CO in Europe

Freedom of conscience in Europe? An analysis of three cases of midwives with conscientious objection to abortion.

Fleming V, Ramsayer B, Škodič Zakšek T.
J Med Ethics. 2018 Feb;44(2):104-108
doi: 10.1136/medethics-2016-103529. Epub 2017 Jul 29.


While abortion has been legal in most developed countries for many years, the topic remains controversial. A major area of controversy concerns women’s rights vis-a-vis the rights of health professionals to opt out of providing the service on conscience grounds. Although scholars from various disciplines have addressed this issue in the literature, there is a lack of empirical research on the topic. This paper provides a documentary analysis of three examples of conscientious objection on religious grounds to performing abortion-related care by midwives in different Member States of the European Union, two of which have resulted in legal action. These examples show that as well as the laws of the respective countries and the European Union, professional and church law each played a part in the decisions made. However, support from both professional and religious sources was inconsistent both within and between the examples. The authors conclude that there is a need for clear guidelines at both local and pan-European level for health professionals and recommend a European-wide forum to develop and test them.

Source: Journal of Medical Ethics


Regulation of Conscientious Objection to Abortion: An International Comparative Multiple-Case Study
Wendy Chavkin, MD, MPH, Laurel Swerdlow, MPH, and Jocelyn Fifield, MPH
Health Hum Rights. 2017 Jun; 19(1): 55–68.


Since abortion laws were liberalized in Western Europe, conscientious objection (CO) to abortion has become increasingly contentious. We investigated the efficacy and acceptability of laws and policies that permit CO and ensure access to legal abortion services. This is a comparative multiple-case study, which triangulates multiple data sources, including interviews with key stakeholders from all sides of the debate in England, Italy, Norway, and Portugal. While the laws in all four countries have similarities, we found that implementation varied. In this sample, the ingredients that appear necessary for a functional health system that guarantees access to abortion while still permitting CO include clarity about who can object and to which components of care; ready access by mandating referral or establishing direct entry; and assurance of a functioning abortion service through direct provision or by contracting services. Social attitudes toward both objection and abortion, and the prevalence of CO, additionally influence the degree to which CO policies are effectively implemented in these cases. England, Norway, and Portugal illustrate that it is possible to accommodate individuals who object to providing abortion, while still assuring that women have access to legal health care services.

(Note: The above article has been comprehensively critiqued by Christian Fiala and Joyce Arthur: Refusal to Treat Patients Does Not Work in Any Country—Even If Misleadingly Labelled “Conscientious Objection”, Health and Human Rights Journal, 6 Sept 2017.)


Slide12Conscientious objection and induced abortion in Europe

Heino A, Gissler M, Apter D, Fiala C.
Eur J Contracept Reprod Health Care. 2013 Aug;18(4):231-3

The issue of conscientious objection (CO) arises in healthcare when doctors and nurses refuse to have any involvement in the provision of treatment of certain patients due to their religious or moral beliefs. Most commonly CO is invoked when it comes to induced abortion. Of the EU member states where induced abortion is legal, invoking CO is granted by law in 21 countries. The same applies to the non-EU countries Norway and Switzerland. CO is not legally granted in the EU member states Sweden, Finland, Bulgaria and the Czech Republic. The Icelandic legislation provides no right to CO either. European examples prove that the recommendation that CO should not prevent women from accessing services fails in a number of cases. CO puts women in an unequal position depending on their place of residence, socio-economic status and income. CO should not be presented as a question that relates only to health professionals and their rights. CO mainly concerns women as it has very real consequences for their reproductive health and rights. European countries should assess the laws governing CO and its effects on women’s rights. CO should not be used as a subtle method for limiting the legal right to healthcare.