The court’s decision marks the culmination of what has become an overt persecution of doctors who refuse to perform abortions for reasons of conscience.
Context of the Decision
In 2010, a law authorized abortion up to the 14th week of pregnancy—and up to the 22nd week in cases of fetal malformation or health risks to the woman. However, abortion remains permissible beyond the 22nd week in cases where a serious and incurable disease is detected in the fetus.
Since 2022, the law has penalized obstruction, intimidation, or harassment of women or professionals in the vicinity of clinics with a prison sentence of 3 to 12 months, or with a ban on approaching clinics for a period of 6 months to 3 years.
In 2023, a new reform mandated, among other provisions, the creation of a registry of conscientious objector doctors in every Spanish autonomous community, with the stated aim of improving service organization and continuity; the reform also authorized minors to obtain an abortion without parental consent starting at age 16, and eliminated the mandatory waiting period.
Several Spanish autonomous communities had refused to comply with the mandate to create this registry, notably Aragon, the Balearic Islands, and Madrid. The President of the Community of Madrid, Isabel Díaz Ayuso (PP), has repeatedly characterized the registry as a "blacklist" that would stigmatize doctors who exercise their right to conscientious objection, thereby opening the door to discrimination in future hiring.
In October 2025, the Ministry of Health demanded that the holdouts comply; the first two entities addressed responded favorably. The Madrid College of Physicians responded, through its president, Dr. Manuel Martínez-Sellés, by stating: "What the government seeks is to curtail the right to conscientious objection, and it is doing so through these blacklists of doctors who object."
In November 2025, Isabel Díaz Ayuso stood firm in her refusal: "What is the point of wanting a blacklist of doctors? If you do not intend to use it, why is it so important to you?" She called for the "defense of ideological and religious freedom, as well as freedom of worship, as enshrined in our Constitution." She added: "The most important thing is that the State does not intrude upon our way of thinking."
On January 15, the Ministry of Health referred the case to the Madrid High Court of Justice. On Monday, March 9, the Court upheld the interim measures requested by the Ministry of Health and ordered the Community to "immediately" initiate the administrative process for drafting and approving this registry, a requirement mandated by national legislation on abortion.
However, the Court clarified that the interim measure does not entail the immediate creation of the registry itself, but rather imposes an obligation to commence the necessary administrative procedures for its implementation, in accordance with current legislation.
It is worth noting that in certain regions, such as La Rioja and Castile and León, virtually all doctors refuse to perform abortions on grounds of conscientious objection. In 2023, five of the nine provinces of Castile and León had not reported a single abortion in over a decade.