Late abortions: "disorganized" and "discriminatory" services
Doctors "stigmatized, even intimidated". Women rejected by hospitals. Others who are “forced to continue the pregnancy”,
for lack of access. A confidential report commissioned by the College of Physicians reveals the climate
in which third-trimester abortions are performed in Quebec.
The Clinical Ethics Working Group of the College of Physicians of Quebec (CMQ), author of the report obtained by La Presse , severely denounces the current state of services, which it describes as "disorganized", "discriminatory" and "unacceptable" . In Canada, the termination of pregnancy is legal, unconditional, and whatever the time of pregnancy, recall its authors. They suggest setting up a specialized center with the mandate to perform third-quarter abortions in one province for the province.
Omerta
The official term is "voluntary termination of late pregnancy". It refers to abortions performed after 23 weeks of gestation.
And even in the corridors of hospitals, it is controversial.
In Quebec, a few handfuls of women request it each year. Sometimes they did not know until then that they were pregnant, others live "difficult, even tragic social situations", explains the document. “More recently, there have been requests following Zika virus infection and requests for selective abortion. Cultural reasons may also be involved. The report also reports on maternal health problems and serious fetal abnormalities.
As a sign of the climate prevailing on this subject in the health network, the College of Physicians, sponsor of the report, refused to comment on it so as not to "jeopardize the safety of women and caregivers" and "not to open a debate on this delicate issue ”.Same response to the Federation of Medical Specialists of Quebec (FMSQ).
for lack of access. A confidential report commissioned by the College of Physicians reveals the climate
in which third-trimester abortions are performed in Quebec.
The Clinical Ethics Working Group of the College of Physicians of Quebec (CMQ), author of the report obtained by La Presse , severely denounces the current state of services, which it describes as "disorganized", "discriminatory" and "unacceptable" . In Canada, the termination of pregnancy is legal, unconditional, and whatever the time of pregnancy, recall its authors. They suggest setting up a specialized center with the mandate to perform third-quarter abortions in one province for the province.
Omerta
The official term is "voluntary termination of late pregnancy". It refers to abortions performed after 23 weeks of gestation.
And even in the corridors of hospitals, it is controversial.
In Quebec, a few handfuls of women request it each year. Sometimes they did not know until then that they were pregnant, others live "difficult, even tragic social situations", explains the document. “More recently, there have been requests following Zika virus infection and requests for selective abortion. Cultural reasons may also be involved. The report also reports on maternal health problems and serious fetal abnormalities.
As a sign of the climate prevailing on this subject in the health network, the College of Physicians, sponsor of the report, refused to comment on it so as not to "jeopardize the safety of women and caregivers" and "not to open a debate on this delicate issue ”.Same response to the Federation of Medical Specialists of Quebec (FMSQ).
We will not comment on this matter as long as there are doctors who are the subject of death threats.
We must protect them to guarantee the provision of care for women.
Doctors who work and campaign in the field also declined our interview requests.
A community worker who requested anonymity told us that professionals who perform this type of abortion are called "baby killers" by colleagues.
In addition, there are threats from anti-abortion activists. A health professional who also wanted to keep
her name silent said that security issues cause "a lot of concerns" for the teams.
"It's still very taboo," notes Patricia LaRue, director of the Outaouais Women's Health Center. Even those who perform first trimester abortions are still discriminated against in their environment. They are told: "We know, you kill babies". "
Doctors who agree to perform third trimester abortions work in such a secret that even Ms. LaRue,
who is nevertheless immersed in the community, does not know their identity.
These names do not circulate.
The CMQ Clinical Ethics Working Group is aware of the discomfort. “The termination of pregnancy raises moral issues such that they crystallize the debate, pro-life versus pro-choice. The late termination of pregnancy, which concerns the fate of a fetus closer to the end of pregnancy, exacerbates the pro-life arguments and makes the decision to proceed more difficult for both the woman concerned and the caregivers ” , he writes.“Whether it is for the pregnant woman, the couple or the caregivers, the fact of ending the life of a fetus
capable of surviving a termination of pregnancy is a source of suffering. "
It is in this context that the group studied the subject. His findings are sharp.
"Sell your salad"
Each year, between 10 and 25 women are sent by the state to the United States for abortion after 23 weeks of gestation because no one here wants to perform the procedure. An “unacceptable” practice, slices the report, which costs between $ 10,000 and $ 15,000 each time, depending on the age of the fetus. These agreements with American clinics are relatively well known to the general public. In May, La Presse revealed that Quebec was considering repatriating services to Quebec.
What the CMQ document reveals is that such abortions are already performed here, in an exceptional and discreet manner,
in cases where women cannot or do not want to go to the United States.
Only one hospital center in the province, whose name we do not publish for safety reasons,
has an official service agreement for this type of care.
It accepts women according to specific criteria: mental health problem, drug or alcohol dependence and "complex psychosocial problems".
Those who do not enter any of these boxes and who cannot obtain a passport must find and convince a doctor somewhere in Quebec who will then try to obtain authorization from the establishment where he practices and a team open to assisting with the intervention, notes the report. Otherwise, they will "often be forced to continue the pregnancy".
"In Quebec, there is consensus for the first quarter, but when we talk about the second and third quarter, it becomes an area of discomfort, says a health professional. People say it doesn't make sense to have an abortion at this point. But they don't know the stories of these women. A good example is domestic violence. A love story that begins with a desired pregnancy. Jealousy sets in, then violence. For women, abortion is a love decision that tears their hearts out. She does not want to give birth to a child in violence and she wants to be detached from her attacker. "
As director of the Outaouais Women's Health Center, Patricia LaRue sometimes has to supervise women for a late abortion. " It's very complicated. There are some who have a criminal record, others who are homeless or who come from certain cultural communities for whom it is almost impossible to travel and who end up continuing their pregnancy even if it is not desired. "
To convince a doctor to perform such an intervention, says Ms. LaRue, "you have to lobby as if you were dealing with a therapeutic committee of the 80s. When there is a very significant fetal malformation, it's easier , but otherwise, it is almost impossible ”.
Dr. Geneviève Bois works at the Montreal Women's Health Center. It tells a similar reality. “After 24 weeks, you have to take steps, you have to explain yourself, you have to deserve a procedure that is difficult to access. Why would a woman's access to an abortion be determined by her ability to sell her salad, to tell a pretty sad story? Not everyone has the same ability to express their thoughts and reasons. "
This reality is severely criticized. “It is unacceptable for hospitals to impose criteria limiting their access after 23 weeks of pregnancy. A hospital center should welcome all pregnant women who suffer an in utero death, whatever the term of the pregnancy and whatever the reason,
”decide the ethicists of the College of Physicians.
Conscientious objection
There is no question here of forcing health professionals to perform abortions. As in the case of medical assistance in dying, the Task Force on Clinical Ethics recognizes the right to raise a conscientious objection “while respecting not only the values and wishes of women,
but also their professional responsibilities of clinician ”, on the condition of directing the patient towards a colleague.
"The challenge is not to provide a purely technical response to the request of the pregnant woman,
but to provide her with the best possible care", we read.
“The limits of doctors must be respected, like those of healthcare teams. "But" an institutional objection is not allowed ".
In the office of Minister of Health Danielle McCann, we are clear. “We want to protect the right of women to abortion. It is up to them to decide what they do with their bodies, whether in the third, second or first quarter, said McCann's press secretary, Alexandre Lahaie. We understand that third trimester abortion is very delicate. It is an issue that we look at with respect and caution. You can't force doctors to perform abortions. "
We must protect them to guarantee the provision of care for women.
Doctors who work and campaign in the field also declined our interview requests.
A community worker who requested anonymity told us that professionals who perform this type of abortion are called "baby killers" by colleagues.
In addition, there are threats from anti-abortion activists. A health professional who also wanted to keep
her name silent said that security issues cause "a lot of concerns" for the teams.
"It's still very taboo," notes Patricia LaRue, director of the Outaouais Women's Health Center. Even those who perform first trimester abortions are still discriminated against in their environment. They are told: "We know, you kill babies". "
Doctors who agree to perform third trimester abortions work in such a secret that even Ms. LaRue,
who is nevertheless immersed in the community, does not know their identity.
These names do not circulate.
The CMQ Clinical Ethics Working Group is aware of the discomfort. “The termination of pregnancy raises moral issues such that they crystallize the debate, pro-life versus pro-choice. The late termination of pregnancy, which concerns the fate of a fetus closer to the end of pregnancy, exacerbates the pro-life arguments and makes the decision to proceed more difficult for both the woman concerned and the caregivers ” , he writes.“Whether it is for the pregnant woman, the couple or the caregivers, the fact of ending the life of a fetus
capable of surviving a termination of pregnancy is a source of suffering. "
It is in this context that the group studied the subject. His findings are sharp.
"Sell your salad"
Each year, between 10 and 25 women are sent by the state to the United States for abortion after 23 weeks of gestation because no one here wants to perform the procedure. An “unacceptable” practice, slices the report, which costs between $ 10,000 and $ 15,000 each time, depending on the age of the fetus. These agreements with American clinics are relatively well known to the general public. In May, La Presse revealed that Quebec was considering repatriating services to Quebec.
What the CMQ document reveals is that such abortions are already performed here, in an exceptional and discreet manner,
in cases where women cannot or do not want to go to the United States.
Only one hospital center in the province, whose name we do not publish for safety reasons,
has an official service agreement for this type of care.
It accepts women according to specific criteria: mental health problem, drug or alcohol dependence and "complex psychosocial problems".
Those who do not enter any of these boxes and who cannot obtain a passport must find and convince a doctor somewhere in Quebec who will then try to obtain authorization from the establishment where he practices and a team open to assisting with the intervention, notes the report. Otherwise, they will "often be forced to continue the pregnancy".
"In Quebec, there is consensus for the first quarter, but when we talk about the second and third quarter, it becomes an area of discomfort, says a health professional. People say it doesn't make sense to have an abortion at this point. But they don't know the stories of these women. A good example is domestic violence. A love story that begins with a desired pregnancy. Jealousy sets in, then violence. For women, abortion is a love decision that tears their hearts out. She does not want to give birth to a child in violence and she wants to be detached from her attacker. "
As director of the Outaouais Women's Health Center, Patricia LaRue sometimes has to supervise women for a late abortion. " It's very complicated. There are some who have a criminal record, others who are homeless or who come from certain cultural communities for whom it is almost impossible to travel and who end up continuing their pregnancy even if it is not desired. "
To convince a doctor to perform such an intervention, says Ms. LaRue, "you have to lobby as if you were dealing with a therapeutic committee of the 80s. When there is a very significant fetal malformation, it's easier , but otherwise, it is almost impossible ”.
Dr. Geneviève Bois works at the Montreal Women's Health Center. It tells a similar reality. “After 24 weeks, you have to take steps, you have to explain yourself, you have to deserve a procedure that is difficult to access. Why would a woman's access to an abortion be determined by her ability to sell her salad, to tell a pretty sad story? Not everyone has the same ability to express their thoughts and reasons. "
This reality is severely criticized. “It is unacceptable for hospitals to impose criteria limiting their access after 23 weeks of pregnancy. A hospital center should welcome all pregnant women who suffer an in utero death, whatever the term of the pregnancy and whatever the reason,
”decide the ethicists of the College of Physicians.
Conscientious objection
There is no question here of forcing health professionals to perform abortions. As in the case of medical assistance in dying, the Task Force on Clinical Ethics recognizes the right to raise a conscientious objection “while respecting not only the values and wishes of women,
but also their professional responsibilities of clinician ”, on the condition of directing the patient towards a colleague.
"The challenge is not to provide a purely technical response to the request of the pregnant woman,
but to provide her with the best possible care", we read.
“The limits of doctors must be respected, like those of healthcare teams. "But" an institutional objection is not allowed ".
In the office of Minister of Health Danielle McCann, we are clear. “We want to protect the right of women to abortion. It is up to them to decide what they do with their bodies, whether in the third, second or first quarter, said McCann's press secretary, Alexandre Lahaie. We understand that third trimester abortion is very delicate. It is an issue that we look at with respect and caution. You can't force doctors to perform abortions. "
The department, he says, is still working to repatriate services that are available in the United States. Discussions in this direction are notably underway with a Montreal hospital. “We are aware that the hospitals that do it at the moment are limited and have specific criteria. "
The law
The abortion provisions of the Criminal Code were found unconstitutional in 1988 by the Supreme Court of Canada in the now famous R. v. Morgentaler.
Since then, no law has regulated the practice of abortion.
In Canada, abortion is legal, regardless of gestational age. It is publicly funded as a medical procedure under the Canada Health Act.
In Quebec, abortion is regulated, like any other medical procedure, by the Health and Social Services Act,
health insurance and clinical standards of professional orders.
No more crime since 1988
In 1969, the Criminal Code was amended to open abortion to pregnant women who would obtain the approval of a committee on therapeutic abortion. This committee was made up of doctors responsible for assessing whether the woman's health or life was in danger.
Until 1988, in all other situations, abortion was a crime.
The law
The abortion provisions of the Criminal Code were found unconstitutional in 1988 by the Supreme Court of Canada in the now famous R. v. Morgentaler.
Since then, no law has regulated the practice of abortion.
In Canada, abortion is legal, regardless of gestational age. It is publicly funded as a medical procedure under the Canada Health Act.
In Quebec, abortion is regulated, like any other medical procedure, by the Health and Social Services Act,
health insurance and clinical standards of professional orders.
No more crime since 1988
In 1969, the Criminal Code was amended to open abortion to pregnant women who would obtain the approval of a committee on therapeutic abortion. This committee was made up of doctors responsible for assessing whether the woman's health or life was in danger.
Until 1988, in all other situations, abortion was a crime.