RESUMO
A propósito de la reciente promulgación de la Resolución Ministerial N.º 4862014/Minsa, que aprueba la guía técnica nacional para el aborto terapéutico, se ha generado un gran debate al respecto. Como un aporte a la discusión, se presenta una revisión sobre las definiciones y tipos de aborto, para luego centrarse en el denominado aborto terapéutico y explorar las dificultades que existen para definirlo. Finalmente, se presentan algunas observaciones a esta Guía técnica emitida por el Minsa. Se concluye que el término aborto terapéutico es anacrónico y contradictorio porque el aborto no es un tratamiento que asegure mejorar la salud de la mujer ni la del niño. El término apropiado debería ser interrupción del embarazo por razones médicas.
With regard to the recent enactment of the Peruvian Ministerial Resolution N.º 4862014/Minsa, which approves the national technical guide for therapeutic abortion, has generated considerable debate. A review of the definition and type of abortion and the focus on the socalled therapeutic abortion is presented. This article explores the difficulties in defining it. Finally, some comments are presented to the Technical Guidance issued by the Minsa. We conclude that the term therapeutic abortion is anachronistic and contradictory because abortion is not a treatment ensuring better health of the woman neither for the unborn child. The proper term should be termination of pregnancy for medical reasons.
Assuntos
Humanos , Aborto Terapêutico , Aborto Terapêutico/legislação & jurisprudência , Saúde da MulherRESUMO
Although abortion for health reasons is not considered a crime in Peru, the State does not allow its inclusion in public policy, thus violating women's right to terminate a pregnancy when it affects their health. When examining the article in the Criminal Code which decriminalizes this type of abortion, provisions are identified which protect women and set the conditions to offer this type of service. This document sets the debate about the arguments used by the Peruvian State for not approving a therapeutic abortion protocol which would regulate the provision and financing of therapeutic abortion in public services, and explains why this obligation should be complied with, based on the conceptual framework of "health exception" In addition, it presents two cases brought before the judicial court in which the Peruvian State was found guilty of violating the human rights of two adolescents to whom a therapeutic abortion was denied.
Assuntos
Aborto Terapêutico , Política de Saúde , Aborto Terapêutico/legislação & jurisprudência , Aborto Terapêutico/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , GravidezRESUMO
A pesar de que el aborto, por razones de salud, no es considerado un delito en el Perú, el Estado niega su inclusión en la política pública, con lo cual infringe el derecho de las mujeres a interrumpir un embarazo cuando este afecta su salud. Al examinar el artículo del Código Penal que exceptúa de delito a este tipo de aborto, se identifican atribuciones que protegen a las mujeres y establecen condiciones para ofertar dicha atención. En el presente documento se pone en debate los argumentos que el Estado Peruano viene usando para no aprobar el Protocolo de Aborto Terapéutico, con el cual se reglamentaria su oferta y financiamiento en los servicios públicos y se fundamenta por qué se debería cumplir con esta obligación, en base al marco conceptual de la causal salud. Se presentan, además, dos casos judicializados, en que el Estado Peruano ha sido encontrado responsable de violar los derechos humanos de dos adolescentes a quienes se les negó el aborto terapéutico.
Although abortion for health reasons is not considered a crime in Peru, the State does not allow its inclusion in public policy, thus violating womens right to terminate a pregnancy when it affects their health. When examining the article in the Criminal Code which decriminalizes this type of abortion, provisions are identified which protect women and set the conditions to offer this type of service. This document sets the debate about the arguments used by the Peruvian State for not approving a therapeutic abortion protocol which would regulate the provision and financing of therapeutic abortion in public services, and explains why this obligation should be complied with, based on the conceptual framework of health exception. In addition, it presents two cases brought before the judicial court in which the Peruvian State was found guilty of violating the human rights of two adolescents to whom a therapeutic abortion was denied.
Assuntos
Feminino , Humanos , Gravidez , Aborto Terapêutico , Política de Saúde , Aborto Terapêutico/legislação & jurisprudência , Aborto Terapêutico , Acessibilidade aos Serviços de SaúdeRESUMO
OBJECTIVE: To describe pregnancies with conjoined twins according to the request for legal termination of pregnancy. METHODS: Retrospective review of pregnancies with conjoined twins, with no possibility of extrauterine survival or postnatal surgical separation, observed at a tertiary teaching hospital, between 1998 and 2010. RESULTS: Amongst 30 cases seen during the study period, six (20.0%) couples decided to continue with the pregnancy, termination of pregnancy was not requested due to advanced gestational age (> 25 weeks) in 5 cases (16.7%). Legal authorization to terminate the pregnancy was requested in 19 (63.3%) cases: permission was granted in 12 (63.2%), denied in five (26.3%) and information was missing in two (10.5%) cases. A successful vaginal delivery was performed in 83.3% of the cases undergoing termination of pregnancy and a cesarean section was performed in all the remaining cases (p < 0.01). CONCLUSION: In pregnancies with conjoined twins and without fetal prognosis, legal termination of the pregnancy is an alternative. Moreover, a successful vaginal delivery can be performed in most cases before the third trimester, further reducing maternal risks and parental suffering.
Assuntos
Aborto Legal/legislação & jurisprudência , Parto Obstétrico/métodos , Gêmeos Unidos , Aborto Legal/estatística & dados numéricos , Aborto Terapêutico/legislação & jurisprudência , Aborto Terapêutico/estatística & dados numéricos , Adulto , Feminino , Humanos , Gravidez , Complicações na Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-NatalRESUMO
OBJETIVO: Descrever casos de gravidez de gêmeos unidos de acordo com a solicitação de autorização judicial para interrupção gravidez. MÉTODOS: Análise retrospectiva das gestações de gêmeos unidos, sem possibilidade de sobrevida extrauterina ou de separação cirúrgica pós-natal, atendidos em um hospital terciário, entre 1998 e 2010. RESULTADOS: Entre 30 casos observados durante o período do estudo, seis (20,0 por cento) casais decidiram continuar com a gravidez, e, em cinco (16,7 por cento) casos, a autorização para interrupção da gestação não foi solicitada devido à idade gestacional avançada (> 25 semanas). A autorização para interromper a gravidez foi solicitada em 19 (63,3 por cento) casos: a permissão foi concedida em 12 (63,2 por cento), indeferida em cinco (26,3 por cento), e não se teve a informação do resultado em dois (10,5 por cento) casos. Nos casos submetidos à interrupção legal da gestação, o parto vaginal foi realizado em 83,3 por cento, e no grupo em que a autorização não foi concedida, a cesárea foi realizada em todos os casos (p < 0,01). CONCLUSÃO: A solicitação da autorização judicial para o aborto é uma alternativa na gravidez de gêmeos unidos sem prognóstico de sobrevida pós-natal. Além disso, o sucesso de um parto vaginal pode ser obtido na maioria dos casos antes do terceiro trimestre, reduzindo os riscos à saúde da mulher e o sofrimento do casal.
OBJECTIVE: To describe pregnancies with conjoined twins according to the request for legal termination of pregnancy. METHODS: Retrospective review of pregnancies with conjoined twins, with no possibility of extrauterine survival or postnatal surgical separation, observed at a tertiary teaching hospital, between 1998 and 2010. RESULTS: Amongst 30 cases seen during the study period, six (20.0 percent) couples decided to continue with the pregnancy, termination of pregnancy was not requested due to advanced gestational age (> 25weeks) in 5 cases (16.7 percent). Legal authorization to terminate the pregnancy was requested in 19 (63.3 percent) cases: permission was granted in 12 (63.2 percent), denied in five (26.3 percent) and information was missing in two (10.5 percent) cases. A successful vaginal delivery was performed in 83.3 percent of the cases undergoing termination of pregnancy and a cesarean section was performed in all the remaining cases (p < 0.01). CONCLUSION: In pregnancies with conjoined twins and without fetal prognosis, legal termination of the pregnancy is an alternative. Moreover, a successful vaginal delivery can be performed in most cases before the third trimester, further reducing maternal risks and parental suffering.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Aborto Legal/legislação & jurisprudência , Parto Obstétrico/métodos , Gêmeos Unidos , Aborto Legal , Aborto Terapêutico/legislação & jurisprudência , Aborto Terapêutico , Complicações na Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-NatalRESUMO
Se analiza el problema ético y jurídico del tratamiento del cáncer cervicouterino en mujeres embarazadas. Se realizó una revisión del tema, de las leyes chilenas y de algunas normativas europeas para después analizar la aplicación de los principios de No Maleficencia, Beneficencia, Autonomía y del Doble Efecto. El tema genera una difícil discusión e interpretación, pues tanto las leyes como los principios son orientadores, pero no explícitos para decidir la conducta más adecuada en cada caso. Lo ideal es preservar la vida materna y fetal, pero hay casos en los que, finalmente, es necesario priorizar una sobre la otra. Corresponde al equipo tratante, la madre, el padre, la familia y la sociedad concordar las conductas más responsables y justas posibles.
Authors analyze the ethical and legal problem about the treatment of cervical cáncer in pregnant women. A review of the Chilean laws and European regulations was made in order to analyze the application of the principies of Non maleficence, Beneficence, Autonomy and the Double Effect. The subject generates a difficult discussion and interpretation since both, law and principies, are guiding but do not give an explicit answer to choose the more appropriate behavior in each case. The goal is to preserve maternal and fetal life, but there are cases in which it is necessary to prioritize one over the other. A consensus between medical staff, the mother, the father, the family and society is necessary for a more responsible and fair decision.
Assuntos
Humanos , Feminino , Gravidez , Aborto Terapêutico/ética , Aborto Terapêutico/legislação & jurisprudência , Complicações Neoplásicas na Gravidez/terapia , Neoplasias do Colo do Útero/terapia , Chile , Legislação como AssuntoRESUMO
En nuestro país recientemente se han presentado dos mociones parlamentarias destinadas a la legalización del llamado aborto terapéutico, concepto difuso y equívoco. Se analiza esta posibilidad legislativa a la luz de la doctrina y la normativa constitucional chilena que protege expresamente la vida del que está por nacer, procurando distinguir aquellas figuras de interrupción del embarazo validadas por el Derecho de las que constituyen aborto provocado, reconociendo quela despenalización de una forma de estas últimas es, necesariamente, admitir el aborto en Chile.
Two parliamentary motions have recently been introduced to discuss the legalization of so-called therapeutic abortion, an ambiguous and equivocal concept. The goal is to analyze this possible legal reform under legal doctrine and the Chilean constitution, which expressly protects the life of the fetus, trying to distinguish all forms of pregnancy termination that are allowed by Chilean law, versus others that are induced and not permitted, recognizing that the decriminalization of the latter will necessarily lead to allowing abortion in Chile.
Assuntos
Humanos , Feminino , Gravidez , Aborto , Aborto Terapêutico/legislação & jurisprudência , Direitos Humanos , ChileRESUMO
Este artículo analiza desde un punto de vista general las razones por las cuales no parece recomendable innovar en la legislación vigente sobre aborto terapéutico. Se explicitan las definiciones utilizadas respecto de aborto, los dilemas éticos que se han generado, las diferencias que existen desde el punto de vista ético entre aborto directo (incluye el terapéutico y aborto indirecto. Se presentan, además, las cifras disponibles desde el punto de vista de Salud Pública para el aborto en Chile, se analizan las consecuencias físicas y psicológicas del aborto en la mujer y, finalmente, se presentan los desafíos para el futuro y se hace una propuesta de cómo avanzar en el debate para superar la disputa entre aquellos que están a favor de una nueva legislación y los que estamos a favor de no innovar.
This article analyzes, in general terms, why innovation of the existing legislation on therapeutic abortion does not seem advisable. It discusses the definitions regarding abortion, the ethical dilemmas that have been generated in this respect and the differences between direct abortion (including therapeutic abortion) and indirect abortion. Abortion figures available in Chile from a public health perspective are presented. There is an analysis of the physical and psychological consequences for women having an abortion. Finally, the article discusses future challenges and offers a proposal to achieve consensus in order to overcome the dispute between those who advocate new legislation and those who oppose innovation.
Assuntos
Humanos , Feminino , Aborto Terapêutico/estatística & dados numéricos , Aborto Terapêutico/legislação & jurisprudência , Anormalidades Congênitas , Ética Médica , ChileRESUMO
OBJECTIVE: In the last decade, important advances were made in the struggle for reproductive rights in Mexico. The goal of this study was to discover the opinions of decision-makers about the grounds for legal abortion as well as to explore their perceptions about further liberalization of abortion laws countrywide. MATERIAL AND METHODS: In-depth interviews were conducted with eight prominent decision-makers working in governmental health, law and social institutions as well as representatives of political parties. RESULTS: Six decision-makers favored a further liberalization of abortion laws. They proposed several strategies to move forward with liberalization. Two decision-makers were against abortion under all circumstances. CONCLUSIONS: Three factors seem to play a key role in the liberalization of abortion: a liberal party governing at the state level, a favorable public opinion and the pressure of NGOs promoting reproductive rights. A state-by-state approach seems more effective for generating changes in abortion laws.
OBJETIVO: En la última década se realizaron avances importantes en la lucha por los derechos reproductivos en México. El objetivo del estudio fue conocer las opiniones de tomadores de decisiones (TD) sobre las causales para un aborto legal, así como explorar sus percepciones sobre la liberalización de las leyes en todo el país. MATERIAL Y MÉTODOS: Se realizaron entrevistas a profundidad con ocho TD de instituciones gubernamentales de asuntos sociales, legales y de salud, así como representantes de partidos políticos. RESULTADOS: Seis entrevistados favorecieron la liberalización de las leyes y propusieron varias estrategias para realizarla. Dos entrevistados estuvieron en contra del aborto bajo cualquier circunstancia. CONCLUSIONES: En la liberalización del aborto, tres factores parecen tener un papel relevante: un partido liberal gobernando estatalmente, una opinión pública favorable y la presión de ONG que promueven los derechos reproductivos. El trabajo estatal parece ser más efectivo para generar cambios en las leyes del aborto.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Aborto Legal/legislação & jurisprudência , Tomada de Decisões , Médicos/psicologia , Administração em Saúde Pública , Aborto Criminoso/legislação & jurisprudência , Aborto Criminoso/psicologia , Aborto Eugênico/legislação & jurisprudência , Aborto Eugênico/psicologia , Aborto Legal/psicologia , Aborto Terapêutico/legislação & jurisprudência , Aborto Terapêutico/psicologia , Catolicismo , Prova Pericial , Previsões , Direitos Humanos , México , Política , Opinião Pública , EstuproRESUMO
Based on the case of Rosa, a nine-year-old girl who was denied a therapeutic abortion, this article analyzes the role played by the social in medical practice. For that purpose, it compares the different application of two similar pieces of legislation in Costa Rica, where both the practice of abortion and sterilization are restricted to the protection of health and life by the Penal Code. As a concept subject to interpretation, a broad conception of medical necessity could enable an ample use of the therapeutic exception and a liberal use of both surgeries. The practice of therapeutic sterilization has been generalized in Costa Rica and has become the legitimate way to distribute contraceptive sterilization. In contrast, therapeutic abortion is very rarely practiced. The analysis carried out proposes that it is the difference in social acceptance of abortion and sterilization that explains the different use that doctors, as gatekeepers of social morality, make of medical necessity.