On both sides of the Atlantic, the battle over abortion rights and medical freedom is intensifying, with governments and advocacy groups locked in legal and ideological struggles that reverberate far beyond clinic doors. In Spain and Missouri, recent developments have thrown the spotlight on the fundamental clash between individual conscience, patient privacy, and the reach of state power—while a powerful U.S.-based legal group works to shape the outcome of these culture war flashpoints in courtrooms nationwide.
In Spain, the Socialist government led by Prime Minister Pedro Sánchez has ignited fierce controversy by directing regional authorities to compile lists—what critics call a "blacklist"—of doctors who refuse to perform abortions. According to El Debate, this move, announced on October 7, 2025, is part of a broader campaign by Sánchez to enshrine abortion rights in the Spanish Constitution, mirroring a similar step taken by France. Sánchez has framed the constitutional amendment as a defense of "women’s freedom and autonomy," but opponents see a darker motive: the suppression of dissent and the enforcement of ideological conformity within the country’s public healthcare system.
Legal experts and medical professionals have been quick to voice alarm. Manuel Martínez-Sellés, president of the Madrid College of Physicians, told El Debate, "This is difficult to see as anything other than an attempt to restrict freedom of conscience." He warned that the so-called "objector lists" would inevitably be used "to discriminate against doctors who refuse to take part in acts they consider morally wrong." In regions like Madrid and Castile and León—where a majority of gynecologists are conscientious objectors—the central government has accused hospitals of "non-compliance" with abortion law, raising the stakes for medical professionals who feel their rights are under siege.
For many in Spain’s medical community, the issue transcends the abortion debate. They argue that conscientious objection is not a loophole but a cornerstone of democratic freedom, protected under both the Spanish Constitution and the EU Charter of Fundamental Rights. Martínez-Sellés added, "If the government wants to organize abortion services, it should ask for a list of those willing to perform them—not those who refuse." The government’s campaign, he suggested, is not just about healthcare but a political diversion from internal scandals, corruption, and division within the ruling Socialist Party. "When under pressure, the government reignites emotional debates over abortion, feminism, or its campaign to rewrite Spain’s Civil War and Franco-era history to rally its base," he said.
The past year has seen Sánchez’s cabinet launch a taxpayer-funded website to promote abortion, dismiss post-abortion trauma as a "myth," and now, with the latest move, seek to criminalize medical dissent. Observers warn that if the government can catalog and penalize citizens for exercising the right to conscientious objection, no domain of personal liberty will remain untouched. What’s at stake, they argue, is not merely the abortion debate—but the freedom to think, believe, and act according to one’s conscience.
Meanwhile, in the United States, a parallel drama is unfolding in Missouri, where the state’s Republican attorney general has set off a legal firestorm by seeking access to the medical records of Planned Parenthood patients who have had abortions. As reported by the Associated Press, subpoenas were issued in late August 2025 targeting employees and former board members of Planned Parenthood affiliates in Kansas City and St. Louis. The requested documents are sweeping: patient records, reports on adverse events, communications about patient care, clinical protocols, equipment maintenance records, contract documents, and compliance records.
Planned Parenthood officials argue that Missouri’s restrictions violate a constitutional amendment narrowly approved by voters in November 2024, which guarantees abortion rights until fetal viability—generally considered to be sometime past 21 weeks of pregnancy. In a joint statement, the two affiliates declared, "Despite the Missouri Attorney General’s blatant attempts to overturn the will of the people, all patients expect and have the right for their medical records to be private. Politicians have no place in the exam room with patients and their medical providers."
The attorney general’s office, led by Catherine Hanaway, did not immediately respond to requests for comment. However, in a June court filing, the state questioned Planned Parenthood officials’ repeated statements that "abortion rarely involves medical complications" and asserted that "the purpose of litigation is to ‘ascertain the truth.’"
Missouri’s abortion policy has been in flux since the U.S. Supreme Court’s 2022 decision overturning Roe v. Wade, which allowed states to enforce bans. The state swung between a near-total ban and allowing most abortions, culminating in the 2024 constitutional amendment. In July 2025, a Kansas City judge blocked enforcement of many restrictions—including licensing requirements and a 72-hour waiting period—while the lawsuit proceeds. Procedural abortions are currently performed in St. Louis, Kansas City, and Columbia, but medication abortions remain on hold amid ongoing regulatory disputes.
The state’s Republican-led legislature, however, is determined to roll back abortion rights. In May 2025, lawmakers approved a proposed constitutional amendment to ban abortion, with exceptions for rape and incest, setting the stage for a high-stakes 2026 ballot fight. But the path to the ballot has been anything but smooth. In late September 2025, Cole County Judge Daniel Green ordered the Missouri Secretary of State to rewrite the ballot summary, noting that the new measure would "Repeal Article I, section 36, approved in 2024," but failing to explain the implications to voters. The legal wrangling continues, with the ultimate fate of abortion rights in Missouri hanging in the balance.
Amid these state-level battles, a powerful national player is working to shape the legal landscape: the Alliance Defending Freedom (ADF), an Arizona-based conservative Christian legal group. As The New York Times reports, ADF is involved in multiple high-profile culture war cases, including abortion access, LGBTQ+ rights, and religious freedom. On October 7, 2025, ADF was representing Kaley Chiles, a licensed counselor challenging a Colorado law banning conversion therapy for minors. The group also has cases before the Supreme Court involving transgender athlete participation laws in Idaho and West Virginia, and a New Jersey subpoena case regarding faith-based pregnancy centers.
In its 2024 annual report, ADF’s CEO Kristen Waggoner described President Trump’s election as a "rebuke to progressive ideology" and declared that ADF is "made for this moment" to "reclaim the truths and freedoms that made the West truly great." With several cases slated to be heard by the Supreme Court, ADF’s influence on the future of abortion rights and related issues is set to grow.
Across Spain, Missouri, and beyond, the struggle over abortion rights has become a litmus test for deeper questions about conscience, privacy, and the limits of government authority. As courts, legislatures, and advocacy groups grapple with these dilemmas, the outcomes will shape not only access to abortion, but the very meaning of freedom in modern democracies.
In the end, what happens in the exam room—and in the courtroom—may determine the boundaries of personal liberty for generations to come.
