Query

I referred a woman for an abortion yesterday. With abortion, the question of sides inevitably comes up, often fiercely: my own feelings on the issue are mixed. Although I see myself as aligned on the side of life, I also acknowledge the right of women to choose what happens to their bodies. The abortion debate is a perpetual one and has many subtleties, and I do not mean to pontificate or to parse further my own position. I wish instead to describe what made this particular referral different.

Figure. Photo by: Anson Liaw

To relieve a full-time physician in the north, I recently started doing week-long locum tenens in a small health centre. Teenage pregnancy is epidemic here. Every time I do a locum — about once every two months — I meet a new teenage mom-to-be. Almost all the young women are excited about the prospect of a having a child. But Catherine isn't.

Just one month shy of her twentieth birthday, she is fifteen weeks along in her pregnancy. Her chart is meticulously kept: blood type is entered, vaginal cultures are done, HIV, hepatitis and syphilis results are filled in. An obstetrical ultrasound has been scheduled for next week, when the radiologist comes with his machine. Everything is in order.

I learned that Catherine is G4P3, that she had her first child at age fifteen, that all her children are being raised primarily by grandparents. At the bottom of the pregnancy record, where the physician put his visit notes, the same entry is written three times: pregnancy counselling.

I read all this standing outside the examining room door. When I walked in, before I could sit down, before I could even introduce myself, Catherine said: “I want an abortion. I told the other doctor over and over but each time he told me to go home and think about it. He says ‘It’s a big decision' and ‘You could regret it for the rest of your life.’”

There was silence. I know from covering his practice that my colleague is thorough and organized. He seems a decent man, but analyzing his character had to wait until I'd dealt with the patient in front of me. I asked Catherine if she was sure; she was. I told her that she would have to go to a hospital in the south, that the clinic would pay for one other person to go with her for support. I told her I would make the referral rapidly and that she would not have to wait long. (She is approaching the gestational cutoff and would be taken preferentially.)

After Catherine was gone I asked the clinic nurse whether she knew if my colleague had tried to dissuade his patients from abortion by means of calculated stalling. I asked her if anyone else had complained of not being given a referral for abortion when she wanted one. I asked her if she knew whether my colleague had an extreme pro-choice position.

I was told no, no to everything.

I wrote up Catherine's referral last night, knowing that in two days my colleague will return. I dread what is my duty: to question him about Catherine, to ask if it is true that he has stalled so that she wouldn't be able to get an abortion. I'm wary of being too inquisitorial, for it may be that Catherine and my colleague have merely misunderstood one another. And what power have I to conduct a mini-investigation?

On the ground, my middle-of-the-road theoretical position on abortion has gotten much more applied than just a day ago. Maybe too much so. Is it right of me to suspect a colleague of professional misconduct when, in one sense, all we may have is an ideologic disagreement?

— Dr. Ursus