Case T-388/09

The petitioner, a Colombian national, filed a tutela (an appeal for legal protection) on behalf of his partner who was 19 weeks pregnant. The petitioner’s partner underwent examination and discovered that the fetus exhibited serious malformations that made the fetus unviable. Despite the advice of a board of specialists to terminate the pregnancy, the local health provider requested a judicial order to perform the therapeutic abortion. The petitioner requested the authorization from the Municipal Court, but  the judge claimed the right of conscientious objection and refused to admit the case, as his moral and religious beliefs would prevent him from being objective and impartial. Upon appeal, the judge’s decision was overturned and the health care provider company, SaludCoop, was ordered to perform the procedure within 48 hours, as well as to perform all necessary testing and give the patient all necessary psychological care. Consequently, the healthcare provider performed the procedure by C-section due to the fact that the pregnancy was six months along by that point.

The petitioner had also claimed that SaludCoop was responsible for covering the costs of the procedure. SaludCoop argued that it should not have to fund the abortion because the petitioner had not demonstrated a lack of sufficient funds to pay for the procedure himself.

Upon revision, the Constitutional Court determined: (i) what mandates are derived from the judge’s decision regarding sexual and reproductive rights?; (ii) what practical considerations arise for health care providers and their medical practitioners? and (iii) can judges deny appeals on the grounds that they are incompetent due to private and personal reasons when fundamental rights are involved?

The Court held that women have the right to decide, without pressure, punishment, or unwanted intervention, the voluntary interruption of a pregnancy if the pregnancy met certain health criteria, such as fetus malformations. The Court further concluded that women should have access to information that allows them to to exercise their sexual and reproductive rights fully and in a completely confidential manner.

In addition, the Court held that health providers did not have an absolute right to claim conscientious objection to deny the requested sexual and reproductive health procedure. Although the Court made clear that the freedom of religion must be respected, it also clarified that medical personnel could only avoid performing the requested procedure if there was another health provider available that could perform the procedure without delay, as well as if denying that procedure did not put the woman’s life or physical integrity at risk.

The Court further held that hospitals, both public and private, without religious affiliations had an obligation to make available medical personnel qualified to perform the procedures. The Court also clarified that a woman's sexual and reproductive rights have a constitutional protection that cannot be breached by such public and private institutions. Furthermore, the Court held that women who chose to voluntarily end a pregnancy should not be subject to discrimination and that their right to privacy should be fully protected.

The Court held that judicial authorities could not claim the right of conscientious objection to excuse themselves from adjudication or to deny the appeal. To the contrary, they were required to carry out their constitutional and legal duties. Accordingly, the first judge violated the rights of the petitioner's wife by not allowing the case due to personal religious convictions.

(i) Las mujeres puestas bajo las hipótesis contenidas en la sentencia C-355 de 2006 gozan del derecho a decidir libres de presión, coacción, apremio, manipulación y, en general, cualquier suerte de intervenciones inadmisibles respecto de la interrupción voluntaria de su embarazo. Es este un derecho de las mujeres quienes aún colocadas en los supuestos allí determinados también pueden elegir con libertad llevar a término su embarazo.

(ii) Todas las mujeres deben poder contar con la información suficiente, amplia y adecuada que les permita ejercer a cabalidad y en libertad sus derechos sexuales y reproductivos, lo que incluye, el derecho a estar plenamente enteradas respecto de lo dispuesto en la sentencia C-355 de 2006 así como en el Decreto 4444 de diciembre 13 de 2006 “Por el cual se reglamenta la prestación de unos servicios de salud sexual y reproductiva”.

1. Permitir a las instituciones prestadores de salud-IPS, cuyo fundamento y razón de ser sea confesional o religiosa, no realizar la interrupción voluntaria del embarazo (IVE), siempre y cuando, este tipo de instituciones no sean las únicas de un determinado lugar o cuando la mujer acuda a la institución en estado de urgencia que ponga en peligro su vida o su integridad física. En estas situaciones tendrán que contar con personal médico capacitado y habilitado para practicar el procedimiento.

2. Las Entidades Prestadores de Salud, EPS, remitirán a las mujeres que soliciten la interrupción voluntaria de su embarazo, sin dilación alguna, a las instituciones que practiquen la interrupción voluntaria del embarazo.

La razón de esta regla es que las Entidades Prestadores de Salud, EPS, son las administradoras del sistema de seguridad social en salud. Dentro de sus funciones se encuentra remitir a los pacientes a las instituciones prestadoras de salud que consideren pertinentes para el procedimiento que se solicite.

3. Las entidades confesionales o religiosas no pueden alegar objeción de conciencia para negarse a remitir a un paciente a determinada institución para la práctica de la IVE.

4. Los hospitales de la red pública hospitalaria y las instituciones privadas sin fundamento confesional o religioso sí están obligados a practicar la interrupción voluntaria del embarazo y no les está permitido alegar la objeción de conciencia como personas jurídicas. Por tanto, tienen el deber de contar con un personal médico calificado y capacitado para practicar dicho procedimiento en todas las circunstancias previstas por la sentencia C-355 de 2006.

La objeción de conciencia es un derecho que se garantiza de modo extenso en el campo privado – cuando no está de por medio el desconocimiento de derechos de terceras personas -. No obstante, queda excluido alegarla cuando se ostenta la calidad de autoridad pública. Quien ostenta tal calidad, no puede excusarse en razones de conciencia para abstenerse de cumplir con sus deberes constitucionales y legales pues con dicha práctica incurriría en un claro desconocimiento de lo dispuesto en los artículos 2º y 6º de la Constitución Nacional.