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a publication of BC's Pro-Choice Action Network
Spring 2002 Issue
Table of Contents
Can Abortion be De-funded in Canada?
Can Abortion Be De-funded in Canada?
By Joyce Arthur
The anti-abortion movement has been lobbying for the de-funding of abortion by the provinces, and has spearheaded a national letter-writing campaign, among other things. They say that abortion is not medically necessary; therefore it is not covered under the Canada Health Act. What does this mean, and is it possible that abortion could be de-funded in Canada, at least at clinics?
The short answer is probably not, but how abortion is funded under the Canada Health Act is a complicated issue that is still unresolved in some provinces. In this issue, I explain what the Canada Health Act means for abortion, how "medically necessary" is defined, why abortions are best performed in clinics—not hospitals, and the still unfolding situations in provinces across Canada in regards to abortion funding. I also spell out why abortions are medically necessary (mostly for the benefit of uninformed politicians, not our astute pro-choice readers!).
Untangling the Canada Health Act
The Canada Health Act (CHA) is our nation's federal health insurance legislation. It establishes criteria and conditions for insured healthcare services, which provinces must meet in order to receive full cash contributions from the federal government. The CHA defines five basic principles to ensure reasonable access to health services for all Canadians without financial or other barriers: comprehensiveness, universality, portability, public administration, and accessibility.
The CHA says that provinces must insure all “medically necessary” services in “hospitals.” The CHA also insures “physician services”—defined only as "medically required services performed by doctors". The CHA doesn't mention abortion or any other specific medical treatment, but it gives general examples of hospital services that must be covered, such as the use of "medical and surgical equipment and supplies," "nursing services," and "operating room facilities".
All provinces fund abortions in hospitals, but four provinces do not fully fund clinic abortions. New Brunswick and Manitoba pay nothing to clinics, while Quebec and Nova Scotia pay only the physician's fee, not the "facility fee." The latter is usually well over half the cost of an abortion, and covers expenses such as drugs, counselling, nursing services, and clinic administration and overhead. Anti-abortion politics often play a role in the decision not to fund clinics, but some provinces also say that that since abortion clinics are privately-run, they are not obligated to pay anything except the doctor's fee.
Not so, according to Health Canada official Tara Madigan, who says the definition of hospitals under the CHA includes clinics, as long as the clinics have physicians providing "medically-necessary hospital services". Since all provinces already insure abortion done in regular hospitals, this means that all provinces have deemed abortion to be a medically necessary hospital service. Therefore, abortion clinics are covered under the CHA as "hospitals" and must be fully funded. Madigan further noted that in October 1995, then-Health Minister Diane Marleau sent to all provinces a federal clinic policy that said provinces must pay facility fees at clinics where they were already paying physician fees for medically necessary services. Health Canada considers the facility fee an illegal “user charge” under the CHA.
The two provinces that provide zero funding to clinics, Manitoba and New Brunswick, justify this in part by claiming that clinics are not "approved" facilities under their provincial standards. But since Health Canada deems abortion clinics to be hospitals under the CHA, this policy does not withstand scrutiny. It also reveals anti-abortion hypocrisy, since the provinces could simply choose to approve the clinics and start funding them.
Since 1995, Health Canada has withheld $319,000 in transfer payments from Nova Scotia, because it pays only the physician’s fee at the Halifax Morgentaler Clinic. Madigan confirmed that the other three provinces are not being penalized yet because negotiations are ongoing, and Health Canada believes it can still work out a solution with these provinces. In contrast, Nova Scotia dug in their heels several years ago and refused to comply with the Act. (Alberta and Newfoundland began compliance a few years ago.)
Progress with the remaining three provinces has been slow. After countless entreaties from Dr. Henry Morgentaler, CARAL, and the clinics, former Health Minister Allan Rock wrote to the offending provinces in January 2001, warning that they were violating the CHA.
In response, New Brunswick simply insisted it is not contravening the CHA, citing an unconstitutional provincial regulation that restricts abortion services. Manitoba put three options on the table last fall, none of them favouring the clinic, which believes that the province is simply trying to wash their hands of Henry Morgentaler. Quebec has chosen to expand some abortion services at a public facility, rather than fund private clinics. (See later in this article for details of these provincial struggles.)
In the face of these less than stellar solutions, Rock suggested in November 2001, a series of non-binding mechanisms to avoid or resolve disputes before Ottawa withholds funding. The new federal Health Minister, Anne McLellan, has recently jumped into the fray with a proposal for a three-member panel to adjudicate federal/provincial disputes over the CHA. All provinces except Quebec have agreed to the idea, but Morgentaler notes that whether the new system will work or not depends on McLellan, "whether she has the guts or the courage or the stamina or the willpower to take on the provinces in this kind of thing."
 For an overview of the Canada Health Act and a copy of the Act itself, see: www.hc-sc-gc.ca/medicare/chaover.htm
 The Canada Health Act and its five basic principles will be preserved and updated, according to the mandate of the Romanow Commission on the Future of Health Care. The Commission is currently holding public consultations across Canada and will make recommendations to ensure the long-term sustainability of Canada's health care system. Regarding the five principles of the Act, Romanow said the question is, "Will Canadians choose the policies required to more aggressively apply these principles, and even expand them? Or will they instead decide to accept that these national principles will only apply to an ever-shrinking part of the health care system?"
What Does “Medically Necessary” Mean, Anyway?
The federal government or the courts have never defined what “medically necessary” means, other than the circular definition, which is: "medically necessary is that which is physician performed".
It is up to the provinces to decide what is medically necessary under the Canada Health Act. They generally do this by putting together a package of insured services, which are then automatically deemed medically necessary. In practice, however, politicians alone cannot decide what is medically necessary; the package of insured services must be negotiated between physicians and government. So even if a province wanted to take abortion off the list of insured services (called "delisting"), they would have to get the cooperation of a medical organization, usually the College of Physicians and Surgeons or the provincial chapter of the Canadian Medical Association.
Further, everyone agrees (even the anti-choice) that at least some abortions are medically necessary, i.e., those performed to save the woman’s life or health. That means the government and medical profession would be forced to decide which abortions are medically necessary and which are not, based on women’s reasons for abortion. This is an impossible task, and one that medical organizations have refused to do (such as in Alberta in 1995). For one thing, the World Health Organization’s definition of health includes “mental health”. In practical terms, this fits all abortions, since if a woman wants an abortion, that is proof enough that having a baby would be traumatic for her. Clearly, the call to delist some abortions is founded on the myth that women have “casual” abortions.
De-funding abortions would also infringe on women's constitutional right to have an abortion by hampering their ability to exercise that right. Lack of funding impairs access and discriminates against women, especially poor women. This is precisely why Canada's old abortion law was struck down in 1988, because it obstructed access and treated women unequally. Ultimately, whether an abortion is "medically necessary" or not is a decision that only the pregnant woman has the right to make (with the assent of her doctor), not a medical organization and certainly not the government.
The "Stink" of Private Clinics
Canada prides itself on having a universal healthcare system—ideally, everyone is adequately insured, and both rich and poor have the same timely access to the same high-quality care. Of course, we know the reality falls short of the ideal, but there is still something sacrosanct about our healthcare system—Canadians rank it very high on their list of what makes Canada great. For that reason, a lot of people are very suspicious of "private clinics". The very term conjures up visions of the rich and the elite jumping queues to get better, faster service, while people on welfare risk death to wait months for vital surgery.
How sadly ironic, then, that abortion is probably the only medically necessary surgery that is delivered much better in clinics than in hospitals. Abortion clinics simply cannot be compared to the typical private clinic that offers MRI's, sports medicine, or laser eye surgery. This fact is not obvious to people, even well-meaning ones. Journalists and politicians frequently seem bewildered over why abortion clinics are even needed, since "hospitals already provide this service". They also can't fathom why women would pay for an abortion at a private clinic when hospitals will do it for free. Such ignorance has led to the ridiculous accusation that private abortion clinics (and Henry Morgentaler) are money-grubbing profiteers, a charge that conveniently forgets that every private abortion clinic has been desperately trying to become publicly funded for years.
Abortion Clinics are Better than Hospitals—Really!
But as we well know, hospitals are a poor environment for women having abortions, for many reasons:
- Hospitals have longer waiting lists, sometimes 6-8 weeks. Every week of delay increases the medical risks to women by 20 percent.
- Hospital abortions require a doctor's referral. Since some doctors are anti-choice and may refuse to help, this forces women into a game of Russian Roulette when it comes to finding a doctor. At clinics, women can simply call and make an appointment themselves, a huge benefit for a procedure as personal and private as abortion.
- Many hospitals impose some restrictions on abortion services, such as quotas, an illegal two-doctor approval process, a 12-week gestational limit, or parental consent for surgery on minors (with no exception for abortion).
- Hospital abortions pose a slightly higher medical risk to women due to the use of general anesthesia. Clinics use local anesthesia, which also shortens recovery time and is less expensive.
- Hospitals can easily fall victim to anti-abortion politics. At least half of all hospitals in Canada don't even provide abortion services, even though it's one of the most common surgical procedures performed. Because of politics, the delivery of hospital abortion services is unstable, always at risk of being withheld, restricted, or discontinued. No other medically necessary procedure is subject to such fluctuating uncertainties.
- Hospitals tend to have a sterile, non-supportive environment, and women have little or no privacy. Women may also be confronted with unsympathetic or even anti-choice medical staff. In contrast, staff at clinics are required to be pro-choice, compassionate, and non-judgmental.
- Hospitals do not provide any counselling. A woman may get some counselling from her doctor, if she's lucky, but all clinics provide full counselling.
In spite of these drawbacks, two-thirds of all abortions in Canada are still performed in hospitals. This number could be greatly reduced, and women better served, with more clinics and full funding for them. One model that has proven itself is the abortion clinic inside a hospital, such as the CARE Program at BC Women's Hospital, and the Women's Services Clinic at Kelowna General Hospital. These facilities enjoy most of the advantages of a freestanding clinic, but since they're clearly part of the hospital, they are in no danger of being de-funded.
New Brunswick: Illegal, Immoral, and Unconstitutional
In February, the Pro-Choice Action Network wrote a letter to the New Brunswick Health Minister, Elvy Robichaud, to urge him to start funding abortions at the Morgentaler Clinic in Fredericton. In response, Robichaud cited the province's Medical Services Payment Act, Regulation 84-20, Schedule 2 (a.1), saying that abortion is only eligible for payment by Medicare when:
“…performed by a specialist in the field of obstetrics and gynaecology in a hospital facility approved by the jurisdiction in which the hospital facility is located, and two medical practitioners certify in writing that the abortion was medically required.”
In our response, we pointed out to Robichaud that his regulation is blatantly illegal. It is unconstitutional under the Canadian Charter of Rights and Freedoms, and it also violates the Canada Health Act in several ways.
First, NB refuses to fund abortions performed at the Fredericton Morgentaler Clinic, but it funds abortions at hospitals. This directly contravenes the Canada Health Act, since clinics are covered under the Act as "hospitals," as explained earlier. Also, NB has no legal grounds to arbitrarily designate abortion clinics as “non-approved” facilities. Its refusal to fund the clinic is a clear violation of both the comprehensiveness principle and the accessibility principle under the Act.
Second, the regulation also violates the other three principles of the Canada Health Act. It violates the public administration principle by forcing the Morgentaler Clinic to privately administer the costs of an essential medical service, when it should be a non-profit public body doing this. It violates the universality principle because all residents of NB are not covered equally for insured services when some women must pay for an abortion at the clinic. In addition, it imposes arbitrary restrictions for hospital abortions by requiring them to be performed by specialists after the written approval of two doctors. This results in limited access and discrimination against pregnant women, who are singled out as a group and forced through extra hoops in order to obtain a simple and necessary medical procedure.
The regulation also underpins the province's violation of the portability principle, which says that when residents move to another province, they are still covered under their previous province's Medicare for three months for medically necessary services (this is called "reciprocal billing"). But NB refuses to remove abortion from the list of services excluded from reciprocal billing, because by doing so, it would have to admit that all abortions are medically necessary, not just the ones that NB doctors approve on a case-by-case basis. Lack of portability also violates the universality principle, since NB residents moving to other provinces are discriminated against and denied funding for a medically necessary service.
Canadian women have a constitutional right to access abortion in an equitable manner, as per the 1988 Supreme Court decision, R vs. Morgentaler. This ruling deemed access to abortion to be a legal right for women under Sections 2, 7, and 15 of the Charter of Rights and Freedoms. New Brunswick's treatment of abortion services violates women’s Charter rights in several major ways.
First, the province makes funded abortion difficult to access by arbitrarily limiting its performance to specialists (OB/GYNs) in hospitals. In fact, abortion is a common, simple, and safe medical procedure often performed by general practitioners in other provinces. Since there are many more GP’s than OB/GYNs, the regulation unfairly and unlawfully limits access to this important service for women. Second, no possible health consideration justifies the requirement that women obtain the approval of two doctors in writing. This arbitrary policy, which does not exist in other parts of Canada and does not apply to other medical procedures, is designed to place unnecessary obstacles in the path of women seeking abortions. It also takes away women's decision-making power and gives it to doctors. As such, it is in direct violation of the Charter and the 1988 Morgentaler decision. The judges held that the abortion decision belongs to women under the Charter's "freedom of conscience" clause, and they threw out Canada’s old abortion law because it presented unfair and unequal obstacles for women seeking abortions.
Finally, the NB government has been told clearly and repeatedly by more than one federal health minister over the years that since NB pays for abortions at hospitals as a medically necessary service under its provincial health plan, it must fully fund abortions regardless of where they are done—private clinics or public hospitals.
In spite of the above, Robichaud had the effrontery to tell Pro-CAN that he “believes the present policies fairly and equitably address the current needs of New Brunswickers in this matter.” Needless to say, we did not appreciate being lied to so that the Health Minister could obfuscate the real reason for his negligence towards the women of New Brunswick—his government’s discriminatory anti-abortion bias.
New Brunswick is now the only province not being held to account for their unlawful actions. The governments of Manitoba and Quebec are being sued by women who had to pay for their abortions at clinics (see stories below), and Nova Scotia is subject to financial penalties by the federal government. Given New Brunswick's blind obstinance, and the blatant unconstitutionality of its regulation, the question is not if, but when a court challenge will take place.
Prince Edward Island Far From Idyllic
Not nearly enough has been done about the sad plight of women from Prince Edward Island. Although the PEI government theoretically funds abortions in hospitals, no hospitals on the Island even provide the service. An estimated 200 women a year must travel to other provinces, mostly New Brunswick, to get an abortion. Not only does PEI refuse to fund clinic abortions for these women, hospitals in New Brunswick will not perform abortions on out-of-province women. A few PEI women are able to obtain funded abortions in Nova Scotia, but they must navigate a precarious approval process and pay their own travel costs.
Dr. Henry Morgentaler wrote to Health Minister Anne McLellan in January, arguing that the province of Prince Edward Island should pay for an abortion clinic (and also urging her to force other non-compliant provinces to fully fund their abortion clinics).
Morgentaler told the Charlottetown Guardian that without a clinic, women's health is endangered. "It pushes them into later terms where the operation is more dangerous and it prevents some women from getting them altogether, because, beyond a certain point, you cannot have an abortion.'' He said that the situation in PEI was scandalous. "Why should women in Prince Edward Island not have the same rights as women in Ontario or Alberta? There is absolutely no reason for that and the provincial governments are at fault. They are in violation of the Canada Health Act and they basically discriminate against women.''
Morgentaler hopes McLellan is more sympathetic with the issue than her predecessor Allan Rock, who he said was "afraid to put pressure on the provincial ministers of health, possibly due to the fact that he's in a leadership campaign and he doesn't want to antagonize anybody."
Quebec: Victory at Last?
After years of fighting with the Quebec government to convince it to fully fund abortions at its private clinics, the Quebec pro-choice community can finally sense a potential victory in the air.
According to Dr. Claude Paquin, Associate Medical Director of Montreal's Clinique Médicale Fémina, the provincial government has recently offered to open discussions with Montreal's four private abortion clinics to reach an agreement on fully funding abortions at Quebec clinics.
Why suddenly now, you ask? Because the clinics have been busy preparing a class-action lawsuit (recours collectif) against the province, and as soon as the government got wind of it, they made a conciliatory call to the clinics' lawyer.
There are no guarantees from the government yet, said Dr. Paquin, so the clinics are still pursuing the lawsuit. However, they hope to reach a solution with the government before the suit goes to court. They had earlier banded together to form a non-profit coalition for the express purpose of launching the lawsuit. A woman who had paid for an abortion at the Montreal Morgentaler Clinic has already agreed to represent Quebec women.
Dr. Paquin explained that the situation in Quebec has been particularly galling for abortion clinics, and for the women they serve. The government is not really anti-choice, but they have a strong aversion to private clinics, especially surgery at private clinics. The government has ordered the "régies régionales" (regional health authorities) not to make contracts with any private clinics, effectively tying their hands.
In Quebec, abortions are fully funded at hospitals, as well as at some "Centre Local de Services Communautaires" (CLSCs), which offer a variety of outpatient services. CLSCs are a bit more private than hospitals, but they still perpetuate many of the disadvantages of hospital abortions. Only about a dozen of 135 CLSCs provide abortions in Quebec, so clinics fill a very real need. But clinics receive only the physician's fee and a very small portion of the facility fee from the province—women are still left paying hundreds of dollars for their abortions.
A few years ago, the Montreal régie régionale agreed to start taking a few second-trimester patients at CLSCs, since the high cost of such abortions was out of reach for many women. When the clinics started referring some second trimester patients, the CLSCs found themselves suddenly overwhelmed with calls. The obvious solution for easing the workload would have been to pay clinics to perform both first and second tri-mester abortions—after all, the clinics were already fully equipped and able to handle the demand. But the government opted instead to expand an existing CLSC to handle second trimester procedures. Dr. Paquin said that the clinics promptly lost most of their second-trimester patients, and the CLSC even hired away many of the clinics' doctors. The clinics have been left playing the role of a pressure valve, with the CLSC sending their overflow patients to them (although the CLSCs still pay the tab for these women).
But the expanded CLSC has endangered not just the clinics, but also women. Since women still have to pay for a first trimester abortion at a clinic, a few are tempted to wait until their second trimester so they can go to the facility of their choice, for free. Late abortions carry considerably more medical risk than early abortions.
This disgraceful situation exists in spite of the best efforts of the clinics, which over many years have written dozens of letters to every new Quebec health minister, every Prime Minister, every federal health minister, and every minister responsible for the status of women, all to no avail. Unfortunately, it has taken the threat of a lawsuit to force the government to take seriously the rights and health of Quebec women.
To help Quebec's pro-choice coalition at this critical juncture, please write the provincial health minister and urge him to start fully funding abortion clinics:
M. François Legault
Ministère de la Santé et des Services Sociaux
1075, Chemin Sainte-Foy, 15e étage
Quebéc, Québec, G1S 2M1
Manitoba at Impasse, Next Stop—Court
Manitoba provides zero funding to the Winnipeg Morgentaler Clinic, putting them in contravention of the Canada Health Act and the Charter of Rights and Freedoms. (Most of the same arguments that apply to New Brunswick as described previously also apply to Manitoba.)
Last fall, Manitoba's Health Minister Dave Chomiak put forward three possible scenarios to solve the abortion clinic funding crisis in the province: buying the Winnipeg Morgentaler clinic, expanding existing hospital services, or opening a new public clinic that also provides other women's health services.
But negotiations appear to have stalled and no solution lies in the immediate future, according to a clinic spokesperson, as well as Dr. Henry Morgentaler. Part of the problem is that Dave Chomiak likes to say he is personally anti-choice but that he "belongs to a pro-choice government." The latter credential has proven to be of no help to the clinic. In fact, Morgentaler suspects that Premier Gary Doer may have caved into anti-choice pressure, resulting in negotiations being suspended between Morgentaler and Chomiak last year.
Manitoba has arbitrarily singled out a particular private clinic—the Winnipeg Morgentaler Clinic—and refused to grant it approval as a public facility performing medically necessary services. Meanwhile, the province has given public funding to Pan Am, a sports medicine clinic. Chomiak's proposal to open a new publicly funded women’s clinic also ignores the fact that the Morgentaler Clinic already has full resources and staffing to deliver the required services.
The only logical explanation for these actions is an anti-abortion bias by the Manitoba government. When provincial politicians abuse their elected office by imposing their personal religious or philosophical beliefs onto citizens, they are guilty of violating the Charter of Rights and Freedoms.
For now, the Manitoba pro-choice community is pinning their hopes on a lawsuit filed last July by two anonymous Manitoba women, challenging the province's illegal refusal to fund abortions outside public hospitals. They are suing the provincial government for the costs of their abortions at the Winnipeg Morgentaler clinic in years past, during two different governments. The lawsuit is progressing slowly, with a court date now set for the end of May.
In the last issue of Pro-Choice Press, we reported that Alberta Premier Ralph Klein had flatly rejected the possibility of delisting abortion. But then, in a March letter to Alberta Pro-Life, Health Minister Gary Mar apparently conceded that abortion funding will indeed be on the table for discussion by a government panel. Mar wrote, "As stated publicly, this panel will review all procedures currently funded by the province." In February, Mar had given assurances to Planned Parent-hood in Alberta that abortion would not be delisted.
However, judging by Mar's careful pro-choice wording in a letter sent to BC's Pro-Choice Action Network in late March, it appears highly unlikely that abortion will be delisted in Alberta. Mar's letter says, "Through the Canada Health Act, the federal government requires that publicly funded abortions be made available when they are deemed medically necessary. In this province, the College of Physicians and Surgeons of Alberta has provided guidelines for a patient and her physician to use in determining the medical practice of pregnancy termination." This comment confirms that changes to abortion funding would likely be impossible, because the province has given the College discretionary power over the issue. In 1995, the College refused to redefine medically necessary abortions so that Alberta could delist some abortions.
What's Next for "un-Liberal" BC?
There has been some concern in the BC pro-choice community that the reactionary BC Liberal government may try and delist abortion services, at least at clinics. The new Liberal budget has a frightening clause in it that calls for “shifting costs for services not mandated under the Canada Health Act from government to consumers and/or private health insurers”.
But BC Health Minister Colin Hansen has told the right-wing Report Magazine that de-insuring abortion is not an option "because of the commitment we made," referring to the BC Liberal's New Era document that specifically guarantees the maintenance of abortion services and funding. He also said that Vancouver's two free-standing clinics are not on the chopping block because they are "cost-effective". Hansen considers abortion to be medically necessary and said that provinces are legally required to fund abortions, but regardless of any law, the Liberal party's policy is to fund abortions. Hansen also discounted the relevance of opinion polls that say a majority support de-funding abortions. "I don't think you can run a public healthcare system on polls. There are huge moral and ethical dilemmas that would be present." (Report Magazine, April 29, 2002)
Even if the government were to break its New Era promise and try to delist abortion, it would not likely be successful, for the following reasons:
- It probably wouldn’t survive a legal challenge under the Canada Health Act, and/or the Charter of Rights and Freedoms.
- Historical precedent is against it—both former premiers Bennett and VanderZalm failed at getting abortion delisted in the 1980’s.
- There would be a lot of opposition from medical organizations and doctors, as well as from the pro-choice community.
- Liberals are unlikely to touch abortion because it’s a controversial and risky issue for politicians to deal with, especially if they’re trying to restrict it.
- The New Era document says the Liberal abortion policy is a matter of “confidence in government”, which means that all MLA’s would be required to vote along pro-choice party lines, not according to their own conscience. (There are nine anti-choice Liberal MLAs in the caucus that we know of.)
What may be more critical for BC is that abortion services will be eroded at the same time as everything else, i.e., with hospital closures and general cuts to health services. This will be much harder to fight because everything and everyone will be affected—abortion won't be singled out.
Why Abortion is Medically Necessary
Below are talking points to use when explaining why abortion is, in fact, medically necessary and must be fully funded by provinces under the Canada Health Act, whether performed in hospitals or clinics.
- Access to abortion is a constitutional right: Abortion is unlike any other medical procedure—legal, accessible abortion is also a constitutional right guaranteed to women to protect their liberty, equality, and bodily security, as per the January 1988 Supreme Court decision, R vs. Morgentaler. Not funding abortions means that some poor women may be forced to deliver to term against their will, a violation of their constitutional rights.
- Abortion is time-sensitive: Unlike elective procedures, abortion is very time-sensitive. Women can't wait months for an abortion, and even waiting weeks increases the medical risk of the procedure. Dr. Henry Morgentaler has said: "Every week of delay increases the medical risks to women by 20 percent."
- Women’s lives and health are at stake: Abortion services are a critical component of public health programs, since women will otherwise risk their lives to obtain unsafe, illegal abortions. (No Choice: Canadian Women Tell Their Stories of Illegal Abortion. Edited/published by Childbirth by Choice Trust, 1998.)
- Pregnancy outcomes are inescapable: Unlike elective procedures, a pregnant woman cannot simply cancel the outcome. Once she is pregnant, she must decide to either give birth or have an abortion. Therefore, both outcomes need to be recognized as medically necessary, on an equal basis.
- “Choice” rhetoric is inappropriate in this context: The co-opting of the word “choice” by anti-abortionists to marginalize the medical necessity of abortion is inappropriate and irrelevant. Childbirth is also a “choice,” often a socio-economic one, but no-one would suggest making it an elective procedure. Also, every medical procedure is essentially a choice—people have the right to opt out, even if it means choosing death instead.
- Unwanted pregnancies are costly: If abortion were de-funded, more women would be forced to carry to term. But the medical costs of childbirth are at least three times higher than the medical costs of abortion, and the social costs of raising unwanted children are prohibitive. According to U.S. figures, for every $1 spent by government to pay for abortions for poor women, about $4 is saved in public medical and welfare expenditures resulting from the unintended birth. Known risks of unintended birth include inadequate prenatal care, smoking and drinking during pregnancy, low birth-weight babies, and increased medical risks and poor social outcomes for pregnant adolescents and their babies. (www.cbctrust.com/ECONOMIC.html). Compared to wanted children, unwanted children are up to four times more likely to have an adult criminal record, and up to six times more likely to receive welfare between ages 16 and 21 (www.prochoiceactionnetwork-canada.org/articles/civilize.shtml).
Anti-Choice "Charities" Exposed
Over 170 anti-abortion groups in Canada have charitable tax status, including at least 70 political groups and 100 anti-abortion counselling agencies. Most anti-abortion groups say their main charitable areas are education, or research, or family/crisis counselling.
In March, the Pro-Choice Action Network sent formal complaints to the Canada Customs and Revenue Agency (CCRA) asking them to initiate audits of five anti-abortion groups in BC and Alberta, to determine if their tax status should be revoked. The groups are the Pro-Life Society of BC, Vancouver Right-to-Life Society, the Burnaby Pro-Life Society, Crisis Pregnancy Centre of Vancouver, and the Calgary Pregnancy Care Centre.
The Pro-Choice Action Network sent along extensive evidence supporting specific non-charitable activities that these five groups have engaged in. For example, charities can only devote about 10% of their resources to political activities, under limited circumstances, but it appears that some of these groups may be spending far more than 10%. The list of specific examples of non-charitable activities we documented was long. It included: intervening in court cases in order to change laws or public policy • holding politically-oriented conferences • political lobbying • submitting government briefs urging changes in laws • publishing inaccurate and inflammatory literature • making political and inflammatory statements to the media • condoning the murder of abortion doctors • misleading and inflammatory advertising • participating in illegal protests • publishing and distributing inaccurate and tendentious literature • being sued for slandering an abortion provider. In the case of anti-abortion counselling agencies, non-charitable activities included: refusing to help women who want abortions • providing misinformation on abortion • scare-mongering on the effects of abortion • Christian proselytizing to clients under the guise of providing counselling services • teaching abstinence-only classes in public schools in which zero or negative information on birth control and abortion is given • distributing "educational" materials that are often inaccurate, distorted, inflammatory, emotional, and present only one side of the issue.
We also told the CCRA that we believe anti-choice groups do not qualify for charitable tax status by their very nature, because:
- Their anti-abortion purpose has become detrimental to society since the 1988 Supreme Court decision legalizing abortion, and serves no public benefit. Charities must benefit the public.
- Their de facto purpose is to change laws to make abortion illegal again, or at least restrict abortion services by changing current public policy. Charities cannot do this.
- They espouse a specific cause and seek to sway the public to their point of view. Charities cannot do this.
- Their activities do not meet CCRA's definition of educational activities. Their “educational” materials are mostly tendentious propaganda, consisting of opinion, misinformation, and appeals to emotion. CCRA specifically prohibits this.
- They distort the issue of abortion when presenting the “other side”. CCRA says that charities involved in controversial social issues must present both sides objectively and fairly.
- They advocate for the “unborn” but charitable advocacy must not be on behalf of “narrow, sectional interests.”
- They contravene international human rights documents by not recognizing that women have a right to unbiased information on reproductive services and access to those services, where legal.
“Charitable” anti-abortion groups exploit an unfair and unethical tax advantage and enjoy higher donation rates compared to pro-choice groups. Charitable donations reduce the amount of tax the government collects, meaning everyone has to pay more taxes to make up for it. And research shows that people donate three times as much money when they can claim a charitable tax credit than when they can't (Ottawa Citizen, April 22, 1995).
Only one pro-choice group in all of Canada has charitable tax status, Childbirth by Choice Trust in Toronto, an educational group. Ironically, it was audited by the CCRA several years ago after a complaint from an anti-abortionist. The group successfully passed the audit, but it was required to change a few brochures to make them more "neutral". Our position, however, is that pro-choice education is not inherently biased or political, since its very purpose is to provide accurate, non-judgmental information on all options. Therefore, pro-choice education meets charitable requirements. Also, the pro-choice view represents mainstream society and exemplifies professional health care standards. All patients must be respected as responsible decision-makers, be given unbiased and accurate information on all options, and not be morally judged for the choices they make. Anything less is unethical and unprofessional, and of course, uncharitable.
The CCRA will not divulge whether any audits will take place or the status of any audits, citing confidentiality provisions of the Income Tax Act. Last September, the Ontario Coalition for Abortion Clinics made a complaint to the CCRA over the "charitable" Aid to Women, a Toronto anti-abortion counselling agency next door to the Cabbagetown abortion clinic. The CCRA is not saying what’s happening with this case, even though Aid to Women engages in numerous illegal and harassing activities.
James Kopp Was Friend of Vancouver Protester
Accused anti-abortion sniper James Kopp used to be friends with a Vancouver anti-abortion protester, Maurice Lewis, according to a U.S. Catholic journal. Lewis was convicted in a bubble-zone trial in Vancouver in 1996 and died in 1997. Kopp is currently behind bars in France, where he was captured in March 2001 after two years on the run. He is charged with the shooting death of Dr. Barnett Slepian in New York in Oct. 1998 and the shooting of Dr. Hugh Short of Ancaster, Ontario in 1995. Kopp is also a suspect in the shootings of Dr. Jack Fainman of Winnipeg in 1997 and Dr. Garson Romalis of Vancouver in 1994.
The admission came in the February issue of the Catholic World Report, in an article by Philip F. Lawler called "Is He Being Framed?". Lawler repeats claims that Kopp is innocent and is being framed by the police, based on questionable research done by anti-abortion group Life Dynamics Inc. in its Kopp Report .
In answering the key question as to why an innocent man would run from the law and flee to Europe, Lawler explains that Kopp believed that the police were "in league with the abortion industry in an effort to crush the pro-life movement." Kopp complained of police brutality and told friends that "they're coming to get us, sooner or later." Lawler then says:
"While many pro-life activists entertain suspicions about the legal system, James Kopp took a special interest in one particular incident. His friend Maurice Lewis, a Canadian pro-lifer, had been arrested for holding a sign outside an abortion clinic in violation of a new 'bubble zone' law. Lewis had appealed his conviction, challenging that law, and won his case in a local court. Shortly before his appeal was to be heard by a Canadian appeals court, Lewis—a truck driver by profession—was found dead inside the cabin of his semi-trailer. Police chalked up the death to "natural causes," citing the high levels of carbon monoxide in the truck. But before dropping the investigation, they did ask Lewis's friends whether he had received any threats.
"James Kopp—like many other pro-life militants—was convinced that Maurice Lewis had been killed. When he found that he was wanted in connect with the Slepian case, he was fearful that he, too, could become a murder victim. Worse still, he feared that the police themselves might kill him—explaining that he was resisting arrest—so that they would be able to lay the Slepian murder at his doorstep without ever presenting evidence at trial."
We have a few questions. If Kopp knew at least one local Vancouver person, how many others did he know? How often has Kopp been to Vancouver? When? And the big question: Could Kopp have had local help in carrying out the Garson Romalis shooting in 1994, not to mention the other two shootings in Hamilton and Winnipeg?
The Pro-Choice Action Network has reported the Kopp/Lewis connection to the Winnipeg-based Task Force investigating the doctor shootings.
Kopp may be extradited very soon to the U.S. from France to face trial for the fatal shooting of Dr. Barnett Slepian in New York in October 1998. The French Prime Minister, Lionel Jospin, signed the extradition order in March. (Kopp will probably never stand trial in Canada.)
Although Kopp still has one level of appeal open to him in France before being extradited (his deadline for appealing is late May), his American and French lawyers are having a disagreement over whether Kopp should appeal or not. The American lawyer says Kopp wants to come back to the U.S. as soon as possible to "clear his name", while the lawyer in France is trying to persuade Kopp to appeal because the lawyer doesn't trust U.S. Attorney General's John Ashcroft's assurances that the death penalty will be waived.
Kopp could be back in Buffalo, New York as early as this summer if he doesn't appeal. Otherwise, another appeal could take up to a year. Meanwhile, Kopp's alleged accomplices in New York, Loretta Marra and her husband Dennis Malvasi, are scheduled to stand trial July 30. The couple are accused of sending Kopp money and information to help him remain a fugitive for more than two years after Slepian's 1998 murder.
Moderates Win Leadership Campaigns
Stephen Harper won the Canadian Alliance leadership on the first ballot on March 20, with Stockwell Day coming second. Harper has said he will not allow the party to focus on abortion, and will not sponsor any anti-abortion legislation or campaigns.
In February, Canada's national anti-choice group, Campaign Life Coalition (CLC), and its Quebec chapter Campaign Quebec-Vie, sent letters to all of their members urging them to buy memberships in the Canadian Alliance Party through the CLC (which claims 125,000 to 150,000 supporters.) Members were asked to cast their votes for anti-abortion candidates, either Grant Hill or Stockwell Day.
But CLC came under fire from the media when it was quickly pointed out that groups are not allowed to buy party memberships. Jim Hughes, president of CLC, immediately backed off from the campaign because his group "had no idea the party's rules governing memberships had changed".
Meanwhile, the new Progressive Conservative Premier of Ontario is Ernie Eves, elected by the PC membership on March 23 to replace resigned premier Mike Harris. Eves was probably the most liberal and pro-choice candidate among the five that ran.
Unfortunately, ugly anti-choice extremism marred the PC campaign just three days before the election. An offensive anti-abortion pamphlet was mailed to homes of party members. The pamphlet, unsigned and unattributed, claimed that candidate Tony Clement's wife, Lynne Golding, "is a known lawyer for abortionists." And that she: "Believes the murder of innocent children is permissible in certain circumstances." The pamphlet endorsed candidate Jim Flaherty for his anti-abortion views.
Clement was very upset, almost crying in front of reporters, but the other candidates professed their innocence and condemned the ugly tactic, as did Campaign Life Coalition. Clement's wife is a corporate lawyer who has done some work for hospitals.
Ontario Doctor Refuses to Prescribe Birth Control Pills
Stephen Dawson, a doctor from Barrie, Ontario could lose his medical licence because he refuses to prescribe birth control pills to unmarried women, citing his religious beliefs. Four female patients made formal complaints to the Ontario College of Physicians & Surgeons last summer. Dawson also refuses to provide single men with Viagra prescriptions, give unmarried women the morning-after pill, or refer for abortions.
Dawson will face a College disciplinary committee in April. He is charged with professional misconduct. The committee alleges Dawson compromised his patients' mental, moral, and physical health by failing to ensure their needs were met after refusing their requests for contraception. The committee has several discipline options: it can reprimand the doctor, suspend his licence, impose certain terms and conditions, or revoke it altogether.
Dawson believes that doctors who prescribe birth control pills to unmarried women unwittingly promote "fornication", because the fear of pregnancy is removed. "If a Christian physician must forsake his religious beliefs to maintain his medical licence, we cannot delude ourselves to believe we live in a free country,'' said Dawson. Although he was advised to refer the patients to another doctor to prescribe the pill, he feels that because the pill doesn't require a referral to a specialist, the patients were free to find another doctor on their own, or use condoms. However, Dawson's medical clinic is the only one in the Barrie area that is accepting new patients.
Dawson did agree to send letters of apology to the women for his "overzealous" approach, but said he won’t apologize for not offering the pill to single women. He told the anti-choice LifeSite Daily News, "Under no circumstances will I compromise. I would rather lose my licence."
Dawson began his policy in February 2000, after reading a Bible verse that convinced him providing birth control prescriptions was immoral. He informed his patients of his decision at subsequent visits and by a letter that quoted judgementally from the Bible: "When you do not warn or dissuade an unrighteous man from his evil ways, he will lose his soul for his iniquity, and his blood will be on your hands. Yet if you do warn him and he does not change from his evil ways, he will lose his soul, but you will at least save your own soul." (Ezekiel 3:18-21)
Dawson said the College's allegations amount to religious persecution. "We live, supposedly, in a free country," he said. "In this country, we are allowed to have fundamental freedoms of conscience, religion, and expression of our views." Dawson ignores the fact that while engaged in his profession, the patient's freedom of conscience, religion, and expression must trump his.
"He's entitled to his beliefs and he is certainly entitled to express his beliefs," said Laura Shanner, a reproductive ethics researcher at the University of Alberta's John Dossetor Health Ethics Centre. "What he is not entitled to do is to deny the standard of care to his patients. He absolutely must refer patients to a practitioner who is able to deal with sexuality and reproductive issues in a non-judgmental and helpful way. This individual has a responsibility to get out of the business where he's put in the position to have to make those choices. He is not able to deal with a very common question that faces family practitioners. Maybe he should become a pathologist and work with tissue samples and not have to get involved in people's sex lives."
Louise Hanvey, president of the Planned Parenthood Federation of Canada, said patients already face too many obstacles to obtaining contraception in Canada. "We see this as a human rights issue," she said. "Women and men are entitled to their reproductive rights."
Winnipeg lawyer Catherine Tolton, who has represented doctors in discipline cases in both Ontario and Manitoba, said the wording of College policies varies from province to province, but the general rule is this: A doctor is not obliged to provide a service that goes against his or her beliefs, except in certain emergencies, but must ensure that an appropriate referral is made to someone who will. The Canadian Medical Association Code of Ethics has similar requirements.
Although the requirement to make appropriate referrals seems like a reasonable compromise at face value, it has the potential for leading to a reductio ad absurdum situation. What if a doctor converts to Christian Science, and announces to his patients that his only treatment from now on will be prayer, because his religious beliefs say that pain and illness are illusions? Under current College guidelines, it seems he could simply refer his objecting patients, while still collecting patient visit fees from Medicare! The bottom line is that health professionals are obligated to offer real help for their patients' needs. If they can't do that for whatever reason, they should switch professions.
Ontario — On April 6, Canada Customs seized two 4'x4' signs of aborted fetuses from Windsor anti-abortion activist Earl Amyotte, who was returning from Detroit. The Customs officer thought the signs were obscene, but after review by other officers, they were deemed to be not obscene and hand-delivered back to Amyotte.
Saskatchewan — On February 18, Bill Whatcott of Christian Truth Activists in Regina was charged with disrupting traffic near the Regina General Hospital, along with four other protesters. They were carrying graphic anti-abortion signs. Police later dropped the charges. In January, Whatcott was outraged at the "filthy" nature of a safe-sex pamphlet written for the gay/lesbian community by Gay and Lesbian Health Services in Saskatoon, and funded by the government. In response, he distributed 5,000 photocopies of the pamphlet to random households in Saskatoon, with a cover letter condemning the government funding and homosexual practice in general. At least one family reported his actions to the police. It is illegal to deliver obscene and offensive pamphlets, according to Canada Post.
Canada News Bytes
Banning condoms kills —Catholics for a Free Choice (CFFC) in Toronto launched a billboard and public transit ad campaign in February targeting Catholic bishops for their stance against condoms. One ad reads: "Catholic people care, when will our bishops? Banning condoms kills." Catholic bishops claim that condoms do not protect against AIDS, and in fact increase the risk of AIDS due to increased promiscuity. CFFC also plans public education and a major condom distribution at Catholic World Youth Day in July in Toronto. The Catholic Church says the only way to prevent AIDS and other sexually transmitted diseases is to practise abstinence before marriage and fidelity within marriage.
TV ads promote emergency contraception — Planned Parenthood Federation of Canada launched five public service announcements in February to promote the morning after pill in Canada. The ads are airing on CBC, Global, WTN, and MuchMusic, and 16 regional broadcasters. (According to the National Post, CTV refused to run the ads because they do not meet the definition of a PSA.) The ads are part of PPFC's "Emergency Contraception Awareness Campaign," which also includes the distribution of 5,000 posters to across the country.
New guidelines on stem cell research — In March, the Canadian Institutes of Health Research issued guidelines that ban the cloning of human embryos, but allow federally-funded research on embryos left over from fertility treatment, aborted fetal tissue, and embryonic stem cells imported from foreign suppliers. There will be strict protocols on how researchers should get consent to use embryos and fetal tissue. For example, a woman's decision on whether to continue a pregnancy must not be influenced by the possibility of donating fetal tissue for research. The CIHR introduced the new guidelines because there is a legal limbo in Canada on the status of embryonic and fetal tissue research. Canada's legislation on reproductive technologies is still pending, and researchers had been working under a self-imposed moratorium on stem cell research.
Emergency contraception distributors apply for over-the-counter status — Paladin Labs, distributors of Plan B emergency contraception, applied to Health Canada in March to change the drug's status from prescription to over-the-counter. Co-sponsors of the application include the Society of Obstetricians and Gynaecologists of Canada, and the Canadian Pharmacists Association. The applicants have asked for priority review that would allow for approval in less than a year. The provincial governments of BC and Quebec have already approved the dispensing of emergency contraception by pharmacists.
U.S./International News Bytes
Nepal legalizes abortion — Nepal's Parliament has finally passed an amendment to its Civil Code that partially legalizes abortion and makes sweeping changes to many other discriminatory laws. Once Nepal's king signs the legislation, abortion will be legal during the first twelve weeks of pregnancy, when a woman's life or health is in danger, and in cases of rape, incest, and fetal impairment. Under the former ban, women accused of abortion faced criminal prosecution and in many cases, were charged with infanticide, which carried a life sentence in prison. At least 65 women are still serving sentences of one year to life in prison for abortion-related convictions. New York's Center for Reproductive Law and Policy, which helped family planning groups in Nepal lobby for the new law, is now calling for Nepal to release women jailed for having or performing abortions.
Suspended UN funding will lead to more abortions — In March, President Bush suspended $34 million in funding for the United Nations Population Fund (UNFPA) because of false allegations by a radical anti-abortion group that the UNFPA was participating in coerced abortions in China. Impartial observers have found no evidence whatsoever to support the charges. In fact, the UNFPA has helped to significantly decrease the incidence of forced abortion in China. The suspension of funds has forced the UNFPA to cut new programs and staff for family planning and maternal health. A UNFPA spokesperson calculated that the loss of funds will translate to as many as 2 million unwanted pregnancies, 800,000 induced abortions, 4,700 maternal deaths, and 77,000 infant and child deaths in China.
U.S. gives health insurance to fetuses — The Federal Department of Health & Human Services published new rules in March allowing states to call an embryo an "unborn child" eligible for government health care under state Children's Health Insurance Programs (CHIP). The move was ostensibly to allow low-income pregnant women to get pre-natal care, but its real purpose is to give embryos legal standing as persons. The Bush Administration could have helped women access pre-natal care by simply extending the CHIP program to pregnant women. Also, the new policy comes with no new federal funding.
Pro-CAN Leads Workshops
Since November, the Pro-Choice Action Network has organized and led four half-day workshops for activists and reproductive health personnel. The free workshops, funded by the former Ministry of Women's Equality, were very well-received by the participants.
In November and December, we held two workshops called "Safety & Security for the Pro-Choice Community." Pro-choice activists, medical students, and abortion clinic staff attended. Some of the topics covered were: the history and nature of anti-choice violence and harassment; how to feel safe and to trust your intuition; risk management; safety tips for home, work, and transit; safety how-to's at clinics and pro-choice events, and a group exercise on what to do in certain risky scenarios.
In March and April, we held two "Media Relations for Women Activists" workshops. Women activists from non-profit groups throughout the Lower Mainland were invited, and the attendees represented a diverse mix of issues and interests. Some of the topics covered were: the nature of news; what's newsworthy; creating a publicity plan; framing your message; dealing with reporters; tips for TV, radio, press conferences, public speaking, and more. Attendees participated in exercises on writing media releases and prioritizing key messages on an issue.
As part of this project, we also met and talked with editors and reporters at various mainstream media outlets in the Lower Mainland to improve our media relations, learn how to work more productively with the media, and share our safety guidelines for protecting abortion providers in the media.
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