The Italian Debate on the Lowest Threshold of Viability and Fetalneonatal- maternal Rights: Conflicts Between Law, Case Law, Religious Insights and Clinical Practice

Mariarosaria      Di Tommaso

Abstract

The question of periviability in Italy represents an area of conflict between science, religion and politics. There is an ever widening gap between laws, which are strongly influenced by the Roman Church and the judiciary and the laicism of many Italians, too. From an obstetrical point of view the first contradiction in this field is found in the law that regulates voluntary abortion after the 90th day of pregnancy. An Eugenetic abortion is not allowed. Fetal malformations can not be an indication for abortion, but only in the case the knowledge of this induces a physical or psychical illness in the mother that can worsen with the continuation of pregnancy end. Fetal intra cardiac injection of potassium chloride is not allowed and although the limit in performing an abortion is represented by the possibility for the fetus of having an autonomous life, if there is any possibility of fetal survival, every effort should be done to save the fetal/neonatal life. From a neonatological point of view the kind of care strategies in extremely preterm infants is underlined by a document produced by the National Ministry of Health released on march 08. The consideration that can be drawn from this document is that the science and conscience of a doctor in protecting fetal and neonatal life, continues to be the only indicators in the choices of which kind of assistance a neonate should receive at the threshold of viability, and that the doctor’s science and conscience is superior to parental opinion.

Keywords: Extreme prematurity, ethics, health care practices, resuscitation; end-of-life decisions

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