Joanne Van Halteren was a nurse with 16 years experience and a respected leader in the obstetrics wing of the Markham-Stouffville hospital in Ontario. Her expertise in emergency neo-natal resuscitation was recognized by the hospital, and she was given responsibility for certifying other healthcare professionals in the technique. She loved to care for newborn babies and their mothers.
She even volunteered at the hospital’s breast-feeding clinic.
Still, after a 1994 in-house amalgamation, first of the labour and delivery wings and later of all areas related to mother and child, her job was not safe. Now abortions would be carried out next to delivery rooms, and nurses morally opposed to abortion would not be accommodated.
Van Halteren says at first the hospital said they would accommodate her and nine other nurses who refused to take part in abortions. She said management told the staff to work it out among themselves—which wasn’t feasible, since nurses involved in abortions were resentful of those who were not.
Van Halteren eventually transferred to the emergency unit for what she describes as “a very stressful year, before leaving the profession I love.” She now cares for her four children at home full-time. She says if she remained in obstetrics she would only be working part-time.
Of the ten nurses who left Markham-Stouffville as a result of pressure to take part in abortions, five are still not working. “The hospital lost a mitt-full of highly prized nurses who care about life,” Van Halteren says.
The situation has revealed that there is little recourse for healthcare workers who, like Van Halteren, a member of the Canadian Reformed Church, are opposed to abortion. Ontario, like every other Canadian province, lacks laws protecting a healthcare professional’s right to refuse participation in acts which violate their religious or moral beliefs.
But many Ontarians are now determined to address the problem, and there’s now hope that a private member’s bill will be introduced this fall to forbid discrimination against or coercion of healthcare workers because they won’t act against their consciences. Supporters call it “conscience legislation.”
The need for such measures in Canada is felt to be so great, in fact, that a Coalition for Conscience has been formed—including experts in medicine, law, and ethics, healthcare workers, and ordinary citizens—to work for change. The Coalition says 48 of the 50 U.S. states and many European countries have already recognized the conscience rights of healthcare workers.
Steve Jalsevac, a Coalition for Conscience coordinator, says the only recourse Canadian healthcare professionals have now is the Charter of Rights and Freedoms and the provincial human rights codes. Both routes are expensive and long, and neither addresses the healthcare worker’s need for immediate protection from the threat of firing or demotion.
Five years after the problem arose, the Markham-Stouffville nurses’ case is just now being considered by the Ontario Human Rights Commission. Van Halteren says their case-worker feels they have a strong case on religious-discrimination grounds. But their lawyer, Peter Jervis, says it could be years until anything happens. The OHRC will decide by September whether or not the case will go before the board of inquiry.
In contrast to this rather cumbersome process, conscience-protection legislation would “make very explicit rules known to all parties, with very clear penalties,” says Jalsevac. Van Halteren says if the conscience legislation had been around five years ago, “we would not have lost our jobs.” “I want all nurses in the future to have the right to say, ‘No,'” she says.
The reason the issue has not received much media or political attention stems from the nature of the problem itself. Most healthcare workers won’t go public because speaking out about their beliefs is precisely what’s put them in jeopardy.
Jalsevac says that as a result, few people realize how widespread the problem is. Van Halteren says the ten nurses at Markham-Stouffville were told that if they went public with their story they would be fired.
Peter (not his real name) is a pharmacist with 14 years experience who left his job with a chain drug store in part because he was not comfortable working there. He wouldn’t dispense the “morning-after pill” or intrauterine devices (IUDs) because of their abortifacient functions, and was uncomfortable dispensing birth-control pills. He had talked to management about his concerns, and felt he would be accommodated; but when a manager asked him whether his pro-life beliefs were affecting his work, Peter said he felt he was being intimidated.
Trouble came when a woman came in to fill a Micronor prescription. Micronor is a birth-control pill which prevents ovulation only fifty percent of the time. The rest of the time it can prevent a newly-conceived life from implanting in the womb, thus causing an abortion. When Peter told the woman how the drug works, she exclaimed, “So the pill makes my body cause an abortion.” She said she wanted to consult her doctor, but left with the prescription filled.
A month later the same woman phoned to re-fill the prescription. Although he didn’t refuse her request, this time Peter asked if she could come the next day to pick it up because he was uncomfortable dispensing the drug. She agreed; but for some reason one of Peter’s colleagues wrote to the company’s management, accusing Peter of refusing to fill the prescription.
The regional manager, who is not a pharmacist, sent a letter reprimanding Peter. “You are not employed by the company to make moral or philosophical decisions about whether birth control is appropriate for the customer,” he said, noting, “we are engaged in a retail activity.” The letter concluded, “any further instance of your refusal to fill prescriptions on the basis of personal belief will result in the termination of your employment.” The manager said if Peter couldn’t separate his beliefs from his job, he should “think long and hard about whether you could continue in your capacity.”
For Peter the decision to inform patients fully is both a professional and a religious duty. Peter is Roman Catholic and pro-life, but he says the College of Pharmacy also requires documentation that pharmacists have counselled their clients on their first prescription about usage and possible side-effects. The College of Pharmacy and the Regulated Healthcare Disciplines Act also requires patients be given accurate information. Peter says many pro-life women don’t know that common birth-control pills can be abortifacient, and that they appreciate knowing the facts.
The Code of Ethics says no patient should be deprived of medical services because of the pharmacist’s “personal convictions or religious beliefs,” but makes allowances for the patient to be referred to another pharmacist—which is what Peter did.
Peter now works relief at a couple of pharmacies, but would like to work full-time. “I try not to dispense birth-control pills,” he says. “Many of the independent pharmacies are understanding.” But he does not want to return to the chain drugstores, which he says are not as accommodating. The proposed Ontario conscience legislation, Peter says, would protect people like him who take a position defending life. “Many forms of contraception have a high potential to kill a child. No one should be forced to take part in that if they don’t want to.”
Another nurse, Mary (not her real name), saw her hospital’s merger with another institution lead to the joining of the post-partum and ante-partum units. Mary, who has 30 years experience in Canada and abroad working with mothers and their babies, told administration she could not take part in abortions although she would help in emergencies (with a hemorrhaging woman, for example). Eight nurses joined her in refusing to take part in abortions.
They were allowed to do so, but felt the resentment of fellow nurses. After a year, management interviewed the nine nurses in what Mary calls a “divide-and-conquer strategy” in which they were presented with the choice of taking part in abortions or quitting. She says neither the union nor the College of Nurses was helpful. Their position, she says, is that “nurses have to help everyone.”
Mary says the time for conscience legislation has definitely come, “because many good nurses have been forced to leave the profession.”
The Canadian Abortion Rights Action League (CARAL) says people should have full access to “reproductive health information and services, and that must include abortion.” Chris Melnick, president of the Toronto chapter of CARAL, says if a healthcare professional “is not interested in taking part in a procedure, whatever that might be, they should not place themselves in such a position where they might be called to do so.” Melnick said she couldn’t comment on the legislation, because she has yet to read the bill.
Earlier this year, CARAL reported on “The Status of Abortion Services in Canada” 10 years after the Supreme Court’s Morgentaler decision ushered in abortion on demand. The report says abortion must be protected, doctors should take “mandatory abortion training,” and that failure to provide abortion referrals “should be considered gross medical misconduct … liable to professional and criminal sanctions.”
Jalsevac says CARAL’s report “clearly indicates they do not believe in choice. It betrays their extreme position, which forces people to accept their world view.” CARAL’s report also illustrates how urgently conscience legislation is needed, Jalsevac says, arguing healthcare professionals are being held hostage by the pro-abortion movement.
“Pregnancy is not a disease,” he says. “By forcing doctors and nurses to do this elective procedure, (abortion supporters) are trying to replace medicine with ideology.”
But it’s not just abortion and contraception that concern many Canadian healthcare workers. With euthanasia gaining acceptance and hospitals facing budget cuts, doctors and nurses are increasingly faced with decisions about withdrawing or withholding treatment, and even active euthanasia.
“In Holland you have patients killed so the next patients can use their beds,” says Jalsevac. “We don’t want that here. Doctors and nurses don’t want to be involved in the killing of their patients.”
A March 1998 Environics poll found 56 percent of Ontarians favour conscience legislation, with 38 percent opposed. In the last few months, 56 petitions in favour of such a measure have been presented at Queen’s Park.
“This legislation isn’t just for the workers,” Jalsevac says. “We’ll all benefit. We don’t have to be afraid to go to the hospital, knowing good people are there.”