Seven Italian doctors who refused to perform a potentially life-saving abortion are fighting accusations of manslaughter in a trial that is expected to set a precedent for Italy’s medical attitude towards the procedure.
The trial held in Catania, Sicily, focuses on the circumstances of the death, in 2016, of five-months pregnant Valentina Milluzzo. Members of Milluzzo’s family, who are due to testify on Tuesday, said that when the 32-year-old was admitted to hospital with complications, doctors said her unborn twins would not survive but refused to terminate the pregnancies on moral grounds, which ultimately led to fatal sepsis.
The case has become a symbol of the difficulties Italian women face when they seek to exercise their right to abort in Italy. In 1978, the country legalised the procedure but also allowed doctors to refuse to carry it out by raising “a conscientious objection”.
In 2017, more than two-thirds of gynaecologists declared themselves as conscientious objectors, up 10 per cent in the past 20 years, according to a government report released in December.
Women’s rights activists say increasing hostility to abortion rights go hand in hand with the rise of rightwing populism in many western democracies. In Italy, the far-right League, which was part of the ruling coalition for a year until this summer, proposed legislation weakening the abortion law and facilitating adoption in the womb to bolster declining fertility. The northern town of Verona last year introduced rules requiring women to consult anti-abortion groups offering financial assistance before seeking an abortion.
“In Italy, as all over the world, all the rights won by women — divorce, contraception, abortion — are under attack,” said Eleanora Cirant of Non Una di Meno, a feminist group.
High levels of objectors among the medical staff in Italy are also a result of the Catholic Church’s enduring power, according to Elisabetta Canitano, a gynaecologist and founder of the women’s health non-profit organisation Vita di Donna. “The central problem is that the Church considers this country its own.”
The head of the obstetrics department in the Cannizzaro hospital where Ms Milluzzo died said in 2016 that he and the other doctors working for him were conscientious objectors but that their views were not a factor. They merely followed protocol, they said.
Ms Milluzzo’s father Salvatore disagrees, saying the medical staff refused to terminate the pregnancies when it was clear the foetuses were not viable.
“The doctor told me, ‘Look there is no hope for the babies, but even though Valentina is in pain we can’t intervene as we can still hear the heart beat,’” he told the Financial Times. “With the right antibiotics and removing the source of infection Valentina would be alive.”
Prosecutors accuse the seven medical staff, including an anaesthetist, of negligence and malpractice. The hospital and staff deny wrongdoing.
Many ordinary Italians have come to terms with abortion, said Sebastian Maffetone, professor of Political Philosophy at Luiss University in Rome. But there are big regional differences. In Sicily, only one in 10 gynaecologists performs abortions, while in Molise just one doctor carries out all the region’s abortion procedures.
In these conservative Catholics areas, many doctors come under pressure to object to abortions. Silvana Agatone, a gynaecologist who heads women’s rights group Laiga, said: “It is not about ethics, it is about going along with the majority.”
Non-objecting doctors face “cumulative disadvantages. in terms of workload, distribution of tasks, [and] career development opportunities”, the Council of Europe ruled in 2016.
Rossana Cirillo, a doctor in Genoa, said she eventually became an objector because she was overwhelmed by a workload of 800 abortions a year. “I do not identify as an objector,” she said. “I was working so much it became unsafe for the women.”
That means long waiting lists and women travelling abroad when they can afford it. Illegal abortions are punishable with fines.
Valentina Magnanti, a 33-year-old from Rome, sued the hospital where she terminated her pregnancy after she was called “an assassin” by medical staff who waved Bibles at her. When her doctor went off shift, they refused to assist her, leaving her to deal with the abortion in the toilets. “It was medieval,” she recalled.