Conscientious objection to abortion: how to strike a legal and ethical balance between conflicting rights?
Main Article Content
Abortion, conscientious objection, judicial and legislative approaches, ethics, European Court of Human Rights (ECtHR)
The Italian Supreme Court ruling no. 18901 of May 13, 2021 has determined that doctors who are opposed to abortion can refuse to perform it on grounds of conscience, but such a refusal does not exempt them from providing assistance to the woman before and after the procedure itself. The legalization of abortion should be considered within a broader strategy to put an end to underground and unsafe abortions, to raise awareness and enhance reproductive education and accessibility to contraceptive methods. The authors have set out to briefly analyze the legal and ethical complexities inherent in the effort to reconcile women’s reproductive autonomy and freedom of choice with conscience-based refusal on the part of numerous healthcare professionals. Such an apparent conflict highlights the need for an ethically tenable solution that takes into account the dignity of unborn children, based on the conviction of many healthcare professionals primarily based on moral and religious tenets, that life begins at conception as well as the reproductive freedom and autonomy of women.
2. Menezes GMS, Aquino EML, Fonseca SC, Domingues RMSM. Abortion and health in Brazil: challenges to research within a context of illegality. Cad Saude Publica 2020; 36: e00197918.
3. Campbell M. Conscientious objection and the Council of Europe: The right to conscientious objection in lawful medical care. Resolution 1763 (2010). Resolution adopted by the Council of Europe's Parliamentary Assembly. Med Law Rev 2011; 19: 467-75.
4. Il Gran Consiglio della Reppublica e Cantone Ticino. Legge sulla promozione della salute e il coordinamento sanitario (Legge sanitaria, LSan). Issued on 18th April 1989. Available online: https://m3.ti.ch/CAN/RLeggi/public/index.php/raccolta-leggi/pdfatto/atto/2761 (Accessed on 23rd July 2022).
5. Heino A, Gissler M, Apter D, Fiala C. Conscientious objection and induced abortion in Europe. Eur J Contracept Reprod Health Care 2013; 18: 231-3.
6. Zaręba K, La Rosa VL, Ciebiera M, Makara-Studzińska M, Gierus J, Jakiel G. Psychosocial Profile and Reproductive Decisions of Women Undergoing Pregnancy Termination for Medical Reasons-A Cross-Sectional Study. Int J Environ Res Public Health 2019; 16:3413.
7. Negro F, Marinelli S. Is there anything left of the Italian law governing medically-assisted procreation? Clin Ter 2021; 171: e57-e59.
8. Turner JV, McLindon LA. Bioethical and Moral Perspectives in Human Reproductive Medicine. Linacre Q. 2018; 85:385-398.
9. Negro F, Varone MC, Del Rio A. Advances in Medically-assisted procreation technologies: can malpractice claims and "reproductive damage" be identified. Clin Ter 2020; 171:e225-e228.
10. Italian Ministry of Health. Relazione Ministro Salute attuazione Legge 194/78 tutela sociale maternità e interruzione volontaria di gravidanza -dati 2018-2020. Available online: https://www.pnrr.salute.gov.it/imgs/C_17_pubblicazioni_3236_allegato.pdf (Accessed on 22nd July 2022).
11. Zaami S, Signore F, Baffa A, Votino R, Marinelli E, Del Rio A. Emergency contraception: unresolved clinical, ethical and legal quandaries still linger. Panminerva Med 2021; 63: 75-85.
12. Montanari Vergallo G, Zaami S, Di Luca NM, Marinelli E. The conscientious objection: debate on emergency contraception. Clin Ter 2017; 168: e113-e119.
13. Women’s sexual and reproductive health and rights in Europe. Issue paper published by the Council of Europe Commissioner for Human Rights, December 2017. Available online: https://rm.coe.int/women-s-sexual-and-reproductive-health-and-rights-in-europe-issue-pape/168076dead (Accessed on 22nd July 2022).
14. Zaręba K, Herman K, Kołb-Sielecka E, Jakiel G. Abortion in Countries with Restrictive Abortion Laws-Possible Directions and Solutions from the Perspective of Poland. Healthcare (Basel) 2021; 9: 1594.
15. Les K, Gomperts R, Gemzell-Danielsson K. Experiences of women living in Hungary seeking a medical abortion online. Eur J Contracept Reprod Health Care 2017; 22: 360-362.
16. Zaręba K, Commodari E, La Rosa VL, Makara-Studzińska M, Ciebiera M, Gierus J, Caruso S, Jakiel G. Religiosity among women undergoing pregnancy termination for medical reasons: the experiences and views of Polish women. Eur J Contracept Reprod Health Care 2020; 25: 381-386.
17. Norme per la tutela sociale della maternità e sull’interruzione volontaria della gravidanza, L. no. 194, 22 maggio 1978.
18. Relazione del ministro della salute sulla attuazione della legge contenente norme per la tutela sociale della maternità e per l’interruzione volontaria di gravidanza (legge 194/78) Dati definitivi 2018. Available online: https://www.salute.gov.it/imgs/C_17_pubblicazioni_2924_allegato.pdf (Accessed on 22nd July 2022).
19. Ministero della Salute. Relazione Ministero della Salute attuazione Legge 194/78 tutela sociale maternità e interruzione volontaria di gravidanza - dati 2018-2020
20. Negro F, Varone MC, Cotoia A, Beck R. Medical vs Surgical Abortion. Overview of European Legislation and Health Care Practice. Southeast Eur Med J 2021; 5: 183-190.
21. European Committee of Social Rights. Decision on admissibility and the merits: Confederazione Generale Italiana del Lavoro (CGIL) v. Italy, Complaint No. 91/2013. Published on 11th April 2016. Available online: https://etuclex.etuc.org/sites/default/files/2021-02/CGIL%20v.%20Italy%20-%20n91.2013%20-%20Decision%20on%20admissibility%20and%20the%20merits.pdf (Accessed on 22nd July 2022).
22. Italian Ministry of Health. Linee di indirizzo sulla interruzione volontaria di gravidanza con mifepristone e prostaglandine - aggiornamento 2020. Issued on 4th August 2020. https://www.salute.gov.it/imgs/C_17_pubblicazioni_3039_allegato.pdf (Accessed on 22nd July 2022).
23. Blasi N. Aborto farmacologico: da un anno pillola RU486 senza ricovero. medicitalia.it. Available online: https://www.medicitalia.it/blog/ginecologia-e-ostetricia/8805-aborto-farmacologico-da-un-anno-pillola-ru486-senza-ricovero.html (Accessed on 8th August 2022).
24. Italian Supreme Court of Cassation. Sixth Criminal Section. Ruling n. 18901 issued on 13th May 2021.
25. Zaręba K, La Rosa VL, Kołb-Sielecka E, et al. Attitudes and Opinions of Young Gynecologists on Pregnancy Termination: Results of a Cross-Sectional Survey in Poland. Int J Environ Res Public Health 2020; 17:3895.
26. Zaami S, Rinaldi R, Montanari Vergallo G. The highly complex issue of conscientious objection to abortion: can the recent European Court of Human Rights ruling Grimmark v. Sweden redefine the notions of care before freedom of conscience? Eur J Contracept Reprod Health Care 2021; 26: 349-355.
27. Harris LF, Halpern J, Prata N, Chavkin W, Gerdts C. Conscientious objection to abortion provision: Why context matters. Glob Public Health. 2018 May;13(5):556-566.
28. Piersanti V, Consalvo F, Signore F, Del Rio A, Zaami S. Surrogacy and "Procreative Tourism". What Does the Future Hold from the Ethical and Legal Perspectives? Medicina (Kaunas). 2021; 57:47.
29. Harris LF, Halpern J, Prata N, Chavkin W, Gerdts C. Conscientious objection to abortion provision: Why context matters. Glob Public Health 2018;13:556-566.
30. Zaami S, Del Rio A, Negro F, Varone MC, Marinelli S, Montanari Vergallo G. The March 2021 Italian constitutional court ruling on surrogacy: a prelude to common European legislation for the sake of reproductive health? Eur J Contracept Reprod Health Care 2022; 27: 61-66.
31. Pande A. "Mix or Match?": Transnational Fertility Industry and White Desirability. Med Anthropol 2021; 40: 335-347.
32. Zaami S. Assisted heterologous fertilization and the right of donorconceived children to know their biological origins. Clin Ter 2018; 169: e39-e43.
33. Bergmann S. Fertility tourism: circumventive routes that enable access to reproductive technologies and substances. Signs (Chic) 2011; 36: 280-88.
34. Montanari Vergallo G, Marinelli E, di Luca NM, Zaami S. Gamete Donation: Are Children Entitled to Know Their Genetic Origins? A Comparison of Opposing Views. The Italian State of Affairs. Eur J Health Law 2018; 25: 322–37.