Updated 5.50pm with reaction
Legislative amendments will be tabled in parliament next week, allowing doctors to terminate a pregnancy when a woman’s life or health is at serious risk.
The reform was unveiled on Wednesday and was described as being “pro-life” (in favour of life), by Health Minister Chris Fearne.
It comes after an American tourist whose request to terminate a non-viable pregnancy was refused by health authorities.
Andrea Prudente was 16 weeks pregnant when in June she began bleeding profusely while on holiday in Malta and was told by doctors that the pregnancy was no longer viable.
She was eventually transferred to Spain where she had an abortion.
The case cast Malta in the international spotlight attracting the attention of global media outlets. Days later a group of 135 doctors signed a judicial protest asking for a review of Malta's blanket ban on abortion care.
What does the reform say?
On Wednesday, Fearne said the State Advocate had looked into Malta’s legal regime to identify legal loopholes which need addressing following the Prudente case.
Two instances had been identified. At present, he explained that the Criminal Code laid down that any doctor or specialist who gave means to cause abortion was liable to imprisonment for between 18 months and four years and/or interdiction from practising medicine. There were no exceptions.
The same applied to women who caused an abortion by taking medication. Again, no exception was allowed.
The legal amendment will see a new clause presented in the law that will establish that no offence would have been committed if the death of the foetus was the result of medical intervention carried out when the mother’s life was at risk, or her health was at serious risk.
Fearne said that there would still need to be the agreement of the pregnant woman for any procedure to be carried out.
He said that the seriousness of the risk to the mother’s health will be defined by standard operating procedures given to doctors by medical authorities.
‘Reform is to protect mothers’
Fearne said that the reasoning behind the reform was to address a number of situations in which a pregnant woman could be in serious danger to her health or safety.
If the fetus died then matters went on as normal. However there existed situations in which the pregnancy was ongoing, the fetus was still young and couldn't be delivered, and the mother was suffering serious medical problems that could endanger her life, he said.
"The choice isn’t between the mother living or the baby living. The choice here is whether the mother and baby both die, or if the mother’s life is saved," he said.
“We don’t believe that after going through this ordeal the woman should face the possibility of imprisonment."
Justice Minister Jonathan Attard said the reform would ensure that expectant mothers are given the best medical care with the full backing of the law.
He said an extensive legal review showed that even if criminal action was seldom if ever taken, the fact that this possibility existed needed to be addressed.
Reforms Parliamentary Secretary Rebecca Buttigieg said, "imagine going to visit a doctor and being told an expecting mother’s life is at risk and the law precludes doctor’s from intervening to save the mother’s life."
“Imagine if she were your wife, your daughter, or mother?” She said.
Speaking “as a woman MP” she appealed for level-headed debate on the matter.
A threat to health or life?
Part of the issue surrounding the Prudente case was a medical and ethical debate about when, if at all, it is acceptable to carry out a form of abortion.
Doctors were faced with the question of whether the mother’s life was at risk or if the situation Prudente found herself, was a risk to her health but fell short of being life-threatening.
Some doctors in Malta argue that an abortive procedure can be carried out if the situation threatens the mother’s life, while others have argued that it should be carried out even if it simply poses a threat to the mother’s health.
Another question raised is the viability of the pregnancy in the first place.
In terms of the ethics of the matter, some medical practitioners argue what is known as the principle of double effect.
This is an ethical device originally used to understand the ethical implications of killing in self-defence and has been applied to understanding medical ethical dilemmas such as euthanasia or indeed abortion.
What does Robert Abela think?
In his first interview with Times of Malta, Prime Minister Robert Abela struck a sympathetic chord with women who advocate for abortion. However, he stopped short of saying he would be introducing it.
He said he had met with dozens of women who aborted, saying “conservatively” around 300 or 350 women abort pregnancies in Malta using medication every year.
“Over a ten-year period, we’re talking about 3,500, 4,000 people. How can I close my eyes to this?” he said.
However, when pressed on whether he would change the law to allow abortion Abela effectively shut the door on it this legislature.
“What I can say is that our electoral manifesto does not give me a mandate to introduce abortion,” he said.
What has the reaction been?
Gynaecologist Isabel Stabile from the Doctors for Choice campaign group, welcomed the confirmation that Malta's blanket ban on abortion in all circumstances will end.
She described it as a "step in the right direction".
"Many people were genuinely concerned about the care they would receive in Malta should they have an obstetric complication like Andrea Prudente did last summer. This legal change will help put their minds at rest," she said.
However, she said the amendments do not go far enough.
They do not allow the termination of pregnancies in cases of rape or incest, or in cases of fatal foetal anomaly. There will also not be any provision for elective abortions at the pregnant person’s request at any stage of pregnancy.
"We know up to 400 people in Malta a year order abortion pills online and use them at home," she said. "These vulnerable people will continue to be criminalised while those who can afford to travel to clinics elsewhere in Europe will continue to do so."