Sweden

Parliamentary Motion 2009/10:K354

Freedom of conscience

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5 October, 2009: Motion proposed by Christian Democrat Annelie Enochson. She had introduced a similar motion in 2007.

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Swedish Original Text (html) | Word	English (Caution: Machine assisted translation)
Motion 2009/10:K354 Samvetsfrihet	Motion 2009/10:K354 Freedom of conscience
Motion till riksdagen 2009/10:K354 av Annelie Enochson (KD)	Motion to parliament 2009/10:K354 by Annelie Enochson (CD)
Samvetsfrihet	FREEDOM OF Conscience
Förslag till riksdagsbeslut	Proposal for a Parliament decision
1. Riksdagen tillkännager för regeringen som sin mening vad som anförs i motionen om en samvetsklausul inom sjukvården och högskoleutbildningen.	1. Parliament advises the Government of its opinion as stated in the motion of a conscience clause in healthcare and education.
2. Riksdagen tillkännager för regeringen som sin mening vad som anförs i motionen om att införliva samvetsfriheten i rättighetskatalogen i Sveriges grundlag.	2. Parliament advises the Government of its opinion as stated in the motion that freedom of conscience should be incorporated into the catalogue of rights in the Swedish constitution.
Motivering	Justification
När Sverige gick med i EU 1995 blev europeiska konventionen om skydd för de mänskliga rättigheterna och de grundläggande friheterna från 1950 svensk lag. I artikel 9 står det om samvetsfrihet:	When Sweden joined the EU in 1995 the European Convention on Human Rights and Fundamental Freedoms of 1950 became part of Swedish law. Article 9 addresses freedom of conscience:
Tankefrihet, samvetsfrihet och religionsfrihet 1. Var och en har rätt till tankefrihet, samvetsfrihet och religionsfrihet; denna rätt innefattar frihet att byta religion eller tro och frihet att ensam eller i gemenskap med andra, offentligt eller enskilt, utöva sin religion eller tro genom gudstjänst, undervisning, sedvänjor och ritualer.	Freedom of thought, conscience and religion 1. Everyone has the right to freedom of thought, conscience and religion: this right includes freedom to change religion or belief and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in worship, teaching, practice and observance.
I FN:s allmänna förklaring om de mänskliga rättigheterna från december 1948 står det i artikel 18 om samvetsfrihet: Var och en har rätt till tankefrihet, samvetsfrihet och religionsfrihet. Denna rätt innefattar frihet att byta religion och trosuppfattning och att, ensam eller i gemenskap med andra, offentligen eller enskilt, utöva sin religion eller trosuppfattning genom undervisning, andaktsutövning, gudstjänst och religiösa sedvänjor	The United Nations Universal Declaration of Human Rights from December 1948 deals with freedom of conscience in Article 18: Article 18 Everyone has the right to freedom of thought, conscience and religion. This right includes freedom to change religion or belief, and that, alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and religious practices.
Samvetsfrihet innebär att jag genom att hänvisa till samvetsskäl inte behöver utföra en viss uppgift. De länder som har en samvetsklausul kan tillvarata kunnandet och engagemanget hos alla de personer som funnit sin uppgift inom sjukvården, utan att tvinga den som hyser samvetsbetänkligheter kring vissa svåra etiska frågor att delta i viss verksamhet. Detta kan gälla abort, insättandet av abortiv spiral1eller forskning som inbegriper celler från aborterade foster samt annan praxis som utifrån traditionell etik är kontroversiell. Annan verksamhet som kan upplevas stötande ur ett annat etiskt perspektiv är vissa djurförsök eller transplantationer av djurorgan till människor. Om Sveriges riksdag skulle lagstifta om rätt till dödshjälp i någon form och om det skulle ingå i en yrkesgrupps uppgifter och åligganden att utföra momentet, då hör det till de grundläggande mänskliga rättigheterna i en rättsstat att kunna vägra att utföra detta för sitt samvetes skull, utan rättslig eller någon annan påföljd. Exemplet visar behovet av en samvetsklausul som utgår från traditionell etik och vidgar dess tillämpning och inför det som en naturlig del inom t ex sjukvården och utbildningsväsendet.	Freedom of conscience implies that, on grounds of conscientious objection, I need not perform a particular task. The countries that have a conscience clause are protecting the skill and dedication of all the people who found their role in health care, without, in difficult ethical issues, forcing conscientious objectors to participate in certain activities. This may include abortion, the insertion of the abortive coil1 or research using cells from aborted fetuses and other practices deemed controversial based on traditional ethics. Other activities that may be objectionable from a different ethical perspective may include some animal studies or transplantation of animal organs into humans. If the Swedish Parliament were to legalislate a right to euthanasia in some form, and if it were part of a professional group functions and duties to put this into effect, then one of the fundamental human rights in a constitutional state is to refuse to perform it for on grounds of conscience; without judicial or other remedies. The example shows the need for a conscience clause, based on traditional ethics and broadened in scope, and to view it as a natural part of such health care and education.
När sjukvårdspersonal på kvinnokliniken vid Mälarsjukhuset tog illa vid sig av en kvinnas aborterande av flickor begärde verksamhetschefen besked av Socialstyrelsen om personal kunde vägra att berätta om det väntade barnets kön, för att inte behöva medverka vid könsselektiva aborter.2 Socialstyrelsen meddelade senare att något undantag inte kunde medges, vilket aktualiserar frågan om det är rimligt att tvinga svensk sjukvårdspersonal, män och kvinnor, att abortera flickor av det enda skälet att den gravida kvinnan eller hennes partner hellre vill ha en pojke.	When the medical staff at Women's Clinic at the Mälardalen Hospital were upset that a woman wanted to abort girls, they asked the head of the clinic to seek direction from the National Board as to whether or not they could refuse to disclose the expected baby's sex, to avoid having participate in sex-selective abortions.2 The National Board later explained that no exemption could be granted, which raises the question whether it is reasonable to force the Swedish health care personnel, men and women to abort girls for the sole reason that the pregnant woman or her partner would rather have a boy.
Enligt en doktorsavhandling av Meta Lindström, där 224 gynekologer tillfrågades om möjligheten för dem att av samvetsskäl slippa delta i abortverksamheten, ansåg 64 % av de manliga samt 46 % av de kvinnliga gynekologerna att "det är rätt att gynekologer innehar rätten att av personliga skäl vägra medverka vid aborter".3	According to a dissertation by Meta Lindstrom, where 224 gynecologists were asked about the possibility of them for reasons of conscience not to require any abortion activities, 64% of male and 46% of female gynecologists said "it is right that gynecologists reserve the right, for personal reasons, to refuse participate in abortions."3
Således anser majoriteten av den yrkesgrupp som utför aborter i Sverige att en samvetsklausul, åtminstone för gynekologer, bör finnas.	Thus, the majority of the profession who performs abortions in Sweden should be supportive of a conscience clause, at least for gynecologists.
I Sverige har regering och riksdag resonerat tvärtom och menat att dessa personer bör söka sig till andra yrken om de känner att de inte kan gå emot sitt samvete. När Samvetsklausulutredningen presenterade sitt förslag 1996 framkom emellertid att individuella lösningar ofta arbetades fram på berörda arbetsplatser. Det är inte heller sällsynt att man hör vårdpersonal hänvisa till en samvetsklausul de tror existerar och som man därför följer. Detta gör att det ofta i realiteten finns en informell samvetsklausul, men långt ifrån alltid.	In Sweden, the government and parliament have reasoned on the contrary, stating that these people should seek other jobs if they feel they can not go against their conscience. When the Conscience Clause Inquiry presented its proposal in 1996 it revealed, however, that individual solutions often were developed in the workplace. It is not rare to hear professionals refer to a conscience clause they believe exists and that it therefore follows. This means that it is often in reality there is an informal conscience clause, but not always.
Trots att Samvetsklausulutredningen i betänkandet Samvetsklausul inom högskoleutbildningen, SOU 1994:84, inte ansåg det berättigat att införa en samvetsklausul inom utbildningsväsendet, förordades att studenterna bör ges rätt att hos Överklagandenämnden för högskolan särskilt överklaga beslut om deltagande i obligatoriska utbildningsmoment. Utredningen undersökte inte heller förutsättningarna för att införa en samvetsklausul inom arbetslivet. När frågan om organtransplantation utreddes fanns det även förslag om att införa en samvetsklausul gällande denna verksamhet, och ett antal remissinstanser förordade att en samvetsklausul för vårdpersonal skulle ge möjlighet att avstå från deltagande i transplantationsverksamhet med organ från aborterade foster. Så blev emellertid inte fallet.	Although the Report of the Inquiry into the Conscience Clause in Higher Education (SOU 1994:84)4 did not consider it justified to introduce a conscience clause in the education system, it was proposed that students should be given the right to appeal to the University Appeals Board, in particular to appeal participation in mandatory training modules. The study also failed to examine the conditions for introducing a conscience clause in the workplace. When the issue of organ transplantation was investigated, there were also proposals to introduce a conscience clause about this activity, and a number of respondents supported the idea that a conscience clause for health professionals would provide the opportunity to abstain from participating in the transplantation of organs from aborted fetuses. That was not the case.
Till syvende och sist handlar det emellertid inte om att utreda huruvida Sverige ska ha en samvetsklausul inom sjukvården eller ej. Frågan är i stället hur Sverige ska tillämpa Europakonventionen, som redan är en del av svensk lagstiftning. Det bör därför utredas hur ett införande av samvetsfriheten som en grundläggande mänsklig rättighet i den svenska regeringsformens rättighetskatalog kan genomföras. Grundlagens högre rang i det svenska rättssystemet motiverar denna åtgärd. Regeringen bör snarast återkomma till riksdagen med ett förslag om hur en samvetsklausul inom sjukvården och högskoleutbildningen skulle kunna utformas.	Ultimately, we need not ask whether Sweden should have a conscience clause in healthcare or not. The question is how Sweden is to apply the European Convention, which is already a part of Swedish law. We should therefore examine how the introduction of freedom of conscience as a basic human right in the Swedish Instrument of Government of Rights is to be implemented. This is justified by the constitional precedence of the Swedish legal system. The Government should return to parliament as soon as possible with a proposal on how a conscience clause in healthcare and higher education might be implemented.
Stockholm 5 oktober 2009 Annelie Enochson (KD)	Stockholm 5 October 2009 Annelie Enochson (CD)

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Notes

Provided by the Protection of Conscience Project

1. Apparently a reference to the intrauterine device (IUD).

2. The incident, which became public in February, 2009, occurred Women's Clinic at Mälardalen Hospital in Eskilstuna, Sweden. A pregnant woman who already had several girls asked her physician for pre-natal genetic screening. The physician complied, though there was no medical reason for the screening, and the woman learned that the child she was carrying was a healthy girl. She promptly had an abortion. Staff at the hospital did not realize this had happened until the same woman returned, again pregnant, learned during an ultrasound that the child was a girl, and again had an abortion. See -

Swedish	English
"Abort upprör personal." Svenska Dagbladet (SvD),16 February, 2009 (Accessed 2011-05-19)	"Abortion upsets staff." The Swedish Daily Paper, 16 February, 2009 (Accessed 2011-05-19)
"Lagarna ses över." Svenska Dagbladet (SvD), 16 February, 2009 (Accessed 2011-05-19)	"The laws to be reviewed." The Swedish Daily Paper, 16 February, 2009 (Accessed 2011-05-19)
"Gjorde abort - för att hon väntade flickor." Wendela, 16 February, 2009 (Accessed 2011-05-19)	"Had abortion - because she was expecting girls." Wendela, 16 February, 2009 (Accessed 2011-05-19)

3. The dissertation included, without comment, opinions that suggest some dissonance in the responses. On the one hand, both gynecologists and midwives "considered it absolutely right, that Sweden have legal abortion and that the law was being followed," and most believed "that women should be allowed to have an abortion even after they had felt fetal movements." ("Både gynekologer och barnmorskor ansåg att det är helt rätt att kvinnor i Sverige har lagstadgad rätt till abort och att lagen används enligt intentionerna. De flesta ansåg också att kvinnor ska få genomgå abort även efter att de känt fosterrörelser.") They had, according to the dissertation, no "doubts about participating in abortion." ("Ingen av yrkesgrupperna hade emellertid tvekat inför att medverka vid abort.") However, the dissertation also noted that "[o]ne in four had had misgivings when involved in surgical and medical abortions, and one in two with abortions after the 18th week." ("Var fjärde hade känt samvetsbetänkligheter i samband med kirurgisk och medicinsk abort och varannan vid abort efter 18:e graviditetsveckan.") This experience may explain the results of the survey cited by Annelie Enochson:

"Kvinnorna, barnmorskorna och kvinnliga gynekologer, svarade som grupp ungefär lika på frågan om de borde få vägra att delta i abort på grund av "personliga skäl". Sextiofyra procent av männen instämde i att det borde vara tillåtet och 41- 48 % av kvinnorna (Artikel II, Tabell III och artikel III, Tabell III). Skillnaden mellan kvinnliga och manliga gynekologer var på gränsen till att vara statistiskt signifikant p = 0.06 (II)."

"Women, midwives and female gynecologists, said that group similar to the question whether they should be allowed to refuse to participate in abortions because of "personal reasons". Sixty-four percent of men agreed that there should be permitted, and 41-48% of women (Article II, Table III and Article III, Table III). The difference between male and female gynecologists were at the borderline of being statistically significant P = 0.06 (II)."

Lindström, Meta, Gynekologer och barnmorskor inom svensk abortvård- åsikter, erfarenheter och upplevelser. Umeå Universitet, Medicinska fakulteten, Klinisk Vetenskap, Obstetrik och Gynekologi, 2007, p. 53. Citing Hammarstedt M, Lalos A, Wulff M., A population-based study of Swedish gynecologists' experiences of working in abortion care. Acta Obstet Gynecol Scand. 2006;85(2):229-35.

Lindström, Meta, Gynecologists and midwives about Swedish abortion care- views, experiences and perceptions. Umeå University, Faculty of Medicine, Clinical Science, Obstetrics and Gynecology, 2007, p. 53. Citing Hammarstedt M, Lalos A, Wulff M., A population-based study of Swedish gynecologists' experiences of working in abortion care. Acta Obstet Gynecol Scand. 2006;85(2):229-35.

4. Conscience Clause in Higher Education: Report of the Conscience Clause Inquiry.

ISBN 91-38-13710-0 ISBN 91-38-13710-0 Stockholm : Fritze, 1994 Stockholm: Fritze, 1994 Svenska 157 s. (157, [5] s.) Swedish P. 157 (157, [5] p.) Serie: Statens offentliga utredningar, 0375-250X ; 1994:84 Series: Government Official Reports, 0375-250X; 1994:84. [Samvetsklausul inom högskoleutbildningen : betänkande / av Samvetsklausulutredningen. Samvetsklausulutredningen. ISBN 91-38-13710-0 Stockholm : Fritze, 1994 Svenska 157 s. (157, [5] s.) Serie: Statens offentliga utredningar, 0375-250X ; 1994:84]

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Translated from "Abort upprör personal." Svenska Dagbladet (SvD),16 February, 2009

The Swedish Daily Paper
(Caution: machine assisted translation)

SvD News

Abortion upsets staff

16 February 2009, 15:04,
Updated 11 maj 2009 22:06

A pregnant woman demanded to know the sex of her fetus. After she learned that it was a girl she had an abortion. The same thing happened the next time she became pregnant. Currently, the director of the women's clinic is seeking the National Board's guidance as to whether clinic staff can refuse to disclose the sex of the fetus to mothers.

In a letter to the National Board the clinic director explains what happened. The woman, who already has several girls, asked for an amniocentesis for the so-called chromosome study. She stated that she was worried and wanted even to determine the sex of the fetus. According to the director, there were no medical reasons for the investigation but the doctor agreed to do it anyway.

The results showed a normal number of chromosomes and that the child was a girl. After receiving the news, ​​the patient had an abortion.

After some time the woman became pregnant again and had the same desire. The examining doctor once again determined that there was no medical reason for the inquiry. But later a midwife performed an ultrasound on the woman and was asked about the child's sex. The midwife said it was a girl and the patient requested a doctor's appointment for the abortion the same day. The abortion was performed four days later.

The director told for SvD.se that the events aroused strong feelings among the staff.

- They feel they have been pushed into a corner and participated in an abortion because the fetus was the "wrong" sex, "he says.

The chief physician points out that the abortion law says that a woman can request the interruption of a pregnancy before the 18th week.

-I usually do not ask for reasons for abortion, and should not have to do it either.

According to health care law, people who work in health care are obliged to inform the patient about their condition. But the chief physician says this can be interpreted in different ways.

- If it is about disease, you have to inform. But most also answer questions relating to health care. If you do not know the fetal sex you cannot answer the question.

Now, the case has landed on the National Board's desk. The staff at the current women's clinic calls for clinical guidelines that say you should not need to determine fetal sex unless it is medically justified. The letter to the National Board said the head of the staff asked for a directive to avoid getting into a situation where they may feel pressured to examine the fetal sex during first half of a pregnancy and contribute to an abortion procured because the the feuts is the "wrong" sex.

- On the other hand, there are private ultrasound clinics, so patients can learn about it anyway, " he told SvD.se.

The Chief Physician also seeks guidance on whether a health care provider may challenge a patient's right to abortion.

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Translated from "Lagarna ses över." Svenska Dagbladet (SvD), 16 February, 2009

The Swedish Daily Paper
(Caution: machine assisted translation)

SvD News

The laws to be reviewed

16 february, 2009, 23:26
updated: 16 februari 2009, 23:31

The woman had two abortions, both for the same reason: the fetus was a girl. The National Board is considering the possibility of limiting tests used to determine fetal sex. But Social Affairs Göran Hägglund do not think a change in the law is the solution.

It is terrible to discriminate because of sex, says Göran Hägglund on what happened on the women's clinic in MÃ Hospital in Eskilstuna.

The pregnant woman, who already had several girls, asked for an amniocentesis for the so-called chromosome study. She stated that she was worried and wanted even to determine the sex of the fetus. According to clinic director Kaj Wedenberg's letter to the government authorities, there were no medical reasons for the inquiry but the doctor agreed to do it anyway.

The results showed that the woman was carrying a perfectly healthy baby. But because it was a girl, she chose to have an abortion.

After some time the woman became pregnant again and had the same desire. The examining doctor once again determined that there was no medical reason for the inquiry. But later a midwife performed an ultrasound on the woman and was asked about the child's sex. The midwife said it was a girl and the patient requested a doctor's appointment for the abortion the same day. The abortion was performed four days later.

The events aroused strong feelings among the staff.

- They feel they have been pushed into a corner and participated in an abortion because the fetus was the "wrong sex", said Kaj Wedenberg, consultant and operations manager at the clinic.

Now we appeal to the National Board for direction to refuse to disclose fetal sex to parents.

All women may have an abortion up to gestational week 18. As the abortion law now stands, one can only deny a woman an abortion if there are medical risks. Thus, there is now no control over the reasons for abortion.

Thomas Tegenfeldt, deputy director of the National Board Inspection Department, says it has already started a project to revise the provisions of the law on genetic integrity passed in 2006.

-Today the legal situation is such that we cannot deny any abortion. But we have initiated a process where we are now reviewing whether we should be able to refuse sex determination because it is wanted in cases where it is not medically justified.

As the rules stand, today can the same woman come back and have a third abortion because she does not want a girl?

Yes.

But Goran Hagglund believes more in conversation than in trying to legislate away the problem. If you are denied an abortion requested because the fetus is the "wrong" sex, he thinks there is a risk that the person will find a different reason.

-Then the case must be examined by a committee, and I think it would be extremely difficult to make an impact in the real world.

The staff at Mälardalen Hospital Women's clinic calls for clinical guidelines that say you should not have to determine fetal sex unless it is medically justified. The letter to the National Board said the head of the staff asked for a directive to avoid getting into a situation where they may feel pressured to examine the fetal sex during first half of a pregnancy and contribute to abortion performed because the fetus is the "wrong" sex.

-On the other hand, there are private ultrasound clinics so patients can learn about it anyway," says operations manager.

Neither Thomas Tegenfeldt nor Ulf Högberg, chairman of the Swedish Society of Obstetrics and Gynecology, SFOG, which represents the country's gynecologists, have heard of more cases in Sweden where fetal sex has been a cause for abortion.

-So far, it is relatively rare in Sweden. Ethically, it would be a very unfortunate development if we found that women were using prenatal diagnosis for this purpose," said Ulf Högberg.

There is a lively debate in the U.S. and Europe about the possibility of sex selection in the course of in vitro fertilization.

-There are private companies in southern European countries where women go for an abortion. But it is a commercial operation that we in no way support. We strongly reject this, "said Ulf Högberg.

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Translated from "Gjorde abort - för att hon väntade flickor." Wendela, 16 February, 2009 (Accessed 2011-05-19)

Wendela
(Caution: machine assisted translation)

16 February, 2009

Had abortion - because she was expecting girls

Twice the woman asked for an abortion - after having been told that the child she was carrying was a girl.

Now hospital staff want to refuse to investigate fetal sex.

- They were very upset and do not want to get into this situation again, says chief Kaj Wedenberg.

The woman had several daughters already. When she became pregnant again, she asked for an amniocentesis for a chromosome study - and also wanted to know the child's sex. The number of chromosomes was normal, and the child was a girl. Six days after the woman received the information she had an abortion.

- No one was able to put it together then," said Kaj Wedenberg, chief physician at the Women's Clinic at Mälardalen Hospital in Eskilstuna.

But a month later the woman came in again for a screening ultrasound and was again told that she was expecting a girl.

- The same day she had an abortion. The staff then saw that it was due to fetal sex and became very upset," said Kaj Wedenberg.

"Unpleasant to participate "

Doctors and midwives at the hospital would now like directives that give them the right to deny investigations of fetal sex. Kaj Wedenberg has therefore written to the National Board to know how he should behave.

- In Sweden we have, in principle, free abortions to the 18th week. This has large popular support and is also strongly supported in health care. We want to protect this. But people can feel uncomfortable about participating in this if they personally value gender equality.

Can not deny

Welfare has begun to investigate the case, but would not currently provide any comment,"said lawyer Kerstin Risshytt. However, the Swedish Society of Obstetrics and Gynecology ethics states that unwanted sex is not a ground for abortion.

- All gynecological societies in the world condemn this. It occurs in India and China. It's about female fetuses and led to major demographic consequences, says chairman Ulf Hedberg.

Today, doctors cannot refuse to disclose to a woman the sex of her child.

- But we would never go ahead and do prenatal diagnostic testing to find out the baby's sex if we do not suspect a serious hereditary disease. That is the catch," he says.

Elin Swedenmark