Normalization of Medical Violence: Conscientious Objection Under Global Threat

by Kristina Artuković



In the summer of 2018, a group of 45 activists, medical practitioners, scholars, and attorneys from 22 countries issued a report called “Unconscionable: When Providers Deny Abortion Care”. The document provided a very negative overview of conscientious objection to abortion. It went so far as to propose a bold and apparently popular idea to replace the phrase “conscientious objection” with “refusal to offer services”.


While it already had not been easy for quite some time, from that point on, it has rapidly become harder and harder – to the point of being truly heroic – to take a stand against medical violence from within the medical community.


Not long after the report was published, in October 2018, the UN’s Human Rights Committee issued General Comment no. 36 on Right to Life. The Comments instantly received praise from the chorus of abortion advocates who tried to market the publication as solid proof that abortion stands in perfect accord with the International Covenant on Civil and Political Rights. Some even argued – and still do – that it proclaimed abortion as a human right. It did not, though. Even if it did, such a claim simply cannot stand because the Committee does not have any authority to do so. The line was merely blurred, though it has not been crossed yet.


The Committee did place abortion and human rights in dangerous vicinity of each other by connecting certain grounds for abortion, such as protection of a mother’s life, with human rights. It made sure to obfuscate the difference as to when the Comment actually refers to those countries where abortion is legal but less accessible and when they refer to all UN countries that have ratified The Covenant on Civil and Political Rights. Using a similar technique, the Committee also argued that conscientious objection should not block access to abortion (where abortion is legal). It did not claim that conscientious objection to abortion constitutes a violation of human rights, although it made sure to indicate the committee sees it as a nuisance.


The right to conscientious objection is protected by an array of international treaties. Article 18 of the Universal Declaration of Human Rights says:


"Everyone has the right to freedom of thought, conscience, and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship, and observance."


The words of Article 18 of the International Covenant on Civil and Political Rights, and of Article 9 of the European Convention on Human Rights, are almost identical to the quote above.


Most countries in the world explicitly guarantee the right to conscientious objection under a “conscience clause” mentioned in their legislation. In the United States, medical conscientious objection is also explicitly guaranteed, not only by state laws, but also via legislation such as the Church Amendment, the Coats-Snowe Amendment, and the Weldon Amendment.


In the Comment, the UN Human Rights Committee actually outlined the two most important objectives for settling the issue of universal legal permissibility of abortion once and for all:


1) Installing abortion into health care, and

2) Dismantling the institution of conscientious objection.


Repercussions in the US and Europe

The current year of 2021 marks a period of an unprecedented number of attacks on conscientious objection both in the United States and in Europe alike.


In March, the Equality Act of 2021 was passed in the US House of Representatives. A few months later in Europe, the Matic Resolution was adopted by the European Parliament. Both of these documents propagated the agenda of abortion as health care and conscientious objection as a violation of human rights, and both did so under the shroud of gender anti-discrimination. The best way to establish a lie is to make it an implied truth in the background, while addressing other issues in the foreground. The American Act broadened the meaning of “sex” by injecting abortion into it. The European Resolution used “abortion as health care” as an a priori assumption of its context.


In May 2021, president Biden eliminated the Weldon Amendment from the HHS spending proposal. The Weldon Amendment is somewhat less well known than the Hyde Amendment, but it is nevertheless crucial for federal protection of conscientious objection. Its purpose is to make sure that parties in healthcare who refuse to have anything to do with abortion are not denied federal funding. Luckily, recent events provide some hope in this particular area. On August 12, the US Senate voted to restore the Hyde Amendment and Weldon Amendment to the federal budget.


Removing the Pillars of Medical Ethics

In addition to these legal instruments in Europe and in the US, the battle is currently being fought on the grounds of institutionalized medical ethics, as well.


In April of this year, the World Medical Association (WMA), an international alliance of national medical associations, announced the revision of the International Code of Medical Ethics (ICoME).


ICoME is a supplement to the Declaration of Geneva. WMA issued the Declaration of Geneva in 1947, in the aftermath of World War II. This Declaration followed the ancient guidelines of the Hippocratic Oath and soon became known as “the modern Hippocratic Oath”. The first version of the ICoME was issued a year later. ​​


The Declaration of Geneva itself has been revised five times since 1947. It originally contained this sentence:


"I will maintain the utmost respect for human life from the time of conception (...)."


In 1983, the term “conception” was replaced by a less precise word: “beginning”. In 2005, even the term “beginning” was removed, the sentence now simply stating:


"I will maintain the utmost respect for human life."


Thus preborn humans have been erased from the modern Hippocratic Oath in a confoundingly contrary course of action for applied ethics: restricting, instead of broadening, the scope of ethical validity.


The announced revision of the ICoME now aims to limit conscientious objection. The proposed draft version obliges conscientious objectors to provide referrals to other practitioners who are willing to perform the action in question. This obligation of referral undeniably violates the conscience of a conscientious objector, because it prescribes a high level of necessary participation in the act: there is no act without this referral.


In addition, the obligation to provide a referral normalizes medical violence by positing it as effectively incontestable. It turns a crucial element of medical ethics into an obsolete act of self-serving and futile moralizing.


Some countries like Italy and, as of late, Croatia, are being regularly used as examples of how states violate their citizens’ human rights by failing to provide access to abortion due to the great number of conscientious objectors in their medical communities. These same arguments popped up both in the UN’s General Comment on Right to Life and in the Matic Resolution.


However, if a country fails to effectively apply its law without violating the fundamental human rights of freedom of conscience of its citizens, does that not indicate that, rather than violating human rights by policing conscience, the state should instead reconsider the very law which raises that many ethical objections?


Global agenda of medical violence

The entire narrative of the permissibility of abortion rests upon the premise of the medicalization of violence. Said medicalization produces and informs the construct of abortion as health care. Since health care constitutes a human right, in accordance with this narrative, conscientious objection to abortion is set to become a serious human rights violation. Once deconstructed through abortion, it will become a moot point in regards to euthanasia, assisted suicide, and all other forms of medical violence.


As long as medical practitioners are still free to conscientiously object to violent medical practices, those practices will be problematized, at the least. People who exercise this right play an enormously important part in the rehumanization of medicine. As long as we protect them and their right to freedom of conscience, we will have a chance of transforming the culture and establishing laws in true accordance with human rights.



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