Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
  • LinkedIn
  • Instagram
Article CommentaryCommentary

Therapeutic abortion counseling and provision

Are Canadian family physicians opting out?

Susan Phillips and Sonya Swift
Canadian Family Physician April 2016; 62 (4) 297-298;
Susan Phillips
Professor in the Department of Family Medicine at Queen’s University in Kingston, Ont.
MD CCFP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: phillip@queensu.ca
Sonya Swift
Second-year medical student at Dalhousie University in Halifax, NS.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

A pregnant 22-year-old woman is offered an abortion when prenatal screening suggests the fetus has Down syndrome. Another pregnant 22-year-old woman requests a therapeutic abortion (TA) for personal rather than medical reasons. Both make a choice based on what is best for themselves, the fetuses, and society. The first woman easily obtains this procedure; access to an abortion for the second woman might be constrained by lack of information or provider, or by the woman’s location or finances. What has happened to the accessibility, universality, and comprehensiveness guaranteed in the Canada Health Act?

In 1974, author 1 (S.P.) entered medical school. Contraception had been legal in Canada for a mere 5 years, and abortion was only available after a 3-doctor committee determined that continuing the pregnancy presented a risk to the pregnant woman’s health. Nevertheless, medical students were expected to present abortion as a choice when pregnancy was accidental or unwanted, and to know how first- and second-trimester abortions were performed. During their gynecology rotations, family medicine residents attended TA clinics, assessed uterine size, and completed the paperwork required for abortion approval. Participation was expected. The author’s recollection is that none of her residency colleagues opted out.

In 2014, when author 2 (S.S.) entered medical school, the era of illegal contraception and abortion seemed like ancient history. A 1988 Supreme Court ruling had removed the legal framework for abortion and recognized it solely as a medical procedure.1 Nevertheless, constraints on access remain, perhaps embedded in the values and religious beliefs of some practitioners and regulators.

From illegal to invisible

The “voices” of organized medicine view terminating a pregnancy as a personal decision. Following the decriminalization of abortion, the Canadian Medical Association adopted the following policy: The decision to perform an induced abortion is a medical one, made confidentially between the patient and her physician within the confines of existing Canadian law. The decision is made after conscientious examination of all other options.Induced abortion requires medical and surgical expertise and is a medical act. It should be performed only in a facility that meets approved medical standards, not necessarily a hospital.2

Similarly, the Society of Obstetricians and Gynaecologists of Canada states, Every woman seeking abortion should receive supportive and compassionate counselling on all the options available, including continuing the pregnancy and having the child adopted or seeking assistance should she wish to parent. Counselling should take place early enough to avoid any delays in the event the woman chooses to terminate the pregnancy. The counsellor should be free of personal bias and responsive to the woman’s circumstances.3And yet, medical education, practice, and policy have steadily rendered abortion invisible and unavailable in parts of Canada. All medical students must write examinations set by the Medical Council of Canada (MCC) to obtain licences to practise. Questions are linked to the MCC’s objectives. Section 082 of the 1999 objectives, titled “Contraception/Pregnancy Prevention/Termination,”4 stated that knowledge of termination was necessary and that students should be able to present contraceptive and termination alternatives while respecting the individual’s moral, ethical, and religious beliefs—not the doctor’s beliefs, but the patient’s. The current version of those MCC objectives (updated in November 2012) is quite different. Termination has disappeared completely. Abortion is addressed under professionalism and referred to as a “complex ethical issue” (section 6.7).5 Therapeutic abortion has been redefined as (and limited to) a necessary referral following a clinical finding (implying a fetal genetic abnormality) (sections 80 to 81).6

Aligning education with provision of care

In Canada there are 28 abortions for every 100 live births.7 Women seeking a termination will often consult with a family physician for referral. Approximately 61% of abortion providers are family physicians.8 How well does physician education align with provision of care? Family medicine residents are more likely to view abortion as an option and provide this service if they receive training.9 However, there is no mention of options counseling or abortion training in the 99 “priority topics,” the essential competencies the College of Family Physicians of Canada expects of those entering family practice.10 The Royal College of Physicians and Surgeons of Canada’s competencies for gynecology trainees are also silent on abortion as a choice. Therapeutic abortion is mentioned tangentially but not directly and is not among the detailed list of expected procedural competencies. By explicitly addressing only second-trimester abortions, the document implies (although does not state) that the indication for termination is an abnormal prenatal genetic screening result.11 Among the Royal College of Physicians and Surgeons of Canada’s enabling competencies for obstetricians and gynecologists is a statement that seems to remove direct responsibility for provision of care, suggesting that the specialist need only “facilitate medical care for patients even when that care is not provided personally or locally or when that care is not readily accessible (e.g., therapeutic abortion).”11

Put simply, the national organizations that guide the education of physicians have enabled TA to essentially disappear from training.

Family medicine residency programs across the country generally do not include abortion training and residents anecdotally report difficulty arranging elective instruction in provision of abortions. Canadian medical schools set their own curricula and, therefore, the nature and content of undergraduate teaching surrounding pregnancy termination will vary. Schools might very well be addressing counseling, assessment, procedural skills, etc. However, they, too, are subject to implicit or explicit pressure to make abortion invisible. One school refuses to allow their very clear teaching on reproductive choice to be recorded, as all other lectures are, stating that the content is overly sensitive. This is a decision made by the school rather than the lecturer. By recording lectures, the school ensures long-term student access to the knowledge being disseminated. Not recording this lecture limits information for future physicians.

Conclusion

Abortion is safe, available, and accepted as the most humane option for the woman, the fetus, and society when medicine-centred reasons (eg, fetal genetic anomalies) are identified. But, it would seem we are reverting to silence with respect to education, provision, and access when the reason for an abortion request is patient-centred rather than medicine-centred.

Footnotes

  • This article has been peer reviewed.

  • La traduction en français de cet article se trouve à www.cfp.ca dans la table des matières du numéro d’avril 2016 à la page e169.

  • Competing interests

    None declared

  • The opinions expressed in commentaries are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Dunsmuir M
    . Abortion: constitutional and legal developments. Ottawa, ON: Law and Government Division, Government of Canada; 1998. Available from: www.publications.gc.ca/Collection-R/LoPBdP/CIR/8910-e.htm. Accessed 2015 May 19.
  2. 2.↵
    1. Canadian Medical Association
    . Induced abortion. Ottawa, ON: Canadian Medical Association; 1988. Available from: http://policybase.cma.ca/dbtwwpd/PolicyPDF/PD88-06.pdf. Accessed 2015 May 18.
  3. 3.↵
    1. Davis VJ
    . Induced abortion guidelines. J Obstet Gynaecol Can 2006;184:1014-27.
    OpenUrl
  4. 4.↵
    1. Medical Council of Canada
    . Objectives for the qualifying examination. 2nd ed. Ottawa, ON: Medical Council of Canada; 1999. p. 162.
  5. 5.↵
    1. Medical Council of Canada
    . Professional. Objectives for the qualifying examination. 3rd ed. Ottawa, ON: Medical Council of Canada; 2012. Available from: http://apps.mcc.ca/Objectives_Online/objectives.pl?role=professional&lang=english&keys=abortion. Accessed 2016 Feb 26.
  6. 6.↵
    1. Medical Council of Canada
    , editor. Prenatal care. Objectives for the qualifying examination. 3rd ed. Ottawa, ON: Medical Council of Canada; 2012. Available from: http://apps.mcc.ca/Objectives_Online/objectives.pl?role=expert&id=80-1&lang=english&keys=therapeutic_abortion. Accessed 2016 Feb 26.
  7. 7.↵
    1. Statistics Canada
    . Induced abortions. The Daily 2008 May 21. Available from: www.statcan.gc.ca/daily-quotidien/080521/dq080521c-eng.htm. Accessed 2015 May 18.
  8. 8.↵
    1. National Physician Database
    . National Grouping System Categories Report, Canada 2003–2004. Ottawa, ON: Canadian Institute for Health Information; 2006.
  9. 9.↵
    1. Raymond E,
    2. Kaczorowski J,
    3. Smith P,
    4. Sellors J,
    5. Walsh A
    . Medical abortion and family physicians. Survey of residents and practitioners in two Ontario settings. Can Fam Physician 2002;48:538-44.
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    1. Working Group on the Certification Process
    . Priority topics and key features with corresponding skill dimensions and phases of the encounter. Mississauga, ON: College of Family Physicians of Canada; 2010. Available from: www.cfpc.ca/uploadedFiles/Education/Priority%20Topics%20and%20Key%20Features.pdf. Accessed 2016 Feb 23.
  11. 11.↵
    1. Royal College of Physicians and Surgeons of Canada
    . Objectives of training in the specialty of obstetrics and gynecology. Version 1.0. Ottawa, ON: Royal College of Physicians and Surgeons of Canada; 2013.
PreviousNext
Back to top

In this issue

Canadian Family Physician: 62 (4)
Canadian Family Physician
Vol. 62, Issue 4
1 Apr 2016
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Therapeutic abortion counseling and provision
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Therapeutic abortion counseling and provision
Susan Phillips, Sonya Swift
Canadian Family Physician Apr 2016, 62 (4) 297-298;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Therapeutic abortion counseling and provision
Susan Phillips, Sonya Swift
Canadian Family Physician Apr 2016, 62 (4) 297-298;
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • From illegal to invisible
    • Aligning education with provision of care
    • Conclusion
    • Footnotes
    • References
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • Avortement thérapeutique et counseling
  • PubMed
  • Google Scholar

Cited By...

  • Abortion remains absent from family medicine training in Canada
  • Lavortement toujours absent de la formation en medecine de famille au Canada
  • Google Scholar

More in this TOC Section

  • Toward an identity and team-based practice rooted in transdisciplinarity
  • Task sharing, community health workers, and Canada’s primary care crisis
  • Increased proportion of family medicine residents did not want to be family physicians
Show more Commentary

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • LinkedIn
  • Instagram
  • RSS Feeds

Copyright © 2025 by The College of Family Physicians of Canada

Powered by HighWire