'Scapegoated’ doctors demand clarity on whether to report abortions

Doctors are calling for clear, written guidance on their legal obligations when a woman is admitted to hospital with a suspected abortion.

The demand comes after a consultant was reportedly “scapegoated” for acting on what appears to have been incorrect legal advice that he was required to report the patient to the police.

The police report made by the consultant, who has since been named as obstetrician and gynaecologist Max Dingli, led to the woman being charged, convicted and given an 18-month jail term suspended for three years.

Wednesday’s conviction rekindled conflicting versions about whether doctors are legally obliged to report cases of suspected abortion.

Abortion is illegal in Malta except when performed by doctors to save a woman’s life.

But there is no explicit legal requirement for doctors to report abortion cases to the police, resulting in some doctors doing so and others not.

In this case, medical sources said the consultant was told by the Mater Dei Hospital legal team that, as the consultant responsible on the day, failing to file a police report would mean he was breaking the law.

But that advice is now being questioned, and hospital sources said doctors want definite and clear answers.

“There is still conflicting advice being given, and doctors themselves are seeking a definite answer about their obligations. Doctors are used to clear-cut courses of action as a profession. Opinions and interpretations are not helpful, whereas written policy is. This is what they are asking,” one medical source said.

Another said: “He [Dingli] was given what appears to be incorrect advice from the Mater Dei legal team and is now being scapegoated”.

Questions were sent to the Health Ministry asking for the guidelines being used by the hospital legal team in such cases. No replies were received by the time of writing.

Ongoing discussions to clarify ‘grey area’

Patrick Sammut, president of the Malta Medical Association, said it is not fair for a single person to have to take responsibility in what he described as a legal “grey area”.

“The real issue is not the individual doctor but the system… The way forward is to examine situations like this and learn from them. This is an opportunity to reflect on existing processes and identify grey areas, so that clear guidelines and protocols can be established to protect both patients and healthcare professionals.”

Sammut said the MMA was in discussions with the hospital administration to establish clearer guidelines.

Sammut described the issue as a complex situation in which the country’s criminal law intersects with medical confidentiality and clinical care.

“As citizens – like any other citizens – we are obliged to practise according to the law of the country, and the act [abortion] remains an offence except in specific circumstances,” he said.

At the same time, he stressed that patient safety must always come first. He pointed to two safety concerns: the safety of doctors and their duty towards patients.

“Our fear is that if we are not careful, we might discourage women from seeking medical care without delay. Doctors will always prioritise their patients’ health,” Sammut said.

Opinions and interpretations are not helpful, whereas written policy is

This comes after Prime Minister Robert Abela criticised the legal advice that led to the report and said he disagreed with it.

He also said he would be willing to seek a cabinet review that could lead to less severe punishment for a woman handed a suspended sentence after being found guilty of abortion.

Abela made reference to the president’s prerogative of mercy, which can lead to a pardon, grant respite to a person or substitute a punishment for a less severe form.

The woman will be appealing

Meanwhile, the woman’s legal team said she will appeal.

“The intention is to use all means at law to overturn this conviction,” said lawyers Emma Portelli Bonnici and Martina Caruana. 

The woman featured in Wednesday’s court case was accused of having an abortion in January 2024.

After visiting Mater Dei complaining of heavy bleeding, she told medics she had taken medicine to terminate a pregnancy, with an ultrasound showing an empty uterus at the time of admission.

The court heard Dingli testify that he reported the woman because the legal team told him it was his legal obligation. He also said that it was not possible to know what caused the pregnancy to end.

His team had said the woman told them she had taken four pills to terminate her pregnancy, though this information was not given to him directly.

The Voice for Choice, a coalition of pro-choice organisations, said the case “highlights the dangerous reality of keeping abortion within Malta’s criminal law”.

“Crucially, there is no scientific or medical way to assess if a miscarriage occurred voluntarily or involuntarily,” the statement read.

“By keeping abortion in the criminal code, the state is creating a situation where even women suffering from a miscarriage are now potential suspects in the eyes of the law.”

It’s been a long time coming

A year ago, Times of Malta reported how lawyers were calling for clear guidelines to help doctors determine whether they should report abortions, warning that the lack of policy is leading to subjective interpretation.

Daniel Bianchi, a lawyer and health law lecturer at the University of Malta, had said medical practitioners could benefit from guidance on when and if they should report anything, not just abortion.

There would, however, always be an element of subjective interpretation, which was inevitable in the exercise of most professions subject to duties of professional secrecy and confidentiality. Ultimately, the first step was to train medical practitioners about what the requirements of the law were.

Lawyer Emma Portelli Bonnici, from Lawyers for Choice, went further, calling the legal ambiguity “dangerous”.

“It undermines care, endangers patients and creates a chilling effect that discourages others from seeking help at all,” she had said.

The issue first emerged when Times of Malta revealed how four of the seven abortions reported to the police over the past decade were flagged by doctors at Mater Dei Hospital.