The voluntary termination of pregnancy: a snapshot of the Italian situation

The Italian law governing the voluntary termination of pregnancy is very often brought into question.
This law, proclaimed in May 1978 (Italian Law 194/1978), doesn’t admit a right to abortion, but allows the termination of pregnancy in some specific situations and only in the hospitals of the national health service. The law establishes a difference between non-therapeutic abortion (possible within ninety days of gestation) and therapeutic abortion (within 24 weeks of gestation). This law is not the most desirable law on earth but it has been useful for reducing the number of abortions during the last thirty years, and it especially helped to avoid the big problem of undercover abortions that were very common when the termination of pregnancy was considered a crime.

In recent days, Italian newspapers have reported many news items on a juridical battle about the application of the abortion law in the hospitals of the Lombardy Region. In order to understand what happened, we should go a little back in time and start from the beginning. In January 2008 the Lombardy Region decided to apply new guidelines for therapeutic abortion in its hospitals. These guidelines recommended practising therapeutic abortions only until 22 weeks and three days from gestation, instead of the 24 weeks of the Italian law. The reason of this request is that thanks to medical advances in the Lombard hospitals, foetuses can survive autonomously after the 22nd week of pregnancy. In May, as a reaction to this decision, a small group of eight doctors supported by the Trade Union called CGIL turned to the Administrative Regional Tribunal (for short TAR) asking for the Lombardy  Region to change the new guidelines about abortion.
TAR agreed that the guidelines were against the best interest of women and against doctors’ professional autonomy. The Region did not accept this, and appealed to the judicial chambers of the Council of State, asking to be allowed to use different guidelines. A few days ago the Council of State rejected Lombardy’s appeal passing a judgment that obliges the Lombard Hospitals to practise therapeutic abortions until the 24th week. The reaction of the Lombardy Governor was quite surprising: he simply said that anyway the law allows doctors to decide when practising therapeutic abortions and that this should mean that if they do not want to terminate pregnancies after the 22nd week and 3 days, none can force them to do so.

Therefore it seems that the juridical battle was practically useless because, after all, doctors will continue to do what their internal ethical codes (read themselves) established. To understand the motivations that brought to these internal moral codes I would like to mention that the Italian law on voluntary termination of pregnancy obliges doctors to resuscitate (but without useless over-treatment) viable foetuses at the moment they are out of the body of the mother. The Lombard doctors’ opinion is that with the current level of medical technology, after 22 weeks and 3 days, the there are many chances for a viable foetus to survive autonomously. My opinion is that this is the crux of the matter, because the problem is that now foetuses of 22 weeks and 3 days have more possibilities to survive than in the past, thanks to innovation in the field of resuscitation. But is the fact that a foetus could survive a good moral reason for trying to keep it alive? When a woman decides to go for a therapeutic abortion this usually means that the foetus is affected by severe diseases, so severe that continuing the pregnancy is a danger for the foetus’ life, or for the woman’s life, or that the disease of the foetus is a danger for the physical and psychological health of the mother (paragraph 6 law 194/1978). So what is the sense of resuscitating foetuses that are affected by severe diseases and, furthermore, will suffer all of the (quite often severe) diseases connected to an extremely pre-term birth? Is the fact that the parents decided to interrupt the pregnancy, according to their moral perspective on life, not a good enough reason for helping these people resolve a painful situation? Resuscitating extremely premature foetuses could maybe make sense in the case of a spontaneous abortion, when parents want that child to survive. But when someone decides to intentionally terminate a pregnancy that naturally could continue, why should doctors or laws force a person to become a parent? When technologies will be so advanced to keep foetuses of less than 90 days alive (90 days is the limit law consents for non-therapeutic abortions), this implies that doctors will have to keep alive foetuses that were aborted because the man and woman involved did not want to become parents? There are lots of good reasons because people can refuse to become parents. For example, this is the case of women that want to terminate a gestation because they were pregnant after a sexual abuse, or women that do not feel ready for being mothers because of their age, or because of their economical situation, or because they don’t have a partner and so on.

Chances offered by new technologies are not a good moral reason for obliging people to become parents if they do not want to, neither doctors’ opinions nor laws should be an interference in such a private sphere of choice.
To suggest as a solution that unwanted foetuses could be adopted by someone else does not work, because there is a huge difference between not becoming a parent at all or giving birth to someone that will be adopted. In the first case you are not related to someone that is genetically connected to you (because this person does not exist) and in the second case you just do not have a social relation with someone. I think this is a big difference and people should be free to decide for their own best interest.
To briefly conclude I’d just want to add that the common objection that we are not acting in the best interest of foetuses is totally irrational to me, because there is no best interest of someone who is not born and will never be born. Someone could object that once the foetus is born maybe it has some best interests. First we could underline that a foetus is something really different from a person, so we’re not supposed to think that it has best interests or that we should care about its best interests. Second, even if we think that an extremely pre-term foetus could survive, there is no evidence that its best interest is to be kept alive. Especially in the case of a therapeutic abortion, we can suppose that the foetus is aborted because of a severe disease, this means that probably his quality of life will never reach a high standard, more if we consider health disadvantages connected to an extremely pre-term birth. So I find quite hard to imagine that someone’s best interest is living a whole life as a sick person.  And in the end we cannot oblige people to take care of a sick child if they don’t want to do that. Maybe someone would like dedicating the whole life to a sick offspring, but it’s unfair to ask people to give up their life for their children. But the most important argument for me is that I don’t really think it’s fair, from a moral perspective, giving birth to someone who will probably never be healthy and happy in his life.