Medical Conscientious Objection in Latin America 30 Years After Cairo

Abstract

The 2018 and 2020 debates on abortion legislation in Argentina, the decriminalization rulings by the Mexican Supreme Court, the resistance from physicians in Peru, and Chile’s unsuccessful attempt at constitutional reform share a common element: the centrality of conscience clauses. These provisions enable healthcare personnel to invoke conscientious objection (CO), allowing them to refuse participation in medical procedures that conflict with their moral or religious beliefs. This phenomenon gained attention following the 1994 International Conference on Population and Development (ICPD), marking a significant global shift from population control towards a rights-based approach to reproductive health and rights. As this framework became more established, the role of CO in healthcare began to change. It became a way out not only for those with religious convictions but also for health professionals concerned about the stigma surrounding sexual and reproductive health services, particularly abortion. In other words, it turned into a means to navigate new professional obligations, and even a strategy to cope with excessive workloads. However, its most problematic use arises when it becomes a political tool, as conservative groups started to invoke CO as a form of resistance to new sexual and reproductive rights laws and as a symbol of ideological cohesion. As a result of its increasingly broad and strategic use, CO has ultimately limited timely access to quality sexual and reproductive health services for women, trans people, and adolescents. This has led to systemic disruptions in healthcare provision, directly undermining the ICPD’s commitment to ensuring universal access to reproductive healthcare. This article focuses on abortion, where most CO regulations and legal disputes have surfaced. We examine conscience clauses of Latin America and their impact on healthcare provision, identifying trends and regulatory innovations that go beyond simply transplantation European or North American models. Among these innovations, we highlight the incorporation of institutional safeguards within conscience clauses in some Latin American countries as a novel strategy to mitigate the negative effects of expanded and misused CO. At the same time, however, we also observe that several courts and legislatures in the region have recognized the right to institutional conscientious objection (ICO), a development that has further exacerbated the harmful consequences of CO by allowing entire healthcare institutions to refuse services that conflict with their mission or identity. We argue that the expansion of CO clauses, along with the increasing diversity and impact of their applications, not only calls for new regulatory responses, some of which are already emerging in the region, but also demands an empirically informed reconceptualization. Such a reconceptualization must move beyond the classical definitions of CO inherited from the context of compulsory military service in order to fully grasp the current nature of this phenomenon.