Morning-after pill poses moral dilemma for some MDs
Doctors don't have to prescribe contraceptive pill but they have to
offer patients an alternative
The Standard (St.
Catharines - Niagara)
29 June, 2000
Reproduced with permission
Of the 10 doctors who rotate shifts in St.
Catharines General hospital's emergency room, only one will not prescribe
the emergency contraceptive pill on moral grounds. . .If a doctor is morally
opposed to a medical treatment, it is his or her obligation to provide the
patient with alternatives. . .
[Project Letter to the Editor]
When a young woman arrived in a panic at the St. Catharines General's
emergency department last month looking for a drug, commonly known as a
morning-after pill, she didn't expect to be told the doctor on duty wouldn't
give it to her.
The woman, who did not want to be identified for reasons of privacy, was
told by a nurse the doctor was morally opposed to the pill, which prevents
pregnancy after sex, and would not prescribe it.
The recent incident raises several questions about the controversial
issue of doctors refusing to administer a drug based on personal beliefs.
The issue set off a debate when the drug Preven, known as the
morning-after pill, was approved by Health Canada late last year. It is now
sold in some pharmacies.
"As far as a physician is concerned they can decide to give treatment or
withhold depending on his moral feeling,'' said Dr. Ashok Sharma, chief of
staff at the St. Catharines site of the Niagara Health System.
As long as doctors are upfront with their patients, give them sufficient
information or alternatives and fall within the province's Regulated Health
Professions Act, they have the right to limit their medical practice, said
Jill Hefley, spokeswoman for the College of Physicians and Surgeons of
"It is up to physicians to define the parameter of their practice,'' said
Of the 10 doctors who rotate shifts in St. Catharines General hospital's
emergency room, only one will not prescribe the emergency contraceptive pill
on moral grounds, said Sharma. The hospital would not release the name of
the physician and said the doctor did not wish to talk publicly about his
If a doctor is morally opposed to a medical treatment, it is his or her
obligation to provide the patient with alternatives, said Sharma.
In a non-emergency situation where contraception was not used during sex
or it failed, a doctor at St. Catharines General can recommend a woman go to
a walk-in clinic, a birth control centre or another hospital emergency room.
In a case of sexual assault, the circumstances change, said the chief of
"There is a standing order that they (doctors) have to give the pill in
any emergency,'' he said.
The Sexual Assault Treatment Centre, which serves the region, is located
at the hospital.
Women who fear an unwanted pregnancy have 72 hours after intercourse to
take the drug.
"It is not uncommon for people to come to get the morning-after pill,''
said Maria Vuono, program manager of the hospital's critical care unit.
The emergency room gets a handful of non-emergency requests each month
for the treatment, she said.
"ER is not the right place for contraceptive care,'' said Sharma. "We are
The emergency room can't provide sufficient counselling or follow-up
care. Family doctors or walk-in clinics provide more appropriate care, said
In the recent case of the St. Catharines woman, she was told by the nurse
on duty she had the option of either waiting until another doctor came on
duty or go to the St. Catharines birth-control centre or a walk-in clinic to
get the pill. She went to a centre.
Niagara Region runs three birth-control centres. If a woman goes to a
centre looking for the morning-after pill, she can't get it without a
"Emergency contraception is always prescribed by a physician,'' said Alan
Spencer, program manager of sexual health with the Region's public health
department. "People can access it through the clinic.''
The clinics in Welland and Niagara Falls are only open during the
afternoon. The St. Catharines clinic is open all day but doctors are not
on-duty at the three clinics at all times. If a physician is not available,
the woman will be referred to a family doctor or walk-in clinic, said
A person would only be denied the emergency contraceptive on a medical
and not a moral basis, he said.
"We believe in non-judgmental health treatment,'' said Spencer. "We want
people to be healthy.''
At Hotel Dieu Hospital, the decision to prescribe the drug is left to the
emergency room physician, said Rick Mauro, the hospital's spokesman.
The Catholic hospital would prefer to refer a woman to the city's other
hospital because it is better equipped to deal with such cases, said Mauro.
However, administering the drug is still a decision each doctor must
make, said Mauro.