A group of P.E.I. doctors recently accused the government of failing to protect the unborn child in its proposed abortion legislation. In a July 17 letter to all MPs, Doctors Opposing Non-Therapeutic Abortions (DONA) stated that “Amendment A is fraught with potential for abuse, and that many thousands of non-therapeutic abortions would continue to occur across our country.” Although the government has since withdrawn its three-pronged abortion motion (of which Amendment A was part), The Interim believes that the doctors’ trenchant arguments should be made public. The text of the letter follows:
The realities of clinical practice are that patients very adeptly seek out practitioners who are most likely to give them what they want. There are numerous physicians, who in our opinion, would act “in good faith” (with convictions perhaps as genuinely strongly pro-abortion as ours are pro-life) to do these abortions, after having justified in their own minds that there were “reasonable grounds” for doing so. We perceive a number of loopholes in Amendment A, four of which we will outline.
(1) The most pervasive error, of this proposed legislation is the continued use of the term “heath”, the resultant interpretation of which has led to our current situation where 5,000, or so, non-therapeutic abortions occur month by month in our not-so-fair country. There is a basic semantic fallacy inherent in the use of the term “health.” “Heath” has become a very widely defined to include a state of physical, mental and social well-being. However, the absence of such a state is not disease. Clearly, many unhealthy states of human existence such as grief, suffering, boredom, apathy or bitterness, do not meet scientific medical criteria for disease. We believe the Supreme Court of Canada decision of January 28, 1988 did not adequately address the issue of “health.”
We also believe the Canadian Medical Association must address our standards of ethical practice, review our medical tradition to protect life and treat disease, and more precisely define which treatments are “therapeutic.” “Therapeutic” should include the criteria of treating a disease, and of doing more good than harm. We believe that abortion is the destruction of precious human life, and disease that necessitates truly therapeutic abortions is exceedingly rare.
Many loopholes will be possible with the continued use of the term “health”, with its broad connotations for instance, a pregnant woman’s general sense of well-being could include her freedom and security of person, and her right to philosophical and intellectual freedom. This could be “seriously and substantially” endangered without recourse being needed on the grounds of “the effects of stress or anxiety” or “social or economic” grounds.
Effects of stress
(2) “The effects of stress” is not a medically defined term, and it is vulnerable to a liberal interpretation by physicians. We would predict that the most commonly used criteria to warrant an abortion would be depression. The argument could reasonably be that the endangerment to health is not due to the general “effects of stress” but due to the distinct disease entity of endogenous depression, which medical evidence has clearly shown to be etiologically related to biochemical imbalances at the level of neurotransmitter function within the brain.
Various other justifications could also be used. For instance, a similar argument could be given for the biochemical basis of psychosis. A different approach cold address the risk of suicide as being qualitatively distinct from “the effects of stress.” Also, pregnant women continuing to use cigarettes, alcohol or drugs, because they choose to do so as they previously had done before becoming pregnant, may qualify because of the increased risks imposed by the combination of pregnancy and substance abuse. For instance, there is an increased risk of thromboembolic disease with smoking during pregnancy. Also, any pregnant woman with pre-existing disease, such as diabetes, cardiac, pulmonary, gastrointestinal, and renal diseases, could qualify due to the increased risk from the physical changes of pregnancy. For instance, complications from hyperglycemia in a patient with diabetes mellitus.
(3) It is our belief that the word “procedure” has in medical circles come to possess a technical orientation. This could allow the potential for interpretations which would eliminate other accepted therapies, including pharmacotherapy, psychotherapy, and the milieu therapy of hospitalizations.
(4) The phrase “effectively treating” is not clearly defined. Pharmacotherapy could be excluded as an effective treatment, particularly since the risk/benefit ration would be shifted due to the strong precaution not to use most medications in early pregnancy, and because pharmacotherapy often provides only control not cure. Psychotherapy could be challenged on its degree of effectiveness. Hospitalization could be challenged because it could be argued to interfere with the pregnant woman’s right to freedom to live in the community. The case could be made then, that the pregnant woman has a right to effective treatment to such a degree that only the total elimination of the fetus would suffice.
We hope that the Parliament of Canada will conclude that Amendment A of the proposed Motion in Relation to Abortion is not sufficient to result in “giving pre-eminence to the protection of the fetus.”