Italy, year 2020. A woman in her 18th week of pregnancy arrives at the hospital in Naples, the foetus already lacking a heartbeat; a pharmacological abortion must be performed immediately to save the woman’s life. The gynaecologist on duty refused to perform the abortion on the grounds of conscientious objection, the woman was consequently saved by another doctor called in urgently by a midwife.
The objecting gynaecologist was subsequently dismissed for failing to provide assistance.
In Italy, the termination of pregnancy is legal thanks to Law 194 of 1978, but conscientious objection makes abortion increasingly difficult in the country. The absurd episode mentioned at the beginning of this article demonstrates that conscientious objection is so deep-rooted and closeminded among some doctors that they even allow an already dead foetus to drag its mother to the same irreversible fate.
Conscientious objection is the refusal to comply with an obligation imposed by law that is contrary to one’s morals, conscience or religious beliefs. Historically, it represented an act of courage in opposition to a law or a ban that was considered to be unjust. In Italy, thanks to Law 772 of 1972, which recognised the possibility of refusing military service, that was compulsory at the time; conscientious objection became a right and replaced it with another unarmed but still compulsory service: civilian service. Today, Italy’s legal system provides three forms of ‘objection’: the first applies to military service, the second to animal experimentation and finally, in the medical field. As far as this last field is concerned, there are several forms of abstaining the law. The first of which, in chronological order, concerns the voluntary termination of pregnancy (VTP), introduced in Italy by the aforementioned Law No. 194 of 1978, decriminalising and regulating the practice of abortion.
Would it be fair to inhibit access to gynaecological especialisation for conscientious objector physicians?
This law contains a specific article, number 9, in order to assure the objection. This article states that healthcare personnel and personnel carrying out auxiliary activities are not required to take part in the procedures referred to in articles 5 and 7, and in interventions for the termination of pregnancy when they raise conscientious objection, with a prior declaration. There are no specific indications regarding objection itself, except that conscientious objection can be withdrawn and the status of the objector does not exempt them from assistance prior to and following the actual procedure of terminating a pregnancy. Nor can it be invoked when the intervention is essential to save the life of the woman in imminent danger. Nonetheless, authorised hospitals and nursing homes are in any case required to ensure that VTP can be carried out. Furthermore, Italy’s regions, according to the law, must monitor and guarantee the implementation of the right of abortion, including through staff mobility.
Today 7 out of 10 gynaecologists are conscientious objectors, reaching 96.9% in the Basilicata region, as claimed by ISTAT. Nevertheless, 82% of Italy’s population are in favour of the voluntary interruption or termination of pregnancy according to research carried out by Eurispes. Therefore, how can the large number of conscientious objecting physicians be explained?
First and foremost, religious reasons are to be accounted for. In fact, the Christian religion emphasises the sacredness of life from conception onwards and, therefore, equates abortion with murder. Despite being used in most cases as a monolithic justification for the objecting physician’s status, religious belief is actually a fairly marginal element in the balance of factors that lead to becoming an objecting physician. Some researches, promoted by LAIGA (the Italian association representing non-objecting doctors), claim that in most cases doctors become conscientious because this facilitates their career and creates greater consensus, as well as making working circumstances more pleasant. In fact, VTP is a relatively simple and monotonous practice and is generally considered to be an unrewarding job. This is due to the fact that the few non-objecting gynaecologists end up practising all abortions themselves, because VTP is namely perceived as a ‘subsidiary’ job, regardless of the fact that it is the most widespread gynaecological practice after childbirth.
Then, in some cases, the objection is a choice of convenience because abortionists feel stigmatised by their colleagues who object: in particular, if the latter occupy prestigious positions within hospitals, the careers of non-objecting physicians can come to a standstill precisely when it involves the practice of VTP. In hospitals of northern Italy, for example, since a large part of the Lombardy’s health service is under direct or indirect influence of the Communion and Liberation political party, Catholics possess extensive authority.
Lastly, there is an economic motive, given the fact that abortions can be performed either in public hospitals free of charge or in private clinics. As far as the public health service is concerned, abortion cannot be included among the free professional services provided by hospital outpatient clinics, and this legitimises many so-called ‘objection for convenience‘ doctors to declare themselves conscientious objectors to the national health service and then perform VTP for a fee in their own clinics. On closer inspection, it seems that great strides have been made since “Whoever causes the abortion of a woman, with her consent, shall be imprisoned from two to five years. The same punishment shall apply to the woman who has consented to the abortion“, yet many are the cases that still need to be executed. Legislative advances have made it possible for abortion to become, on paper, a choice open to pregnant women, and thus a right of self-determination. Unfortunately, however, the choice of many gynaecologists’ refusals to perform abortions on the grounds of conscientious objection (claiming that such a practice is against their moral views) very often risk transforming a civil right into an opportunity that is not always guaranteed. This makes it very difficult for a woman to obtain an VTP within the timeframe laid down by law, i.e. within 90 days from conception, counted from the first day of her last period.
In actual fact, by ensuring an adequate percentage of non-objecting doctors in every facility it is necessary not only to work on making abortion rights effective in every Italian hospital, but if one really wanted to solve the problem for good, one could also think of making the specialisation in gynaecology inaccessible to objecting physicians. In fact, there are a great many medical specialisations for trainees that do not require them to perform abortions: if we weigh the dream of becoming a gynaecologist (albeit an objecting physician) against the possibility of a woman having access to a right provided for her by law, the latter inevitably ends up – in the writer’s opinion – having greater influence. Especially in a context where the high number of the former prevents the effective respect of a legitimate right.