Policy Brief No. 9. Conscientious Objection in Healthcare and SOGI Equality Policies. Freedom of professional conscience and effective access to healthcare in pluralist democratic systems

• Pages: 77-86
• Author: Francisca Pérez-Madrid

TARGET AUDIENCE

National and European health policy-makers; legislators; healthcare system managers; parliamen-

tary health and equality committees; Council of Europe bodies; European Commission (DG SANTE,

DG Justice & Consumers); EU Fundamental Rights Agency (FRA); national fundamental rights ins-

titutions and ombudsman oces.

EXECUTIVE SUMMARY

The progressive integration of SOGI (sexual orientation and gender identity) services into public

healthcare systems across Europe has generated acute governance tensions between the freedom of

conscience of healthcare professionals and the obligation to guarantee eective, non-discriminatory

access to legally recognised services. These conicts, situated within the broader context of moral

pluralism, resist resolution through simplistic regulatory responses.

The core diculty is that the rights at stake each require eective institutional frameworks to be

meaningfully exercised. Insuciently precise regulation has blurred the boundaries between cons-

cientious objection, clinical disagreement and normative resistance, and has fostered litigation over

situations that clear organisational rules should have pre-empted.

This document proposes an approach grounded in the understanding of conscientious objection as

an individually held right that can be integrated into an organisational system ensuring care conti-

nuity, genuine equality of access, and equal treatment of healthcare professionals without requiring

them to act against their convictions. The Italian model of fungibilità — institutional substitution

guaranteeing availability — is the preferred regulatory mechanism, superior to classical registries of

objectors.

KEY POLICY QUESTION

How can healthcare systems legally and organisationally balance the freedom of conscience of pro-

fessionals with the eective access of structurally vulnerable groups to SOGI-related services, in a

framework that neither suppresses conscience nor creates systemic barriers to care?

77

GENDER EQUALITY AND RELIGIOUS FREEDOM IN THE 2030 AGENDA:

TEN POLICY BRIEFS

Francisca Pérez-Madrid (coord.)

Dykinson, Madrid, 2026

POLICY BRIEF

CONSCIENTIOUS OBJECTION IN HEALTHCARE AND SOGI EQUALITY POLICIES

FREEDOM OF PROFESSIONAL CONSCIENCE AND EFFECTIVE ACCESS TO HEALTHCARE

IN PLURALIST DEMOCRATIC SYSTEMS

Francisca Pérez-Madrid

Full Professor of Law, Universitat de Barcelona

1

THE POLICY

PROBLEM

Contemporary equality and non-discrimination policies in SOGI matters have led

to the progressive integration of certain healthcare services — including hormone

therapies and gender-arming interventions — into the ordinary catalogue of pu-

blic health systems. This evolution has produced new tensions between rights and

obligations that the classical framework of healthcare conscientious objection is ill-

equipped to resolve.

This conict is not structured around the legitimacy of the equality principle or the