That the Standing Committee on Health fully examine, study and report to Parliament on: (a) whether or not abortions are medically necessary for the purpose of maintaining health, preventing disease or diagnosing or treating an injury, illness or disability; and (b) the health risks for women undergoing abortions compared to women carrying their babies to full term.
Mr. Speaker, I am pleased to be starting the debate today on the first piece of private members' business of the many I have introduced in the House which now will be votable. Nine years of work to make all private members' business votable has finally paid off and I wish to thank all my colleagues in all parties who made this change to our Standing Orders possible.
Today I am hoping to convince the majority of members of the House to support my Motion No. 83. The motion is very simple. It asks the Standing Committee on Health to fully examine, study and report to Parliament on two issues related to the delivery of abortion services in Canada. The first is to determine whether or not abortions are medically necessary as defined in the Canada Health Act. The second is to determine the health risks for women undergoing abortions.
Doctors take an oath to “do no harm”. I believe that government should take the same oath. We should hold the government to the same standard we would hold individuals and corporations, that is, we are all responsible for our actions and the damages they cause. If medical procedures are proven to cause harm, then precautions have to be taken. If medical procedures cause more harm than good, then we have to be even more careful in how we deliver these services under the Canada Health Act.
Let us start this debate with the health minister's position on abortion. On October 3, 2002, the health minister said in the Saint John Telegraph-Journal :
Our view is that obviously abortion is a medically necessary service, therefore it has to be insured whether it's performed in a hospital or a private clinic.
The minister's statement came as a complete surprise to me because I had a letter from Health Canada dated March 8, 2001, stating that there were no records in the department that would “provide evidence that abortions are medically necessary”. I immediately filed another access to information request asking for the new information the Department of Health must have to support the minister's statement, but on October 31, 2002, Health Canada once again responded that after a thorough search no records were located.
I was shocked that the Minister of Health would make such a clear policy statement for the government without having the medical evidence to support her claim, so I dug through my files looking for some justification for the minister making such a statement without medical evidence being immediately available in her department.
I found a memorandum dated March 30, 2001, sent by Health Canada in response to questions asked by members of the Standing Committee on Health during committee hearings held on March 13 and 15, 2001. The committee asked, “Does Health Canada have a list of what it considers 'medically necessary' hospital and physician services?” Health Canada responded and I would like to quote the response:
The comprehensiveness criteria of the Canada Health Act (CHA) requires that provincial/territorial health insurance plans insure all medically necessary hospital and physician services. Health Canada does not maintain a list of medically necessary physician and hospital services for the purpose of the administration of the CHA, although the definition of hospital services in the Act is very detailed. The federal government's position with respect to the determination of medical necessity has always been to leave the responsibility to decide what services are medically necessary to the provinces and territories, in conjunction with the medical profession.
Health Canada monitors provincial/territorial decisions to remove or add services to their lists of insured services on an on-going basis to ensure that there is no breach to the requirements of the CHA. The assessment of whether the deinsurance of a service by a province or territory is a breach of the comprehensiveness criterion generally takes into consideration whether the service is covered in other provinces or territories, and whether there is a consensus in the medical community that the service is effective for the purpose of maintaining health, preventing disease and diagnosing or treating an injury, illness or disability.
I remind everyone listening today that the health department's definition of which procedures it considers medically necessary is identical to the wording of my motion. This is because I took the definition for my motion right out of the Canada Health Act.
The Standing Committee on Health was told by the Department of Health that the responsibility of determining which medical procedures are medically necessary rests with the provinces and territories, so last summer we wrote the ministers of health in the provinces and territories. Only Quebec did not respond. Those that responded considered abortion to be both medically necessary and therapeutic, but also informed us that they had not conducted any risk benefit analysis with respect to the provision of abortion services delivered in their jurisdiction.
So in fact, nowhere in Canada were we able to find any medical evidence to justify the minister's conclusion that “obviously abortion is a medically necessary service”. If no government, federal, provincial or territorial, has completed a risk benefit analysis on abortion, how can it be claimed that all abortions are medically necessary and therapeutic? How can the federal government demand that all abortions be insured under the Canada Health Act if the government does not know what the risks are or if the benefits outweigh those risks? This question can only be resolved by independent research and analysis provided by medical professionals and reported to the Standing Committee on Health. This is why I introduced the motion and this is why the research is so essential to preserve the integrity of the Canada Health Act and its enforcement.
Despite the lack of medical evidence to support the minister's view that all abortions are medically necessary, the government still enforces the Canada Health Act quite vigorously against some provinces that do not provide abortion services as dictated by the federal government. For example, the minister of health for Newfoundland and Labrador, Mr. Gerald Smith, MHA, in his letter dated August 22, 2002, wrote:
I understand that the decision to pay for the health costs in connection with abortion procedures in this Province largely came as a result of views expressed by the federal government that abortions are medically necessary services under the Canada Health Act and should be covered by the provinces. Indeed, for a period of time some transfer payments from the Federal Government were withheld from this Province because the Province did not cover the full cost of abortion services.
Media reports last fall revealed that the Province of Nova Scotia had been penalized by Health Canada since 1995 for failing to pay the facility fee at the Morgentaler abortion clinic in Halifax.
How can the government ensure that abortion services are enforced equally in all provincial jurisdictions or provided equally to women in each and every province, as Dr. Morgentaler is demanding, if it does not have the medical evidence justifying that all abortions are in fact medically necessary and therapeutic and that the medical benefits outweigh the risks in all cases being insured under the Canada Health Act?
The Standing Committee on Health needs to hear Dr. Morgentaler's views on why he feels it is important for the health of the mother to conduct an abortion as early as possible in the pregnancy and how the health risks for the mother increase as the pregnancy progresses. Even Dr. Morgentaler appears to agree that at some point during the pregnancy the risks for the mother of having an abortion would outweigh the medical benefits.
The committee also has to hear from front line health care providers such as the Canadian Nurses for Life, who wrote a letter to each one of us dated November 18, 2002, that clearly stated “Abortion is not a medical necessity”. The Canadian Nurses for Life went on to say:
As members of the most populous health care profession, we are well aware of the necessity of conserving our health care dollars. We are there on the front lines of health care twenty-four hours a day, seven days a week. We are uniquely involved in every aspect of caring for our patients and as such are able to distinguish the need for medical information when we see it.
The standing committee should also hear from the Canadian Physicians for Life, who wrote to the Prime Minister on October 7, 2002, stating:
Women's health is being harmed by abortion, without their knowledge or consent. Available studies make this clear and the politics of abortion is keeping this information from women--they are not fully informed before they make their choice for abortion.
The letter goes on to list a number of the more serious risks of which women contemplating an abortion should be informed, including increased risk of breast cancer, post-abortion emotional trauma, and loss or impairment of children through premature delivery in subsequent pregnancies.
The Health Canada response to the standing committee also stated that another factor in determining the medical necessity of a medical procedure is “whether there is a consensus in the medical community”.
Another issue for the health committee to examine and report on to Parliament is whether or not such a consensus exists and how the consensus was determined. The letters from Nurses for Life and Physicians for Life would seem to indicate that there is not a consensus.
I would like to quote from a secret memo I received under access to information. The subject of the memorandum to the minister was a letter to Dr. Henry Morgentaler. Page 6 of the document states, and I quote:
Abortion is recognized as a medically necessary insured service in all the provinces and territories. Under the Canada Health Act, all medically necessary health services (physician or hospital) must be insured, and access to these services should be provided on uniform terms and conditions. In 1995, the federal policy on private clinics came into effect requiring provinces paying the physician fee for services provided at private clinics to also pay the facility fee. Three provinces (Alberta, Newfoundland and Nova Scotia) were penalized for not paying the facility fee at private abortion clinics. While Alberta and Newfoundland have since resolved the situation, Nova Scotia remains in non-compliance. New Brunswick, Manitoba and Prince Edward Island were not penalized under the clinics policy because clinic abortions were not deemed to be an insured service in these provinces. Quebec was not penalized because it was paying the physician fee plus an additional $40 facility fee for abortions performed in private clinics. Quebec's position was that any additional charges to patients were for non-insured services (e.g. counselling).
Clearly this shows the confusion that exists in regard to the medical necessity and insurability of abortion. It is obvious that a consensus does not exist in the provinces either. Maybe this can explain the inconsistency in enforcement of the same violation in non-compliant provinces.
It is obvious from this one government document alone that every jurisdiction would benefit from having the medical evidence necessary to prove when and where a medically necessary procedure can be provided at the lowest risk to the health of the mother.
I believe that every province should insure counselling for mothers so they are completely and fully aware of all the risks associated with having an abortion and the alternatives to having an abortion. This counselling for mothers concerning the risks would also have to be based on sound medical evidence that does not appear to be available at either the federal or the provincial level.
I have not had time to go into all the medical evidence that is being debated across the country, but I have another quote that shows there is risk to having an abortion. In response to Order Paper Question No. 151 dated April 24, 2002, Statistics Canada reported, and I quote:
Statistics Canada has only a limited amount of data and research on the death rate after a pregnancy. Statistics Canada also annually publishes data on deaths and death rates, including maternal mortality, defined as deaths caused by complications of pregnancy, childbirth, and the 42 days following termination of a pregnancy. Of the 329 maternal deaths that occurred from 1979 to 1998, seven deaths had an underlying cause of complications from abortion.
Unfortunately, another Access to Information Act request to Health Canada drew another “no records” response when I tried to find reports documenting the total death risk for women having an elective abortion compared to that for women carrying their baby to term. There is also a long list of medical complications suffered by women undergoing abortions but I will leave that for others to itemize, or hopefully for the health committee to study to reveal and determine the extent of these complications and their impact on the therapeutic nature of providing abortion services in Canada.
In closing I would like to add that every argument I have made today was made on medical grounds, not moral grounds. I strongly believe that our laws should protect all life from the moment of conception. I recognize that the medical evidence gathered by the Standing Committee on Health may not support my strongly held belief, but I am willing to live with whatever the committee finds during its examination. I hope that every member of Parliament is prepared to do the same. I appeal to everyone voting on this motion to vote on the actual wording of the motion. I look forward to the debate that will be held over the remainder of this hour and in the second hour.
I ask the people of Canada to let their members of Parliament know how they feel about this, and I hope members will vote accordingly. This is an important issue, an issue that has not been debated in the House as long as I have been an MP. I appeal to members to listen, read the words of the motion and then vote accordingly.