In the December 1983 issue of Interim I gave a broad overview of the interesting situation in Langley, B.C. where the local hospital board of trustees has satisfactorily resolved a controversy over therapeutic abortions. In that article I promised to follow up with a second, detailing the ways in which this success was achieved.
The 1968 changes to the Criminal Code of Canada, legalizing abortion in this country, opened a veritable Pandora’s Box of evil consequences, which have affected every consequence which have affected every community and hospital in Canada. Langley, B.C. and Langley Memorial Hospital were no exceptions. Following the astronomical rise in the national abortion rate during the 1970s, with British Columbia spearheading the rest of the provinces, Langley Memorial Hospital was performing 180 abortions a year in 1979 – a number approaching the number of live births there. Understandably, the community began to be alarmed and questioned the necessity of these abortions.
In 1980 the local branch of the Pro-Life Society decided to run a slate of pro-life candidates for the Langley Memorial Board of Trustees. At that time the board was made up of nine elected trustees, of whom three were elected for three-year terms each year, and one appointee each from the regional district and the provincial government. The present of the hospital’s medical staff and the president of the hospital auxiliaries were also invited to meetings, but did not have voting rights. Thus the pro-life society needed three nominees, and it enlisted the help of its members and of local churches and other pro-life groups in finding candidates.
Any democratic election is based on a simple, obvious premise: the winner collects a greater number of votes than his opponent. In other words, it’s a numbers game. Langley Memorial is run by a hospital society, the members of which are entitled to elect the board of trustees. Therefore, the Pro-Life Society found it necessary to ensure that pro-life people joined the hospital society and then turned out for elections. A great deal of preliminary groundwork therefore was done by the various community pro-life agencies before the Hospital’s Annual General Meeting, when the elections were held.
The choice of candidates was also made carefully. All prospective nominees were interviewed and assessed not only on their pro-life commitment, but also on their other qualifications, for one of the fundamental secrets to our success in this community was the recognition that a hospital performs many functions and the abortion controversy was only one aspect of a very complex institution. Therefore, the nominating committee of the Pro-Life Society was looking for individuals who had potential in areas other than their pro-life stance. We had learned from the disastrous events at Surrey Memorial and Vancouver General Hospital that a radical pro-life stance in actual fact ended up destroying our aims, because the boards were labeled as radical, one issue boards, which were then replaced or superseded. The ensuing tensions and confrontations jeopardized all aspects of health-care delivery in these two institutions. At Langley Memorial, we were determined not to repeat those mistakes.
Finally, on election night itself, the pro-life supporters were kept deliberately low-key. The candidates stated their pro-life stands in their speeches, but stressed their other qualifications for trusteeship, to present themselves as a well-balanced, well-rounded, competent team. All three were elected, and the new board of trustees acquired the expertise of a personnel administrator and two local businessmen.
This strategy has been followed in each succeeding year, with a 100 percent success rate. The current board of trustees now comprises eight avowed pro-life members and the ninth was also accepted by the pro-life community, since he had proven an excellent trustee with sympathies to our views, though he stopped short of endorsing them. On this board there are now a personnel administrator, two accountants, a school principal, a consultant, a non-practicing doctor, a nurse, and a businessman – a true cross-section of the professions in the community.
First year, 1980-81
After the first election, the pro-life trustees were in the minority. They were, as expected, viewed with considerable suspicion and even hostility by the medical staff and hospital personnel. They decided therefore to spend the major part of that year learning as much as possible about the functions of the hospital and the problems and challenges the board had to contend with. They realized that their most important battle was to establish their own credibility as board members. A conscious decision was made to keep their pro-life mandate low-key, though not neglected. One of the problems studied during the year was the development of a policy and guidelines of the Therapeutic-Abortion Committee, which had been operating until then on a very loose, ad-hoc basis.
This group succeeded so well during the first year that, by the next annual general meeting, a well-defined and workable abortion policy and application guidelines had not only been developed and accepted by the whole board, but had also been approved by the medical staff, albeit somewhat reluctantly.
The salient features of this policy, basically following the requirements set out in the Criminal Code, but stricter in application, are these:
- The board establishes its right of veto and selection to the committee.
- The committee must meet regularly, and these meetings must be minuted.
- Applications for abortion must be in writing, with full case-histories and supporting evidence.
- Repeat abortions cannot be “rubber-stamped”. No abortion will be performed for economic or birth-control reasons.
- The Committee’s work is reviewed regularly by the board and is answerable to the board.
Second year, 1981-82
This board of trustees now had six pro-life trustees out of the elected nine. Together with the two appointees, this represented a minimal pro-life majority, but in their potential for influence by the medical staff and auxiliary representatives, their position was still precarious. Therefore, again, a deliberate decision was made to concentrate on establishing their all-round credibility, and to consolidate the gains in acceptance made during the first year. One majority milestone was in the election of one of the pro-life trustees as chairman of the board.
During the second year, the Therapeutic Committee guidelines were fully implemented, in spite of much opposition from certain factions of the medical staff. However the board remained firm in its resolve and tried to be fair in its assessments so that by the end of the year there was a gradual acceptance of cooperation with policy.
This resulted in a drastic drop in the number of abortions performed, plus a smaller, but statistically significant rise in the number of live births. Of even more significance, however, was a decision by the two obstetricians in the community not to perform any more abortions. This was quite unexpected from the board’s point of view, but most gratifying, and we feel that, although not necessarily influenced by the board or its policy guidelines, maybe the policies helped create a climate which made it possible for these two specialists to decide without fear of political retribution.
During this year also the board recognized the need to change the society bylaws to make the chief of the medical staff and the president of the auxiliary’s full-fledged board members, rather than the honourary status they currently enjoyed, which was at the whim of the board. Unfortunately for this year at least, the proposal was rejected at the annual general meeting. But the groundwork was laid, and the obvious commitment of the board helped greatly towards a much improved relationship with the medical staff.
Finally, during this second year, the board greatly increased its, and the hospital’s, involvement in community projects and education, largely through the CHEC committee described in the December article.
Third year, 1982-83
The addition of two more pro-life trustees to the board now meant that Langley Memorial Hospital had a majority pro-life board. This, in fact, increased our sense of responsibility to the whole hospital and community greatly, and we worked on further strengthening the links between administration, the hospital board, and medical staff, and began developing bylaw changes to make these permanently recognized. This culminated at the 1983 annual general meeting, when the society finally adopted a motion to make the chief of medical staff and the auxiliary president full-fledged, though non-voting, members.
Also during this year a problem-pregnancy service was started in the community, which, although totally independent of the hospital, is approved as a necessary adjunct to our therapeutic policy.
By now other hospitals in the province had learned of our dramatically decreased abortion rate, and we began to receive requests for advice and copies of our policy guidelines. We were only too pleased to provide these, but always caution that whereas they have worked for our community, each situation is different and must be assessed accordingly.
Our work in community health education has also attracted some attention and we were asked to give a presentation concerning that Committee at the provincial hospital association’s regional meeting, which has subsequently been written up in their publication.
Fourth year, 1983-84
This year’s annual general meeting represented the completion of the first term of the original three pro-life trustees. We were very gratified and proud when all three were resoundingly re-elected. We feel that this represented recognition by the community that a board elected with a certain mandate – in this case, reduction of the abortion rate – can be a successful all-round board.
The Board of Trustees of Langley Memorial Hospital now has the confidence of all levels of hospital administration and personnel and of the medical staff, as well as the high regard of the community. We are proud of these achievements, and proud of what we have done in the pro-life field, but we do not take any of it for granted. We will maintain this respect and continue this progress only through constant vigilance. We are continually reviewing our goals, progress and attitudes, trying to keep everything in perspective, and at the same time remaining responsive to the changing needs of the community. Any success that we have achieved has not been due to the efforts of ourselves as individuals, but to a team-work approach, plus considerable support from the various community groups we are members of. We do feel that we have shown it possible to solve an apparently insoluble problem, in a manner that has been not only non-combative, but has resulted in a growing respect that great cooperation among the various entities. Of this we are justifiably proud.