary Affiliation Information (E2547)

54. Which the "Other Litigation Subgroup" believed undermined the credibility of the CRR with respect to the interests of "women of colour." DLPS Memo #3, E2541) One of the Center's trustees also expressed concern that much of the funding from individuals was coming from donors over 60 years old ( The Center for Reproductive Rights: Summary and Synthesis of Interviews, E2546)

55. ". . .both the ICPD Programme of Action and the Beijing PFA reflect an international consensus recognizing the inalienable nature of sexual rights." ILPS Memo # 1, 2537

56. International Planned Parenthood Federation,Sexual rights: an IPPF declaration. Adopted May, 2008. Accessed 2008-11-28

57. "Legally binding or ''hard'' norms are norms codified in binding treaties such as the International Covenant on Civil and Political Rights (ICCPR) or the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)" ILPS Memo # 1, E2535

58. The Center acknowledges that there is no binding international legal instrument that recognizes a right to abortion. ILPS Memo # 1, E2536

59. "The ILP's overarching goal is to ensure that governments worldwide guarantee reproductive rights out of an understanding that they are legally bound to do so." International Legal Program Summary of Strategic Planning: Through October 31, 2003 (E2535)

"Our goal is to see governments worldwide guarantee women's reproductive rights out of recognition that they are bound to do so." ILPS Memo #1, E2537; ILPS Memo # 2, E2538.

"The Center needs to continue its advocacy to ensure that women's ability to choose to terminate a pregnancy is recognized as a human right." ILPS Memo # 2, E2539

"Advocates use of enforcement mechanisms can help cultivate a "culture" of enforcement . . ." ILPS Memo #2, E2539

Pursuing the notion that abortion is part of "the fundamental rights strand of equal protection" is one of the suggestions in the report of the "Other Litigation" Subgroup, DLPS Memo #3, E2540. To establish abortion as a "fundamental" right would give it precedence over less "fundamental" rights in cases of conflict.

60. The norms offer "a firm basis for the government's duties, including its own compliance and its enforcement against third parties."ILPS Memo #2, E2538

61. "Supplementing . . .binding treaty-based standards and often contributing to the development of future hard norms are a variety of 'soft norms.' These norms result from interpretations of human rights treaty committees, rulings of international tribunals, resolutions of inter-governmental political bodies, agreed conclusions in international conferences and reports of special rapporteurs. (Sources of soft norms include: the European Court of Human Rights, the CEDAW Committee, provisions from the Platform for Action of the Beijing Fourth World Conference on Women, and reports from the Special Rapporteur on the Right to Health.)." ILPS Memo # 1, E2535

62. ILPS Memo # 2, E2538.

63. Whether or not the effect would be absolute would depend upon the relative value assigned to freedom of conscience vis a vis a 'right' to abortion. If both were considered equally fundamental, some tradeoffs might be permitted.

64. The Center also recognizes the importance of public opinion and public education. "Public education and awareness building" is identified as one form of advocacy (ILPS Memo # 2, E2539; DLPS Memo #2, E2540-E2541). The CRR recognizes that it is important to use arguments that are "appealing and understandable to the public" (DLPS Memo #2, E2540), and, similarly, the limited appeal of highly technical or legalistic approaches (DLPS Memo #2, E2541). It is foreseen that enforcement of new rights might require "sustained public awareness-raising campaigns" in addition to support from the medical community and others. One concern raised in the documents is the possibility that to try to formally establish "reproductive rights" in a new international instrument might, "as a matter of public perception," undermine CRR's claims that such rights already exist (ILPS Memo # 1, E2538). It also encourages and takes advantage of favourable domestic political developments: ". . . the national political moment may be ripe for change, with or without the influence of international standards. Such changes. . . particularly in key countries in a region, may have a catlytic effect on neighbouring countries." (IPLS Memo #2, E2539).

65. ILPS Memo #2, E2538)

66. The Center seeks ways to bring its agenda "into the mainstream of legal academia and the human rights establishment"(ILPS Memo #2, E2539), seeing the media as a way to bring it "to the attention of relevant international, regional and national normative bodies, including legislators, other government officials, local and international judicial bodies, as well as medical bodies that can influence law and policy" (ILPS Memo #2, E2539).

67. DLPS Memo #1, E2539. Answers suggested in different parts of the documents include identifying "allies in government and civil society" (ILPS Memo #2, E2539) "fostering alliances with members of civil society who may become influential on their national delegations to the UN," (ILPS Memo #2, E2539), "collaboration with NGO's engaged in establishing legal norms at the national level" (ILPS Memo #2, E2539), and "providing input to civil society or government actors" (ILPS Memo #2, E2539). Consistent with a focus on elites rather than the public, references to "workshops around the world" are made within the context of getting input from "key players" and reinforcing the interest of "allies"(ILPS Memo #1, E2538), not public education.

68. ILPS Memo #1, E2538

69. For example, when the Center seeks sexual autonomy and access to abortion for children and adolescents, it proposes to work with "major medical groups" to achieve this end, not organizations representing parents. (DLPS Memo #2, E2540)

70. Center for Reproductive Rights, Memo #1 - International Reproductive Rights Norms: Current Assessment, E2538

71. ILPS Memo #1, E2536

72. ILPS Memo #1, E2537 - E2538

73. "Arguments based on the decisions of one body can be brought as persuasive authority to decisions made in other bodies. . . As interpretations of norms acknowledging reproductive rights are repeated in international bodies, the legitimacy of these rights is reinforced." ILPS Memo #1, E2538

74. ISLP Memo #1, E2535, E2538.

75. "These lower profile victories will gradually put us in a strong position to assert a broad consensus around our assertions." ISLP Memo #1, E2538

76. University of Toronto law professors asserted in the Journal of Obstetrics and Gynaecology Canada that conscientious objectors "should not practise clinical medicine." Cook RJ, Dickens BM, "In Response". J.Obstet Gyanecol Can, February, 2004; 26(2)112 The statement was unsupported by their legal references, and one of which, arguably, contradicted it. The Journal reluctantly published a response from the Project, accompanied by a rebuttal from the authors, and thereupon closed the discussion. The legal claims made in the rebuttal proved to be even more problematic than their original article, but the Journal has not published a further review by the Project. So readers of the Journal will never know, for example, that the leading case cited by the professors against freedom of conscience actually supports the view that physicians should not be forced to refer for services that they find morally objectionable. Murphy, Sean, Postscript for the Journal of Obstetrics and Gynaecology Canada: Morgentaler vs. Professors Cook and Dickens. Protection of Conscience Project.

Charo, R. Alta J.D., The Celestial Fire of Conscience: Refusing to Deliver Medical Care N Eng J Med 352:24, June 16, 2005. Accessed 2008-09-13.

Gordon, Michael,"Belief systems and the professional caregiver." Medical Post, October 19, 2004 Volume 40 Issue 39.

McLeod, Carolyn, "Demanding Referral in the Wake of Conscientious Objection to Abortion." In Cohen, JC and Keelan, JE (Eds.) M C I S B R I E F I N G S: Comparative Program on Health and Society, Lupina Foundation Working Papers Series 2004-2005 (January, 2006). Munk Centre for International Studies, University of Toronto. Accessed 2006-04-07.

77. Writing in the Canadian Pharmaceutical Journal in 2000, an ethicist implied that there is no right to conscientious objection, and insisted that pharmacists must ensure that patients "are provided with recognized pharmacy services, despite personal religious or moral objections." The article was cited at a subsequent Canadian Pharmacy Association conference, where pharmacists who spoke on behalf of conscientious objectors were told by more than one colleague that they should leave the profession. Murphy, Sean, In Defence of the New Heretics: A Response to Frank Archer. Protection of Conscience Project

At a 2002 ethics conference in Vancouver hosted by regulatory authorities and professional associations, an ethicist speaking at a plenary session asserted that abortion was a 'legitimate' medical service, and that a patient's wish to have one would take precedence over the 'personal morality' of the physician. When, in private conversation after the session, the Project Administrator reminded him that the Canadian Medical Association did not require referral for abortion because no ethical consensus existed on the subject, the ethicist explained that he had meant to offer only a personal opinion, and that he could be wrong. Of course, that was not the impression he had left with the audience. Letter from the Administrator, Protection of Conscience Project, to the BC College of Family Physicians, 28 April, 2002

Thompson, Polly,"The public trust and access to medication", Canadian Pharmaceutical Journal, October, 2004, Vol. 137, No. 8. Accessed 2006-06-13.

78. Romalis, Garson, "Current Abortion Management."British Columbia Medical Journal, Dec. 1999, Vol. 41, No. 11, p. 554; "Morgentaler calls decision to halt abortions 'disgusting.'" New Brunswick/St. John Telegraph Journal, 9 November, 2002

79. Parallel litigation can also be initiated outside the professions in quasi-judicial forums, like human rights tribunals, especially if professional regulatory forums are perceived to be less receptive to the complainant's case.

80. "[Interviewer] Should doctors be allowed to conscientiously object to performing an abortion? [Morgentaler] Yes. One fundamental reason is that doctors should not be obliged to do things which they don't approve of themselves, and secondly, a more practical reason, a doctor who doesn't believe in it is more likely not to do a good job." National Review of Medicine, Vol. 5, No. 1,"The Morgentaler decision turns 20." (Interview with Dr. Henry Morgentaler) 15 January, 2008. Accessed 2008-11-28

81. Induced Abortion. Canadian Medical Association, 15 December, 1988. Accessed 2008-11-28. Blackmer, Jeff, "Clarification of the CMA's position concerning induced abortion." CMAJ • April 24, 2007; 176 (9). doi:10.1503/cmaj.1070035. Accessed 2008-11-28. See also"Responses to Abortion: ensuring access." Protection of Conscience Project, 2006.