The rationale behind the draft of the resolution was to regulate the use of conscientious objection by reproductive healthcare providers. The resolution did not pass as proposed and its provisions were severely diluted by a number of harmful anti-abortion amendments. As a result, instead of offering a set of comprehensive guidelines from a regional or international body on how governments must balance a woman’s right to reproductive health and autonomy with an individual’s right to conscientious objection, the adopted resolution: (1) fails to oblige health care institutions to provide legal health services to the public; (2) enables both doctors and institutions to refuse emergency care without being held liable; (3) is based on the false assumption that the practice of conscientious objection is adequately regulated in the vast majority of Council of Europe member states.

 

“25 organizations-members of ASTRA Network supported by Action Canada for Population and Development (Canada), Association for Women’s Rights in Development, Catholics for Choice (USA), Center for Reproductive Rights, Family Planning Association (Ireland), French Family Planning Movement (France), International Women’s Health Coalition, IPAS, Sensoa (Belgium), Swedish Association for Sexuality Education (Sweden) expressed deep concern with the result of voting on the resolution “Women’s access to lawful medical care: the problem of unregulated use of conscientious objection” that took place during the 35th sitting of the Parliamentary Assembly of the Council of Europe in a letter sent to the President of the Parliamentary Assembly of the Council of Europe, Mr Mevlüt Çavusoğlu.

read the full letter here:

 

http://www.astra.org.pl/astraletter.pdf

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Schwangerschaftsabbrüche: Noch steht das Recht nur am Papier.
Europaratsbeschluß über die Pflicht der Krankenhausträger wurde vorläufig zu Fall gebracht

‚Im Prinzip schon, aber….’ So beginnen die bekannten Radio-Eriwan-Witze. ‚Im Prinzip schon’ hat jede Frau in Österreich ein Recht auf den ärztlichen Schwangerschaftsabbruch. Aber was tun, wenn wohnortnahe keiner angeboten wird?

Tatsächlich ist die Verfügbarkeit eines (medizinisch korrekt durchgeführten) Schwangerschaftsabbruches in Österreich eher die Ausnahme als die Regel: In den Bundesländern Burgenland, Tirol und Vorarlberg bietet keine einzige  Krankenanstalt den Abbruch an. In den anderen Bundesländern gibt es nur vereinzelte Angebote; lediglich in Wien besteht eine gewisse Auswahl. Insgesamt werden nur an 17 der 100 österreichischen Krankenanstalten Abbrüche vorgenommen.

Was von Seiten der Krankenhausbetreiber gerne als Gewissensentscheidung der Ärzte dargestellt wird, beruht jedoch in den meisten Fällen auf massivem ideologischem oder politischem Druck. So wird in Niederösterreich über eine persönliche Weisung des Landeshauptmannes berichtet, derzufolge in ‚seinen’ Landesspitälern keine Schwangerschaftsabbrüche durchgeführt werden dürfen. Im Bundesland Salzburg sorgte eine konservative Ärztelobby dafür, dass sich entgegen der Weisung der (sozialistischen) Landeshauptfrau nur eine einzige Gynäkologin bereit fand, Abbrüche durchzuführen. So kam es zu der aberwitzigen Konstellation, dass jeden Samstag eine Gynäkologin/ein Gynäkologe aus Wien anreisen muss, um das Recht auf Schwangerschaftsabbruch sicherzustellen. Andernfalls müssten die Frauen eine Fahrt von mehreren hundert Kilometern auf sich nehmen.

Selbstredend verweigern alle von (katholisch-)konfessionellen Krankenhausträgern betriebenen Spitäler ihren ÄrztInnen die Vornahme entsprechender Eingriffe und bedrohen sie sogar mit Entlassung.

Europarat soll Verpflichtung klarstellen
Ein gestern vom Europarat debattierte Bericht hätte diese unwürdige Situation beendet. Die britische Abgeordnete Christine McCafferty brachte am  20.07.2010 für das Social, Health and Family Affairs Committee. das Dokument Nr. 12347 ein, das den Titel trägt: “Women’s access to lawful medical care: the problem of unregulated use of conscientious objection” oder „Zugang von Frauen zur gesetzlichen Gesundheitsfürsorge: das ungeregelte Problem von Verweigerung aus Gewissensgründen“.

In dem Entwurf der Resolution heißt es:
„Es kommt immer öfter vor, dass Ärzte oder sonstiges medizinisches Personal aus Gründen der Religion, der Moral oder Philosophie bestimmte medizinische Dienstleistungen verweigern. Zwar kann man niemanden zwingen, gegen sein Gewissen zu handeln, aber da solche Fälle sich gerade in Fragen der Fortpflanzung (Schwangerschaftsabbruch, künstliche Befruchtung usw.) häufen, bedarf es gesetzlicher Regelungen. Es soll ein Gleichgewicht zwischen dem Recht des Arztes, einen Eingriff aus Gewissensgründen zu verweigern, und dem Recht der Frau auf bestimmte gesetzlich erlaubte medizinische Eingriffe oder Behandlungen gefunden werden.“

Gleichgewicht der Interessen herstellen
Die 47 Mitgliedsstaaten sollen also sicherstellen, dass kontroversiell gesehene medizinische Dienstleistungen auch gegen Gewissenswiderstände einzelner Ärzte angeboten werden und für Patienten zugänglich sind. Denn das Recht auf freie Gewissensentscheidung gilt nur für direkt in medizinische Eingriffe involvierte Personen (Angestellte wie Ärzte etc.), nicht aber für nicht unmittelbar betroffenes Personal (z. B: Krankenschwestern, Stationspersonal). Insbesondere wird die Verweigerung von Eingriffen wie z. B. Schwangerschaftsabbrüchen in einzelnen öffentlichen medizinische Einrichtungen oder Kliniken ‚aus Gewissensgründen’ abgelehnt. Vielmehr müssen Institutionen sicherstellen, dass sie Ärzte anstellen, welche diese Behandlungen durchführen.

Zur Begründung heißt es, dass ein Gleichgewicht zwischen dem persönlichen Recht auf Gewissensentscheidungen und dem Recht der Patienten auf die gesetzlich zulässige Versorgung in angemessener Frist hergestellt sein müsse.

Der Entwurf wurde von (religiös fundamentalistischen) Gegnern so lange mit Änderungsanträgen unterlaufen (insgesamt 89), bis der Inhalt der Resolution in sein Gegenteil verkehrt war und daher auch von den ursprünglichen Befürwortern nur noch abgelehnt werden konnte. So bleibt es vorläufig dabei, dass Patienten ihre Interessen nicht gegen die der Ärztin/des Arztes durchsetzen können.

Mitteilung des Museums für Verhütung und Schwangerschaftsabbruch, Wien

http ://de.muvs.org/

October 7, 2010

New York, NY – Today, the Parliamentary Assembly of the Council of Europe (PACE) undercut a resolution intended to regulate the use of conscientious objection by reproductive healthcare providers. The resolution did not pass as proposed and its provisions were severely diluted by a number of harmful anti-abortion amendments.

 

“It is truly a dismal day in Europe when the lives and health of women take a back seat to political agendas and ideological imperatives,” said Christina Zampas, regional manager and senior legal adviser for Europe at the Center for Reproductive Rights. “Today’s disappointing vote shows the growing political power of the anti-choice movement among both governments and civil society, as well as a lack of political commitment to women’s reproductive health by ostensibly pro-choice politicians.”

The resolution would have offered the first set of comprehensive guidelines from a regional or international body on how governments must balance a woman’s right to reproductive health and autonomy with an individual’s right to conscientious objection. In many member states of the Council of Europe, the practice of conscientious objection in the medical field is largely unregulated. As a result, healthcare providers deny women access to lawful reproductive health services based on moral or religious objections–severely impacting their health and lives. The PACE resolution as originally proposed recommended that governments develop comprehensive regulations and guarantee the right to conscientious objection only to individuals, not to public health facilities. They also recommended that public facilities provide patients with information on all of their medical options and treatment in cases of emergency regardless of an individual practitioner’s objections.

“When a healthcare worker objects to providing legal reproductive services because of his or her conscience, it is imperative to a woman’s health and life that the government make sure that she can still get the services she needs and is legally entitled,” said Zampas, whose  expertise helped draft a report presented to PACE on the unregulated use of conscientious objection.

In a number of European countries, including Italy, Poland, Hungary, and Croatia, there are laws requiring doctors to inform patients of any conscientious objection to a procedure and refer the patients to another provider, but there is no oversight mechanism.  For example, the Center is currently working closely with the Polish Federation for Women and Family Planning and the Warsaw University Law Clinic on a lawsuit against Poland in the European Court of Human Rights for the death of a woman who was refused treatment for colon disease because doctors feared it would harm the fetus. Edyta* was two months pregnant when she was diagnosed with the painful colon disease which was aggravated by her pregnancy. When she sought medical care in her Polish hometown and other cities, however, doctor after doctor refused to treat her illness because she was pregnant. They repeatedly expressed concern about the fetus, but none of them formally raised a moral or religious objection so they did not have to refer Edyta to a doctor that would treat her. Edyta’s symptoms grew worse until she miscarried and eventually, died. The lawsuit aims to ensure that Poland maintains enough healthcare workers who are willing to provide all legal health services and that patients get timely referrals. The suit also asks the court to prohibit hospitals and other institutions from invoking conscientious objection or using it to deny patients information or emergency care.

 

FOR MORE INFORMATION:


Dionne Scott, dscott@reprorights.org, (917) 733-4357

Bojana Stoparic, bstoparic@reprorights.org, (917) 637-3683

 

Importance of the PACE draft resolution on “Women’s access to lawful medical care: the problem

of unregulated use of conscientious objection”


The Parliamentary Assembly of the Council of Europe will discuss and vote on the resolution on

Women’s access to lawful medical care: the problem of unregulated use of conscientious objection”

(Doc. 12347, 20 July 2010) on 7 October 2010 during the 2010 Ordinary Session in Strasbourg.

The draft report and resolution (attached to this summary) was prepared by Ms Christine McCafferty

(United Kingdom, SOC) and adopted by the Social, Health and Family Affairs Committee on 22 June

2010.


Why is the draft resolution significant?

International law recognizes the importance of conscientious objection to the exercise of an

individual’s right to freedom of thought, conscience and religion.1 However, international standards

also recognize this must be balanced against an individual’s rights including right to life, health,

privacy and non-discrimination.2 And that states have a duty to ensure that exercise of such refusals

does not harm the health and rights of patients. If adopted, this resolution will be in accordance with

international human rights standards, which include rights relevant to health care providers and users

in the context of conscientious objection, as set forth in the International Covenant on Civil and

Political Rights (ICCPR), the International Covenant on Economic, Social and Cultural Rights

(ICESCR) and the Convention on the Elimination of All Forms of Discrimination Against Women

(CEDAW). This resolution will provide guidance to states on how the right to freedom of thought,

conscience and religion can appropriately be balanced with the right to access lawful medical

services. It has potential to ensure that interests and rights of both healthcare providers and

individuals seeking legal medical services are respected, protected and fulfilled.

In many member states of the Council of Europe, the practice of conscientious objection in the

medical field is largely unregulated. In a number of countries, women are denied access to lawful

reproductive health services, where conscientious objection most often arises, severely effecting their

health and lives. The unregulated practice disproportionately affects low income and rural women.

Two cases pending before the European Court of Human Rights against Poland illustrate the impact the

unregulated practice has on women’s lives. One in which a woman was repeatedly denied a genetic

prenatal examination she was legally entitled to receive3 and the other case concerns a woman with a

wanted pregnancy who was refused diagnostic care and treatment by doctors, in part, because of they

claimed it would harm her foetus. Tragically, she miscarried and then died due to the lack of care.4

In Austria healthcare professionals frequently conscientiously object to performing abortion and there are

no specific legal guidelines regarding this practice.5 In Bratislava, Slovakia’s capital, a recent news

report notes that only one out of five public hospitals provides abortion.6 Moreover, hostile and

judgemental treatment from some health personnel in the remaining hospital towards a woman

undergoing abortion on request has been reported.7 It is not unusual that practitioners who provide this

medical service face contempt and judgemental behaviour from their colleagues who object to performing

abortions.

Where comprehensive and clear regulations exist, many member states lack oversight and

monitoring mechanisms to ensure that healthcare providers act in accordance with these regulations

and that patients can exercise their right to access lawful health services (e.g. Poland or Italy).



According to data provided by Italy’s Ministry of Health, nearly 70% of gynaecologists and 50.4% of

anaesthetists in Italy refuse to perform or participate in abortions. In the southern parts of the country, the

numbers are even higher.8


What has the European Court of Human Rights said about this issue?

The European Court of Human Rights, in the only decision to date that addresses the issue in a

reproductive health care context, held that two French pharmacists, who refused to deliver medically

prescribed contraceptives, were imposing their beliefs on the public. The Court declared the application

inadmissible and explained that ‘religious beliefs can be manifested in many ways outside the

professional sphere’ and that the right to freedom of religion, as a matter of individual conscience, does

not always guarantee the right to behave in public in a manner governed by that belief. The Court

concluded “as long as the sale of contraceptives is legal and occurs on medical prescription nowhere

other than in a pharmacy, the applicants cannot give precedence to their religious beliefs and impose

them on others as justification for their refusal to sell such products.”9 This is the only case thus far

where the Court has ever addressed conscientious objection in access to health care.


What does the draft report and resolution recommend to member states?

To develop comprehensive and clear regulations that define and regulate conscientious objection

with regard to health and medical services, including reproductive health services, which:

a. guarantee the right to conscientious objection only to individual healthcare providers directly

involved in the performance of the procedure in question, and not to public/state institutions such

as public hospitals and clinics as a whole;

In France, a Constitutional Council decision recognized that conscientious objection applies to

individuals, not institutions.10 In Germany, the Federal Administrative Court indicated that public hospitals

must provide abortions, enabling women to realize their entitlement to abortion under the law.11

b. oblige the healthcare provider to:

provide information to patients about all treatment options available (regardless of whether

such information may induce the patient to pursue treatment to which the healthcare provider

objects),

inform the patient in a timely manner of any conscientious objection to a procedure, and to

refer patients to another healthcare provider in that case,

ensure that the patient receives appropriate treatment from the healthcare provider to whom he

or she has been referred;

For example, in Poland a woman with wanted pregnancy died as a result of being denied necessary

medical treatment on the grounds that doctors conscientiously objected to this treatment for fear it would

harm the foetus.12

c. oblige the healthcare provider to provide the desired treatment to which the patient is legally

entitled despite his or her conscientious objection in cases of emergency (notably danger to the

patient’s health or life), or when referral to another healthcare provider is not possible (in

particular when there is no equivalent practitioner within reasonable distance).

Only eleven Council of Europe member states expressly prohibit the invocation of conscientious objection

in the case of emergency or risk of death as well as danger to the patient’s health.13

To provide oversight and monitoring, including an effective appeals mechanism if a patient is denied

access to services they are legally entitled to receive so as to ensure that everyone has access to an

effective and timely remedy, and to guarantee the effective implementation and enforcement of these

regulations within member states’ respective health services.

The aim of this recommendation is not an adversarial proceeding, but to ensure effective access

to lawful health care. In Tysic v. Poland, a case which did not concern denial of abortion due to

conscientious objection, but lack of an effective means of appeal in case of lawful therapeutic

abortion, the European Court of Human Rights recognized the importance of a timely remedy due

to legal and biological time restrictions on abortion and pregnancy, and emphasized that “[o]nce

the legislature decides to allow abortion, it must not structure its legal framework in a way which

would limit real possibilities to obtain it.”14

In Poland, Croatia and Hungary, laws require physicians to inform patients of any conscientious

objection to a procedure and refer such patients to other doctors, but they do not have an oversight

mechanism to ensure that this happens, leaving many patients without a referral.15 In addition, in

Poland, it has been reported that some doctors who refuse to perform lawful abortions in public hospitals

will offer patients to perform abortions privately, for excessive money.16



1

See Human Rights Committee, General Comment No. 22: The Right to Freedom of Thought, Conscience and Religion, UN Doc.

HR1/GEN/1/Rev. 1 (1993) (the right to conscientious objection can be derived from the right to freedom of thought, conscience and

religion); European Union Network of Independent Experts on Fundamental Rights, Opinion No. 4-2005: The right to conscientious

objection and the conclusion by EU Member States of concordats with the Holy See (2005).

2

See EU Network of Independent Experts on Fundamental Rights, id. See also Art. 9(2) of the European Convention on Human

Rights that reads: “Freedom to manifest one’s religion or beliefs shall be subject only to such limitations as are prescribed by law

and are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or for

the protection of the rights and freedoms of others.”; Human Rights Committee (CCPR), General Comment 22: The right to freedom

of thought, conscience and religion, CCPR/C/21/Rev.1/Add.4; Committee on Economic, Social and Cultural Rights (CESCR),

General Comment 14: The right to the highest attainable standard of health, E/C.12/2000/4.

3

RR v. Poland, ECtHR, Appl. no. 27617/04, the case is pending.

4

Z. v. Poland, ECtHR, Appl. no. 46132/08, the case is pending.

5

PACE – Social, Health and Family Affairs Committee, “Women’s access to lawful medical care: the problem of unregulated use of

conscientious objection”, Explanatory memorandum by Ms McCafferty, rapporteur, Doc. 12347, 20 July 2010 [hereinafter

Explanatory memorandum by Ms McCafferty, rapporteur”], para. 46, citing to International Planned Parenthood Federation

European Network, Abortion Legislation in Europe.

6

Potrat? Nerobíme! Chote inam, hovoria lekári Slovenkám” (“Abortion? We do not perform! Go somewhere else, the doctors say

to Slovak women”), 30 July 2010, available at: http://tvnoviny.sk/zeny/top-tema/potrat-nerobime-chodte-inam-hovoria-lekari-

slovenkam.html (last visit: 27 August 2010).

7

Id.

8

Explanatory memorandum by Ms McCafferty, rapporteur, supra note 5, para. 45, citing to Republic of Italy, Ministry of Health,

Report of the Ministry of Health on the Performance of the Law Containing Rules for the Social Care of Maternity and Voluntary

Interruption of Pregnancy: 2007-2008.

9

Pichon and Sajous v. France, ECtHR, Appl. no. 49853/99 (admissibility decision).

10

Explanatory memorandum by Ms McCafferty, rapporteur, supra note 5, para. 26.

11

Explanatory memorandum by Ms McCafferty, rapporteur, id. para. 27.

12

Z. v Poland, supra note 4.



Explanatory memorandum by Ms McCafferty, rapporteur, supra note 5, para. 40.

14

Tysic v. Poland (2007), ECtHR, Appl. no. 5410/03, ¶ 116.

15

Explanatory memorandum by Ms McCafferty, rapporteur, supra note 5, para. 33.

16

Reproductive Rights in Poland, the effects of the anti-abortion law, Federation for Woman and Family Planning, edited by Wanda

Nowicka (2008).

European Parliament Platform for Secularism in Politics held a Platform´s meeting last Wednesday 15 September on the subject of “Conscientious Objection in Medicine”.


The aim of the Platform is to initiate debate on secularism in politics. The Platform reaches out to a wide group of people, including practitioners, experts and the civil society.

Please find below the links to the videotaped contributions.

F – 67075 Strasbourg Cedex | e-mail: assembly@coe.int | Tel: + 33 3 88 41 2000 | Fax: +33 3 88 41 27 33

Doc. 12347

20 July 2010

Women’s access to lawful medical care: the problem of

unregulated use of conscientious objection

Report1

Social, Health and Family Affairs Committee

Rapporteur: Ms Christine McCAFFERTY, United Kingdom, Socialist Group


Summary

The practice of conscientious objection arises in the field of health care when healthcare providers refuse to

provide certain health services based on religious, moral or philosophical objections. While recognising the

right of an individual to conscientiously object to performing a certain medical procedure, the Social, Health

and Family Affairs Committee is deeply concerned about the increasing and largely unregulated occurrence

of this practice, especially in the field of reproductive health care, in many Council of Europe member states.

There is a need to balance the right of conscientious objection of an individual not to perform a certain

medical procedure with the responsibility of the profession and the right of each patient to access lawful

medical care in a timely manner.

The Parliamentary Assembly should thus invite member states to develop comprehensive and clear

regulations that define and regulate conscientious objection with regard to health and medical services,

including reproductive health services, as well as to provide oversight and monitoring, including an effective

complaint mechanism, of the practice of conscientious objection.

The Assembly should also recommend that the Committee of Ministers instruct the competent Steering

Committees and/or other competent Council of Europe bodies to assist member states in the development of

such regulations and the setting up of such oversight and monitoring mechanisms.

(more…)

During its 3rd plenary session in Strasbourg that was held from 21-24 June 2010, the Parliamentary Assembly of the Council of Europe’s Committee of Social Affairs and Health adopted the report without any additional amendments. This is the first and important vote before the report will go to the Plenary in October to be adopted by all 47 Council of Europe Members States Parliamentarians.

The report and the draft Resolution will be the first documents on the level of the Council of Europe to address and regulate the practice of conscientious objection-the right of health services providers, including doctors, nurses and other medical personnel to refuse to provide certain health services based on religious, moral or philosophical grounds. The main purposeof the report is to ensure that the practice of conscientious objection which often arises in provision of reproductive health services does not prevent women from accessing lawful medical care in a timely manner. In the report the Rapporteur Hon. Christine McCafferty (Socialist, UK) expresses her concern about the increasing and largely unregulated occurrence of the practice of conscientious objection, especially in the field of reproductive health. If adopted, the Resolution will call on Member States to develop comprehensive and clear regulations that define and regulate conscientious objection with regard to health and medical services including reproductive health as well as to provide oversight and monitoring.