Portugal Update: Doctors’ Consciences Act Up

Andrea Lynch

Mixed news from Portugal: abortion was officially legalized up to 10 weeks without restriction on July 15, but some doctors are refusing to perform the procedures due to a conscience clause.

Mixed news from Portugal, where abortion was officially legalized up to 10 weeks without restriction on July 15. The legislation came in response to a public referendum put forth earlier this year by Prime Minister Jose Socrates, famous for calling Portugal's draconian abortion laws and related epidemic levels of unsafe abortion "a sign of a backward country." Nearly 60 percent of the 40 percent of Portuguese voters who cast their ballots on February 11th agreed with Socrates, and in March 2007, parliament approved the new law, which requires a three-day "reflection period" between a woman requesting and receiving a safe and legal procedure, as well as a mandatory counseling session on contraception and family planning.

In April, President Anibal Cavaco Silva ratified the legislation, recommending that all women who seek safe abortions also receive anti-abortion counseling, be informed of the "psychological and physical consequences of abortion," and be shown ultrasound images of their fetuses before receiving permission to terminate their pregnancies. The government rejected his recommendations (this isn't the South Dakota legislature, after all), but they did include a restriction that is already threatening to undermine the integrity of the new law: a hefty conscience clause for doctors.

The clause, which is strongly supported by the Catholic Church, allows doctors who are "conscientious objectors" to abortion to deny women safe and legal procedures. Put another way, if doctors don't like the new law, they don't have to follow it. As a result of this loophole, at least 9 out of 50 public hospitals in Portugal are already reporting that they cannot guarantee the procedure to their female patients, with some hospitals reporting that only 20 percent of their doctors are willing to comply with the new law.

I always find it fascinating when doctors from countries with restrictive abortion laws oppose the introduction of safe and legal abortion: aren't they sick of watching women hemorrhaging from unsafe abortions stagger into the ER? Portugal's law may be new, but abortion is by no means a new feature of the landscape: thousands of Portuguese women travel across the border to Spain to seek legal abortions every year, and around 20,000 women who can't afford the trip risk unsafe, illegal abortions in Portugal. Of those, around 5,000 are hospitalized with complications annually. So the law isn't really introducing a new phenomenon, it's turning a dangerous phenomenon into a safe one. You'd think, from a public health perspective, that doctors would be thrilled. Then again, you'd also think that even in countries where abortion is totally illegal, doctors wouldn't just stand by and watch while pregnant women die. Sadly, you'd be wrong.

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Enter Portugal's conscience clause, which pleases the Church and sounds like a nice compromise between doctors' and legislators' beliefs. But here's the problem: what about pregnant women, whose lives and rights the law is designed to protect? The casualties of Portuguese physicians' consciences are Portuguese women seeking safe abortions—just like the casualties of American pharmacists' consciences are American women seeking birth control pills and emergency contraception. For squeamish doctors and politicians, conscience clauses are a win-win. But for women—especially those who don't have the time or the means to travel to multiple hospitals or pharmacies—they represent the difference between technically having a right, and fully and freely enjoying it. Only time will tell if Portugal's government is willing to do what's necessary to ensure the latter scenario.

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