Caring for Both:  Pregnancy Care that Respects Life

Provincial College guidelines and the Canadian Medical Association Code of Ethics require physicians to "Provide your patients with the information they need to make informed decisions about their medical care, and answer their questions to the best of your ability." As well Canadian doctors are to "inform your patient when your personal morality would influence the recommendation or practice of any medical procedure that the patient needs or wants."  1

Quebec family physician Dr. André Bourque notes that a pro-life physician's "dissenting view is likely to be more easily accepted if dissenting physicians demonstrate that they are not merely refusing to prescribe a type of medication or procedure but are going out of their way to truly help patients within the boundaries of their beliefs."

Respect for the Patient

"Pregnancy counselling that respects life starts with a generous, considerate and respectful attitude towards the patient," says Ontario family physician Dr. Deborah Zeni. "A woman who presents with an unplanned or unwanted pregnancy will probably need gentle encouragement to talk of her pregnancy and her feelings. I start with leading questions which give her an opportunity to express her fears, anxieties and feelings about the unwanted pregnancy. Needless to say, this can get messy, as some home lives are dreadful. I assiduously avoid the line, 'I know what you are feeling, but.' I believe this comment undercuts the patient's sense that I am listening and caring."

Dr. Larry Reynolds of London, Ontario, notes that women facing crisis pregnancies have often experienced severe rejection at the hands of their family, partner or other friends so it is particularly important that as her doctor he does not leave her feeling rejected or isolated from access to life-giving solutions to her crisis pregnancy.

Exploring Options

"I go over the positives and negatives of all three options with an unwanted pregnancy: keeping the baby, adoption, and abortion," says Alberta family physician Dr. Christin Hilbert. "I have the patient listing the positives and negatives. Then I give her the sheet and tell her that she's got a lot to think about, and that I will be there if she has any other questions. But if she chooses to go the abortion route, then I can't participate in that for reasons of my own conscience."

Dr. Dave Hepburn writes a humourous medical column and practices medicine in Victoria, BC. He writes, "With most patients quite distressed at the news of an unplanned or unwanted pregnancy I feel this is an important time to take a deep breath and consider the three options.

1. Having a baby. There seems to almost never be a perfect time anymore to have a baby. A huge proportion of girls/women who are pregnant never planned it that way. Few ever reply when informed they are pregnant, "I know, I designed it that way.'' Though this is the option their mother obviously chose, today in a world where career aspirations, financial instability and tenuous relationships are such complicating factors, having a baby becomes less and less "convenient.''

2. The adoption option. In every doctor's desk drawer sit stacks of letters and packages he/she has received from couples who are unable to have children and are pleading with us as physicians to inform any pregnant girl who is uncertain as to what to do, that they would love the opportunity to raise that child. These heart-rending pleas are accompanied by photos, detailed histories of the prospective parents and even financial statements and promises.

Though no less difficult than the other options and by no means perfect, I favour this option for unwanted pregnancies. Not only does it enrich the lives of a childless couple, but, were I the prospective baby I'd lobby hard for this option.

3. Abortion. We discuss abortion and then I explain that I personally, as a doctor, have a difficult time participating in any part of this process. I ask them to take time and discuss the options with parents or someone whose opinion they know to be wise."  2

Motherhood Misconceptions

Chatelaine magazine's October 2000 feature article "Motherhood Misconceptions" reveals the success of many young mothers and those in disadvantaged circumstances. Reporting on a study initiated by the Nova Scotia Department of Community in 1978, tracking 700 mothers and their children over the next 20 years, the researchers comment "Life doesn't stop at adolescence, even for people who start families before we think they should. Teen parenting is not a permanent state."

Dr. Zeni agrees. "When we discuss the possibility of my patient actually raising the child I am warmly supportive, regardless of the age of the woman. Women who show their regard and love for their infant at this early stage generally do very well if they go on and raise the baby themselves. For many of them, the pregnancy and early infancy are a time when they begin to integrate successfully into an educational community and other community support services."

Dr. Bourque tells his patients "Under the best of circumstances, mothering a child will be one of the greater challenges of a woman's life. Accepting the responsibilities of an unplanned pregnancy is truly a great challenge. I wish to offer you my support as a physician should do. I can also refer you to help, that you should not be discouraged or in need of shelter or food or of assistance to pursue your studies or other projects. There are many resources in the community to support a mother in the face of an unwanted pregnancy."

Abortion counselling

Calgary family practitioner Dr. Joe Askin believes that refusing to discuss the abortion option with patients is a serious mistake. "Giving information is not the same as participation and just may cause a patient to reconsider her position. physicians should have at their fingertips up to date data regarding abortion procedures and complications (eg. growing evidence of serious breast cancer risk.)"

Dr. Bourque observes that most women do not desire an abortion, but feel driven to it by the circumstances and people who would advise them to take that path. He tells his patient, "You are asking for my help as a physician and I truly wish to assist you. I believe that life begins at conception and that abortion, the destruction of a human being, is wrong. A physician's primary role is to be of service to life, to every life, however small and frail. .You must first decide to do what is right, what your conscience tells you to do. I urge you to think it over. Whatever your decision will be, I will not reject you, I will be happy to assist you as a physician."

Dr. Zeni admits that exploring a patient's reasons for seeking an abortion as 'the' solution is emotionally difficult. "But I try to be open. This enables me to help her ask whether the problems and difficulties that are in her life are just a result of the pregnancy, or whether they have been there for a while. Frequently, the desire for an abortion is a sign that the pregnancy is forcing hidden issues into the open. Many of these problems cannot be solved easily, but I offer hope, encouragement, follow-up, and if appropriate, a referral to another support service.

If, despite these interventions, abortion is still seen as the only option, I politely inform the patient that I can't refer her for an abortion. I know that her unborn baby is my patient, too, and I cannot prescribe what is harmful. Rather, I tell her that I want the best for her and for her child. I let her understand from the language that I use that the baby is special, unique, alive, and very much a person. I suggest that she take the time to think about things, and discuss the problems with family and friends. I offer to help as an intermediary or as an advocate.

At the end of the appointment, especially if my patient is still adamant about seeking an abortion, I let her know that she is welcome to come back to our office anytime and we will continue to care for her, regardless of her ultimate decision."

Two Patients

A physician's duty of care extends to two patients in the case of a pregnant woman - the woman and her unborn child. For a woman to make a truly "informed decision" she must be presented with the facts of human embryology of her unborn child so that she will know that what she is aborting is a human being, not just a clump of cells or a piece of her own tissues. Withholding basic information shows disrespect for women and is, according to Dr. Reynolds, both dishonest and patronizing, since it implies that women are too weak to know the truth.

Says Dr. Zeni, "As I write this, foremost in my mind are all the special children in our practice whose mothers reconsidered. Their mothers made that very generous and loving decision to nurture their baby, and gave them the gift of love-life. These children are worth the sacrifice, and more than worth any difficulties and pain that I experience in counselling women who seek an abortion."

1.  Code of Ethics of the Canadian Medical Association. Approved by the CMA Board of Directors, October 15, 1996

2.  David Hepburn, "Dr. Dave tackles medical ethical controversies," The Free Press , March 7, 2000