On October 7 the Parliamentary Assembly of the Council of Europe debated 'Women's access to lawful medical care'. The main concern was doctors' conscientious objection affecting women's access to abortion and family planning (including contraception and fertility treatment).
While recognising the right of individuals to follow their (usually religious) conscience, the debate and planned resolution happened because of a growing concern about the increasing and largely unregulated practice of refusing abortions. The intention was to get members states to introduce clear and comprehensive regulations. It did not go to plan.
In the majority of member states, there is little or no effective regulation in this area. The draft resolution proposed that only individuals should be allowed to opt out, not public or state institutions - hospitals and clinics. It also proposed that objecting doctors must give women full and unbiased information about all the options and refer them to a practitioner who would give them the procedure with the absolute minimum of delay. In emergencies or where there was no other doctor/clinic to refer women to, then the doctors should set aside their beliefs, put the patient's welfare first and carry out the procedure.
Under international human rights law, member states have a duty to ensure that healthcare providers' exercise of conscientious objection does not harm the health and rights of their patients.
Before the debate, Rapporteur Christine McCafferty prepared a report on the current situation in Europe. The report called for all medical personnel to state in advance any objections and a register of objectors to be established (as is currently the case in Norway).
Then the pro-life religious lobby weighed in. The resolution as adopted was so watered down that the religious lobby hailed it as a victory. The provisional Resolution 1763, re-titled 'The right to conscientious objection in lawful medical care' now begins: No person, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion, the performance of a human miscarriage, or euthanasia or any act which could cause the death of a human foetus or embryo, for any reason.
It effectively gives primacy to conscience.
However, it was not quite the whitewash they are claiming as the vote was won by 56 votes to 51.
Sophia Kuby, a pro-life advocate and head of the group European Dignity Watch that lobbied hard against the McCafferty Report, said the vote “is a victory for common sense and for freedom” and “a great victory for Europe. Europe has made clear tonight that freedom of conscience constitutes a pillar of a democratic society that needs to be defended, at times also against a radical minority that wishes to limit freedom and impose a unique pro-abortion thinking in Europe. It is a great sign of hope that a majority has clearly voted against a radical pro-abortion, anti-freedom, anti-diversity lobby that tries to establish unhealthy and suffocating legislation.”
Not freedom for women but freedom for believers. Diversity is hardly well served if only certain people or organisations benefit. And it's ironic that the word 'healthy' was used when it's women's reproductive health under threat. It's not clear in what way lobbying to protect women's legal right to abortion is 'unique'. The McCafferty report did not for one minute suggest that doctors could not object, just that the situation should be regulated to protect both conscience and health needs. There was no promotion of abortion.
Gregor Puppinck, the director of the European Centre for Law and Justice (a Christian organisation), commented: "The Council of Europe reaffirms the fundamental value of human conscience, and of liberty in the face of attempts at ideological manipulation of science and of medicine. Independence of science and of medicine is also an essential value at the heart of democracies."
It's not clear how routinely putting religious conscience before women's rights makes science and medicine independent. Puppinck fails to see that he is trying to manipulate medicine to suit his own ideology. He also cites the Nuremberg trials, implicitly comparing pro-choice groups with Nazis.
Putting a doctor's beliefs always and inevitably before a patient's needs creates a hierarchy of values and rights.
The women most likely to be affected are those in remote or rural areas where it's hard to get to another doctor or hospital, often because there is no public or cheap transport, women on low incomes who cannot afford to travel long distances or go private, young women still living at home who may not want their parents to know and other vulnerable groups like women with learning difficulties. Unwanted teenage pregnancies can ruin young women's education prospects and cause social stigma both for her and the child.
Other risks include raised maternal mortality rates, the increase of unsafe and illegal abortions and an increase in HIV/AIDS and other STIs where practitioners refuse to supply information about contraception or condoms. It's not just women who suffer; their partners and children also suffer if the woman's health is affected, a family that cannot afford a child (or another child) will be pushed further into hardship and couples can be denied fertility treatments. It's not clear how some - if not all - doctors would explain their conscientious objections to patients without expressing personal judgement. Not every patient in a vulnerable condition would feel able to complain or stand up to such a response.
The European Centre for Law and Justice developed out of the American version, founded by evangelical Christians, but they are not the only religious influence at work. The Catholic Church is also, not surprisingly, involved.
I wrote about two of the more extreme versions of Catholic influence in May - in the US a nun was excommunicated for allowing a life-saving abortion in the hospital where she worked and last year there was the case of an abortion given to a nine year old Brazilian girl pregnant with twins after being raped, allegedly by her stepfather. The doctor, the medical team and the child's mother were excommunicated by Archbishop Don Jose Cardoso Sobrinho of Recife who said that "A graver act than rape is abortion, to eliminate an innocent life". The child was not excommunicated because she was a minor.
British organisations also lobbied against the McCafferty Report. Anthony Ozimic from one of them, the Society for the Protection of Unborn Children (SPUC) said, in characteristic emotive style, “This evening witnessed an incredible victory for the right of staff in medical institutions to refuse to be complicit in the killing of unborn children and other unethical practices."
McCafferty's report includes examples of the current situation and of how conscience clauses are being abused. In Croatia, for example, it is reported that doctors refuse abortions but then offer them privately - and charge for them. In Italy, nearly 70% of gynaecologists refuse to perform abortions on moral grounds and 50% of anaesthetists refuse to assist even though abortion is legal. In Slovakia and Poland, conscience clauses are often abused by top management who have unwritten policies banning abortions or sterilisations throughout the hospital whatever the rest of the staff think. There is a detailed report on how Slovakia is falling in with Vatican policy here. Another tactic is delaying so that the pregnancy goes beyond the legal limit for abortion.
It's not just Catholic countries where religious conscience is imposed to the detriment of women. In the UK in 2003, a High Court judgement found a doctor negligent for failing to give proper advice to a woman about her raised risk of having a baby with Down's Syndrome because he was a devout Catholic. Also in the UK, religious groups lobbied against a TV advert for the private Marie Stopes clinics as I reported in May.
The doctrine that religious groups attempt to impose on reproductive rights is not even supported by the majority of believers in some countries. In the UK, for example, seven out of ten Catholics support abortion and nine in ten support contraception.
The resolution has to be ratified by the Committee of Ministers, who include William Hague, before it becomes formal policy. His email address is firstname.lastname@example.org should you want to write to him urging him not to pass this resolution as it stands. Conscientious objection can also affect other areas such as end of life choices.
The full Parliamentary Assembly document is here.
Part 1 was about conscience opt-out for pharmacists dispensing emergency contraception (morning after pill).