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NEWS: Fabio Turone Abortion becomes hot political issue in run up to Italian election BMJ 2008; 336: 408-b-409-b [Full text]

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Some notes on the Italian Abortion law

Andrea Dovio   (22 February 2008)

Guidelines are missing

Luca Puccetti, Renzo Puccetti, MD   (24 February 2008)

Some notes on the Italian Abortion law 22 February 2008
Andrea Dovio, Attending Specialty School San Luigi Hospital- Orbassano (TO) - I-10043 Send response to journal: Re: Some notes on the Italian Abortion law	Dear Editor I read with great interest the paper of Turone "Abortion becomes hot political issue in run up to Italian election". According to the Italian Abortion Law, "The State [...] protects human life from its beginning". After the first trimester abortion is admitted only under two conditions: - when there is a severe danger for the life of the mother - when there is a severe danger for the physical or psychological health of the mother, including risk deriving from conditions affecting the health of the fetus. It must be clearly stated the Italian Law tries to balance the possibly conflicting mother's and conceived's rights and interests; it does not affirm an uncontrolled autonomy of the mother, nor does it deny the conceived's right to life; more specifically, the law does not legalize eugenetic abortion, which is simply inadmissible in Italian law system in the context of a more general refusal of eugenetic principles and practices, clearly reaffirmed by Supreme Court [1]. As for Ferrara's initiative, he has repeatedly stated that it is a moral rather than a legal one, in order to raise awareness of and fight against sexist (mostly in some Asian countries) and eugenetic (mostly in Western countries) abortion; it is not intended to restore criminal prosecution of abortion. I would suggest a deeper debate on the concept of "psychological health", which has been improperly interpreted to support eugenetic selection of fetuses, and at least a true effort to improve prevention of abortion and social support to pregnancy and motherhood, in accordance with the current law. A. Dovio [1] Corte di Cassazione, Sezione III Civile, sentenza 29.07.2004 n° 14488. Available at: http://www.altalex.com/index.php?idnot=2391 (last access: 9.10.05). Competing interests: None declared
Guidelines are missing 24 February 2008
Luca Puccetti, President of Interdisciplinary Medical Society Promed Galileo Pisa, 56011, Renzo Puccetti, MD Send response to journal: Re: Guidelines are missing	Italian law rules (act N. 194/1978) that termination of pregnancies after the first trimester is possible only "when pathological processes are ascertained, including those concerning relevant foetal abnormalities or deformities, which determine a serious danger for the woman's physical or psychological health" [1]. By Italian law (1) when foetus can lives independently abortion is possible only when pregnancy (or delivery) represents a serious danger for the woman's life. Thanks to improvements in life support prematures can now live independently also at 22-23 weeks. In Italy in 2005 abortions were 132790, those performed after the first trimester were 2,7% and those performed at/after the 21th gestational week were 0,7% which means 929 abortions (2) performed near to the beginning of the possible, independent life. Incredibly no guidelines exist to evaluate what could be considered a "relevant" abnormality, neither any document or guideline has ever been provided about validated methods or procedures to evaluate the risk for the woman's mental health. The certification of the risk for woman's health is valid even if signed by a not specialized physician and it is possible to reiterate the request for certification without any limit in case of physician's refusal. Given the lack of specific guidelines the physician's judgement is absolutely discreptional, thus an abortion can occurr after the first trimester also in case of minimal abnormalities. Notwithstanding the quality of life in 47 XXY Klinefelter's syndrome is near normal in most cases, pregnancy termination rate of Klinefelter's foetus may be up to 73,9% [3], but the presence of a genetics specialist in the post-diagnosis counselling decreases the probability of termination [4]. Therefore it is necessary to provide the woman a good quality care not only a mere good quality diagnostics. References [1] Legge 22 maggio 1978 n. 194. Norme per la tutela sociale della maternitā e sull'interruzione volontaria della gravidanza. Available at: http://www.giustizia.it/cassazione/leggi/l194_78.html (last access: 24.02.2008). [2] Relazione del Ministro della Salute sulla attuazione della legge contenente norme per la tutela sociale della maternitā e per l'interruzione volontaria di gravidanza (legge 194/78)anno 2007. avaliable at: http://www.ministerosalute.it/imgs/C_17_pubblicazioni_679_ulterioriallegati_ulterioreallegato_0_alleg.pdf (last access: 24.02.2008). [3] Hamamy HA, Dahoun S. Parental decisions following the prenatal diagnosis of sex chromosome abnormalities. Eur J Obstet Gynecol Reprod Biol. 2004 Sep 10;116(1):58-62. [4] Marteau TM, Nippert I, Hall S, Limbert C, Reid M, Bobrow M, Cameron A, Cornel M, van Diem M, Eiben B, García-Miņaur S, Goujard J, Kirwan D, McIntosh K, Soothill P, Verschuuren-Bemelmans C, de Vigan C, Walkinshaw S, Abramsky L, Louwen F, Miny P, Horst J; DADA Study Group. Decision-making after diagnosis of fetal abnormality. Outcomes of pregnancies diagnosed with Klinefelter syndrome: the possible influence of health professionals. Prenat Diagn. 2002 Jul;22(7):562-6. Competing interests: None declared