World Medical Association
Revision of WMA Declaration of Oslo on Therapeutic
Abortion (2006)
12 December, 2017
Introduction
This is a précis of a commentary
prepared at the request of an Associate Member of the World Medical
Association. It is intended for the use of WMA Associate and Constituent
Members, and members of national physicians' associations that are
Constituent WMA Members. The original WMA documents quoted and cited
herein are available on the WMA website.
Précis
I. BACKGROUND
I.2 Policy review: abortion
I.2.1 The WMA has an annual policy review process. In April, 2016, the
Council decided that the 2006 WMA Declaration of Oslo on
Therapeutic Abortion should be reaffirmed with minor revisions. In October,
the Secretariat submitted a draft revision of the Declaration for
consideration by the Council (Secretariat Revision - SR).5 With one exception, the revisions were purely
editorial (Appendix "A").
I.2.5 . . . The substance of the 2006 Declaration remained
intact in the Secretariat Revision (Appendix "A").
In October, 2016, the Council decided to circulate the Secretariat Revision to WMA members for
comment.7 . . .
I.2.7 The Medical Ethics Committee met in April, 2017. . .
8 It was decided to refer the Secretariat
Revision to a working
group consisting of volunteers . . .9
I.2.8 The working group . . .10
reported back to the Medical Ethics Committee in October, 2017. . . . [They] submitted the group's draft
revision [Working Group Abortion Policy (WGAP)].
II. [ IMPOSITION OF THE DUTY OF REFERRING THE PATIENT
TO ANOTHER NON-OBJECTING DOCTOR OR PERFORMING THE ABORTION ITSELF]
II.3.1 Clause 6 of the 2006 Declaration . . . states:
If the physician's convictions do not allow him or her
to advise or perform an abortion, he or she may withdraw while ensuring the
continuity of medical care by a qualified colleague.
[The working group revision of the clause states:]
[ "8. Individual doctors have a right to conscientious
objection to providing abortion, but that right does not entitle them to
impede or deny access to lawful abortion services because it delays care for
women, putting their health and life at risk. In such cases, the physician
must refer the woman to a willing and trained health professional in the
same, or another easily accessible health-care facility, in accordance with
national law. Where referral is not possible, the physician who objects,
must provide safe abortion or perform whatever procedure is necessary to
save the woman's life and to prevent serious injury to her health."]
[CONSEQUENCES (From the commentary abstract)]
Almost all members of the World Medical Association (WMA) were satisfied
with a minor revision of the WMA's 2006 Declaration of Oslo on Therapeutic
Abortion circulated for comment in 2016. . .
The WGAP has serious adverse implications for physicians who, for reasons
of conscience, refuse to provide abortion. The 2006 Declaration states that
they “may withdraw while ensuring the continuity of medical care by a
qualified colleague.” This ensures continuity of care without requiring
facilitation of abortion by referral or other means. The provision was
unchanged in the Secretariat Revision and acceptable to almost all WMA
members.
In contrast, the WGAP requires objecting physicians to refer patients for
abortion, even if they believe that referral is unethical. It is incoherent
to assert that physicians are ethically obliged to do what they believe to
be unethical, and many objecting physicians consider referral unacceptable.
The WGAP requirement is not supported by the returns from even the
handful of members who commented on the Secretariat Revision. Only one
suggested a minor revision, and none recommended compulsory referral.
Further, to force objecting physicians to facilitate what they believe to
be unethical or immoral procedures would be inconsistent with other WMA
statements and policies that explicitly prohibit physicians from doing so.
Moreover, as demonstrated by developments in Canada, especially
in Ontario, the WGAP provides a precedent for compelling unwilling
physicians to refer for other morally contested procedures, including
euthanasia, assisted suicide. It can also be cited to support demands that
physicians personally perform such procedures.
Finally, the Working Group ignored or failed to notice the distinction
between therapeutic and elective abortion drawn to its attention by
responding WMA members. The distinction is essential to identifying a
physician's ethical and professional obligations concerning abortion.
However, the WGAP is ambiguous on this point, and controversial because it
can be cited to support the claim that physicians must provide or refer for
elective abortions.
The WGAP should be rejected. It is subversive of physician freedom of
conscience concerning abortion in the short term, and euthanasia and
assisted suicide in the long term. On the other hand, the 2006
Declaration could be safely reaffirmed . . .
IV. SUMMARY
IV.1 The WGAP is a radical revision of the 2006
Declaration of Oslo on Therapeutic Abortion not called for by the
overwhelming majority of WMA members. It demonstrates a general bias in
favour of abortion and against physician freedom of conscience. The demand
for mandatory referral is not supported by the comments of the few members
who commented on the Secretariat Revision of the Declaration.
IV.2 The Working Group claims that physicians are
ethically obliged to facilitate abortion by referral, even if they believe
that doing so is unethical or immoral. This claim is incoherent, since there
can be no ethical obligation to do what one believes to be wrong.
IV.3 To force objecting physicians to facilitate what
they believe to be unethical or immoral would contradict the Declaration of
Geneva. It would also be inconsistent with WMA statements concerning organ
and tissue donation, capital punishment, torture and interrogation, all of
which prohibit physicians from even indirectly facilitating conduct by
others that contradicts principles of medical ethics. Finally, adopting the
WGAP would signal the support of the WMA for discrimination based on ethical
orientation.
IV.4 The distinction between therapeutic and elective
abortion is essential to identifying a physician's ethical and professional
obligations concerning the procedure. The Working Group not only failed to
acknowledge the distinction, but replaced the existing policy with a passage
that is ambiguous on this very point. Hence, the WGAP, if adopted, would
likely cause more controversy, since it would usually be applied in order to
compel physicians to facilitate elective abortions for the purpose of birth
control.
IV.5 Forcing physicians to facilitate abortion is
preliminary to forcing them to facilitate other morally contested
procedures, including euthanasia, assisted suicide, and, ultimately, to
personally providing such services. This would drive many physicians from
medical practice and close the medical profession to many religious
believers and others whose philosophy of medicine reflects a traditional
Hippocratic approach.
V. CONCLUSION
V.1 The WGAP should be rejected. It is subversive of
physician freedom of conscience concerning abortion in the short term, and
euthanasia and assisted suicide in the long term.
V.2 On the other hand, the 2006 Declaration
could be safely reaffirmed . . .