World Medical Association

Revision of WMA Declaration of Oslo on Therapeutic Abortion (2006)

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Notes

1.  World Medical Association, Members List (Accessed 2017-11-29).

2.  World Medical Association, Members: Who can be a WMA member? (Accessed 2017-11-29).

3.  World Medical Association, Structure (Accessed 2017-11-29).

4.  World Medical Association, What we do - events (Accessed 2017-11-29).

5.  World Medical Association, Inc., Proposed revision of WMA Declaration on Therapeutic Abortion. Document no. MEC 206/Therapeutic Abortion COM REV/Apr2017.

6.  WMA Declaration of Oslo on Therapeutic Abortion. Adopted by the 24th World Medical Assembly, Oslo, Norway, August 1970; amended by the 35th World Medical Assembly, Venice, Italy, October 1983; amended by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006 (Accessed 2017-11-26).

7.  World Medical Association, Inc., Proposed revision of WMA Declaration on Therapeutic Abortion. Document no. MEC 207/Therapeutic Abortion COM REV2/Oct2017.

8.  Committee members present: Australia – Dr. Michael Bryant Gannon; Austria – Dr. Artur Wechselberger; Britain – Dr. Andrew Dearden, Dr. Mark Porter; China – Dr. Shuyang Zhang; Denmark – Dr. Andreas Rudkjoebing; Germany – Dr. Frank-Ulrich Montgomery & Dr. Ramin Paras-Parsi; India – Dr. Ajay Kumar; Israel – Dr. Leonid Eidelman; Japan – Dr. Kenji Matsubara & Dr. Mari Michinaga; Mexico – Dr. Serafin Romero; Netherlands – Dr. René Héman; South Africa – Dr. Mzukisi Grootboom; Sweden – Dr. Heidi Stensmyren; USA – Dr. Andrew W. Gurman, Dr. Steven J. Stack. World Medical Association, Inc., Report of the Medical Ethics Committee. Document no. MEC 206/Report/Apr 2017, p.1.

9.  World Medical Association, Inc., Report of the Medical Ethics Committee. Document no. MEC 206/Report/Apr 2017, para. 4.3.1.

10.  Notice dated 30 November, 2017 to WMA Constituent and Associate Members from O. Kloiber, Secretary General Re: Follow up to the WMA General Assembly, Chicago, October 2017.

11.  Committee members present (* indicates member not present at previous meeting); Australia – Dr. Michael Bryant Gannon; Austria – Dr. Thomas Szekers (apparently Szekeres)*; Britain – Dr. Andrew Dearden, Dr. Mark Porter; China – Dr. Shuyang Zhang; Denmark – Dr. Andreas Rudkjoebing; Germany – Dr. Frank-Ulrich Montgomery & Dr. Ramin Paras-Parsi; India – Dr. Ajay Kumar; Israel – Dr. Leonid Eidelman; Japan – Dr. Kenji Matsubara & Dr. Mari Michinaga; Mexico – Dr. Serafin Romero; Netherlands – Dr. René Héman; South Africa – Dr. Mzukisi Grootboom; Sweden – Dr. Heidi Stensmyren; USA – Dr. Andrew W. Gurman, David O. Barbe*. World Medical Association, Inc., Report of the Medical Ethics Committee. Document no. MEC 206/Report/Oct2017, p. 1.

12.  World Medical Association, Inc., Report of the Medical Ethics Committee. Document no. MEC 206/Report/Oct2017, para. 3.2, 3.2.1.

13.  Standing Committee of European Doctors (English) (Accessed 2017-11-29).

14.  World Medical Association, Inc., Report of the Medical Ethics Committee. Document no. MEC 206/Report/Apr2017, para. 4.10.

15.  WMA Medical Ethics Conference 2018, Reykjavik, 2-4 October, 2018. (https://icelandtravel.artegis.com/event/wma2018) Accessed 2017

16.  Which requires physicians to ensure that they do not accept or use organs or tissue obtained by unlawful or unethical means. WMA Statement on Organ and Tissue Donation. Adopted by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012and revised by the 68th WMA General Assembly, Chicago, United States, October 2017 (Accessed 2017-12-02).

17.  “[I]t is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions.” (Emphasis added). WMA Resolution on Physician Participation in Capital Punishment. Adopted by the 34th World Medical Assembly, Lisbon, Portugal, September/October 1981 and amended by the 52nd WMA General Assembly, Edinburgh, Scotland, October 2000 and the 59th WMA General Assembly, Seoul, Korea, October 2008(Accessed 2017-12-02).

18.  “Physicians will not facilitate the importation or prescription of drugs for execution.” (Emphasis added). WMA Resolution to Reaffirm the WMA's Prohibition of Physician Participation in Capital Punishment. Adopted by the 63rd General Assembly of the World Medical Association, Bangkok, Thailand, October 2012 (Accessed 2017-12-02).

19.  Physicians must not “countenance, condone, or participate in” torture and similar acts, must not “provide any premises, instruments, substances or knowledge to facilitate” such practices, and must not “facilitate or otherwise aid” torture or even legal interrogation by allowing the use of medical knowledge, skill, or personal health information for such purposes. (Emphasis added.) WMA Declaration of Tokyo – Guidelines for Physicians Concerning Torture and other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment.  Adopted by the 29th World Medical Assembly, Tokyo, Japan, October 1975. Editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006. Revised by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 (Accessed 2017-12-02).

20.  WMA Declaration of Geneva, Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968 and the 35th World Medical Assembly, Venice, Italy, October 1983 and the 46th WMA General Assembly, Stockholm, Sweden, September 1994 and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006 and amended by the 68th WMA General Assembly, Chicago, United States, October 2017 (Accessed 2017-12-04).

21.  Genuis, S. 2008. Discrimination on the basis of ethical orientation. Canadian Family Physician 54(12): 1679-1680 (Accessed 2017-12-11).

22.  Canadian Medical Association, Submission to the College of Physicians and Surgeons of Ontario: Consultation on CPSO Interim Guidance on Physician-Assisted Death (13 January, 2016).

23.  American Medical Association Code of Medical Ethics (2016) 1.1.7 Physician Exercise of Conscience.

24.  Swedish Parliamentary Debate: Freedom of conscience in health care. Re: Resolution 1763(2010) of the Parliamentary Assembly of the Council of Europe (11 May, 2011).

25.  WMA Resolution on Female Foeticide. Adopted by the 53rd WMA General Assembly, Washington, DC, USA, October 2002 and reaffirmed by the 191st WMA Council Session, Prague, Czech Republic, April 2012 (Accessed 2017-12-04).

26.  The President of the College of Physicians and Surgeons of Ontario stated that a new policy, Professional Obligations and Human Rights, respected physician freedom of conscience and religion.  The policy requires "effective referral" by objecting physicians for abortion, euthanasia and assisted suicide.  College of Physicians and Surgeons of Ontario, News Release: College Council approves new policy that safeguards human rights and puts patients first (6 March, 2015) (Accessed 2017-12-12).

27.  Canadian Medical Association Code of Ethics (1965). Transcribed from the original by
A. Keith W. Brownell MD, FRCPC and Elizabeth “Libby” Brownell RN, BA (April 2001) (Accessed 2017-12-12)

28.  The Physician and the Liberal Society: Understanding in Winnipeg. Association News, CMAJ July 18, 1970, Vol. 103, p. 195 (Accessed 2017-12-12)

29.  Canadian Medical Association Code of Ethics (1970). Transcribed from the original by
A. Keith W. Brownell MD, FRCPC and Elizabeth “Libby” Brownell RN, BA (April 2001) (Accessed 2017-12-12).

30.  “Forty per cent of hospital employees who objected to assisting at abortions were denied the right to do so.” De Valk A. The Worst Law Ever. Edmonton: Life Ethics Centre, 1979, p. 15, citing Badgley R.F. Report of the Committee on the Operation of the Abortion Law. Ottawa, Supply and Services, 1977, p. 287.

31.  Geekie DA. Abortion referral and MD emigration: areas of concern and study for CMA. CMAJ, January 21, 1978, Vol. 118, 175, 206 (Accessed 2017-12-12).

32.  Forster J.M. Letter to the editor. CMAJ, April 22, 1978, Vol. 118, 888 (Accessed 2017-12-12)

33.  Ethics problem reappears. CMAJ, July 8, 1978, Vol. 119, 61-62 (Accessed 2017-12-12).

34.  Canadian Medical Association Code of Ethics (1978). Transcribed from the original by
A. Keith W. Brownell MD, FRCPC and Elizabeth “Libby” Brownell RN, BA (April 2001) (Accessed 2014-02-22).

35.  The following parts of the policy statement are of particular interest with respect to freedom of conscience:

• A physician should not be compelled to participate in the termination of a pregnancy.
• No patient should be compelled to have a pregnancy terminated.
• A physician whose moral or religious beliefs prevent him or her from recommending or performing an abortion should inform the patient of this so that she may consult another physician.
• No discrimination should be directed against doctors who do not perform or assist at induced abortions. Respect for the right of personal decision in this area must be stressed, particularly for doctors training in obstetrics and gynecology, and anesthesia.
• No discrimination should be directed against doctors who provide abortion services.
• Abortion services should meet specific standards in the areas of informed choice, medical and surgical procedures, nursing and follow-up care.

Canadian Medical Association Policy: Induced abortion. Approved by the CMA Board of Directors, December 15, 1988. (Accessed 2017-12-12).

36.  Mackay B. Sign in office ends clash between MD's beliefs, patients' requests. CMAJ January 7, 2003 vol. 168 no. 1 (Accessed 2017-12-12).

37.  World Medical Association Medical Ethics Manual (3rd Edition, 2015) (Accessed 2017-12-04).

38.  Rodgers S. Downie J. Abortion: Ensuring Access. CMAJ July 4, 2006 vol. 175 no. 1 doi: 10.1503/cmaj.060548 (Accessed 2017-12-12).

39.  Blackmer J. Clarification of the CMA’s position on induced abortion. CMAJ April 24, 2007 vol. 176 no. 9 doi: 10.1503/cmaj.1070035 (Accessed 2017-12-12).

40.  "(We decided to proceed by way of these provincial regulatory bodies rather than the CMA, in part, because of the negative reaction of the CMA to the Rodgers/Downie editorial, which made policy reform by the CMA seem unlikely.)" McLeod C, Downie J. Let Conscience Be Their Guide? Conscientious Refusals in Health Care. Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/bioe.12075 Volume 28 Number 1 2014 pp ii–iv.

41.  Let their conscience be their guide? Conscientious refusals in reproductive health care. (Accessed 2017-12-12).

42.  McLeod C, Downie J. Let Conscience Be Their Guide? Conscientious Refusals in Health Care. Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/bioe.12075 Volume 28 Number 1 2014 pp ii–iv.

43.  Daniel Weinstock was the other. Let their conscience be their guide? Conscientious refusals in reproductive health care: The Team. (Accessed 2016-07-22).

44.  Schuklenk U, van Delden JJM, 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)["Royal Society"] p. 96 (Accessed 2014-02-23). 

45.  Or at least provincial guarantees of immunity from prosecution for those providing the procedures, as Quebec had done with respect to abortion. Royal Society, p. 97.

46.  Royal Society, p. 69, 101.

47.  Royal Society, p. 62.

48.  In the Supreme Court of British Columbia, Notice of Civil Claim between Lee Carter, Hollis Johnson, Dr. William Shoichet and the British Columbia Civil Liberties Association (Plaintiffs) and the Attorney General of Canada (Defendant) dated 26 April, 2011 (Accessed 2017-12-12).

49.  Carter v. Canada (Attorney General) 2012 BCSC 886 ["Carter v. Canada (BCSC)"], para. 124 (Accessed 2016-06-24).

50.  Carter v. Canada (BCSC),para. 1393

51.  Downie J, McLeod C, Shaw J.,Moving Forward with a Clear Conscience: A Model Conscientious Objection Policy for Canadian Colleges of Physicians and Surgeons. Health Law Review, 21:3, 2013 (Accessed 2017-12-12).

52.  Letter from Bryan Salte to the Registrars of Colleges of Physicians and Surgeons in Canada.  Redacted in Document 200/14, College of Physicians and Surgeons of Saskatchewan, Report to Council from the Registrar, 31 July, 2014 ["CPSS Report"], p. 8 (Accessed 2017-12-12).

53.  Quebec, Nova Scotia, and Saskatchewan. CPSS Report, p. 8.

54.  College of Physicians and Surgeons of Ontario, Physicians and the Ontario Human Rights Code (Draft) p. 4 (Accessed 2017-12-2).

55.  The "draft policy statement developed by the Conscientious Objections Working Group" was discussed during a meeting of the Registrars of the Colleges of BC, Alberta, Saskatchewan, Manitoba and Ontario.  Saskatchwan’s Associate Registrar Bryan Salte of seems to have taken the lead. He later reported that the other Colleges agreed to consider the policy and consider implementing it. CPSS Report, p. 3.

56.  College of Physicians and Surgeons of Ontario, Professional Obligations and Human Rights (March, 2015) (Accessed 2017-12-12).

57.  Ontario Superior Court of Justice, Between the Christian Medical and Dental Society of Canada et al and College of Physicians and Surgeons of Ontario, Notice of Application, 20 March, 2015. Court File 15-63717 (Accessed 2017-12-12).

58.  Ballingall A.  "Assisted death: How to weigh doctors’ rights with right to die?  Canada's medical circles abuzz with debate over how to balance newly recognized right to assisted death with doctors' right not to provide it." The Star, 7 February, 2015 (Accessed 2017-12-12).

59.  "The College of Physicians and Surgeons of Ontario took the position that physicians who object to physician-assisted dying requests have a positive obligation to make an effective referral. An effective referral, as described by the Ontario College, is a referral made in good faith to a non-objecting available and accessible physician, other health care professional, or agency. The College noted that the medical community has an obligation to ensure access and that conscientious objection should not create barriers." External Panel on Options for a Legislative Response to Carter v. Canada, Consultations on Physician Assisted Dying: Summary of Results and Key Findings - Final Report (15 December, 2015), p. 100. (Accessed 2017-12-12).

60.  The College Council was likely unaware that the policy had been co-authored by one of Canada’s leading euthanasia advocates. The Associate Registrar was less than candid about its origins. Protection of Conscience Project, Submission to the College of Physicians and Surgeons of Saskatchewan Re: Conscientious Refusal (5 March, 2015) Appendix "B": Development of the CPSS Draft Policy Conscientious Refusal. ((Accessed 2017-12-12).

61.  "Physician-assisted suicide, in particular, has the potential to challenge Colleges of Physicians and Surgeons to provide guidance to its members. I think that it will be much better for the Colleges and the physician members if the Colleges are prepared for the issue. If no policy is in place, and either the legislation in Quebec dealing with assisted suicide comes into effect, or the Supreme Court of Canada strikes down the prohibition against assisted suicide in the Taylor [sic] case, there will be an expectation that Colleges provide guidance to their members. The situation could have to be addressed on an urgent basis if there is no policy in place at the time.” CPSS Report, p. 8. The Carter case is probably misidentified here as "Taylor" because Gloria Taylor became the most prominent plaintiff.

62.  "Saskatchewan doctors could face discipline over assisted suicide." Global News, 13 February, 2015 (Accessed 2017-12-12). Annotated transcription at Protection of Conscience Project, Submission to the College of Physicians and Surgeons of Saskatchewan, Re: Conscientious Refusal, Appendix "C": Interview of Associate Registrar, College of Physicians and Surgeons of Saskatchewan Re: CPSS Draft Policy Conscientious Refusal, CI.2, CI.3; CIII.2 to CIII.4, CIV.1, CV.1 (Accessed 2017-12-12).

63.  Grant K.  "Canadian doctors drafting new rules in case doors open to assisted suicide."  Globe and Mail, 5 February, 2015 (Accessed 2015-07-03).

64.  Hume J.  "Supreme Court strikes down ban on assisted suicide."  Toronto Sun, 6 February, 2015 (Accessed 2017-12-12).

65.  Branswell H.  "Canadian MDs, many hesitant about assisted death, assessing Supreme Court ruling." Times Colonist, 6 February, 2015 (Accessed 2017-12-12)

66.  Schuklenk U. "Supreme Court of Canada heard arguments in Charter challenge to assisted dying criminalization." Udo Schuklenk’s Ethx Blog, 16 October, 2014 (Accessed 2017-12-01).

67.  Schuklenk, U. Conscientious objection in medicine: private ideological convictions must not supercede public service obligations (2015) 29:5 Bioethics ii, DOI: 10.1111/bioe.12167

68.  Schuklenk U, Smalling R. Why medical professionals have no claim to conscientious objection accommodation in liberal democracies (2016) 43:4 J Med Ethics 234, DOI: http://dx.doi.org/10.1136/medethics-2016-103560.

69.  Savulescu J, Schuklenk U. Doctors have no right to refuse medical assistance in dying, abortion or contraception (2017) 31:3 Bioethics 162, DOI: 10.1111/bioe.12288

70.  Though conceding that a lethal drug might be administered in the physician’s presence by a delegate, and that referral might be necessitated by technical incompetence. Attaran A. The Limits of Conscientious and Religious Objection to Physician-Assisted Dying after the Supreme Court’s Decision in Carter v Canada (2016 ) 36:3 Health L Can 86 ["Attaran"], p. 87-88, 96.

71.  "[W]hen a doctor refuses to assist a patient who is disabled by a 'grievous and irremediable medical condition', just because the patient wants death rather than something else, that arguably discriminates against the disabled patient." Attaran, p. 89.

72.  Attaran, p. 91–93.

73.  The King v Bourne (1939) 1KB 687 ["Bourne"]

74.  Bourne, p. 692-693.

75.  Bourne, p. 693-694.

76.  Waring G. Report from Ottawa. CMAJ Nov. 11, 1967, vol. 97, 1233 (Accessed 2017-12-12).

77.  There were about 590,000 live births during this period. Statistics Canada, Vital Statistics and Health, "Series B1-14: Live births, crude birth rate, age-specific fertility rates, gross reproduction rate and percentage of births in hospital, Canada, 1921 to 1974." (Accessed 2017-12-04).

78.  In 1971 there were almost 39,000. Therapeutic abortion: government figures show big increase in '71. CMAJ May 20, 1972, Vol. 106, 1131 (Accessed 2017-12-12).

79.  Canadian Medical Association 104th Annual Meeting, Halifax, Nova Scotia. Reports to General Council, Council on Community Health Care. CMAJ Vol. 104, 19 June, 1971, p. 1133-1134 (Accessed 2017-12-12).

80.  In 1976 there were about 54,500 abortions (14.9/100 live births). EMR. 1976 advance report on abortion compares statistics with 1975. CMAJ, January 7, 1978 Vol. 118, 76 (Accessed 2017-12-12).

81.  Criminal Code, RSC 1985, c C-46, s 287(4)c as it appeared on 5 December, 2017.

82.  The CMA resolutions on abortion. CMAJ, September 4, 1971, Vol. 105, p. 441 (Accessed 2017-12-12).

83.  "Health is not simply the absence of illness, but is also more than a state of physical, psychological and social flourishing, and includes an individual’s ability to adapt to physical, social and mental adversity." WMA Statement on Access to Health Care. Adopted by the 40th World Medical Assembly, Vienna, Austria, September 1988 and revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006 and by the 68th WMA General Assembly, Chicago, United States, October 2017 (Accessed 2017-12-02).

84.  Ann Furedi, the chief executive of the British Pregnancy Advisory Service, told New Zealanders that abortion is required as a part of family planning programmes because contraception is not always effective. She noted that abortion rates do not drop when more effective means of contraception are available because women are no longer willing to tolerate the consequences of contraceptive failure. Abortion a necessary option: advocate. 18 October, 2010, TVNZ. (Accessed 2014-02-15).

85.  Furedi Ann, "Abortion is safe, and it should be as easily available as contraception." Independent, 21 October, 2014 (Accessed 2017-12-05).

86.  "[F]or two decades of economic and social developments, people have organized intimate relationships and made choices that define their views of themselves and their places in society, in reliance on the availability of abortion in the event that contraception should fail. The ability of women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives." Planned Parenthood of Southeastern Pa. v. Casey - 505 U.S. 833 (1992), p. 856 (Accessed 2017-12-12).

87.  Gilbert D.  Let Thy Conscience Be Thy Guide (but not My Guide): Physicians and the Duty to Refer (2017) 10:2 McGill JL & Health 47 ["Gilbert"] p. 48, 95.

88.  Gilbert, p. 77

89.  Gilbert, p. 48.

90.  Gilbert, p. 89.

91.  Gilbert, p. 69.

92.  Gilbert, p. 77, 83.

93.  Gilbert, p. 56, note 21.

94.  Gilbert, p. 50, 77, 83, 84, 97.

95.  Gilbert, p. 68.

96.  Gilbert, p. 69.

97.  Gilbert, p. 47, 61, 62 63, 65, 67, 68, 86, 92, 98.

98.  Gilbert, p. 72,79.

99.  Gilbert, p. 55-56.

100.  Gilbert, p. 69-71.

101.  Gilbert, p. 97.

102.  Note that those making such a distinction may use terminology that distinguishes between the procedures. For example: they may distinguish “abortion” (or “direct abortion”) as a form of birth control from “early induction of labour”(or “indirect abortion”) causing the death of an infant incidental to the evacuation of infectious tissue from the uterus.