5/09/2007

The a word

Reprinted from The National Post

The a word:
How did abortion, that most contentious of issues, become one that is simply not discussed publicly?
Anne Marie Owens, National Post
Published: Saturday, May 05, 2007

When several thousand anti-abortion demonstrators gather on Parliament Hill next week, as they do every year at this time, their protest is likely to be largely ignored, as it is every year, by most politicians and the media. The annual silent treatment could be explained away by the frequency of protest marches on Parliament, if the reaction was not such an apt reflection of the state of the abortion debate, such as it is, in Canada.
While the American squabbles between the religious right and the pro-choice movement spill over into the mainstream, the Canadian abortion debate is largely reserved for the fringes. But does the silence in the middle, which is typically put down to complacency, really signify that most Canadians consider the abortion debate pretty much over?
Complacency is certainly not what is conveyed by the recent debate that ensued when abortion was raised in the pages of the otherwise staid Canadian Medical Association Journal. The flood of letters from people on both sides that followed -- some of it apparently the result of orchestrated campaigns, but much of it not -- was so vociferous that it prompted the journal to publish in its latest issue a clarification of its policy on abortion and a call for a halt to the letter-writing.
Beneath the surface of what is often regarded as a sort of national sense of complacency about abortion, there is considerable evidence of confusion, passion and an intensity of opinions.
"If you write about abortion, just watch what happens," warned Dr. Paul Hebert, editor-in-chief of the national medical journal. Ever since his publication ran a guest editorial last July urging doctors to continue ensuring access to abortions, there have been letters and e-mails that now number in the several hundred.
"Just like for the rest of society, abortion is a very polarizing issue among physicians ? Both sides are just as emphatic about the issue."
So polarizing in fact, that the journal's latest issue, released last week, featured a piece from the CMA's executive director of ethics attempting to clarify the organization's position on abortion.
"We received a large number of letters in response to the editorial ? with particular regard to the CMA's policy on induced abortion. We asked the CMA to assist our readers by clarifying their position using a casebased example, which they have provided here," the article explained.
"You are dealing with extremes of opinion on this, but it is not the fringes," Dr. Jeff Blackmer, the association's director of the office of ethics, said in an interview.
The letters, from both sides, were heartfelt but reasoned, not fanatical.
"The differences about the ethics of abortion are deep, and those differences should not be minimized," said a letter co-written by Dr. James Read of Winnipeg, and Dr. Beverley Smith of Toronto. "That there are health professionals who may feel bullied into compliance is disturbing," they wrote, referring to doctors feeling pressured to make referrals or even perform abortions despite their personal opposition to it.
In an opposing letter, Andree Cote, director of legislation for the National Association of Women and the Law, argued that "in the face of the demonstrated resistance of individual doctors to offering adequate abortion services in most institutions and regions across Canada, the medical profession has a collective responsibility to ensure access to this procedure."
What is so surprising about this recent medical journal debate is not so much the tone or details of the arguments but that such an open and free-flowing discussion on this topic is happening at all. For any number of reasons, that is not generally the case in Canada.
In the past several months, three major American newsmagazines -- Time, Newsweek and the New York Times Magazine -- have each devoted cover stories to various aspects of the abortion debate in that country. One featured a gripping image of four model fetuses held in a delicate hand above a headline that read, "The Abortion Campaign You Never Hear About." Another has an odd-looking fabric doll above the headline, "Is There a Post-Abortion Syndrome?" The cover stories, and the debate within the country, are virtually unimaginable here in Canada.
Part of the reason for the cross-border difference in the abortion debate is the much greater clout of the religious right in the U.S., which constantly pushes the issue. Another key difference is legislative and legal. Although the Supreme Court's 1973 Roe vs. Wade decision legalized abortion in the U.S., state legislatures often attempt to impose restrictions on access. There are also continued court challenges, including the one that led to the recent Supreme Court decision that upheld the ban on partialbirth abortions, or late-term abortions.
Rebecca Cook, an expert in reproductive law, says Canada's 1988 Supreme Court decision really defined the framework for the way the abortion debate would unfold in this country, and explains, in part, how many Canadians feel the issue has been framed in a way that is in line with significant cultural and societal differences from the situation in the United States.
"We have certain principles in our health care system--fairness, transparency, accountability, accessibility," said Prof. Cook, Chair in International Human Rights Law at the University of Toronto's law school and an editor of the International Journal of Gynecology and Obstetrics. "But there is also the whole issue of looking at abortion as an equality issue, which defined how the issue was considered," in a way, she maintains, that allows many Canadians to feel comfortable with the situation.
But there is more to it than that. In the many years that have passed since abortion was decriminalized in Canada, the debate has gradually become the domain of the extremes on either side. What got squeezed out in that din of dramatically opposing views was any sense of a middle ground.
"Abortion is not on the agenda in Canada for the mainstream in Canada and has not been for a very long time," said Darrell Bricker, president and chief operating officer of public affairs for Ipsos-Reid. But he says this sense that the majority do not want to reopen the issue is often incorrectly taken to mean that there is consensus on the issue in Canada.
"Is there consensus? No, the opinions are all over the map. And you'd be wrong to see this as a consensus in favour of abortion under any circumstances."
His organization has not done any specific polling on abortion since 2000. The issue has been raised in other surveys, such as the one in February, 2006, shortly before Stephen Harper became Prime Minister, to assess what issues might bring down the minority government.
In that survey, 50% of Canadians said they would not support bringing down the government if they tried to pass a law that limits a woman's access to abortion; but 45% said they would be in favour of bringing down the government on such an issue.
The polling done in 1988 and 2000 compares attitudes about when abortion should be permitted: only when a woman's life is in danger, only in certain circumstances, or whenever a woman wants one. It showed slight increases in support for abortion on demand (from 36% in 1988 to 41% in 2000) and for abortion in certain circumstances (39% to 41%) and a slight decrease in the percentage who support abortion only in the most extreme, life-saving circumstances (23% in 1988 and 17% in 2000.)
When Environics surveyed Canadians about their attitudes toward abortion last fall, they found that about a third each of Canadians supported the view on one end of the spectrum that human life should be legally protected from conception on and, on the other end, that it should be protected only from birth on. Another third think it should be protected prior to birth, but some months after conception.
According to the survey, conducted for the anti-abortion group LifeSite, 31% said protection should begin from conception on, 23% said after three months of pregnancy, and 10% said after six months of pregnancy; another 30% think human life should receive legal protection only from the point of birth.
What is most compelling about all of these numbers, and most surprising considering the way the abortion issue is typically framed in Canada, is that they are not at all conclusive. As Mr. Bricker says, "it's not like 100% are in favour of abortion on demand ? There are a lot of lines being drawn on this issue."
He equates it to the Canadian stance on same-sex marriage, where what is often spun as widespread support actually reflects myriad gradations of approval under certain conditions.
So why then has the abortion issue become a relative non-issue in Canadian public debate, with flareups such as the one that emerged in the medical community extremely rare?
One key reason, Mr. Bricker says, "is that the forces that would want change have not organized themselves in a way that is conducive to having this issue opened up again."
It is not, on either side, for lack of trying.
If the organizers of the 10th March for Life are right, more than 5,000 anti-abortion activists are likely to descend on Parliament Hill next week for their annual campaign lobbying for dramatic legislative change.
Yet there will likely be no televised images of the demonstration and only sparse coverage from the mainstream media of an event that those on the other side of the debate typically characterize as a gathering of a couple hundred radicals from the fringe.
The campaign's media liaison, Wanda Hartlin, is accustomed to hearing the complaints of members frustrated each year by the resounding silence of media coverage of their key public awareness exercise.
"I don't think the media is that interested in religious topics and the media sees this as a religious topic," she says. "I don't think the media is ignoring us. I think you take us from a different direction.
"We call ourselves pro-life. The media calls us anti-abortion. The pro-choice people call us anti-choice."
She believes that the reluctance to engage in a national debate about abortion is a quintessentially cautious and polite Canadian response to a volatile issue: "It's a place where people don't want to go. Abortion has touched many lives. A lot of people say it's too close to home, it's too sensitive," she said. "To get there, people's hearts have to change. It's an emotional issue, it's not an intellectual issue."
The March for Life protest on Thursday is the most visible part of the group's ongoing campaign to convince politicians to reopen political debate on abortion and pass legislation that restricts the practice.
It is often said that Canada stands virtually alone as a country that has no law governing abortion.
Bernard Dickens, professor emeritus at the University of Toronto's law school and vicepresident of the World Association for Medical Law, says both sides tout the no-abortion-law claim, which is "greeted with relief and triumphalism by one side; horror and revulsion by the other." Yet, he says, the assertion is wrong.
What was decided by the majority in the 1988 Supreme Court challenge by Dr. Henry Morgentaler, the longtime advocate of abortion rights, was not, Prof. Dickens maintains, a legal vacuum, but rather an acknowledgement that the prevailing system, which required women to get approval from therapeutic abortion committees, was unfair.
He says that other countries that have abortion laws have what he calls "exceptional laws, where abortion is the exception to other laws."
Canada too had that kind of law after 1969, where what was until then considered illegal was allowed with the approval of a hospital therapeutic abortion committee. That law was overthrown in 1988 when the Supreme Court considered a challenge under the Charter of Rights and Freedoms over the inconsistent availability of the procedure.
"Because we no longer have that exceptional kind of law, abortion is now covered by the general law -- laws covering consent to be treated, the law of conscientious objection, and if the abortion is done negligently, there could be remedy under the civil law," he said. "To say there is no abortion law is not correct."
He says that once abortion was truly considered a medically required treatment, then, just as in neurosurgery or cardiac care, no law was necessary. What complicates the reaction, of course, is that it is a procedure "rooted in religious, moral and ethical judgment."
Prof. Dickens, who has conducted 10-year reviews of abortion regulations worldwide and found a general liberalizing trend, says the morality aspect of abortion is diminishing somewhat but has not at all disappeared.
"It is still somewhat of an epithet. Other than Henry Morgentaler, nobody describes themselves as an abortionist. It's not too different from doctors who treat venereal disease -- there are still moralistic undertones to the judgment of the work," he said.
The intensity of moral emotion about the procedure was evident in the reactions of physicians to the guest editorial in their medical journal.
In their essay "Abortion: Ensuring Access," law professors Sanda Rodgers and Jocelyn Downie misstated what turns out to be a key aspect of the Canadian Medical Association's moral compromise on this issue: the physicians' conscientious objector status and the referral of patients desiring an abortion.
The CMA's abortion policy, which has been in place since 1988 and is reviewed annually, requires that physicians in no way impede patients from accessing abortion but does not force them to provide the necessary referral.
"It is a small distinction but it's absolutely crucial," said Dr. Blackmer, the organization's ethics officer. "For those who feel strongly on this, the feeling is, 'If I refer the patient, it is the same as performing the act.' "
He says that what has been interesting about this latest controversy is that even those who feel strongest about the issue are not pushing to have the policy made any more restrictive, only to ensure the status quo.
Dr. Blackmer suggests there are only a few things that would force a re-evaluation of the policy: a huge groundswell from the membership one way or another, a legislative review of the issue by the government, or a significant decrease in access to abortions.
"This is a legally sanctioned, medically indicated service, so if it came to a point where we felt people weren't getting access, that could prompt some sort of change," he said.
That possibility of resolving the access question may be close at hand. Last month, advocates for access to abortion released a report that said abortion services were less accessible in Canada than they were three years ago. The study found that only 15.9% of Canadian hospitals provide abortion services, a reduction from 17.8% that occurred without any change in official regulations or policies.
The issue of access will go before the court again too, when later this month, the Morgentaler Clinic sues the government of New Brunswick over provincial regulations that insist hospital abortions be performed by a gynecologist, be approved first by the gynecologist and another doctor, and does not cover the cost of abortions in clinics.
Canada's abortion debate may well be back where it was in 1988, with a court-focused dispute forcing a wider discussion about the disconnection between the avowed accessibility and the reality of access.

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