RESUMO

En este artículo se sostiene, en primer lugar, que (1) la persistencia a nivel internacional de debates éticos en torno al estatus moral del nasciturus y (2) el tradicional compromiso deontológico de los profesionales sanitarios con la salud, tanto de la embarazada como del hijo que espera, dotan de pleno sentido y vigencia al derecho a la objeción de conciencia de dichos profesionales. Sin embargo, donde el aborto legal se configura como prestación sanitaria, surge entonces la dificultad de gestionar esa prestación y, al tiempo, el conflicto moral que expresa la objeción de conciencia. Si en una institución sanitaria pública la objeción es generalizada, se plantea una disyuntiva con implicaciones éticas entre derivar a las gestantes a otras instituciones o aplicar estrategias de integración de personal a nivel de servicio de salud. En el caso de España, se ha aprobado este año una reforma de la Ley Orgánica de salud sexual y reproductiva y de la interrupción voluntaria del embarazo (LOSSRIVE), que manifiesta una voluntad más taxativa de que la objeción de conciencia no impida el acceso al aborto en las instituciones sanitarias públicas, estableciéndose previsiones específicas al efecto. A partir de los trabajos parlamentarios identificamos los principales puntos de discrepancia política que remiten a dispares posiciones de fondo sobre el aborto y afectan al propio planteamiento de la reforma, así como a otros elementos no siempre novedosos -algunos de ellos ya estaban en la LOSSRIVE o se venían aplicando a nivel autonómico con el plácet del Constitucional.

This article argues, first, that (1) the persistence at the international level of ethical debates on the moral status of nasciturus and (2) the traditional ethical commitment of health professionals to the health of both the pregnant woman and the unborn child, give full sense and validity to the right to conscientious objection of these professionals. However, where legal abortion is configured as a health care service, the difficulty of managing this service and, at the same time, the moral conflict expressed by conscientious objection arises. If, in a public health institution, objection is widespread, there is a dilemma with ethical implications between referring pregnant women to other institutions or implementing staff integration strategies at the health service level. In the case of Spain, a reform of the Organic Law on Sexual and Reproductive Health and the Voluntary Interruption of Pregnancy (LOSSRIVE) was approved this year, which shows a more stringent willingness that conscientious objection does not prevent access to abortion in public health institutions, establishing specific provisions to that effect. Based on the parliamentary work, we identified the main points of political discrepancy, which remit to different basic positions on abortion and affect the very approach of the reform, as well as other not always new elements -some of them were already in the LOSSRIVE or were already being applied at the regional level with the approval of the Constitutional Court.

Este artigo argumenta, em primeiro lugar, que (1) a persistência, em nível internacional, de debates éticos sobre o status moral do nascituro e (2) o tradicional compromisso deontológico dos profissionais de saúde com a saúde da gestante e do filho que ela espera, dão pleno sentido e vigência ao direito à objeção de consciência desses profissionais. Entretanto, quando o aborto legal é configurado como um serviço de saúde, surge a dificuldade de gerir esse serviço e, ao mesmo tempo, gerir o conflito moral expresso pela objeção de consciência. Se, em uma instituição de saúde pública, a objeção for generalizada, haverá uma escolha com implicações éticas entre encaminhar as gestantes a outras instituições ou aplicar estratégias de integração de pessoal no nível do serviço de saúde. No caso da Espanha, foi aprovada este ano uma reforma da Lei Orgânica de Saúde Sexual e Reprodutiva e a Interrupção Voluntária da Gravidez (LOSSRIVE) que expressa uma vontade mais constrangedora de garantir que a objeção de consciência não impeça o acesso ao aborto em instituições públicas de saúde, estabelecendo disposições específicas para esse fim. Com base no trabalho parlamentar, identificamos os principais pontos de discrepância política, que remetem a diferentes posições de fundo sobre aborto e afetam a própria aproximação da reforma, assim como outros elementos que nem sempre são novos -alguns deles já estavam no LOSSRIVE ou já estavam sendo aplicados em nível regional com a aprovação do Tribunal Constitucional-.

RESUMO

BACKGROUND: Multiple studies have been recorded regarding the perception of abortion among students in the health area. OBJECTIVE: To know if medical-scientific training is sufficient to generate a change in the perception of first-year students of the National Autonomous University of Mexico Faculty of Medicine. MATERIAL AND METHODS: A cross-sectional survey was applied in two times, with the level of relationship between the items of each dimension being analyzed using Cramer's V test. The results were compared to analyze if there was a change in the perception of abortion after the human embryology course. RESULTS: With an initial population of 2,150 students, 393 pre-course and 394 post-course surveys were conducted. The results indicated that despite the existence of changes in the perception of Faculty of Medicine students with regard to abortion, they are not significant. CONCLUSIONS: The medical-scientific training provided by the human embryology course is not enough to provide foundations to the perception of students on issues such as abortion or conscientious objection.

ANTECEDENTES: Actualmente se han registrado diversos estudios sobre la percepción del aborto en el alumnado del área de la salud. OBJETIVO: Conocer si la formación médico-científica puede generar un cambio en la percepción del alumnado que cursa el primer año en la Facultad de Medicina de la Universidad Nacional Autónoma de México. MATERIAL Y MÉTODOS: Se aplicó una encuesta transversal en dos tiempos y se analizó el nivel de relación de los ítems de cada dimensión mediante coeficiente V de Crámer. Los resultados se compararon para identificar si existió un cambio de percepción acerca del aborto después del curso de embriología humana. RESULTADOS: Con una población inicial de 2150 alumnos, se realizaron 393 encuestas previas al curso y 394 encuestas posteriores. Los resultados indicaron que a pesar de existir cambios en la percepción de los alumnos de la Facultad de Medicina sobre el aborto, no fueron significativos. CONCLUSIONES: La formación médico-científica que proporciona el curso de embriología humana no es suficiente para fundamentar la percepción del alumnado en temas como el aborto o la objeción de conciencia.

Assuntos

RESUMO

Introduction: After decades of absolute criminalization, on September 14, 2017, Chile decriminalized voluntary termination of pregnancy (VTP) when there is a life risk to the pregnant woman, lethal incompatibility of the embryo or fetus of genetic or chromosomal nature, and pregnancy due to rape. The implementation of the law reveals multiple barriers hindering access to the services provided by the law. Objectives: To identify and analyze, using the Tanahashi Model, the main barriers to the implementation of law 21,030 in public health institutions. This article contributes to the follow-up of this public policy, making visible the obstacles that violate women's rights of women to have dignified access to abortion and that affect the quality of health care in Chile. Material and method: Qualitative design, following the postpositivist paradigm. The sample consisted of relevant actors directly related to pregnancy termination. Snowball sampling and semi-structured interviews were used. Grounded theory was used through inductive coding, originating categories regrouped into meta-categories following Tanahashi's model. The rigor criteria of transferability, dependability, credibility, authenticity, and epistemological theoretical adequacy were used. The identity of the participants and the confidentiality of the information were protected. Results: From January 2021 to October 2022, 62 interviews were conducted with 20 members of the psychosocial support team; 18 managers; 17 members of the biomedical health team; 4 participants from of civil society, and three women users. The main obstacles correspond to availability barriers, accessibility barriers, acceptability barriers, contact barriers, and effectiveness barriers. Conclusions: Barriers to access abortion under three grounds violate the exercise of women's sexual and reproductive rights. It is urgent to carry out actions of control and follow-up of this public policy to the corresponding entities.

Assuntos

RESUMO

Introdução: a objeção de consciência possibilita assegurar direitos médicos, mas é um entrave para a saúde pública no Brasil. Objetivo: realizar uma revisão de literatura brasileira avaliando a motivação por parte dos profissionais da saúde que apresentam objeção de consciência em casos de abortamento legalizados. Método: para tanto, realizou-se uma revisão de literatura brasileira PICO, com a pergunta norteadora: ensino tecnicista médico versus religiosidade interferem na opção para a objeção de consciência diante do abortamento legalizado? Utilizou-se as bases: Cochrane Library, Lilacs, PubMed, Scielo e Periódicos CAPES, contando com os descritores "(Objeção de Consciência)"; "(Objeção de Consciência) AND (Religião)"; "(Objeção de Consciência) AND (Educação Médica)"; "(Objeção de Consciência) AND (Religião) AND (Educação Médica)" e seus respectivos termos em inglês acrescidos do termo "abortion". A busca foi realizada em janeiro de 2023 e limitada ao período entre 2016 e 2023. Resultado: a busca inicial resultou em 1746 artigos, sendo desses apenas 17 incluídos. Pode-se observar que a religião é uma influência, contudo, a falta da temática nas faculdades de Medicina faz com que os médicos procedam de forma incorreta ou incompleta ao objetarem a consciência. Conclusões: este estudo servirá para futuros projetos de intervenção com acadêmicos de Medicina, que minimizem o entrave no acesso ao aborto

Introduction: conscientious objection makes it possible to ensure medical rights, but it is an obstacle to public health in Brazil. Aims: to carry out a Brazilian literature review assessing the motivation of health professionals who present conscientious objection in cases of legalized abortion. Methods: to this end, a PICO Brazilian literature review was carried out, with the guiding question: does medical technical teaching versus religiosity interfere with the option for conscientious objection in the face of legalized abortion? The following databases were used: Cochrane Library, Lilacs, PubMed, Scielo and Periodicals CAPES, using the descriptors "(Conscientious Objection)"; "(Conscientious Objection) AND (Religion)"; "(Conscientious Objection) AND (Medical Education)"; "(Conscientious Objection) AND (Religion) AND (Medical Education)" in Portuguese and in English plus the term "abortion". The search was carried out in January 2023 and limited to the period between 2016 and 2023. Results: initially, the search resulted in 1746 articles, of which only 17 were included. It can be observed that religion is an influence, however, the lack of the subject in medical schools causes doctors to act incorrectly or incompletely when objecting to conscience. Conclusions: this study will serve for future intervention projects with medical students, which minimize obstacles to accessing abortion

Assuntos

RESUMO

Introduction: After three decades of the absolute prohibition of abortion, Chile enacted Law 21,030, which decriminalizes voluntary pregnancy termination when the person is at vital risk, when the embryo or fetus suffers from a congenital or genetic lethal pathology, and in pregnancy due to rape. The law incorporates conscientious objection as a broad right at the individual and institutional levels. Objectives: The aim of the study was to explore the exercise of conscientious objection in public health institutions, describing and analyzing its consequences and proposals to prevent it from operating as structural violence. Materials and methods: This study uses a qualitative, post-positivist design. At the national level, according to the chain technique, people who were identified as key actors due to their direct participation in implementing the law were included. Grounded theory was used to analyze the information obtained through a semi-structured interview. The methodological rigor criteria of transferability or applicability, dependability, credibility, auditability, and theoretical-methodological adequacy were met. Results: Data from 17 physicians, 5 midwives, 6 psychologists, 8 social workers, 2 nursing technicians, and 1 lawyer are included. From an inductive process through open coding, conscientious objection as structural violence and strategies to minimize the impact of objection emerge as meta-categories. The first meta-category emerges from the barriers linked to the implementation of the law, the infringement of the rights of the pregnant person, and pseudo conscientious objection, affecting timely and effective access to pregnancy termination. The second meta-category emerges as a response from the participants, proposing strategies to prevent conscientious objection from operating as structural violence. Conclusion: Conscientious objection acts as structural violence by infringing the exercise of sexual and reproductive rights. The State must fulfill its role as guarantor in implementing public policies, preventing conscientious objection from becoming hegemonic and institutionalized violence.

RESUMO

Within pediatric graduate medical education, the care of transgender youth presents opportunities for deepening learners' understanding of equity, access, the role of the physician as an advocate, and health disparities caused by stigma and minority stress. However, when a pediatric resident objects to providing health care to this uniquely vulnerable population owing to their personal beliefs and values, how should pediatrician-educators respond? Important reasons to respect healthcare professionals' conscience have been described in the scholarly literature; however, equally important concerns have also been raised about the extent to which conscientious objection should be permitted in a pluralistic society, particularly given power differentials that favor healthcare professionals and grants them a monopoly over certain services. In the context of medical education, however, residents are in a unique position: they are simultaneously learners and employees, and although privileged relative to their patients, they are also vulnerable in relation to the hierarchy of healthcare and of institutions. We must find a compassionate balance between nurturing the evolving conscience of students and trainees and protecting the health and well-being of our most vulnerable patients. Educators have an obligation to foster empathy, mitigate bias, and mentor their learners, regardless of beliefs, but in some cases, they may recognize that there are limits: patients' welfare ultimately takes precedence and trainees should be guided toward alternative career paths. We explore the limits of conscientious objection in medical training and propose a framework for pediatrician-educators to support learners and patients in challenging circumstances.

Assuntos

RESUMO

Resumen: Si bien la interrupción terapéutica del embarazo en los casos de fetos anencefálicos ha sido ampliamente discutida, y se han llegado a conclusiones éticas que la justifican (si no existe contraindicación médica y se obtiene el consentimiento informado de la mujer), es importante reevaluar el tema. Por ello, se deben contrastar los principios bioéticos con sentencias judiciales de fenómenos jurídicos que están surgiendo en el mundo, y que pueden provocar cambios en los derechos sexuales y reproductivos. No obstante, esto no debe implicar un cambio en los argumentos bioéticos. Asimismo, debido al resurgimiento a nivel global de un conservadurismo moral, que propone un planteamiento en torno a la objeción de conciencia, se torna imperativo analizar desde la perspectiva bioética si la misma puede ser invocada en casos de interrupción terapéutica del embarazo. Para ello, se deberían ponderar los principios bioéticos y utilizar una bioética laica, pluralista y basada en ética de mínimos, la cual busque la dignidad de las personas que enfrentan una gestación de fetos anencefálicos. En ese sentido, la objeción de conciencia no debería utilizarse como instrumento para negar la atención a estas personas.

Abstract: Although the therapeutic interruption of pregnancy in cases of anencephalic fetuses has been widely discussed, and ethical conclusions have been reached that justify it (if there is no medical contraindication and the informed consent of the woman is obtained), it is important to reassess the issue. Hence, bioethical principles must be contrasted with judicial rulings on legal phenomena that are emerging in the world, and that can cause changes in sexual and reproductive rights. However, this should not imply a change in the bioethical arguments. Likewise, due to the global resurgence of moral conservatism, which proposes an approach regarding conscientious objection, it becomes imperative to analyze, from a bioethical perspective, if it can be invoked in cases of therapeutic interruption of pregnancy. To do this, bioethical principles should be weighed and a secular, pluralistic bioethics based on minimum ethics should be used, which seeks the dignity of persons facing an anencephalic fetus gestation. In this sense, conscientious objection should not be used as an instrument to deny care to these individuals.

Resumo: Embora a interrupção terapêutica da gravidez nos casos de fetos anencéfalos tenha sido amplamente discutida e tenham chegado a conclusões éticas que a justifiquem (se não houver contraindicação médica e for obtido o consentimento informado da mulher), é importante reavaliar a questão . Por isso, os princípios bioéticos devem ser contrastados com as decisões judiciais sobre fenômenos jurídicos que estão surgindo no mundo e que podem causar mudanças nos direitos sexuais e reprodutivos. No entanto, isso não deve implicar uma mudança nos argumentos bioéticos. Da mesma forma, devido ao ressurgimento global do conservadorismo moral, que propõe uma abordagem em torno da objeção de consciência, torna-se imperativo analisar na perspectiva bioética se ela pode ser invocada nos casos de interrupção terapêutica da gravidez. Para tanto, deve-se pesar os princípios bioéticos e utilizar uma bioética laica, pluralista, pautada na ética mínima, que busque a dignidade das pessoas diante da gestação de feto anencéfalo. Nesse sentido, a objeção de consciência não deve ser utilizada como instrumento para negar atenção a essas pessoas.

RESUMO

INTRODUCCIÓN: La Ley 21.030 permite la objeción de conciencia al personal de salud al interior del pabellón y a las instituciones privadas. Ha sido considerada conflicto de intereses no monetario, al anteponer los valores personales, afectando el cumplimiento del deber profesional. OBJETIVOS: Establecer la prevalencia de funcionarios/as objetores/as en los hospitales de la red pública del país y caracterizarles según edad, género y nacionalidad. MÉTODO: Estudio cuantitativo, analítico y transversal. Se utilizaron medidas de tendencia central y dispersión. Para medir la asociación entre variables sociodemográficas, profesión y causal objetada, se utilizaron las pruebas de χ2, exacta de Fisher y de Kruskal-Wallis. RESULTADOS: En 57 hospitales, se observa una mayor frecuencia de objetores en causal 3. En 443 objetores, la mediana de edad fue de 43 años, el 64,8% mujeres y el 87,4% de nacionalidad chilena. En las zonas centro y sur del país se concentra la mayor proporción de hospitales con más del 50% de objetores. CONCLUSIONES: La dificultad para obtener información impide conocer cabalmente la magnitud de la objeción de conciencia. Resulta preocupante la alta prevalencia de objetores, específicamente en la causal violación. La objeción no puede operar como barrera que vulnere los derechos y la dignidad de las mujeres.

INTRODUCTION: Law 21.030 incorporates conscientious objection for health personnel inside the surgical ward and allows its invocation by private institutions. It has been considered a conflict of interest, not monetary, by putting personal values first, affecting the fulfillment of professional duty. OBJECTIVE: To establish the prevalence of objectors in the countrys public network hospitals and characterize them according to age, gender, and nationality. METHOD: Quantitative, analytical, and cross-sectional study. Central and dispersion trend measures were used. For measuring the association between sociodemographic variables, profession and causal objected, test χ2, Fisher exact and Kruskal-Wallis test were used. RESULTS: In 57 hospitals, a higher frequency of objectors were observed in the third causal. In 443 objectors, the median age was 43 years, 64.8% are women, and 87.4% are Chilean. The central and southern areas of the country have the highest proportion of hospitals, with more than 50% objectors. CONCLUSIONS: The difficulty for obtaining the information prevents fully knowing the magnitude of conscientious objection in Chile. The high prevalence of objectors, specifically in the causal violation is worrying. The conscientious objection cannot operate as a barrier that violates the rights and dignity of women.

Assuntos

RESUMO

Três temas ocupam o espaço desta apresentação. Os primeiros dois debruçam-se na mesma problemática, mas sob um ângulo diferente. A relação entre o bem pessoal e o bem comum pode efectivamente ser objecto de pelo menos dois discursos diferentes, o da ética ­e o do direito. Além disso, poderá aparecer estranho ligar a estes dois temas um terceiro, reservado à objecção de consciência. Mas este tem cabimento na medida em que constitui, ao nível da cidadania, uma forma sociopolítica de tensão entre um bem pessoal e um bem comum, de natureza social ou política. Desta maneira, ética, direito e cidadania política interferem quando queremos abrir o processo das relações entre o bem pessoal e o bem comum. O tratamento dos problemas da pandemia não escapou sempre a tais questões espinhosas.

Three themes occupy the space of this presentation. The first two deal with the same problem, but from a different angle. The relationship between the personal good and the common good can in fact be the subject of at least two different discourses, that of ethics -and that of law. In addition, it may seem strange to link these two themes to a third, reserved for conscientious objection. However, this is valid in that it constitutes, at the level of citizenship, a socio-political form of tension between a personal and a common good, of a social or political nature. In this way, ethics, law and political citizenship interfere when we want to open the process of relations between the personal good and the common good. The treatment of pandemic problems has not always escaped such thorny issues.

Tres temas ocupan el espacio de esta presentación. Los dos primeros abordan el mismo problema, pero desde un ángulo diferente. La relación entre el bien personal y el bien común puede de hecho ser objeto de al menos dos discursos diferentes, el de la ética y el del derecho. Además, puede parecer extraño vincular estos dos temas con un tercero, reservado a la objeción de conciencia. Sin embargo, esto es válido porque constituye, a nivel de ciudadanía, una forma sociopolítica de tensión entre un bien personal y un bien común, de carácter social o político. De esta forma, la ética, el derecho y la ciudadanía política interfieren cuando queremos abrir el proceso de relaciones entre el bien personal y el bien común. El tratamiento de los problemas pandémicos no siempre ha escapado a cuestiones tan espinosas.

RESUMO

BACKGROUND: The misuse of conscientious objection (CO) is a significant barrier to legal abortion access in many countries, especially in Latin America. We examine the reasons for denial of legal abortion services in Mexico and Bolivia and identify ways to mitigate the misuse of CO. METHODS: We conducted 34 in-depth interviews and 12 focus group discussions in two states in Mexico and four departments in Bolivia. Results were coded and categorized using a thematic analysis approach. RESULTS: Denial of abortion services based on CO is widespread in health facilities in Mexico and Bolivia and is primarily employed for reasons other than moral, religious, or ethical considerations. The main reasons for denial of services based on CO is lack of knowledge about abortion-related laws and fear of legal problems in abortion service provision. Conversely, the main reason to provide services is to comply with relevant laws. Denying services under the guise of CO negatively impacts pregnant people and health care teams, including fewer safe abortion options and increased workload and stigma, respectively. Most respondents cited training and education on abortion law as the foremost way to mitigate the negative impacts of the misuse of CO. CONCLUSIONS: For many health personnel, knowing, understanding, and following the law is reason enough to provide abortion services. Individuals who object due to lack of knowledge about laws and fear of legal problems represent a key population that can be sensitized and equipped with the necessary information and resources to provide legal abortion services.

RESUMEN: ANTECEDENTES: El mal uso de la objeción de conciencia (OC) es una barrera importante para el acceso al aborto aún cuando es legal, en muchos países, especialmente en países en América Latina. Examinamos los motivos de la negación de servicios de aborto legal en México y Bolivia e identificamos formas de mitigar el uso indebido de la OC. MéTODOS: Realizamos 34 entrevistas a profundidad y 12 discusiones en grupo focal en dos estados en México y cuatro departamentos en Bolivia. Los resultados fueron codificados y categorizados utilizando un enfoque de análisis temático. RESULTADOS: La negación de servicios de aborto basados ​​en la OC está muy extendida en los establecimientos de salud en México y Bolivia y se emplea principalmente por razones distintas a las consideraciones morales, religiosas o éticas. Las principales razones para la negación de servicios basados ​​en la OC son la falta de conocimiento sobre las leyes relacionadas con el aborto y el temor a problemas legales en la prestación de servicios de aborto. Por el contrario, la razón principal para proporcionar servicios es cumplir con las leyes pertinentes. Negar servicios bajo la apariencia de OC impacta negativamente a las personas embarazadas y a los equipos de atención médica, incluidas menos opciones de aborto seguro y mayor carga de trabajo y estigma, respectivamente. La mayoría de los encuestados mencionaron la capacitación y educación sobre la ley del aborto como la principal forma de mitigar los impactos negativos del uso indebido de la OC. CONCLUSIONES: Para parte del personal de salud, conocer, comprender y cumplir la ley es motivo suficiente para proporcionar servicios de aborto. Las personas que se oponen debido a la falta de conocimiento sobre las leyes y el miedo a los problemas legales representan una población clave que puede ser sensibilizada y equipada con la información y los recursos necesarios para proporcionar servicios de aborto legal.

Assuntos

RESUMO

Latin American countries have slowly enacted laws decriminalizing abortion in three circumstances: Life-threatening risk for the pregnant woman, extra-uterine non-viability of malformed foetus, and pregnancy due to rape or incest. Chile is one of the last countries to adopt such a law, formulated in an increasingly restrictive format. Conservative politicians and Church-related healthcare institutions promptly announced individual and institutional conscientious objection based on the right of private facilities to obey their ideology and personal moral integrity. Juridical consultations and Constitutional Court rulings allowed private hospitals to uphold their objection even if contracted to provide some public health services. Under these conditions, only a few hundred women requested and obtained a legal abortion, while an estimated 100,000 continued to depend on unsafe procedures. Bioethical debate was silenced by the unfettered drive for conscientious objection that continues to limit women's autonomy, and fails to ease the public health scourge of massive unsafe clandestine abortions.

Assuntos

RESUMO

This paper critically analyses conscientious objection to abortion in the context of the new regulation of pregnancy termination in Chile. It argues that adequate regulation should not be blind: The bioethical requirements that seek to balance the interests involved must consider the legal regulation of the interests at stake, the context in which they are implemented, and, fundamentally, the effectiveness of the solutions adopted. Attention should be paid to the risks involved in the political use of conscientious objection to prevent the implementation of women's reproductive rights. In describing the process of the entrenchment and expansion of conscientious objection to abortion in Chile, we show how this process has overprotected conscience and how the risks of undermining the effectiveness of the new abortion legislation hinder the enjoyment of rights entrenched by the law.

Assuntos

RESUMO

Resumen El desarrollo científico y médico, sumado a la realidad que vivimos en Colombia, demanda la formación de profesionales coherentes con los principios éticos y con conceptos teóricos claros sobre la normativa actual para trabajar por el respeto de la vida humana. La actualidad constitucional del país evidencia un reto para todo tipo de profesionales, no solo en el campo jurídico o de la salud, ya que se han puesto en pugna derechos fundamentales como la vida y la libertad de conciencia. Este artículo muestra la necesidad y la importancia de fomentar y acceder a la práctica de la objeción de conciencia como respuesta al panorama jurídico al que se enfrenta la protección de la vida en Colombia y que puede ser ejemplo para otros países en Latinoamérica.

Abstract Scientific and medical developments, added to our reality in Colombia, demand the training of professionals consistent with ethical principles and clear theoretical concepts on current regulations that are aimed at respect for human life. The country's current constitutional situation poses a challenge to any professional, beyond the legal or health fields, since fundamental rights such as life and freedom of conscience are being questioned. This paper demonstrates the need and importance of promoting and accessing conscientious objection as a response to the legal landscape of the protection of life in Colombia, which may be an example for other countries in Latin America.

Resumo O desenvolvimento científico e médico, somado à realidade que vivemos na Colômbia, exige a formação de profissionais coerentes com os princípios éticos e com conceitos teóricos claros sobre a legislação atual para trabalhar em prol do respeito pela vida humana. A atualidade constitucional do país evidencia um desafio para todo tipo de profissionais, tanto no campo jurídico quanto no da saúde, já que direitos fundamentais como a vida e a liberdade de consciência têm sido colocados em conflito. Este artigo mostra a necessidade e a importância de fomentar e acessar a prática da objeção de consciência como resposta ao panorama jurídico no qual a proteção da vida na Colômbia se encontra e que pode ser exemplo para outros países na América Latina.

Assuntos

RESUMO

BACKGROUND: The abortion law in Uruguay changed in 2012 to allow first trimester abortion on request. Implementation of the law in Uruguay has been lauded, but barriers to care, including abortion stigma, remain. This study aimed to assess women's experiences seeking abortion services and related attitudes and knowledge following implementation of the law in Uruguay. METHODS: We interviewed 207 eligible women seeking abortion services at a high-volume public hospital in Montevideo in 2014. We generated univariate frequencies to describe women's experiences in care. We conducted regression analysis to examine variations in experiences of stigma by women's age and number of abortions. RESULTS: Most of the women felt that abortion was a right, were satisfied with the services they received, and agreed with the abortion law. However, 70% found the five-day waiting period unnecessary. Women experienced greater self-judgement than worries about being judged by others. Younger women in the sample (ages 18-21) reported being more worried about judgment than women 22 years or older (1.02 vs. 0.71 on the ILAS sub-scale). One quarter of participants reported feeling judged while obtaining services. Women with more than one abortion had nearly three times the odds of reporting feeling judged. CONCLUSIONS: These findings highlight the need to address abortion stigma even after the law is changed. Some considerations from Uruguay that may be relevant to other jurisdictions reforming abortion laws include: the need for strategies to reduce judgmental behavior from staff and clinicians towards women seeking abortions, including training in counseling skills and empathic communication; addressing stigmatizing attitudes about abortion through community outreach or communications campaigns; mitigating the potential stigma that may be perpetuated through policies to prevent "repeat" abortions; ensuring that younger women and those with more than one abortion feel welcome and are not mistreated during care; and assessing the necessity of a waiting period. The rapid implementation of legal, voluntary abortion services in Uruguay can serve in many ways as an exemplar, and these findings may inform the process of abortion law reform in other countries.

Assuntos

RESUMO

Resumen Este artículo examina el fenómeno de la objeción de conciencia (OC) a los servicios de aborto legal en Argentina, Uruguay y Colombia. Basado en relatos obtenidos a través de entrevistas, el análisis toma distancia de aquellos enfocados en diferenciar entre OC y barreras al servicio, o en identificar si las razones de objeción son verdaderas o válidas. Partiendo del hecho de que en muy pocos casos las/los objetoras/es están al tanto de las definiciones legales de la OC, se busca entender los significados que las/los entrevistadas/os le atribuyeron, y desde los cuales organizan su práctica médica, y justifican su negación a prestar servicios de aborto. En los tres países las/los entrevistadas/os se oponían principalmente a que fueran las mujeres quienes tomaran la decisión de qué embarazos interrumpir, y cómo y cuándo hacerlo. Los discursos contingentes a través de los cuales las/os médicas/os construyen las racionalidades de su OC están hechos, sobre todo, de un incuestionado apego al control de los cuerpos con capacidad de gestar; y de entendidos médico-sociales de las mujeres como inexorablemente madres, máquinas de reproducción o soportes vitales de fetos.

Resumo Este artigo examina o fenômeno da objeção de consciência (OC) nos serviços de aborto legal na Argentina, Uruguai e Colômbia. Com base nas narrativas obtidas por meio de entrevistas, a análise se distancia daquelas focadas na diferenciação entre OC e barreiras ao serviço, ou na interrogação sobre a verdade ou validade das razões para a objeção. Partindo do fato de que, em poucos casos, os objetores conhecem as definições legais da OC, procura-se compreender os significados que as/os entrevistadas/os lhe atribuíram e a partir dos quais organizam a sua prática médica e justificam a sua recusa em prestar serviços de aborto. Em todos os três países, os/as entrevistados/as se opuseram principalmente a que as mulheres decidissem por si mesmas quais gravidezes interromper, como e quando o fazem. Os discursos contingentes através dos quais os/as médicos/as constroem as racionalidades da sua OC são feitos, sobretudo, através de um apego inquestionável ao controle dos corpos capazes de gestação; e de compreensões médico-sociais das mulheres como inexoravelmente mães, máquinas de reprodução ou suportes vitais dos fetos.

Abstract This article examines conscientious objection (CO) to legal abortion services in Argentina, Uruguay and Colombia. Based on interviews, the analysis offers an alternative from studies focusing on differentiating between CO and access barriers, or in identifying if the reasons for the objections are true or valid. Considering the fact that it is only in very few cases that the objectors knew the legal definition of CO, the article seeks to understand the meanings that the interviewees attribute to their objection, how they organize their medical practices and how they justify their denial to provide abortion services. In all three countries, the interviewees' main opposition was to women themselves making the decision to interrupt a pregnancy, and how and when to do it. The contingent and variable discourses through which the doctors construct the logic of their CO are made of an unquestioning attachment to controlling gestating bodies; and a default socio-medical understanding of women as mothers, reproductive machines or as fetal life support systems.

Assuntos

RESUMO

Resumen La interrupción voluntaria del embarazo es una opción legal en algunos países bajo circunstancias especiales. Se quiso explorar las actitudes, los conocimientos y las prácticas de internos de medicina frente a la interrupción voluntaria del embarazo en Medellín-Colombia. Se realizó un estudio observacional descriptivo de corte. Se analizaron variables sociodemográficas, actitudes, conocimientos y prácticas frente a la interrupción voluntaria del embarazo. Se realizó un análisis descriptivo de las variables. La información se analizó con el software SPSS® versión 21.0. Se obtuvo consentimiento informado y aprobación del comité de ética universitario. El principal motivo para realizar la interrupción voluntaria del embarazo, fue por riesgo para la salud mental de la madre. Acerca de la objeción de conciencia el 54,7 % la tiene, 21 % objetó conciencia durante el pregrado y el 86,7 % conoce correctamente el proceso a seguir para hacerlo. La totalidad de los encuestados identifica las circunstancias en las cuales el aborto está despenalizado en Colombia, el 96 % conoce el objetivo de la sentencia C355 y el 41 % desconoce que no se establece edad gestacional para practicarla. De los internos que presenciaron IVE el 25,7 % tuvo una repercusión emocional severa con recuerdos frecuentes de lo ocurrido y el 48,7% tristeza con otras emociones.

Abstract Voluntary Interruption of Pregnancy (VIP) is legal under special circumstances in some countries. The objective of this study was to evaluate the skills, knowledge and attitudes about VIP in medical interns from a private university in Colombia. A cross-sectional study with primary data collection was preformed. A descriptive analysis was done for the variables; socio-demographic, skills, knowledge and attitudes about VIP. The SPSS® software, version 21.0, was used for the statistical analysis. A written consent was signed and approved by the research ethics committee. The primary circumstance to practice a VIP was if the mother´s mental health was at risk. 54,7 % of the interns endorsed having a conscientious objection and 21 % applied it during their internship year. 86,7 % of the students answered correctly about how to proceed in a VIP case. All of them identified the special circumstances, in which VIP can be done in Colombia, and 96 % recognized the law, but only 41 % knew details about gestational time limits. 25,7 % of the students report having emotional consequences after witnessing a VIP; 48,7 % presented with depressed mood.

Assuntos

RESUMO

Resumen Resumen: Ante la despenalización de la eutanasia en Colombia, la objeción de conciencia emerge como un recurso legal que ostenta el médico que, por razones de conciencia, se niega a tales prácticas, lo que configura un conflicto de intereses en las relaciones asistenciales. Objetivos: Identificar las condiciones de posibilidad bioético-personalistas de la objeción de conciencia a la eutanasia en Colombia. Se proponen dos escenarios: en el primero se presenta una fundamentación antropológica apelando a la idea de 'vida biográfica' presente en el pensamiento de Julián Marías y, en el segundo, se proponen los cuidados paliativos como escenario posible a la objeción de conciencia a la eutanasia. Materiales y métodos: La temática es eminentemente documental a partir de la hermenéutica crítica propuesta por J. Habermas y K. Otto. Conclusiones: La antropología mariasiana mantiene una apuesta por la integridad moral de las distintas trayectorias vitales, que por ser biográficas se configuran como personales, pero abiertas a establecer relaciones dialécticas con otras trayectorias, dada la naturaleza relacional de la conciencia. Ante la realidad del dolor, del sufrimiento y de la muerte, el modelo bioético centrado en la persona entiende que la salida más adecuada no parece ser un derecho a morir dignamente, sino una adecuada reorientación de los esfuerzos terapéuticos mediante los cuidados paliativos.

Abstract Introduction: Before the decriminalization of euthanasia in Colombia, conscious objection emerges as a legal resource that held the doctor, who for reasons of conscience, refuses such practices configuring a conflict of interests in the care relationships. Objective: Identify the conditions of personal bioethical-possibility of conscientious objection to euthanasia in Colombia. They proposed two scenarios: in the first, an anthropological foundation appealing to the idea of biographical life in the thought of Julián Marías; and in the second, palliative care is proposed as a possible scenario for conscientious objection to euthanasia. Material and method: The theme is eminently documentary from the critical hermeneutics proposed by J. Habermas and K. Otto. Conclusions: Mariasian anthropology maintains a commitment to the moral integrity of the different life trajectories, that because they are biographical, they are configured as personal, but open to establishing dialectical relationships with other trajectories, given the relational nature of consciousness. Faced with the reality of pain, suffering and death, the bioethical model centered on the person understands that the most appropriate exit does not seem to be a right to die with dignity, how much an adequate reorientation of therapeutic efforts through palliative care.

Resumo Introdução: Diante a descriminalização da eutanásia na Colômbia, a objeção de consciência surge como um recurso legal que detém o médico que, por razões de consciência, recusa-se a tais práticas, o que construi um conflito de interesses nas relações assistenciais. Objetivo: Identificar as condições da possibilidade bioético-personalistas da objeção de consciência à eutanásia na Colômbia. Propõem-se dois cenários: no primeiro se apresenta uma fundamentação antropológica apelando à ideia da 'vida biográfica' presente no pensamento do Julián Marías e, no segundo cenário, propõem-se os cuidados paliativos como possível à objeção de consciência à eutanásia. Materiais e métodos: A temática é eminentemente documentário a partir da hermenéutica crítica proposta pelo J. Habermas e K. Otto. Conclusões: A antropologia marisiana mantém um compromisso pela integridade moral das diferentes trajetórias de vida, que por serem biográficas configuram-se como pessoais, mas abertas para estabelecer relações dialéticas com outras trajetórias, dada a natureza relacional da consciência. Diante a realidade da dor, do sofrimento e da morte, o modelo bioético centrado na pessoa entende que a saída mais acertada não parece ser o direito de morrer com dignidade, mas sim uma reorientação corretados esforços terapêuticos através dos cuidados paliativos.

RESUMO

From 1989 through September 2017, Chile's highly restrictive abortion laws exposed women to victimisation and needlessly threatened their health, freedom and even lives. However, after decades of unsuccessful attempts to decriminalise abortion, legislation regulating pregnancy termination on three grounds was recently enacted. In the aftermath, an aggressive conservative drive designed to turn conscientious objection into a pivotal new obstacle, mounted during the congressional debate, has led to extensive, complex arguments about the validity and legitimacy of conscientious objection. This article offers a critical review of the emergence of conscientious objection and its likely policy and ethical implications. It posits the need to regulate conscientious objection through checks and balances designed to keep it from being turned into an ideological barrier meant to hinder women's access to critical healthcare.

Assuntos

RESUMO

Since 2007, when Mexico City decriminalized abortion during the first trimester, a debate has been taking place regarding abortion and the right to conscientious objection (CO). Many people argue that, since the provision of abortions (or "legal terminations of pregnancy" as they are called under Mexico City's law) is now a statutory duty of healthcare personnel there can be no place for "conscientious objection." Others claim that, even if such an objection were to be allowed, it should not be seen as a right, since talk about a right to CO may lead to a slippery slope where we may end up recognizing a right to disobey the law. In this paper, I argue that there is a right to CO and that this may be justified through the notions of autonomy and integrity, which a liberal democracy should respect. However, it cannot be an absolute right, and in the case of abortion, it conflicts with women's reproductive rights. Therefore, CO should be carefully regulated so that it does not obstruct the exercise of women's reproductive rights. Regulation should address questions about who is entitled to object, how such objection should take place, and what can legitimately be objected to.

RESUMO

La Ley 21.030 de Chile despenalizó la interrupción voluntaria del embarazo en tres causales (riesgo de vida de la mujer, malformación de carácter letal del feto y embarazo producto de violación), e introdujo por primera vez en la legislación del país, el derecho a la objeción de conciencia de los equipos clínicos que participan directamente de los procedimientos de vaciamiento uterino de las gestaciones en que concurre alguna de las tres situaciones consideradas en la Ley. Esta Ley tuvo un amplio debate social y legislativo, y a un año de su implementación podemos observar con preocupación, que la objeción de conciencia de los equipos clínicos se alza como la principal barrera de acceso a las prestaciones de salud a las cuales tienen derechos las mujeres en estas situaciones en Chile.1,2 El presente artículo espera aportar al debate nacional sobre el rol de los profesionales de salud ante el nuevo escenario jurídico-sanitario, donde el equilibrio entre las libertades personales de los profesionales y el legítimo derecho de las mujeres a poder acceder a los servicios definidos en la Ley 21.030 estén en el centro de la discusión, y se expresan como una oportunidad o definitivamente una amenaza al estado de derecho, es decir a nuestra democracia

Chile's Law 21.030 decriminalized the voluntary interruption of pregnancy in three situations (when the woman's life is at risk, where the fetus has a lethal malformation, and in pregnancies resulting from rape), and also, for the first time in national legislative history, introduced the right to conscientious objection for clinical teams that participate directly in abortion procedures for the three situations considered in the Law. This Law spurred a broad social and legislative debate, and one year after its implementation, it is concerning to observe that the clinical teams' conscientious objections have been principle barrier impeding women's access to these health benefits, despite their legal right. This article seeks to contribute to the national debate on the role of health professionals in this new legal-sanitary scenario, where the balance between the personal freedoms of professionals and the legitimate right of women to access the services defined in Law 21.030 are at the center of the discussion. These are expressed either as an opportunity or as a definitive threat to the rule of law, which is to say, to our democracy.

Assuntos