Promises, promises

Canadian law reformers promise tolerance, freedom of conscience

What happens after the law is changed is another story.

Sean Murphy*

Introduction

With the passage of the Quebec euthanasia law and the pending decision in Carter v. Canada in the Supreme Court of Canada, physicians, medical students, nurses and other health care workers opposed to euthanasia and assisted suicide for reasons of conscience are confronted by the prospect that laws against the procedures will be struck down or changed.  They may wonder what the future holds for them if that happens. 

Will they be forced to provide or assist with something they find morally abhorrent?  If they refuse to do so, will they be disadvantaged, discriminated against, disciplined, sued or fired?  Will they be forced out of their specialty or profession, or forced to emigrate if they wish to continue in it?

The realpolitik of law reform

These questions have been largely ignored, since much of the public debate about euthanasia and assisted suicide has been about whether or not the procedures should be legalized, not about what effect legalization might have on freedom of conscience, particularly among health care workers.  Opponents of legalization understandably decline to raise the issue because they are concerned that doing so would compromise the message they want to deliver. 

Advocates of legalization, on the other hand, generally recognize that support for euthanasia and assisted suicide may begin to evaporate if it appears that they intend to force unwilling physicians or health care workers to participate in killing patients.  In particular, they do not wish to alienate members of the health care community who, on principle or as a matter of prudent self-interest, would not support such a coercive policy.  Instead, they adopt a reassuring posture of respect for freedom of conscience and tolerance for opposing views within the medical profession.

It is instructive to see how this strategy has been applied in the case of the Quebec euthanasia law and the Carter case, and then to consider how it was applied in the case abortion, another morally controversial procedure.  While we cannot predict the future, we are now in a position to judge the worth of the assurances given when abortion was legalized over forty years ago, and to apply that judgement to assurances now being made about euthanasia. 

Euthanasia Law Reform

Redefining the practice of medicine in Quebec

During 2013 committee hearings into the bill that ultimately became Quebec's euthanasia law (An Act Respecting End of Life Care), committee member Dr. Yves Bolduc, a physician and former Quebec minister of health, repeatedly drew attention to the fact that the law purports to establish a "practically inalienable" legal right to euthanasia, which imposes an obligation on all health care institutions in the province to fulfill demands for it.1  Thus, even though only a minority of patients are expected to seek the service, the law requires that the whole health care delivery system be arranged to accommodate them.2  

Moreover, he reminded his colleagues that genuine respect for physician freedom of conscience added another level of difficulty, "[b]ecause there are three elements: you have the right of the patient, you have the obligation of the institution and then you can also have your conscientious objection."3

[I]f we find ourselves in places where death is relatively imminent and there is nobody in the medical team who can perform these tasks, will this not undermine the right of the patient or prevent the person who has a conscientious objection, from acting on his conscientious objection?4

"What will be the priority or have primacy?" he asked. "Will it be the patient's right?"

"Or," he asked, "will there be a way to force professionals to provide the service?"5

Dr. Bolduc asked the question only to emphasize that, "in reality" (in his view) no physician could be forced to do so.6  Dr. Bolduc did not offer principled reasons to support his view.  His argument was purely pragmatic: 

 If we start with that principle, then you will destroy the bill. Society is in agreement to date, according to the polls, but if you start to force people to do things like this, if you want my opinion, you can talk because you defend a position, but I will not follow you that far, that's for sure. Most professionals do not follow you that far.7

His warning was addressed to the Quebec Association for the Right to Die with Dignity, which responded, that it had always said that it respected "the freedom of the professional."  Speaking for the Association, Hélène Bolduc (no relation to the legislator) said that the organization had never had any intention of forcing physicians to provide euthanasia, as "there is not a doctor who would do it well if, in addition, it was not his inclination to do so, and it is not to anyone's advantage to give this impression."8

The exchange highlights the strategic importance of minimizing opposition that would almost certainly arise if it became clear that legalizing a morally contested procedure (in this case euthanasia) would result in harassment and coercion of and discrimination against health care workers opposed to it for reasons of conscience.  Dr. Bolduc feared - quite rightly - that an expectation of such persecution would destroy the chances of the bill being passed.  The same pragmatic reasoning underlay provisions in the new law that exempt Quebec hospices from a legal obligation to kill their patients under the terms of the statute.9

Redefining the practice of medicine in Carter v. Canada

The plaintiffs in Carter brought an action in the Supreme Court of British Columbia seeking the legalization of physician assisted suicide and euthanasia.  An obligation to at least facilitate euthanasia and assisted suicide was implicit in their notice of claim10 and in the testimony of a plaintiff witness, Professor Margaret Battin, who implied that a physician's refusal to provide assisted suicide or euthanasia would amount to unethical abandonment of patients.11 It appears as an explicit assertion in a report12 introduced as evidence by the appellants.13  Professor Jocelyn Downie, one of the authors of the report, instructed the appellant's expert witnesses.14

Nonetheless, the trial judge stated that there was no need to consider the situation of objecting health care providers, since the plaintiffs did not assert that physicians should be compelled to provide euthanasia or assist in suicide.15  For the same reason, the appellants opposed an intervention in the case by the Protection of Conscience Project, Catholic Civil Rights League and Faith and Freedom Alliance:

Furthermore, each of these proposed interveners' main submission appears to be that no physician and/or medical institution should be compelled to assist in a patient's death because this would violate that physician's freedom of religion and conscience. As the appellants have never argued that any physician should be compelled to perform PAD, these proposed interveners seek to raise issues not properly before the Court.16

Lawyer Josephy Arvay again offered this reassurance in oral submission before the Supreme Court of Canada.

"[N]o one," he said, "is suggesting that a physician who has a religious objection to assisting a patient with his or her death must do so."17

It is obvious that this approach may help to get a contentious law passed or to convince a court to legalize a morally contested procedure.  The same approach was taken to achieve abortion law reform in Canada.

Abortion law reform: promises made

"Leave the choice to individual conscience"

In the mid-1960's, when Canada was  moving toward liberalization of its abortion law,  abortion reform advocates frequently portrayed themselves as champions of freedom of conscience.

The Globe and Mail, for example, in 1965, demanded liberalization of the law "to enable doctors to perform their duties according to their conscience and their calling."18

Two years later, in 1967, an editorial in the Globe and Mail stated that the Government had decided "that where religious moralities conflict, the State should support none, but leave the choice to individual conscience. It is a policy that should also be followed with abortion."19

Three Private Members Bills on abortion were introduced in1967 and referred to the House Standing Committee on Health and Welfare. One of these, Mr. Herridge's bill, had a conscience clause almost identical to British Abortion Act.20 A second bill, introduced by M.P. Ian Wahn, though titled, An Act to Amend the Criminal Code (Birth Control), included a clause legalizing abortion. The explanatory note appended stated that the bill concerned "acts of birth control which more properly should be left to individual conscience and to ecclesiastical and moral laws and not made the subject of criminal legislation."21 

M.P. Grace MacInnis was the sponsor of a third bill.22  She told the committee that, as in the use of birth control, the decision to have an abortion was a matter of "individual conscience."22

I believe the change in the abortion laws ought to be made as we recommended in this Committee in connection with birth control- on the basis of individual conscience--and that no one should be obliged to submit to abortion if she does not want to do so. But, on the other hand, no one should be denied it on the basis of these grounds.24

What she meant by "no one should be denied it on the basis of these grounds" was never clarified.  She later expanded on how she believed the law would work.

But where a woman thought she came within one of these categories and
wanted to have an abortion, then I think she would go to her doctor, and if the doctor and another registered medical man thought that it was legal and proper for her to have that abortion, then she would have it. . . to my mind that does leave it pretty largely to individual conscience with, of course, the safeguards on individual conscience that we would put in this bill. (emphasis added)25

The observation that physicians would provide an abortion only if they thought it "legal and proper" would seen to preclude compulsion.  More important is the reference to "safeguards on individual conscience that we would put in this bill," which may have been a reference to the kind of protection of conscience provision found in Mr. Herridge's bill.  This, too, was not clarified.  MacInnis said only that "we are a democratic country" and that she thought it "very important that we provide a freedom of choice."26

"Nobody," she promised, "would be forcing abortion procedures on anybody else."27

As will be seen presently, she would later vehemently repeat this promise in the House of Commons.

The Omnibus Bill: no protection of conscience provision

In December, 1967, the Omnibus Bill was introduced in the House of Commons. This included what later became Canada's new abortion law.  It did not include a protection of conscience clause, but its absence did not set off any alarms.  For example, the Canadian Welfare Council, considering new abortion law, stated:

At the risk of labouring the obvious, no woman will be required to undergo an abortion, no hospital will be required to provide the facilities for abortion, no doctor or nurse will be required to participate in abortion.28

Nor was the Catholic Hospital Association concerned:

We note that there is no question of [our hospitals] being obliged to change their present norms of conduct. On the contrary, proponents of a 'liberalized' abortion law admit that it should exempt those who object to being involved in procuring abortions.29

Concerns raised

The progress of Omnibus bill was interrupted by the election of 1968, but returned to the Commons the following year, with Pierre Trudeau as Prime Minister, and John Turner as Minister of Justice.  By then, concerns were being expressed that legalization of abortion would result in prosecution of or lawsuits against physicians who refused to provide the procedure.30 However, Lore Perron, President of the Association for the Modernization of Canada's Abortion Law, insisted that the proposed law would permit those opposed to abortion "to follow their conscience" and rebuked members of parliament opposed to the bill for imposing their beliefs on others.31

In April, 1969, as the Omnibus Bill was debated in the House of Commons, the Conference of Catholic Bishops unanimously passed a resolution urging that the bill be amended to prevent lawsuits from being launched against physicians who refused to perform abortions for reasons of conscience.  Bishop Alexander Carter of Sault Ste. Marie explained that the bishops were concerned that "Catholic hospital authorities or doctors might become liable to lawsuits in certain circumstances if they refuse to perform abortions."32

Speaking days before a crucial vote on a protection of conscience amendment to the bill, Conservative M.P. Georges Valade warned that "the Canadian bill gives no protection for a doctor who does not wish to perform abortions, he said, and it leaves the way open for attacks on the doctor's freedom as a moral human being and on his principles as a doctor."33  

Protection of conscience amendment rejected

Seven of the amendments proposed by the Creditistes and Progressive Conservatives were intended to address this problem by guaranteeing the right of conscientious objection to individuals or institutions. It was agreed that debate on one of the amendments would dispose of all seven. What was then debated was to the following effect:

Nothing in the new law shall be construed as obliging any hospital to establish a therapeutic abortion committee, or any qualified medical practitioner to procure an abortion, or any member of a hospital staff to assist in abortion.34

This conscience clause had been proposed by Robert McCleave, an M.P. who was in favour of abortion.35

Justice Minister John Turner responded that the conscience clause was unnecessary, stating, "We have no evidence that questions of conscience have posed a practical problem." 

The assertion was absurd, since, given the general criminal prohibition of abortion, it was extremely unlikely that any but willing physicians were providing the procedure.  Beyond that, Mr. Turner assured the Commons that the proposed law

• imposed no duty on hospitals to set up committees,
• imposed no duty on doctors to perform abortions,
• did not even impose a duty on doctors to initiate an application for an abortion.36 

The protection of conscience clause was rejected.  One of those voting against the clause was Liberal M.P. Stanley Haidasz, a physician.37  Years later, recognizing the problem created by the law, Dr. Haidasz would introduce a protection of conscience bill in the Canadian Senate.38

Assurances: "respect for people who do not believe in abortions"

However, in 1969 reformers were in the ascendant, proclaiming their support for tolerance and freedom of conscience. M.P. Grace MacInnis conceded that those opposed to abortion were entitled to hold and express their beliefs.

But I will not permit the impression to be left by them that this legislation will in any way force abortions on people who do not want abortions and who do not believe that they are right. This legislation will apply only to those who want and who believe in the necessity of abortions.

In spite of much that has been said and implied, no one will force an abortion on any woman who does not want one. No one is going to force a doctor to perform an abortion if he does not want to perform it.

For far too long the minority in this country has held back the majority in this matter.  . . Now it is time that the majority be allowed the right to act according to their conscience, while respecting the right of the minority to continue in their own way according to their own conscience. The other night I heard the Creditiste leader say on television in loud and clear tones, "They must respect us as we respect them." We intend to respect them and we have proven that respect. This legislation will show respect for people who do not believe in abortions.(Emphasis added.)39

This kind of high-sounding rhetoric was very reassuring.  However, the following examples demonstrate that, once the law is changed, promise making does not translate readily into promise keeping.   

Abortion law reform: promises broken

• 1970:  British Columbia Health Minister Ralph Loffmark told the Annual General Meeting of the British Columbia Medical Association that "all hospitals which ban abortions on religious grounds may be forced to change their policies."
  • The chairman of the BCMA hospital committee said that he believed most of his colleagues would support the requirement, but it was acknowledged that the law permitted but did not require provision of abortions.40
• 1970-1974:  There were repeated calls and suggestions that all publicly funded hospitals- or all hospitals - must be made to perform abortions.
  •   The Globe and Mail (that erstwhile champion of freedom of conscience) stated, "[H]ospital boards should never have been allowed a choice in the matter. The Government should . . . require hospitals which receive public grants to establish abortion committees."41
• 1992:  British Columbia Health Minister Elizabeth Cull ordered over 30 B.C. hospitals to perform abortions.42

• 1971:  Frances Martin, head nurse in the labour-delivery unit at the Hamilton Henderson Hospital,  refused to assist at abortions for moral an religious reasons.  She was demoted and transferred.43
• 1977-1984:  Nurse Linda Bradley was denied employment at four British Columbian hospitals because she did not want to assist with abortions. Desperate, she sacrificed her convictions to get a job at the Richmond General Hospital. She lost it after refusing to assist at the hysterotomy of a mother, five and a half months pregnant.44
• 1979:  A medical student threatened with failure for expressing opposition to abortion.44
• 1988:  Paediatric nurses in a Mississauga hospital were told to assist in abortions or accept transfers.46
• 1993-1998:  Maternity nurses at the Markham-Stoufville Hospital were ordered to assist with abortions or face transfer.47
• 1997:  Thunder Bay nurses transferred from St. Joseph's Catholic Hospital to a public hospital were forced to participate in abortions.48
• 1999:    Postpartum nurses at Foothills Hospital in Calgary were told that they would have to be involved with late term abortions, regardless of their moral convictions.49
• 2004:    A medical student received a failing grade after completing his hospital rotation in obstetrics and gynecology because of his opposition to abortion and related issues.50

• 1970-1975:  A biography of Dr. Henry Morgentaler described how he and his staff performed an abortion on a shouting, squealing 16 year old severely retarded girl who could not understand what was happening.51
• 1999:  A Quebec Court ordered the abortion and sterilization of a mentally ill woman who was not capable of requesting or consenting to the procedures.52 

• 1973:  Dr. Robert Walley joined the faculty of medicine at Memorial University.  When the medical school discovered views on abortion, influential people tried to force him out.53
• 1985:  BC welfare worker Cecilia Moore was fired for refusing to authorize payment for an abortion that would have been illegal under the law as it then stood.54
• 1989:  Three transition house workers in Ontario were fired - with the government's approval - for refusing to refer women for abortions.55
• 1988-1990:  Constable David Packer was forced out of the Metropolitan Toronto Police for refusing to guard what was then an illegal abortion facility.56

Discussion

As soon as the new abortion law went into effect, there was an exponential increase in the number of abortions performed in Canadian hospitals.57 By 1974 it had become clear that most abortions were being performed for "non-medical - social, psycho-social or socioeconomic - reasons."58 Dramatic yearly increases in abortion rates continued for a decade before beginning to level off for a short period (See chart).  The same phenomenon had been observed in the United Kingdom and reported in Canada even before the Canadian law was changed,59 but the medical establishment was clearly unprepared to handle the demand.60  The  sudden increase in hospital abortion rates sustained over a number of years probably contributed significantly to the breaking of promises of tolerance and respect for health care workers opposed to abortion.

The reported number of physician assisted suicides and euthanasia has increased annually in jurisdictions where the procedures have been legalized, but it does not appear that, to this point, the impact of these increases on the health care systems in those countries has been comparable to that of hospital abortion rates in Canada.  Thus, while increasing rates of euthanasia and physician assisted suicide following legalization may be predicted on the basis of statistics from other countries, one cannot predict the extent to which this might adversely affect freedom of conscience among health care workers. 

Nonetheless, it is certainly reasonable to believe that the pressure to suppress freedom of conscience will be directly proportionate to the pressures created by demands for the procedures and the number of physicians and other health care workers willing to participate in them.  And it is especially important to note that, in this context, "demand" does not mean only the actual number of people seeking a procedure, but a demand the procedure be provided on the basis of a purported "right" - a claim of "constitutional right" like that advanced by Mr. Arvay and his clients.   As we have seen, Dr. Yves Bolduc was very much aware of this problem in relation to the Quebec euthanasia law.

Conclusion

The history of abortion law reform in Canada demonstrates that, even in the short term, physicians and other health care workers cannot rely on mere promises of tolerance and respect for freedom of conscience.  The greater the demand for a procedure -whether the demand arises from the number of patients or from ideological rights claims -  the sooner objecting health care workers will face discrimination, harassment and coercion. 

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Notes

1.  Quebec National Assembly, Consultations & hearings on Quebec Bill 52 [Consultations] Thursday, 3 October 2013 - Vol. 43 no. 42: Quebec Association of Gerontology (Catherine Geoffroy, Nathalie Adams), T#062

2. Consultations, Wednesday, 2 October 2013 - Vol. 43 no. 4: NOVA Montreal (Dr. Michael Laplante, Marie-Claude Mainville), T#116

3.  Consultations, Wednesday, 2 October 2013 - Vol. 43 no. 4: NOVA Montreal (Dr. Michael Laplante, Marie-Claude Mainville), T#118

4.  Consultations, Tuesday, 17 September 2013 - Vol. 43 no. 34:  Collège des médecins (Dr. Charles Bernard, Dr. Yves Robert, Dr. Michelle Marchand), T#158

5.  Consultations, Tuesday, 17 September 2013 - Vol. 43 no. 34: Federation of General Practitioners of Quebec (Dr. Louis Godin, Dr. Marc-André Asselin),T#103

6.  Consultations, Tuesday, 17 September 2013 - Vol. 43 no. 34: Federation of General Practitioners of Quebec (Dr. Louis Godin, Dr. Marc-André Asselin),T#103

7.  Consultations, Wednesday, 25 September 2013 - Vol. 43 no. 38:  Quebec Association for the Right to Die with Dignity (Hélène Bolduc, Dr. Marcel Boisvert, Dr. Georges L'Espérance), T#102

8.  Consultations, Wednesday, 25 September 2013 - Vol. 43 no. 38:  Quebec Association for the Right to Die with Dignity (Hélène Bolduc, Dr. Marcel Boisvert, Dr. Georges L'Espérance), T#107

9. Murphy S.  "Redefining the Practice of Medicine: Euthanasia in Quebec, Part 8- Hospitality and lethal injection." Protection of Conscience Project, June, 2014.

10.  In the BCSC, Amended Notice of Civil Claim, Part 1, para. 55, 64(c); Part 3, para. 9-11, 18 (https://www.consciencelaws.org/drafts/2011-08-15 carter-noticeofclaim02.pdf)

11.  Carter v. Canada, para. 239-240. Others have made the same claim: see Angell M., Lowenstein E. "Letter re: Redefining Physicians' Role in Assisted Dying." N Engl J Med 2013; 368:485-486 January 31, 2013 DOI: 10.1056/NEJMc1209798 (http://www.nejm.org/doi/full/10.1056/NEJMc1209798) (Accessed 2014-08-16)

12.  Schuklenk U, van Delden J.J.M, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel on End-of-Life Decision Making (November, 2011)  p. 62, 69, 101 (http://rsc-src.ca/sites/default/files/pdf/RSCEndofLifeReport2011_EN_Formatted_FINAL.pdf) (Accessed 2014-02-23)

13.  Carter v. Canada, para. 120-130

14.  Carter v. Canada, para. 124

15.  Carter v. Canada, para. 211. (Accessed 15 June, 2012)

16.  In the SCC on appeal from the BCCA, Appellants' Response to Motions to Intervene, 20 June, 2014, para. 5(c)

17.  Arvay J.  Oral Submission to the Supreme Court of Canada. Carter v. Canada (15 October, 2014)  Supreme Court of Canada Webcast, 74:27/491:20 to 75:04/491:20

18. "Free the Doctor." Globe and Mail, 18 May, 1965. Quoted in de Valk, Alphonse, Morality and Law in Canadian Politics: The Abortion Controversy. Dorval, Quebec: Palm Publishers, 1974, p. 18

19.  "Now the job is to be done, let it be done right", Globe and Mail, 21 December, 1967. Quoted in de Valk, supra, p. 56

20.  2nd Session, 27th Parliament, 16 Elizabeth II 1967.  The House of Commons of Canada, Bill C-136: An Act Concerning the Termination of Pregnancy by Registered Medical Practitioners.

21.  2nd Session, 27th Parliament, 16 Elizabeth II 1967.  The House of Commons of Canada,  Bill C-123, An Act to Amend the Criminal Code (Birth Control)

22.   2nd Session, 27th Parliament, 16 Elizabeth II 1967.  The House of Commons of Canada, Bill C-122: An Act to Amend the Criminal Code (Abortion)

23.  Second Session-Twenty-seventh Parliament 1967: Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence No. 1 (Thursday, June 29, 1967 and Tuesday, October 3rd, 1967), p. 3

24.  House of Commons,  Second Session-Twenty-seventh Parliament 1967: Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence No. 1 (Thursday, June 29, 1967 and Tuesday, October 3rd, 1967), p. 4

25.  House of Commons,  Second Session-Twenty-seventh Parliament 1967: Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence No. 1 (Thursday, June 29, 1967 and Tuesday, October 3rd, 1967), p. 6

26.  House of Commons,  Second Session-Twenty-seventh Parliament 1967: Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence No. 1 (Thursday, June 29, 1967 and Tuesday, October 3rd, 1967), p. 7; see also p. 13

27.  House of Commons,  Second Session-Twenty-seventh Parliament 1967: Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence No. 1 (Thursday, June 29, 1967 and Tuesday, October 3rd, 1967), p. 3

28.  House of Commons,  Second Session-Twenty-seventh Parliament 1967: Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence, Appendix "SS": Canadian Welfare Council Statement on Abortion to the House of Commons Standing Committee on Health and Welfare. (13 February, 1968) p. 707

29.  House of Commons,  Second Session-Twenty-seventh Parliament 1967: Standing Committee on Health and Welfare, Minutes of Proceedings and Evidence, Appendix "QQ": Brief submitted by the Catholic Hospital Association of Canada . . . on the Matter of Abortion. (8 February, 1968) p. 676

30.  In August, 1968, the Catholic Women's League had passed a resolution that amendments to the law should include "guarantees . . . to protect physicians who might refuse to participate in abortion."  "CWL urges commission."  Brandon Sun, 24 August, 1968, p. 5

31.  Perron L. "Abortion Issue." (Letter to the Editor)  Ottawa Journal, 1 February, 1969

32.  Archbishop Joseph-Aurele Plourde of Ottawa commented that the government was willing to protect "those who will, but not those who won't."  Farrell A.  "RC Bishops Reiterate Abortion Law Opposition."  Ottawa Journal, 19 April, 1969, p. 22

33.  Lambe V.  "See Legal Approval of Abortion as 'Remote Control' Killing."  Ottawa Journal, 24 April, 1969, p. 33.

34.  A sub-amendment was added to the original amendment. This paraphrase reflects the effect of both. See House of Commons Debates, Official Report: First Session, 28th Parliament, 18 Elizabeth II, Vol. VIII (hereinafter "Hansard"), p. 8056, 8063 (28 April, 1969)

35.  Hansard, 28 April, 1969, p. 8069

36.  Hansard, 28 April, 1969, p. 8058-8059

37.  Hansard, 28 April, 1969, p. 8087-8088

38.  Bill S-7 (1997) An Act to amend the Criminal Code for the purpose of preventing coercion in medical procedures that offend against conscience.

39.    Hansard, 9 May, 1969, p. 8526-8527

39.   B.C. M.A. Annual Meeting. CMAJ November 21, 1970, Vol. 103, 1223 (Accessed 2013-02-22)

41.  "The Law Denies Equality."  Globe and Mail, 18 January 1974. Quoted in de Valk, supra, p. 137

42.  Hawkins, Anthony, "BC stamps out choice: Orders hospitals to do abortions; taxpayers to fund them" The Interim, 20 April, 1992. (Accessed 2010-05-18); British Columbia Hospital Act, Section 24.1, Schedule (Accessed 2014-10-13); British Columbia Hospital Insurance Act Regulations, Schedule A (Accessed 2014-10-13)

43.  Western Catholic Reporter, Edmonton, 25 July, 1971. Cited in de Valk, supra, p. 140

44.  Murphy S. "Nurse Refused Employment, Forced to Resign: A Two Tiered System of Civil Rights." Protection of Conscience Project.

45.  Ranalli P. Med School 101: You Must Perform or Refer for Abortion. National Right to Life News, 2004

46.  Otis M. "Nurses Fight for Freedom: 21 out of 30 paediatric nurses resign."  The Interim, March, 1989.

47.  Dooley D. "Hospital Restricts Nurses' Freedom of Conscience." The Interim,  June, 1993.

48.  Murphy S. Bishop protests on behalf of nurses: Health care consolidation generates conflict  Protection of Conscience Project.

49.  Ko M. "Personal Qualms Don't Count: Foothills Hospital Now Forces Nurses To Participate In Genetic Terminations." Alberta Report,, April 12, 1999.

50.  O'Neill T. Should doctors be forced to abandon their faith? Western Standard, 2004

51.  Pelrine, EW, Morgentaler: The Doctor Who Couldn't Turn Away. Gage Publishing, 1975, p. 55.

52.  Murphy S. Conscience or Contempt of Court? Court orders abortion of woman.

53.  Edwards GJ. General practice docs and obstetrics.

54.  Murphy, S. "Insubordination: worker fired for refusing payment for illegal abortion."  Protection of Conscience Project.

55.  Kennedy, F.  "Sweeney Defends Firings:Transition house workers fired, denied benefits for 'misconduct'". The Interim, March, 1989

56.  "Constable Packer resigns."  The Interim, 30 March, 1990 (Accessed 2014-10-13)

57.  For example, the number of abortions increased from 11,152 in 1970 to almost 39,000 in 1971, an increase from a rate of 3.0 to 8.3 per 100 live births. Therapeutic abortion: government figures show big increase in '71. CMAJ May 20, 1972, Vol. 106, 1131

58.  Geekie D.A. Abortion: a review of CMA policy and positions. CMAJ September 7, 1974, Vol. 111, 474-477(Accessed 2014-02-22)

59.  McGillivray D.  "Serious questions about results of new act: may need amendments."  Brandon Sun, 8 March, 1968, p. 10;  Emerson G.  "Abortion: Law in Britain One Year Old as Critics Launch New Campaign."  Ottawa Journal, 19 May, 1969.

60.  For example, the Royal Columbian Hospital in New Westminster, B.C. reported a "critical bed shortage" due to the "marked increase in the number of abortions performed."  "Abortion Problem."  Ottawa Journal, 8 August, 1970