Association pour l’acces a l’avortement v. Quebec (Procureur general)

2006 Q.C.C.S. 4694
Download Judgment: English French

This case is a class action against the Quebec government aimed at obtaining a reimbursement for voluntary terminations of pregnancy services obtained in private clinics.

After the 1988 landmark case of R v Morgentaler found a right to elective abortion, the Ministry of Health had been slow in developing ministerial guidance on family planning. At the time of trial, it was recognized that the public sector could not accommodate all the requests for elective abortion services. Some women resorted to a private clinic. While the health insurance law would reimburse the private clinics, many private clinics in Quebec required patients to pay an out-of-pocket fee of $200 to $300 CAD. In contrast, women who received elective abortion services from the public system had no out-of-pocket expense.

The plaintiff, headed by the same person as in R v Morgentaler, brought the case claiming the out-of-pocket fees were a violation of the health insurance law. The position of the government was that the relevant Quebec law provides that no establishment costs can be imposed to patients in cases of medically necessary insured services, but that additional fees can however be incurred by counselling, ultrasounds and anaesthesia surrounding the procedure in private clinics.

The Court held that the government cannot allow organs that it has created and controls to circumvent or breach laws in place for political or financial reasons. The Court agreed with the Attorney General that the Health and Social Services Ministry can decide its policy guidelines and that they cannot constitute a source of law nor be subject to a legal sanction. However, the Court also held that the government and its organs can’t circumvent the laws they make. The Ministry of Health had paid supplemental fees to private clinics for elective abortions, if the patient was referred to by the local public body. This was in violation of the health insurance law. It also held that State immunity was not a valid defence, considering that the purpose of immunity is not to allow the government to circumvent its own laws or to allow third parties to do so.

The Court refused the Association pour l’accès à l’avortement’s argument that the government acted in bad faith, declaring that refusal or negligence to act do not always constitute bad faith. However, the Court did note that the government knew full well that the supplemental fees were going toward the insured service and not for accessory services.

The Court held that the accessory services to an abortion are actually necessary to the abortion and cannot be treated as separate services under the health insurance law. The court found that services like an echography are needed to detect and limit possible complications and are part of the guidelines from the college of physicians. The Court held the government cannot separate the costs of the accessory acts from the elective abortion as that would encourage methods that increase the danger of the procedure.

The Court decided that the private clinics had to reimburse the women who paid additional costs while insured under the Quebec public health insurance.

The Court found no violations of the Canadian Charter of Rights and Freedoms nor of the Quebec Charter of Human Rights and Freedoms as there was no law abridging the rights of the affected women, only the lack of proper implementation of the health insurance law, and because the women did not suffer any emotional or psychological trauma.

 « [89] L’échographie accessoire à l’IVG, n’est pas nécessaire pour poser le diagnostic (22 q)), mais pour s’assurer que l’intervention sera pratiquée en prenant toutes les précautions existantes afin de limiter les complications possibles et inhérentes à toute intervention médicale; les lignes directrices adoptées par le Collège des médecins précisent que les médecins doivent, pour pratiquer une IVG médicale, le faire avec l’échographie.

[90] Pour tous ces motifs, le Tribunal ne peut conclure que le gouvernement a voulu que les IVG pratiquées en cabinets privés le soient en ignorant les règles reconnues par le corps médical; le gouvernement ne peut privilégier des méthodes qui risquent d’augmenter le danger de recourir à ces interventions. »

“[89] The accessory ultrasound to voluntary terminations of pregnancy is not necessary in order to reach a diagnostic (22)), but it is in order to ensure that the intervention will be performed taking into account all the existing precautions aimed at limiting the possible and inherent complications of any medical intervention; the guidelines adopted by the College of Physicians specify that doctors who perform a medical voluntary termination of pregnancy must do so with an ultrasound.

[90] For all these reasons, the Tribunal cannot conclude that the government wanted for the voluntary terminations of pregnancy performed in private clinics to be so whilst ignoring the regulations recognized by the medical corpus; the government cannot favour methods that risk increasing the danger of resorting to these interventions.”

« [106] Les citoyens ne peuvent faire indirectement ce que la loi leur interdit; il en est ainsi pour l’État. Permettre aux cliniques privées d’exiger des frais supplémentaires pour des services assurés, et ce en sachant qu’il y va de leur survie, érige en système, ce que la loi interdit. »

“[106] Citizens can not indirectly do what the law forbids them from doing; the same is true for the State. Allowing private clinics to require additional fees for insured services, and doing so while knowing that their survival depends on it, creates a system for what the law forbids.”

« [129] Contrairement aux principes énoncés dans l’arrêt Morgentaler[20]où ce qui était attaqué était le droit des femmes à avoir recours à un avortement, vu les obstacles imposés par le processus lourd mis en place pour l’obtenir, et ce qui était recherché était l’annulation de certains articles du Code criminel du Canada, dans le présent dossier, il n’y a pas de preuve que les femmes ont souffert d’un traumatisme émotionnel et psychologique imposé par l’application de la loi; en d’autres termes, le Tribunal n’a pas la preuve que le fait d’avoir à payer un supplément leur causait un tel traumatisme. »

“[129] Contrary to the principles listed in the Morgentaler order [20] where what was attacked was the right of women to have access to an abortion, given the obstacles imposed by the heavy process put in place to obtain it, and what was sought was the annulment of certain articles of the Criminal Code of Canada, in the present file, there is no proof that the women suffered an emotional and psychological trauma imposed by the application of the law; in other terms, the Tribunal has no proof that the fact of having paid a supplement caused such a trauma.

View full summary and print   |   Download summary as PDF