Position of the Team of Experts for Bioethics of the Polish Bishops’ Conference on the draft amendment to the Act on healthcare services financed from public funds

Position of the Team of Experts for Bioethics of the Polish Bishops’ Conference
on the draft amendment to the Act on healthcare services financed from public funds and on reimbursement of medicinal products, foodstuffs for special nutritional purposes and medical devices

The parliamentary bill submitted to the Polish Sejm and referred to the Health Committee (Sejm document no. 1850) provides for free access to contraceptives, including intrauterine devices, for women aged 18–25 years. This healthcare benefit would be financed by the National Health Fund. The bill moreover envisages partial reimbursement of these products for women over the age of 25. The proposed amendments further confer the right to issue reimbursed prescriptions for these products on all persons practising a medical profession authorised under the Healthcare Services Act. The bill raises serious reservations of the Expert Team for Bioethical Issues of the Polish Bishops’ Conference. In the opinion of the Team, not only are the proposed provisions highly detrimental from both a medical and a social perspective, but are also profoundly unethical.

Medical Aspects

Hormonal preparations belong to substances with a very strong and broad spectrum of action extending beyond their contraceptive effect. They are used in the treatment of certain diseases; however, their therapeutic application requires due consideration of the risk of adverse effects, some of which may be very serious. They are also administered to girls during puberty, purportedly to regulate the developing endocrine system of the young woman, to improve skin condition, regulate the menstrual cycle, and alleviate pain associated with the rhythm of fertility. Some of these uses may be regarded as therapeutic; nevertheless, even in such cases they are not free from adverse effects and entail the risk of serious complications, sometimes delayed in onset. Concern for women’s health requires that any therapeutic use of these preparations take place only in situations of genuine necessity. Therefore, efforts should be made to develop therapeutic approaches that do not require the use of hormonal preparations; not only do they impair the functioning of the reproductive system but also increase the risk of other serious health complications, including those affecting the cardiovascular systemPoczątek formularza

[1], and increase the risk of breast cancer[2] and cervical cancer[3]. Importantly, breast cancer ranks first among malignant cancers in Polish women[4]. Furthermore, the use of hormonal contraceptives affects women’s mental health and may trigger depression or exacerbate its symptoms[5].

In addition, the use of hormonal preparations with a contraceptive effect is particularly hazardous for women at the peak of their fertility; it is them who would, in fact, be the principal “beneficiaries” of the proposed legislation. In a situation of increased risk of stroke and of dangerous thromboembolic complications,[6] the proposal to authorise the prescribing of hormonal preparations with a contraceptive effect by persons practising a medical profession who neither possess the requisite authorisations nor the competence to carry out the necessary examinations of female patients to exclude contraindications to the use of such preparations is gravely concerning and objectionable.

It should be recalled that facilitated access to contraceptive methods may lead to risky sexual behaviours, early sexual initiation, and an increased risk of infection with sexually transmitted diseases. It creates the illusion that sexual activity may be undertaken without its consequences and, consequently, results in the shifting the consequences of sexual intercourse (as well as of contraceptive use) onto women, purportedly relieving men of this responsibility. Inevitably, acquiescence in the promotion of contraception is, in fact, discriminatory towards women, who become victims of selfish attitudes detrimental to themselves and to social life.

Social Aspect

The promotion of contraception in the name of improving the standard of living in reality creates an illusion of prosperity and convenience. Parenthood, by its very nature requiring sacrifice, time, effort and financial resources, is perceived as an undesirable reality. The effects of promoting such an approach extend beyond the issue of low fertility; they result in the formation of selfish attitudes among both young people and adults, eroding social bond, the spirit of mutual responsibility, social solidarity and patriotism. These effects, although pertaining to individuals, lead to the shaping, among a significant proportion of them, of an attitude of egoistic orientation towards life, thereby entailing serious social consequences on a macro scale.

Particularly in recent years, many individuals and groups have sought to raise public awareness of the threat posed by a declining natural increase rate. Official statistical data confirm the correctness of those who, 30 and 20 years ago, warned that the downward trend observed at that time could not be halted. At present, the fertility rate in Poland is the lowest in Europe and the fourth lowest in the world. There is no generational replacement; the rate would have to be at the level of 2.1 children per woman on average and it now stands at 1.1. In this situation, the promotion of contraceptive attitudes and practices is highly detrimental from the social point of view, including from an economic perspective.

The model of the social contract adopted in Poland, under which the employed support those not in employment (children, pensioners, and those unable to work for various reasons), has long been criticised as inefficient. However, no viable concept or sufficient political will has emerged to replace it with a more economically effective solution. The level of contribution deficits prompts governing authorities to attempt to raise the retirement age, which meets with public opposition. The fact is that, in the absence of children who will in the near future be working to support the elderly, the latter will be left without means of subsistence. Nor can one exclude the possibility that liberal circles, following the example of other countries, may seek the legalisation of euthanasia.

Ethical Analysis

Both the medical and the social perspectives determine the direction of the bioethical assessment, for which the fundamental formal principle is the dignity of the human person and, in the case of the document under consideration, also the common good of society. The proposed legislation, while it responds to a desire for convenience, in fact runs counter to the nature and dignity of the human being, both with regard to the duty to safeguard health and in the dimension of responsibility and social solidarity. Moreover, the fact that hormonal contraceptive agents and intrauterine devices, which are to be subject to reimbursement, exhibit a complex mechanism of action that does not exclude interference at the beginning of human life gives rise to further serious ethical concerns. It is also unclear whether the bill will encompass so-called “morning-after pills”, which are classified as contraceptive agents. Apart from their detrimental impact on women’s health, they may lead to the deprivation of life of a child at the initial stage of their development. The Team of Experts for Bioethics of the Polish Bishops’ Conference deems the bill under discussion in the Sejm as unequivocally harmful and unethical and calls upon all who care for the good of Poland and Poles to reject it.

On behalf of the Team of Experts for Bioethics of the Polish Bishops’ Conference
Bishop Józef Wróbel SCJ

Warsaw, 16 March 2026

Translated from Polish original: Marcin Turski