In April this year, the World Medical Association–the umbrella association of national health organizations–announced a revision of the International Code of Medical Ethics (ICoME), which complements the Geneva Declaration.
Adopted in 1948, after the world was confronted with the truth about the radical abuse of knowledge in medicine (as well as science in general) during the Second World War, the Geneva Declaration was modeled on the ancient guidelines of the Hippocratic Oath. It soon became known as the “modern Hippocratic Oath”. One year later, the accompanying International Code of Medical Ethics was also adopted.
From 1947 until the present day, the Geneva Declaration has been amended five times. Originally, it contained the following sentence:
“I will maintain the utmost respect for human life, from the time of its conception (…).”
In 1983, the term “conception” was replaced by the term “beginning”, which is much more imprecise and thus susceptible to different interpretations. However in 2005, the word “beginning” was left out so today the sentence simply reads:
“I will maintain the utmost respect for human life.”
It took only twenty years and two amendments for unborn humans to be systematically erased from the modern Hippocratic Oath. It is clearly moving in a direction which is in striking contrast with the principles of the development of applied ethics: namely, by narrowing the scope of ethical validity instead of spreading it.
The announced revision of the ICoME now aims to neutralize the conscientious objection of medical professionals. Conscientious objection is protected by a number of international agreements. 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.”
As well, Article 18 of the International Covenant on Civil and Political Rights and Article 9 of the European Convention on Human Rights contain almost identical sentences. Most countries in the world explicitly guarantee the right to conscientious objection in their individual laws. In the USA, conscientious objection is guaranteed by individual laws of federal states, but also by acts like the Church, Coats-Snowe and Weldon amendments.
The proposed working version of the WMA’s ICoME requires that the conscientious objector refer the patient to another doctor who, in turn, has no problem with performing violent medical practices such as abortion, euthanasia, assisted suicide, and the like.
In Serbia, the obligation to refer to another doctor is already incorporated in Article 63 of the Code of Medical Ethics of the Medical Chamber of Serbia. However, unlike the general nature of a similar provision in the proposed version of the ICoME, here it refers exclusively to conscientious objection with regard to abortion. Article 156 of the Serbian Law on Health Care does not contain this clause. According to this law, the health institution is the one that is obligated to provide the abortion “service” in case of a conscientious objection of one of its employees.
The obligation of a conscientious objector to refer to another doctor is in fact a violation of the conscientious objector’s conscience. It implies complicity in a problematic act, which practically nullifies the meaning of conscientious objection. In other words, this obligation incorporates the impossibility of the autonomy of the individual’s conscience into the very normative ontology of that act.
Furthermore, this systematically normalizes all possible problematic practices that have been or may be legalized, and conscientious objection is placed in the basket of vain, self-sufficient moralizing. The institution of conscientious objection was never conceived as an end unto itself and an act of self-contained moralizing, but as a way in which individual moral and professional dignity is effectively transformed into a lever of ethical policy-making, rather than the other way around.
With such a provision in the Code, the legality of certain practices in the national legislation gains primacy over the universal ethical principles of the profession, which are essentially autonomous in relation to political pressures, in accordance with the guiding idea of both the original and modern Hippocratic oaths.
Legally speaking, such a provision is in fact a violent influence of individual law on issues of fundamental freedoms and rights. Once the document is ratified, the fundamental freedoms and rights guaranteed by international legal conventions become normative in relation to individual laws. The rights and freedoms from Article 18 of the International Covenant on Civil and Political Rights (which relates to the freedom of thought, religion and conscience) may be legally restricted only in cases of violation of public safety, order, health, morals or fundamental freedoms and rights of others. This is the reason why overthrowing the institution of conscientious objection is inextricably linked with efforts to impose abortion as health care, because if such a notion of abortion becomes widely accepted, it will be possible to abolish or limit the right to conscientious objection.
Global agenda for the normalization of violence in medicine
Namely, if the system of law and institutionalized ethics accept and introduce the ideology that abortion constitutes health care, we will also have to accept the equally absurd thesis that conscientious objection is a violation of human rights, since human rights include the right to health care.
This agenda began to take on serious proportions a few years before the aforementioned recent developments in the field of medical ethics.
In the summer of 2018, a group of activists, medical workers, scientists and lawyers from 22 countries published a report titled “Unconscionable: When Providers Deny Abortion Care”. The document presented conscientious objection in medicine in a very negative light. Written on over 40 pages, in an extremely alarmist tone, using borderline cases in practice and the ideology of the “right to choose” as arguments, the report justifies the notion of abortion as health care, while a soft delegation is essentially proposed for conscientious objection (written only in quotation marks), with the reformulation of the term itself as “refusal to provide a service”.
Two months after this report and the accompanying lobbying by its authors in international institutions, in October 2018, the UN Human Rights Committee published General comment no. 36 on the right to life. The comment immediately garnered praise from abortion advocates around the world, who tried to advertise it as definitive proof that abortion is in inviolable compliance with the International Covenant on Civil and Political Rights and Human Rights. Some even claimed (and still do) that the comment explicitly introduced abortion into the set of human rights. This, of course, is not true, and even if it were, such a move would have no effect, as the Committee has no authority to adopt new parts of the Covenant.
In this comment, the Committee strategically addressed the broadly understood notion of abortion (which includes elective abortion, as well as procedures for terminating ectopic pregnancies and induced birth of an unviable fetus) and rhetorically brought it worryingly close to human rights. This was achieved by linking certain non-selective grounds for abortion – such as protecting the mother’s life – with the human right to life, although it is well-known that the number of cases in which it is medically necessary to deprive a baby of life rather than induce a live birth when the mother’s life is in danger is almost zero, and despite the fact that the maternal mortality rate in developed countries that prohibit elective abortion (e.g. Ireland before legalizing abortion, Poland and Malta) is the same or even lower than average mortality rates of mothers in their respective region. The implicit basis in which this argument is grounded is none other than the imposition of elective abortion as health care. In some parts, the Committee even linked the unavailability of abortion to a violation of Article 7 of the Covenant on Civil and Political Rights, which refers to torture, without even referring to specific examples or setting the criteria, and leaving this intentionally open to interpretation. Finally, and as expected, the Committee raised the question of conscientious objection, which it referred to as a potential barrier to the exercise of legal rights and fundamental freedoms.
Thus began the most straightforward campaign, to date, to incorporate abortion into health care and deconstruct conscientious objection.
Once conscientious objection is neutralized through the ideology of abortion, it will become completely meaningless in relation to other practices of medical violence such as euthanasia, assisted suicide and other related “services”.
Coordinated strategy of Europe and the US
The year of 2021 is a period of an unprecedented attack at conscientious objection in Europe and the United States.
In March this year, the US Congress passed the Equality Act 2021. Two months later, in May, the European Parliament adopted the Matić resolution. Both documents, each in its own way, promote the agenda of abortion as health care and conscientious objection as a violation of human rights. Both do so under the guise of fight against discrimination, by blurring the line between important gender equality issues and radical trends in identity politics.
Strategy of the American Equality Act of 2021 is that the definition of sexuality and gender issues (“sex”) should be expanded to include abortion. This way, any conscientious objection to issues related to reproductive health becomes unlawful discrimination.
On the other hand, Matić’s resolution takes the notion of abortion as health care as an implicit assumption of its overall context, and is overflowing with references to biased research such as speculative studies by its collaborators, including the Guttmacher Institute, the former research arm of Planned Parenthood, about ineffectiveness of abortion prohibitions and prevalence of unsafe abortions, which underpin almost all recent arguments for promoting abortion in international documents. Following the implicit thesis that abortion is health care, Matić’s resolution explicitly attacks the institution of conscientious objection, which, following the example of the 2018 report “Unconscionable: When Providers Deny Abortion Care”, is persistently used with quotation marks.
In May 2021, US President Biden dropped the Weldon Amendment from the budget proposal for the Department of Health and Social Services. The purpose of the Weldon Amendment is to guarantee that institutions and individuals under conscientious objection are not left without federal funds. Fortunately, the latest developments give hope, since the Senate recently voted to reinstate the Weldon Amendment to the federal budget, and there are also hints that the Roe v. Wade decision may be revised by the US Supreme Court.
Unfortunately, things in Europe do not look so bright. Poland and Malta, the only two European countries where abortion is illegal, are under immense pressure from EU institutions. The same can be said for Hungary whose Constitution from 2012 guarantees the protection of human life from conception, although the Law on Abortion is still in force there, allowing for elective abortion until week 12 of gestation (under certain conditions until week 24).
Some countries, like Italy and, more recently Croatia, are regularly used as intimidating examples of human rights violations because of the unavailability of abortion due to the excessive use of conscientious objection. In many European countries, Serbia included, there are no clear data about the use of conscientious objection to violent medical “services” such as abortion. The general impression from the frontline indicates the devastating reality that this ethical institution is almost never used in Serbia. Judging by the developments at the international legal and institutional-ethical level, the situation could go from bad to worse: instead of defending and further enhancing the institution of medical conscientious objection in Serbia, it could disappear completely.
Conscientious objection is one of the key elements in the battle for the dignity of human life from conception to natural death, especially in countries where there is no grassroot support strong enough to handle these issues, or a sufficiently developed culture of dialogue to address them in public and in legislation. Namely, as long as doctors are free to file a conscientious objection to ethically problematic “services” in medicine, it will be possible to question these practices in the socio-political arena. And as long as that is possible, there will be a chance to transform the culture of death and narcissism into a culture of life and responsibility, and to establish laws and ethical norms in true harmony with human rights.