Abortion has been legal in France for 50 years. However, a clause allowing doctors to refuse to perform the procedure raises questions

It is one of those ethical subjects little known to the general public but which still discreetly divides health professionals. “A doctor is never obliged to carry out a voluntary termination of pregnancy”, specifies article L2212-8 of the public health code. This clause also applies to midwives, nurses and auxiliary medical personnel. With each evolution of the law concerning abortion, since its vote 50 years ago, on January 17, 1975, this specific conscience clause resurfaces in the debates before finally being reaffirmed in the law.

There is also a general clause allowing practitioners to refuse to perform any act for professional or personal reasons. Found in article 47 of the Code of Medical Ethics, the regulatory clause gives any practitioner the right to refuse care, “except in cases of emergency or when this would fail in their duty of humanity”. The coexistence of these two texts has led caregivers to evoke a “double consciousness clause” for abortion. This particular treatment continues to raise questions.

Understanding the fierce opposition of parliamentarians and a significant part of the medical community 50 years ago sheds light on the compromise defended by Simone Veil. To promulgate the law decriminalizing abortion on January 17, 1975, Veil, then Minister of Health under President Valéry Giscard d’Estaing, presented a text which strictly regulated the procedure. It authorizes abortion up to 10 weeks of pregnancy for women declaring themselves in a state of “distress” and grants doctors the possibility of invoking a specific conscience clause. At the time, abortion was not considered a right but rather a concession made in the name of women’s health.

“Clarifying the ambiguity”

It took almost 40 years to remove the requirement for a woman to declare herself in a state of “distress”, which happened in 2014. However, the second condition – the conscience clause – remained in force. “There is no easy answer,” said Joëlle Belaïsch-Allart, president of the National College of Gynecologists and Obstetricians of France. “I think there are still arguments in favor of retaining the specific clause, the obligation to redirect the patient being part of it.” The health professional invoking this particular clause was required by the Public Health Code to “immediately inform the woman of her refusal and to immediately provide her with the name of the practitioners likely to carry out the procedure”.

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