In an article published a few months ago, Soledad Deza and Adriana Álvarez, examine what they consider to be “an unattended medical obligation”: requiring informed consent to girls and adolescents to carry a pregnancy to term and give birth. Deza and Álvarez assess different interrelated and inescapably linked aspects of early motherhood, among which is the “health facet”. For them, “[f]rom time immemorial medical knowledge has monopolized the legitimate discourse of the body. As such, disease, healing, hygiene, sexual reproduction and uniformity of the physical dimension of the human being, are concepts that come historically defined from medicine”. From an anthropological point of view, “the medical system not only appropriates the true knowledge of the corporality realm, but also acts as a powerful socialization system that demands conformity to its conceptualization of the world and penetrates the popular cultures of Western societies”.
However, they note, the health care system today is migrating from a biomedical model, that adopts a paternalistic approach, towards a model of integral care focused on rights. The new model, includes a holistic and articulated approach to health, which translates into practices that incorporate a special focus on health promotion, prevention and rehabilitation, and includes a gender perspective, the notion of autonomy, health equity, citizenship, moral agency and health needs throughout the person’s life.
Referring to developments at the international level that increasingly recognize the progressive autonomy and evolving capabilities of children and adolescents, Deza and Álvarez examine the provisions of Argentina’s new Civil and Commercial Code to show how Argentina “vernacularized” these international developments to recognize greater autonomy to girls and adolescents, especially when it comes to their competence to make a decision over medical acts. They maintain that, consistent with international human rights law -in particular the right to information read in conjunction with the progressive autonomy and evolving capabilities of children and adolescent- requires that health personnel obtain prior and informed consent from girls and adolescents in cases of child or teenage pregnancy.
Deza and Álvarez argue that within the context of a pregnancy consultation, every girl and adolescent should have the right to be informed about her diagnosis, prognosis, therapeutic alternatives, risks, damages and advantages of each alternative and that all the information they receive should be clear, sufficient and adequate to the patient’s ability to understand. They argue that the information should include statistics and objective data about early motherhood, and scientific evidence on the effects that a pregnancy can have on a body that has not yet fully developed. Especially in developing countries, where complications during pregnancy and childbirth are one of the leading causes of maternal mortality in adolescents under 16 years.
Informed consent in these scenarios would ultimately allow for greater autonomy of girls and adolescents, in compliance with international standards. As Deza and Álvarez claim, on the one hand, it will challenge the asymmetric relations of power in health care that historically adopt a paternalistic model based on beneficence and not on autonomy. On the other hand, it will recognize the several overlapping layers of vulnerabilities that make every girl part of a vulnerable group; thus, requiring that the ethical commitment to general well-being and the obligation not to cause harm prevails over the health care professional prejudices and moral intuitions.
The full text of Soledad Deza and Adriana Álvarez article is available in Spanish here.
Photo source: Max Pixels, https://www.maxpixels.net/photo-1245703