The issue of transparency and legality regarding abortion decisions in Madrid has returned to the spotlight. The refusal of regional authorities to screen members of the clinical abortion committee for their status as ‘conscientious objectors’ is raising concerns among experts and the public. Such a practice could result in complex cases being decided without sufficient guarantees of objectivity, directly impacting the rights of both women and medical professionals.
As El Pais reports, Madrid does not maintain a legally required registry of healthcare professionals who have refused to participate in procedures on personal grounds. This means that when the committee is formed to review termination requests after the 22nd week, no one checks whether members are current or recent ‘objectors’ from the past three years. The law stipulates that such professionals must be excluded from the committee to ensure impartiality, but this provision is routinely ignored in practice.
Regional authorities justify their refusal to create a registry by claiming it would be a ‘blacklist,’ citing the position of Madrid’s president Isabel Díaz Ayuso. Nevertheless, Spain’s Ministry of Health has repeatedly stressed the need for a confidential internal list to prevent conflicts of interest and uphold the law. After legislative changes in 2023, this obligation was further reinforced, yet Madrid continues to evade its implementation.
Consequences for the system
The lack of oversight over the committee’s composition means there is no way to verify whether decisions are made impartially. According to El Pais, in 2025 the committee rejected 34% of requests for termination of pregnancy due to severe fetal abnormalities. At the same time, committee members do not disclose their personal stance on the issue of ‘conscientious objection’, fueling further doubts about the transparency of the process.
Opposition parties in Madrid have called the recent rotation of committee members ‘cosmetic’ and believe that without a register, the committee’s objectivity cannot be guaranteed. Moreover, new members were appointed before the implementation of a system to track ‘objectors’, which critics argue undermines the committee’s legitimacy. Regional authorities, meanwhile, are disputing a court order requiring them to create such a register.
Reaction and controversy
Spain’s Ministry of Health has for several years urged the autonomous communities to implement internal lists of ‘conscientious objectors.’ However, in Madrid, the issue remains unresolved despite court orders and pressure from central authorities. As a result, women seeking medical care face additional barriers, while doctors work under unclear rules in complex cases.
According to El Pais, the lack of transparency in the formation of the committee and the refusal to keep a registry may lead to an increase in refusals to perform medically indicated abortions. This creates risks for women’s health and rights and undermines trust in the region’s healthcare system. The opposition continues to demand the immediate implementation of accountability for objectors to restore legality and fairness in decision-making.
Context and similar cases
In recent years, Spain has repeatedly debated the right of medical professionals to refuse to participate in abortions on personal grounds. Some regions have introduced closed registries, increasing transparency and reducing conflicts. However, in several autonomous communities, including Madrid, the issue remains unresolved. Similar debates have taken place in other European countries, where the balance between patients’ rights and doctors’ freedom of conscience is regulated differently. In 2024, comparable discussions emerged in Andalusia and Catalonia, where mechanisms for oversight of medical committee composition were also under review.
