‘Primum educere’. L’Obiezione di Coscienza fra gli studenti dei Corsi di Laurea in Ostetricia in Lombardia: studio osservazionale descrittivo trasversale.

The Italian legislation on abortion and Medically Assisted Procreation (L. 194/78 and L. 40/2004) gives the Healthcare Professionals the opportunity to exercise they right to conscientious objection, a subject of current bioethical debate. From the published literature comes out that students are in an awkward situation and they need to reflect on this issue during the course. The idea of present study emerges from the results of the analyzed literature that underlines how a certain number of medicine students refuses to learn the procedures to provoke the voluntary interruption of pregnancy and claims their right to conscientious objection, more than that, the lack of data referring to midwifery students asserts how necessary a study of this kind can be to help understand their position about the issue. Objective The main aim of this study is to try and explore attitudes, legal knowledge, experiences and decision-making possibilities of the students attending the third year of the Bachelor in Midwifery towards conscientious objection in the Universities of Lombardy and the possible need of further education in the field. Method This study is an observational study that explore attitudes, legal knowledge and experiences in midwifery student enrolled in five Universities in Lombardy. The sample of the study are the 112 undergraduates of the Bachelor in Midwifery that give their consent to take part in the survey. The enrollment and the data collection happened between September and October 2015. A structured, anonymous questionnaire was used for the survey and it includes 37 closed questions in four sections, and three open questions. It has been distributed to the students by the study team. Of the 112 questionnaires, 111 were returned. Results From the study emerges the students have acquired the knowledge of the legislation related the conscientious objection and related laws, with a frequency of 62.9% correct answers. Analyzing the data comes to light that the students think that the time devoted to teaching conscientious objection and protection of motherhood within the curriculum is not enough and only 51% say that the student has sufficient information on the procedures concerning the conscientious objection. The study shows that the majority of the midwifery students do not know that the law does not mention them among the ones with the right to conscientious objection. On the other hand, the last open answer show that some of them do not know if they have the right to express their attitude during their training. Nevertheless, 88% believe that students have the right to act according to their conscience highlighting their conscientious objection while they are carrying out the study program, even though the sample considers important the achievement of their target training and their claim on moral values, as long as the university recognized a method of achieving that objective which does not require than to perform practices that directly conflict with their own moral values. The sample was asked if they thought the knowledge of legislation was sufficient to solve ethical position related to situations that could cause conscientious objection: 42 students out of 60 declared to think the knowledge of legislation a necessary but insufficient element to face and solve the answer to conscientious objection. Conclusion Even though the students have a global knowledge of the legislation, a deeper and wider general knowledge of the laws in question could be a safeguard both for students and women and more than that it could ensure the provision of the highest standard of care. During the three years of the Bachelor in Midwifery, starting from the first one, more time should be dedicated to the discussion of cases and the analysis of conflicting values. A proposal for the Schools of Medicine could be the creation of a specific form for the conscientious objection, to be filled in by the students who feel the need to make their position official but, first of all, the institution has to create a partnership with its students that guarantees the right of each student to be respected for his own moral values and to be led to an informed, conscious and shared choice over the conscientious objection, via a more adequate training, which can prevent the distress generated when students are not put in the position to be able to face conscientious objection.