I wrote this article in 1994 for the Canadian Medical Association Journal, trying to make a point that in the heat of the abortion debate in Canada, people had staked out ideological positions that missed the point of human suffering.

I am not sure I would completely agree with myself today, given my understanding of the theological and spiritual arguments against abortion. It is fine to stand with women on choice, but the sanctity of human life is not a choice. I have no resolution and so simply suffer, in my own simple way. 

The fourth clinic

There are four clinics on the seventh floor of a downtown Montreal hospital ‘s west wing. Many of those who walk past the first three, headed for the orange door of the family planning clinic, wear an unmistakable look of grim determination of overwhelming sadness in the face of unbearable choice. Abortions are performed behind this orange door.

The suffering these people experience is not in the physical pain of the procedure, nor is it necessarily a reflection of the loss of a potential life. Loss, after all, is part of our lives, and pain can be drugged to the point of numbness. No, the suffering stems from the burden of choice.

In all the debates about abortion, there is little to be found that addresses the psychologic pain that people who choose abortion carry with them. The weight may lighten with the years, but it seems to always remain in some measure. Decades later, memories remain vivid. An abortion is nearly al­ ways an event of immense import in the lives of those who act on their decision.

In my practice, I see women who use abortion clinics repeatedly, almost as a method of contraception. They are often young, and come from unsettled back­grounds or depressed socioeconomic settings. Many others are simply irresponsible. They cannot remember to take their pill, or they forget to use a condom.

Most of the women who choose abortion, though, do so for reasons that are difficult to deny or judge. They are in a vast grey area in which moral judgments must be made as to what society can and cannot accept. It is here that the arguments are salient and eloquent, and yet they are always much too cerebral to count emotion.

The two extremes — abortion must always be available on demand and abortion must be out­lawed under all circumstances — are accompanied by every possible position in between.

Certain simple facts exist regarding the emotional experiences of women who choose abortion, and even the bravest face cannot hide the element of guilt. Even those who firmly believe that an embryo is little more than an in­ significant, nonviable collection of tissue may have to cope with disapproving families or unsupportive males. Women who have abortions must be able to grieve their loss without the usual ceremony and ritual that society provides for mothers who lose full­ term babies.

Perhaps relieving the burden of suffering is one of the missions of medicine. Of course, suffering can mean different things to different people. On one level, there can be no comparison with the       suffering that is survived daily on a global scale: the suffering of war, hunger and needless disease in the developing world. The poorest of Canada’s poor are wealthy when compared with the homeless of Somalia, yet suffering knows no economic barriers. It merely changes character.

The peasants of Delhi know no other life, and neither do the children of affluence. They each suffer in their own way. There seems to be no need to punish someone for the bravura of youth or the failure of contraception.

Moreover, the importance of a woman’s ability to control her own fertility is but the first step in a long process that empowers and emancipates women. There are lessons to be learned from the women of countries where contraception is outlawed and women suffer the pain of inequality or domestic violence.

The easy availability and growing acceptability of abortion alters the dynamics of reproductive choice. The balance of power shifts toward women, as does the burden of responsibility, but our family laws have failed to keep up with the reality of our technologically determined choices. We all have our own attitudes and opinions regarding abortion, culled from our individual and shared upbringing and values, but these matter little in the physician’s office.

The issues concerning abortion are not technical. They are not about numbers of weeks, the method chosen, the setting, or even who pays. They have nothing to do with the individual doctor or even those of the patient. They are about the face of suffering, the face of the human condition.