By Sandeep Prasad and Colleen MacQuarrie*
Abortion is legal in Canada and has been for over 30 years. There are no criminal laws restricting access to abortion or post-abortion care in Canada and it is a recognized essential medical procedure, required to be fully accessible and financially covered by provincial and territorial health insurance plans under the Canada Health Act.
One would naturally assume that all people in Canada have access to a recognized essential medical procedure; however, this is far from the case. Only 16 per cent of Canadian hospitals offer abortions, with the majority of facilities located in urban areas and within 150 kilometres of the U.S. border. Most provinces only offer surgical abortion and in PEI, zero providers offer surgical abortion while those who offer medical abortion are far and few between and veiled in secrecy for fear of backlash.
A woman in PEI recently waited five hours in an emergency waiting room after being incorrectly instructed on how to administer a prescription for a medical abortion. She was eventually told by the attending physician that he was uncomfortable treating her and ultimately received no care at the hospital.
While physicians in Canada have the right to conscientiously object to providing a medical service on religious or moral grounds, they also have an obligation to guarantee a patient’s human right to personal integrity, life, health and autonomy. In such a case, the physician is required to refer the patient to another provider who is willing to provide the service. Where a referral is not possible due to a lack of skilled providers in the area, or a patient’s life or health is in danger, the physician has a duty to provide treatment.
In the recent P.E.I. case, the woman, who had been advised to seek ER medical attention by the province’s emergency information telephone service and who had begun to experience cramps and bleeding while waiting, was told by the ER physician to go out-of-province, to Halifax, if she wanted to receive the necessary post-abortion care — Halifax is over 300 km away, with a round-trip bus ticket costing over $100.00.
Disregarding the fact that individuals seeking abortion services in P.E.I. must for the most part travel out of province to access them, the situation is particularly disturbing because the physician refused to meet his professional obligation to use his skills, training and judgment to treat a patient in an emergency situation and in turn, unacceptably risked the patient’s well-being. What is even more disturbing is that hospital officials and the Health Minister consider proper protocols to have been followed.
Physicians have an obligation to provide care. In cases where a physician refuses to provide care on moral or religious grounds or cannot provide care because of a lack of skill or training, the physician has a duty to refer the patient to a physician who will provide timely and effective care. Sending a patient out-of-province for emergency care is neither timely nor effective.
The case speaks to an urgent need to regulate a largely provincial-wide refusal to provide an essential medical procedure. And highlights the need for immediate action on local access to abortion care, including enhanced communications and navigation of systems for abortion care, a policy framework for medication-based abortions, and most importantly, local dedicated clinic days for those seeking abortion care. The PEI Abortion Rights Network has outlined these demands in detail in an open-letter to Premier Wade MacLauchland and Minister Currie.
Not only does the provincial-wide refusal to provide abortion services represent a violation of human rights, it creates a very dangerous and potentially life-threatening situation for those seeking abortion services in P.E.I. In communities without access to essential sexual health services, like abortion, patients (often young women) have to travel across or outside of their province to obtain what is a recognized essential medical procedure in Canada. This can be especially difficult for someone with limited access to resources and transportation or with responsibilities that limit their mobility like a family or inflexible working conditions.
Restricted access to abortion, compounded with physicians who do not fulfill their professional duty to provide patients with timely and effective referrals or necessary service in emergency cases, creates life-threatening situations that could otherwise be avoided. And while P.E.I. is the only province in Canada in which there are zero surgical abortion providers, access to abortion remains limited outside of urban settings and several cases across Canada have brought light to a number of physicians who are unwilling to provide care or referrals related to abortion as well as contraceptive methods.
In response, two provincial Colleges of Physicians and Surgeons have recently undergone policy reviews on conscientious objection. The new policy in Ontario and Saskatchewan’s draft policy both require that physicians provide effective and timely referral and care that is urgent or otherwise necessary. Both policies address a physician’s primary obligation to their patient’s health and emphasize the issue of time, which is particularly relevant for patients seeking to terminate a pregnancy, given the time sensitive nature of the procedure. Most abortions are performed within the first 12 weeks of pregnancy. In Canada, medical abortion is only available until 7 weeks and few physicians are trained to provide abortion services after 12 weeks. Being forced to carry an unwanted pregnancy while waiting for a procedure can also have significant negative emotional and psychological health impacts on a person.
Despite the importance of timely referrals, many provinces and territories outside of Ontario and Saskatchewan follow an outdated Canadian Medical Association Code of Ethics, which does require a physician to inform patients when personal values would influence a recommendation or service but does not require a physician to provide timely referrals. The P.E.I. Medical Society refuses to offer guidance to its physicians.
Whatever the decision a person makes about their sexual health, it is that person’s own choice. In making that decision, healthcare professionals and educators have an important supporting role to play in providing timely, effective, accurate, and science-based information as well as legally permissible and publically funded services that support the choice a person makes.
*Colleen MacQuarrie is an associate professor of psychology at the University of Prince Edward Island and spokesperson for the PEI Abortion Rights Network, a group of individuals and organizations working together to ensure that all women living in Prince Edward Island have access to publicly-funded, accessible, safe abortion services in their own province.