Manitoba

Under the Health Care Directives Act, it is presumed that a person who is 16 years of age or older has the capacity to make health care decisions. Minors under 16 years of age may consent to treatment where there is evidence to establish capacity, meaning they are able to understand the information that is relevant to making a decision and are able to appreciate the reasonably foreseeable consequences of a decision or lack of.

However, some physicians may require a parent or guardian’s permission for someone under the age of 18 to have an abortion.² If a minor cannot or does not want to get permission from a parent or guardian, and are able to provide informed consent for themselves, a pregnancy counselor will refer them to a physician who does not require parental consent.³

Currently, Manitoba does not have any bubble zone legislation. However, federal Bill C-3 applies, which makes it illegal to intimidate healthcare workers and patients or obstruct them from providing care or seeking treatment at locations where healthcare services—including abortions—are delivered.

Winnipeg also passed a motion that calls for the city to enact safe access zones around clinics, hospitals, other health-care buildings and public schools in September 2021. The zones would keep protesters at a 150-metre distance. The motion passed City Council in November 2021 and is currently undergoing an administrative report to determine enforcement and logistics.

Physicians

In 2019, the College of Physicians and Surgeons of Manitoba adopted the Canadian Medical Association’s Code of Ethics and Professionalism, which does not require physicians to provide or refer for a service they object to based on personal beliefs. This means that a physician may deny a patient abortion care, and is not obligated to provide them a referral to another provider or clinic.

Nurse practitioners

The College of Registered Nurses of Manitoba released a document in 2019 titled Duty to Provide Care that obligates nurses to provide a timely referral to another provider in cases of belief-based care denial, and to follow up on that referral. It also states that “[t]he duty to provide care for a nurse with a conscientious objection does not include withholding client health care.”

In cases of belief-based care denial, the document states that it is a nurse’s duty to provide care that includes:

• Acknowledging the client’s request and assuring the client that their request will be conveyed;
• Informing both their supervisor and employer about the client’s request;
• Making a timely referral, in good faith, to a non-objecting provider who is able to carry out the client’s request, and following up on that referral;
• Maintaining a therapeutic relationship with the client;
• Continuing to provide care unrelated to specific request;
• Informing the employer about their conscientious objection; and
• In accordance with professional standards and organizational policy, documenting in the client health record any request for information related to the client’s request, the interaction with the client, the care provided and/or any resources given to the client.

In some instances, patients may have to travel outside of the country to receive abortion care currently not available in Canada. 

Manitoba Health has an Out-of-Province Medical Referral program for patients referred for insured health services not available in Manitoba. For a patient to be eligible for coverage for abortion care in the U.S. that is not available in Canada, a Manitoba specialist must write a letter to Manitoba Health and receive prior approval. If approved, the patient will receive 100% coverage.

Travel support

A patient traveling outside of Manitoba to access abortion care may be eligible for a transportation subsidy from Manitoba Health’s Out-of-Province Transportation Subsidy Program. The program limits subsidies to the round-trip cost of travel using one mode of transportation. For example, if a patient must take a bus to the airport in order to fly to their destination, Manitoba Health will cover the cost of the economy round-trip flight, but not the bus ticket.

In order to be eligible for a transportation subsidy, the specialist referring the patient for out-of-province care must apply for a transportation subsidy on their behalf. Travel costs for a travel companion may also be reimbursed if one is required for the patient’s well-being and safety during travel. Approval must be granted for services requested outside of Canada prior to the treatment occurring. Accommodations, meals, taxis, ambulance services, and other expenses are not covered.

Excluded Services Regulation, Man Reg 46/93 

Section 2(28) of the Excluded Services Regulation, under the Health Services Insurance Act CCSM, c H35, indicates that therapeutic abortions will not be covered under provincial medical insurance unless they are performed by a medical practitioner in one of the following locations: 

1. In a hospital in Manitoba other than a private hospital licenced under The Private Hospitals Act; 
2. In a hospital outside Manitoba that meets criteria set out in the Hospital Services Insurance and Administration Regulation made under the Act; or 
3. In a facility approved by the minister. (Man Reg 46/93, s 2(28))⁴