Current policies and laws
At least 70 countries have provisions that allow so-called “conscientious objection” in health care, according to preliminary data from the World Health Organization’s Global Abortion Policies Database. We know this is an underestimate, as the database has no data for dozens of countries including Canada and the United States, which both allow almost unlimited CO via policies or laws.
A 2014 white paper from Global Doctors for Choice “examines the prevalence and impact of such refusals [CO] and reviews policy efforts to balance individual conscience, autonomy in reproductive decision making, safeguards for health, and professional medical integrity.” The authors discuss a range of CO policies and laws around the world, drawing upon medical, public health, legal, ethical, and social science literature of the past 15 years (since 2013) in English, French, German, Italian, Portuguese, and Spanish.
Read full report: Global Doctors for Choice – Conscientious objection and refusal to provide reproductive healthcare: A white paper examining prevalence, health consequences, and policy responses, by Wendy Chavkin, Liddy Leitman, and Kate Polin. (Note: Authors are biased in favour of “balancing” refusals with patients’ right to healthcare.)
‘‘Dishonourable disobedience’’ — Why refusal to treat in reproductive healthcare is not conscientious objection, by Christian Fiala and Joyce H. Arthur, Woman – Psychosom Gynaecol Obstet (2014), http://dx.doi.org/10.1016/j.woman.2014.03.001
Most western countries allow healthcare professionals some degree of CO through medical policies or codes of ethics— often called ‘‘refusal clauses’’ or ‘‘conscience clauses’’. Typically, healthcare personnel can opt out of providing non-emergency care, but only if they promptly refer the patient to someone else who can help them. The Code of Ethics of FIGO (International Federation of Gynecology and Obstetrics) states (FIGO):
Assure that a physician’s right to preserve his/her own moral or religious values does not result in the imposition of those personal values on women. Under such circumstances, they should be referred to another suitable health care provider. Conscientious objection to procedures does not absolve physicians from taking immediate steps in an emergency to ensure that the necessary treatment is given without delay.
Many countries have enshrined CO into law (Heino et al.,2013):
- Austrian law states: No one may be in any way disadvantaged . . . because he or she has refused to perform or take part in such an abortion. (Government of Austria,1975)
- France’s law says: A doctor is never required to per-form an abortion but must inform, without delay, his/her refusal and provide immediately the name of practitioners who may perform this procedure. . . No mid-wife, no nurse, no paramedic, whatever is required to contribute to an abortion. . . . A private health establishment may refuse to have abortions performed on its premises. (Government of France, 2001)
- Even though the Australian state of Victoria decriminalized abortion in 2008, the new law retains a CO clause:If a woman requests a registered health practitioner to advise on a proposed abortion, or to perform, direct, authorise or supervise an abortion for that woman, and the practitioner has a conscientious objection to abortion, the practitioner must refer the woman to another registered health practitioner [who] does not have a conscientious objection to abortion. (Australasian Legal Information Institute, 2010)
- In the United States, almost every state has passed refusal clauses allowing physicians to opt out of providing abortions and other services. In addition, federal law protects doctors and nurses who do not want to perform abortions or sterilizations, and allows health workers to file complaints if they feel discriminated against (Huffington Post,2011).