Conscientious Objection

Human Rights Watch

Everyone has the human right to the highest attainable standard of physical and mental health. This entails universal access to quality healthcare goods and services on an equal basis, including access to sexual and reproductive health services and abortion services. Conscientious objection in health care enables healthcare practitioners to opt out of certain health practices on grounds of conscience. The topic of conscientious objection in health care, especially regarding abortion care, has been extensively addressed by human rights bodies in over 60 documents. This policy brief describes, systematizes, and analyzes the national and international legislative and regulatory development of conscientious objection in health care in general and around abortion specifically, with the purpose of providing a comprehensive framework for developing health laws and policies that align with international standards and protect the rights of patients and healthcare providers.

The first section provides a high-level overview of the evolving international human rights consensus on conscientious objection in health care. This analysis of human rights bodies' interpretations indicates that international law does not require states to recognize or allow conscientious objection in health care, including regarding abortion care, as a state's primary duty of care is to the individual seeking health care.

The second section lists the key obligations of states that recognize conscientious objection in health care, which are imposed on healthcare providers or discharged by the state itself (also known as "institutional safeguards"). These obligations serve to ensure conscientious objection's invocation respects the rights of both people seeking health care and providers of such services. International and regional human rights bodies have consistently found that a healthcare provider's assertion of conscientious objection should never result in the limitation or denial of access to health care for others, including abortion care. Thus, if a state allows conscientious objection in health care, it must regulate its invocation. The most common procedural requirements for a healthcare provider to invoke conscientious objection are that they: inform the patient in a timely manner that they will exercise conscientious objection, refer the patient to another provider in a timely manner, and inform the patient of their rights. Another limitation on a healthcare provider's assertion of conscientious objection is that they may not invoke the objection in emergencies or urgent care situations. According to human rights bodies, states' obligations include their duties to regulate conscientious objection clearly; prohibit institutional conscientious objection;establish referral mechanisms; ensure the adequate availability of non-objecting healthcare providers, including by hiring those willing to provide abortion services; and establish and implement monitoring, supervision, and sanction mechanisms.

The third section outlines arguments advanced by human rights bodies for why states must regulate the use of conscientious objection in order to respect and protect certain human rights. Human rights bodies have referred to three groups of rights as the basis for these obligations: the rights of patients accessing health care, including abortion care, the rights of non-objecting healthcare providers, and state obligations regarding the organization and provision of health services. The most prominent patients' rights mentioned are their rights to life, health, and personal integrity; equality and nondiscrimination; and freedom from cruel, inhuman, and degrading treatment. The rights of non-objecting healthcare providers specifically concern their right to work in an environment free from violence and discrimination. Finally, state obligations-based arguments rely on democracy and the negative impact of conscientious objection on health services.

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