Implementation of abortion policy in Canada as a women's issue.

A b o r t i o n pol i cy as it is implemented i n Canada has fundamental impl i ca t ions for women. T h e exist ing pol icy , w h i c h grew out of p o l i t i c a l compromise , is f o u n d to be biased, inequitable and subject to c r i p p l i n g problems. L o c a l hospi ta l boards, comprised largely of medical doctors, ult imately serve as arbiters of p u b l i c o p i n i o n . W i t h o u t ac t ing either as pol icy makers or as medical practitioners, these boards decide the proper social roles for women. Legal issues involve shi f t ing responsibi l i ty a m o n g the courts, federal and provinc ia l governments and Par l iament . Evidence shows that i n bat t l ing issues created by abort ion pol icy , access to abort ion by women i n Canada is being d i m i n i s h e d . T h e debate over a b o r t i o n i n C a n a d a c o n t i n u e s to be s p i r i t e d a n d o f t e n heated. D u r i n g the federa l e l e c t i o n c a m p a i g n of 1984, a n t i a b o r t i o n g r o u p s d o g g e d p o l i t i c a l candidates a n d a n a t i o n a l C a t h o l i c n e w s p a p e r suggested that R o m a n C a t h o l i c s n o t vote at a l l ra ther t h a n vote f o r a c a n d i date w h o took a p r o c h o i c e p o s i t i o n o n abort i o n . 1 L e a d e r s of a l l m a j o r part ies were asked to specify their v i e w s o n a b o r t i o n , w i t h some r e s p o n d i n g by c a r e f u l l y s e p a r a t i n g the i r p o l i t i ca l p o s i t i o n f r o m their p e r s o n a l v iews , thereby u n d e r l i n i n g the sens i t iv i ty of the issues i n v o l v e d . T h e a b o r t i o n q u e s t i o n raises a n u m b e r o f c o m p l e x l ega l a n d m o r a l issues. A m o n g these are the sanct i ty of l i f e a n d the r ights of w o m e n . I n the s t r o n g l y p o l a r i z e d debate between a n t i a b o r t i o n forces a n d p r o c h o i c e forces, th is is the centra l p o i n t of c o n t e n t i o n . A n t i a b o r t i o n s u p porters c l a i m to be p r o t e c t i n g the l ives of the u n b o r n w h i l e p r o c h o i c e advocates c l a i m to be p r o m o t i n g r e p r o d u c t i v e r ights for w o m e n . Bey o n d the i m m e d i a t e concerns w i t h r ights of the fetus a n d r i g h t s of w o m e n , l i e w o r l d v i e w s d e f i n i n g w h a t is sacred a n d m o r a l but a l so w h a t is s o c i a l l y preferable . E a c h side has a clear v i s i o n of the p lace of the c h i l d i n society, the p lace of the f a m i l y a n d c r u c i a l l y , the a p p r o p r i a t e ro le of w o m e n w i t h i n the f a m i l y a n d society. T h e s e w o r l d v iews i n c l u d e m o r e subtle , but e q u a l l y s t r o n g l y h e l d v iews , o n the a p p r o p r i a t e roles of the state a n d of the c h u r c h i n m a i n t e n a n c e o r p r o m o t i o n of w h a t is s o c i a l l y preferable for w o m e n . E a c h side has the clear sense that its p o s i t i o n is not o n l y the correct one but the v i e w w h i c h best serves the interests of society i n d e f i n i n g w o m e n ' s roles. A b o r t i o n , for these reasons as w e l l as others w h i c h w i l l be d iscussed subseq u e n t l y , is q u i n t e s s e n t i a l l y a w o m e n ' s issue. T h e c e n t r a l p u r p o s e of this p a p e r is to e x a m i n e the i m p l e m e n t a t i o n o f a b o r t i o n p o l i c y i n C a n a d a as i t relates to w o m e n ' s l ives a n d roles . A s e c o n d p u r p o s e is to assess the s o c i a l forces that are i m p i n g i n g o n the i m p l e m e n t a t i o n of abor t i o n p o l i c y as e v i d e n c e d i n recent c o u r t cases, changes i n o r by h o s p i t a l therapeut i c a b o r t i o n c o m m i t t e e s o r w i t h i n l o c a l c o m m u n i t i e s a n d p u b l i c c a m p a i g n s . A t h i r d i n t e n t is to e x p l o r e the degree to w h i c h a n t i a b o r t i o n forces o r p r o c h o i c e forces have a c t u a l l y affected access to a b o r t i o n by C a n a d i a n w o m e n . I n order to better ana lyze the ways i n w h i c h C a n a d i a n a b o r t i o n p o l i c y is i m p l e m e n t e d , it is u s e f u l to c o m p a r e the C a n a d i a n a n d A m e r i c a n exper ience Abortion Law and Policy in the U.S. I n the U n i t e d States, at present , a b o r t i o n is b e i n g h o t l y debated i n a very p u b l i c m a n n e r , a l t h o u g h the issues i n v o l v e d are s u b s t a n t i a l l y d i f ferent t h a n they are i n C a n a d a . T o i l l u s t r a t e the p u b l i c i m p o r t a n c e of the issue, one A m e r i c a n C o n g r e s s m a n , a n a v o w e d o p p o n e n t of l e g a l ized a b o r t i o n , c o m m e n t e d recently , " . . . a b o r t i o n is the s i n g l e m o s t d i v i s i v e issue f a c i n g C o n g r e s s , the courts a n d the p u b l i c . N o t h i n g l i k e i t has separated o u r society s ince the days of s l a v e r y . " 2 A n e w p o l i t i c a l p a r t y , R i g h t to L i f e , r a n a slate of candidates i n b o t h the 1980 a n d 1984 e lec t ions a n d a d d e d its vo ice to the e lect ions by r a t i n g candidates o n their a b o r t i o n attitudes a n d p o l i t i c a l p e r f o r m a n c e . A n a m e n d m e n t to the U n i t e d States C o n s t i t u t i o n , k n o w n as the H u m a n L i f e A m e n d m e n t , has been p r o p o s e d w h i c h w o u l d p r o h i b i t a b o r t i o n o n a l l g r o u n d s a n d m a k e a n y o n e i n v o l v e d i n o r s e e k i n g to o b t a i n a n abor t i o n l i a b l e to c r i m i n a l p r o s e c u t i o n . 3 A r t i c l e s , b o t h s c h o l a r l y a n d j o u r n a l i s t i c , are assessing the i m p a c t of the a b o r t i o n issue o n C o n g r e s s i o n a l e lec t ions . 4 P u b l i c o p i n i o n p o l l s are b e i n g a n a lyzed a n d r e a n a n l y z e d i n a n a t tempt to ascer ta in the real att i tudes of the A m e r i c a n p e o p l e o n abort i o n . 5 B l a k e a n d D e l P i n a l puzzle over the recent p o l i t i c a l v ic tor ies of the suppor ters of " p r o l i f e " ( a n t i a b o r t i o n ) i n the U . S . i n l i g h t of expressed s u p p o r t for a v a i l a b i l i t y of a b o r t i o n a m o n g most A m e r i c a n p e o p l e . T h e y c o n c l u d e that most peop l e are between the t w o extreme v iews o n abort i o n but tend to be c loser i n terms of b a c k g r o u n d to the " p r o l i f e r s " t h a n to the " p r o c h o i c e r s . " 6 T h i s may a c c o u n t for the p u b l i c ' s s e e m i n g l y e q u i v o c a l s u p p o r t of the " p r o l i f e " side. A n d attempts are b e i n g m a d e to measure the consequences of recent cut -backs of p u b l i c f u n d s for a b o r t i o n i n the U . S . 7 B o t h C a n a d a a n d the U n i t e d States i m p l e m e n t e d l a w s aga ins t a b o r t i o n i n the second h a l f of the n i n e t e e n t h century . I n the U n i t e d States, u n l i k e i n C a n a d a , the t w e n t i e t h century m o v e m e n t to r e f o r m a b o r t i o n l a w was p u b l i c a n d w i d e l y s u p p o r t e d . 8 B y 1972, the i m p e t u s to repeal restr ict ive a b o r t i o n l a w s was s u f f i c i e n t l y s t r o n g that near ly t w o f i f t h s of the states h a d c h a n g e d their l a w s . 9 T h e v i c t o r y for l ega l ized a b o r t i o n i n the U n i t e d States was not a n a c t u a l c h a n g e i n the l a w but a 1973 U n i t e d States S u p r e m e C o u r t d e c i s i o n ( R o e vs. W a d e ) w h i c h stated that restrict ive a b o r t i o n l a w s were u n c o n s t i t u t i o n a l i n that they v i o l a t e d a w o m a n ' s basic r i g h t to p r i v a c y . " S p e c i f i c a l l y , the C o u r t r u l e d that i n the early phase of p r e g n a n c y ( r o u g h l y the f irst three m o n t h s , or tr imester) , states c o u l d not p r o h i b i t o r interfere w i t h a w o m a n ' s r i g h t to a b o r t i o n , except to r e q u i r e that i t be d o n e by a l i censed p h y s i c i a n . " 1 0 S i n c e that l a n d m a r k deci s i o n , the S u p r e m e C o u r t has r u l e d i n several o ther cases i n v o l v i n g a b o r t i o n thereby fur ther c l a r i f y i n g the c i r cumstances u n d e r w h i c h abort i o n is l e g a l l y a l l o w a b l e . A l t h o u g h w i t h o u t u n a n i m i t y o n the issue, the U n i t e d States i n its precedent -se t t ing S u p r e m e C o u r t d e c i s i o n a n d the ear l ier dec i s ions m a d e by the state g o v e r n m e n t s , dec ided i n f a v o u r of c h o ice o n a b o r t i o n . L u k e r , i n her recent b o o k o n the p o l i t i c s of a b o r t i o n , argues c o n v i n c i n g l y that the 1973 c o u r t d e c i s i o n was " m u c h m o r e i n l i n e w i t h the t r a d i t i o n a l treatment of a b o r t i o n t h a n A m e r i c a n s a p p r e c i a t e . " 1 1 L u k e r quotes i m p r e s sive da ta to s u p p o r t her c o n t e n t i o n that " t h e lack of p u b l i c d i s c u s s i o n a b o u t a b o r t i o n s h o u l d not m a k e us bel ieve that a b o r t i o n d i d not e x i s t . " 1 2 She goes o n to say " t h e r a p e u t i c a b o r t i o n , perf o r m e d for a w i d e var iety of reasons a n d w i t h a s t u n n i n g r a n g e of f requencies , was c o m m o n . " 1 3 T h e es tabl i shment of therapeutic a b o r t i o n boards i n h o s p i t a l s i n the U n i t e d States i n the 1950's was, a c c o r d i n g to L u k e r , a d e l a y i n g tactic i n the face of g r o w i n g pressures for c h a n g e i n the g r o u n d s o n w h i c h a b o r t i o n was m e d i c a l l y a v a i l a b l e . L u k e r ' s a n a l y s i s o f this p e r i o d c o n c l u d e s that therapeut i c a b o r t i o n boards i n h o s p i t a l s h a d the effect of r e s t r i c t i n g access to a b o r t i o n a n d even that this m i g h t have been a n i n t e n d e d g o a l i n thees tab l i shment of s u c h boards. O n c e " thera p e u t i c a b o r t i o n boards became perce ived as m o r e a n d m o r e u n f a i r a n d u n w o r k a b l e , p h y s i c ians began to cast a b o u t for other r e s o l u t i o n s of the d i l e m m a . " 1 4 It was at this p o i n t that state g o v e r n m e n t s a n d courts i n c l u d i n g the U n i t e d States S u p r e m e C o u r t dec ided i n f a v o u r of abort i o n as a r i g h t of w o m e n . Abortion Law and Policy in Canada I n v i v i d contrast to the s i t u a t i o n i n the U n i t e d States, a b o r t i o n p o l i c y i n C a n a d a has not been p u b l i c l y debated u n t i l rather recently. " F e d e r a l g o v e r n m e n t s i n C a n a d a have a l w a y s refused to p a y the p o l i t i c a l p r i c e of a d i rec t ly a p p l i e d state a b o r t i o n p o l i c y . " 1 5 Instead of t a k i n g direct legisla t ive a c t i o n to c h a n g e the extremely restrict ive pre-1969 a b o r t i o n l a w to a c t u a l l y legal ize abort i o n , the C a n a d i a n g o v e r n m e n t q u i e t l y c o m p r o m i s e d . T o satisfy the m e d i c a l es tabl ishments w h i c h w a n t e d to m a i n t a i n its m o n o p o l y over the d e l i v e r y of a b o r t i o n services, to g ive p u b l i c s u p p o r t to the reformers b u t a lso to reassure the " p r o l i f e " m o v e m e n t , the 1969 c h a n g e i n the c r i m i n a l code to p e r m i t a b o r t i o n essent ia l ly " e n s h r i n e d the r h e t o r i c of r e f o r m w h i l e b a s i c a l l y jus t l e g a l i z i n g es tabl ished m e d i c a l p r a c t i c e s . " 1 6 P e l r i n e suggests that " . . . the 1969amendments to the C r i m i n a l C o d e of C a n a d a d i d l i t t l e m o r e t h a n to b r i n g the l a w a l m o s t u p to w h a t was then s t a n d a r d prac t i ce i n a h a n d f u l o f m e t r o p o l i t a n h o s p i t a l s . " 1 7 It s h o u l d be noted that not a l l g r o u p s were appeased by the c o m p r o m i s e l a w , w h i c h a d o p t e d the C a n a d i a n M e d i c a l A s s o c i a t i o n ' s r e s o l u t i o n of 1966 a l m o s t v e r b a t i m . D e V a l k , a n a n t i a b o r t i o n i s t , c o m p l a i n s i n a 1981 ar t ic le : W e k n o w the l a w was f i n a l l y c h a n g e d i n M a y 1969. W e also k n o w that the c h a n g e was w o r d e d i n s u c h a w a y as to p e r m i t v i r t u a l a b o r t i o n o n d e m a n d . F r o m the p a r l i a m e n t a r y debates i n 1969 it is c lear this d e v e l o p m e n t was c o n t r a r y to the express ly stated p u r p o s e of the g o v e r n m e n t w h i c h i n t e n d e d to p e r m i t a b o r t i o n o n l y u n d e r f a i r l y restricted c i r c u m s t a n c e s . 1 8 T h e 1969 a b o r t i o n l a w , h e r a l d e d by m a n y as the l a w w h i c h l i b e r a l i z e d a b o r t i o n access i n C a n a d a , i n s u l a t e d elite g r o u p s , most n o t a b l y doctors a n d federal g o v e r n m e n t o f f i c i a l s , f r o m p o l i t i c a l a n d legal l i a b i l i t y by p e r m i t t i n g abort i o n s to take p lace o n l y i n p r o v i n c i a l l y accred i t e d or a p p r o v e d h o s p i t a l s a n d s a n c t i o n i n g doctors w i t h m a k i n g d e c i s i o n s a b o u t the a d v i s a b i l i t y of a b o r t i o n . T h e r e s p o n s i b i l i t y for i m p l e m e n t i n g the l a w rested w i t h i n d i v i d u a l doctors a n d their h o s p i t a l commit tees w h o were g i v e n the a u t h o r i t y to de f ine h e a l t h r i sks i n d e p e n d ent ly for each case presented to t h e m . T h i s s u p p o r t e d the d o c t r i n e l o n g p r e v a l e n t i n the U n i t e d States that the d e c i s i o n o n a b o r t i o n is a t e c h n i c a l m e d i c a l one . L u k e r suggests that i n the U n i t e d States d u r i n g the p e r i o d f r o m 1926 to the 1960's, " t h e d o c t r i n e of m e d i c a l j u d g e m e n t p e r m i t t e d p h y s i c i a n s to use a n a l m o s t u n i m a g i n a b l y w i d e range of c r i te r ia for d e c i d i n g u p o n a n a b o r t i o n a n d ne i ther the p u b l i c n o r i n d i v i d u a l p h y s i c i a n s a p p e a r to have been very t r o u b l e d by the discrep a n c i e s . " 1 9 A l l h o s p i t a l s i n C a n a d a were n o t r e q u i r e d by the 1969 l a w to set u p therapeut ic a b o r t i o n c o m m i t t e e s , thereby l i m i t i n g access to a b o r t i o n for w o m e n w h o l i v e i n areas remote f r o m p a r t i c i p a t i n g h o s p i t a l s . T h e o n u s for i m p l e m e n t i n g a b o r t i o n p o l i c y , i n b e i n g g i v e n to therapeut i c a b o r t i o n c o m m i t t e e s i n accredited h o s p i t a l s , r e m o v e d r e s p o n s i b i l i t y f r o m the courts , the legi s la tors a n d the federal g o v e r n m e n t . O n p a p e r , the 1969 l a w m i g h t have seemed reasonable b u t its i m p l e m e n t a t i o n c lear ly reflects the p o l i t i c a l c o m p r o m i s e o u t o f w h i c h i t g r e w . A s C o l l i n s argues , the 1969 l a w m a y have exacerbated the real soc ia l p r o b l e m by g i v i n g w o m e n a false sense of f r e e d o m of c h o i c e . 2 0 It fur ther creates the i l l u s i o n that a b o r t i o n is a v a i l a b l e i n C a n a d a v i r t u a l l y o n d e m a n d a n d that n u m b e r s o f a b o r t i o n s have d r a m a t i c a l l y increased, w h e n i n fact they m a y have o n l y seemed to be increasi n g because they were b e i n g recorded a n d reported f o r the f i rs t t i m e , as r e q u i r e d by the 1969 l a w . A r m e d w i t h statistics a n t i a b o r t i o n forces c a n eas i ly at tack the 1969 l a w as too l i b e r a l . F u r t h e r m o r e the 1969 l a w a n d the p o l i t i c a l b a r g a i n i n g o n w h i c h it is p r e m i s e d , exaggerates a l ready ex tant s o c i a l a n d g e o g r a p h i c i n e q u i t i e s w h i l e s e e m i n g to be e q u i t a b l e . It a l l o w s , f o r e x a m p l e , the o v e r w h e l m i n g l y m a l e p h y s i c i a n s o n abor t i o n c o m m i t t e e s to r e i g n s u p r e m e as they decide , p r e s u m a b l y o n m e d i c a l g r o u n d s , the fates of f e m a l e " p a t i e n t s " they g e n e r a l l y never see. G i f f o r d J o n e s , the p s e u d o n y m for a w i d e l y s y n d i cated C a n a d i a n m e d i c a l c o l u m n i s t , cites some e x a m p l e s of this : S o m e m e m b e r s of t h e r a p e u t i c a b o r t i o n c o m m i t t e e s have a d m i t t e d the i r reasons for r e j e c t i n g a n a p p l i c a t i o n for a b o r t i o n . F o r ins tance , a 40 year o l d w o m a n w h o became careless i n m i d d l e age a b o u t c o n t r a c e p t i o n s h o u l d be m a d e to suffer a n d bear a c h i l d . T h e i r r e s p o n s i b l e teenager m u s t be taught a lesson a n d a s s u m e the r e s p o n s i b i l i t y of m o t h e r h o o d , w h e t h e r able or n o t . A n d the w o m e n w i t h f ive c h i l d r e n c a n l e a r n to cope w i t h yet a n o t h e r . 2 1 W o m e n , u n d e r a b o r t i o n p o l i c y i n C a n a d a as it is present ly i m p l e m e n t e d , r u n a k i n d of roulet te w i t h the system. G i f f o r d J o n e s a g a i n cites e x a m -