Media gets story wrong about conscience,
misses need for informed consent
On Feb. 4, the Saskatchewan College of Physicians and Surgeons released revised guidelines for dealing with patients who face an unplanned pregnancy. The early media reports erroneously stated that doctors who refused to carry out an abortion had to refer them to one who would.
The Saskatoon Star-Phoenix reported that the preamble to the new protocol says “physicians have an obligation to inform the patient up front and refer the patient to another physician who can provide them with all the information they’ll need to make an informed decision.” The National Post reported that under the new guidelines, “anti-abortion” doctors “who won’t perform the abortion must tell the patient upfront and refer them to another physician who will give them all the tools they need to make an informed decision.”
In fact, the new protocol states that “any physician who is unable to be involved in the further care and management of any patient when termination of the pregnancy might be contemplated should inform the patient and make an expeditious referral to another available physician.”
Denise Hounjet-Roth, president of Campaign Life Coalition Saskatchewan, stressed that the new protocol are guidelines, but more importantly said there is an important distinction between the word the College used – should – and the inference in the media that doctors were obliged or required to refer women for abortions. After consulting with a Saskatoon physician, Hounjet-Roth was assured that the use of the term “should” would not be construed as “must.”
The Protection of Conscience Project stated on their website that the guidelines generated “concern and confusion among some medical professionals and inaccurate claims in the media.” The organization stated on its website that contrary to media reports, physicians are not required to refer patients for abortion.
But beyond the issue of referring women for abortions, the new guidelines require doctors serving women facing unplanned pregnancies to provide them with all the relevant information that could affect their decision to have an abortion including options and the risks.
The guidelines begin by saying that “an unplanned pregnancy is not necessarily an unwanted pregnancy.” It goes on to state doctors must obtain a complete medical history and discuss options in light the pertinent medical facts. Among those facts is the patient’s “reasonable understanding of the stage of fetal development.” Doctors are also required to record the patients reaction to the medical facts reported to her.
Furthermore, physicians should present information and referrals for patients regardless of their decision, including social and community services that assist with adoption or help families in financial need. Physicians are also urged to help patients contact these groups if asked. If the woman is intent on obtaining an abortion, physicians are urged to provide information about facilities that can help procure one.
Doctors who do abortions are to provide all relevant information to “ensure that the decision for termination of the pregnancy was made on the basis of informed consent.” The College states that “informed consent” consists of knowing the “precise nature of the intervention,” “the manner in which the intervention will be conducted,” “the immediate risks” such as infection and haemorrhage “associated with the intervention,” “the long term risks” including effects on future fertility and pregnancies, “psychological effects,” and “follow-up care” plans.
Furthermore, the College advises that doctors who carry out abortions be “skilled” not only in the abortion procedure but in recognizing “incomplete and failed procedures” as well as addressing complications such as a perforated uterus.
In her March newsletter, Hounjet-Roth asked a series of rhetorical questions about whether the guidelines also applied to doctors who carry out abortions: “If doctors must discuss all options when faced with an unplanned pregnancy, are they providing information on adoption, carrying the baby to term, and providing information on the risks of abortion?” She also wondered about whether the Sexual Health Centre – formerly Planned Parenthood – could objectively present alternatives to abortion.
Muriel Nielsen, president of the Saskatchewan Pro-Life Association, told the Star-Phoenix that her organization has no problem with the guidelines as a complete document if physicians follow them. She said that her organization has met numerous women who had an abortion but were never told of all their option or presented information that might have led them to reconsider abortion, and suggested that doctors who obtain informed consent before an abortion might save many women from the physical and psychological aftermath of abortion.
The guidelines state that regardless of how a woman deals with an unplanned pregnancy, “the physician has a professional obligation to explore the patient’s understanding of contraception options” in order to “reduce the risk of future unplanned or wanted pregnancies.”
The Star-Phoenix reported that Dr. Karen Shaw, deputy registrar for the College, said the new protocol updates the 1991 guidelines with the intent of clarifying the regulation body’s professional expectations for doctors in handling patients facing an unplanned or unwanted pregnancy. She also stated that the changes were part of the College’s regular review and were not in response to a specific concern.