Doctors’ rights vs. patients’ rights: analyzing the implementation of Italian abortion policy in Puglia

Many scholars have analyzed the socioeconomic impacts of policies that limit access to abortion: in short, people with wealth and privilege have a much easier time getting an abortion than their peers with less money and limited ability to travel. While some countries’ abortion policies only define abortion seekers’ rights on paper, others endeavor to align de jure rights with de facto access. Italy falls into the latter category: the law that establishes a person’s right to an abortion also requires hospitals to provide abortions. In reality, however, Italian abortion seekers report difficulty procuring an abortion. This is often attributed Italy’s provision for doctors to register as conscientious objectors and thereby opt out of abortion care. Many countries allow conscientious objection to abortion, but Italy has higher rates of objection than other countries as well as high quality data on the rates of objection. There has been a great deal of theory written about the ethics of conscientious objection, as well as analyses of its impact on abortion access, particularly in the Italian case. While conscientious objection is clearly an important piece of the puzzle, in this paper I look at the intersection of policy implementation and conflicting claims of individual rights: abortion seekers’ right to access the service, and doctors’ right to exercise their moral and religious beliefs. By speaking with doctors on both sides of this issue as well as healthcare administrators on various levels, I hope to better understand why Italy struggles to guarantee abortion access through policy measures, with an eye towards what changes might improve the administration of this law while protecting both abortion seekers’ and doctors’ individual rights. I will focus my interviews in the region of Puglia, where there is an above average level of objection among gynecologists, an above average abortion rate, net inflows of abortion seekers from outside the region, as well as a historical court decision that makes it difficult for hospitals to hire abortion providers. This field work will take place in winter and early spring 2021-22. Based on the literature, I expect to find that there may be abuse of claiming conscientious objection, where some people do not truly have a moral objection to abortion but would rather not perform abortions for social or professional reasons. I also anticipate that various authorities will attribute responsibility for guaranteeing the provision of abortion services to other levels of authority, resulting in a situation where no actor feels empowered to enforce this policy.