La interrupción legal del embarazo en Argentina / The legal termination of pregnancy in Argentina

En el contexto de la publicación por parte del Ministerio de Salud de la Nación de Argentina del Protocolo para la atenciónintegral de las personas con derecho a la interrupción legal del embarazo (ILE), resumido y comentado en este mismonúmero de EVIDENCIA, este comentario editorial ofrece: 1) una perspectiva amplia de lo que significa el aborto, desde lamirada estrictamente biologicista hasta definiciones basadas en el enfoque de género; 2) una descripción de los diferentesmarcos jurídicos respecto del aborto que imperan actualmente en Latinoamérica y Argentina, haciendo especial hincapiéen lo concerniente a las ILE; 3) información epidemiológica sobre la mortalidad materna en Argentina y la asociada alaborto inseguro; 4) estadísticas sobre la realización de ILE en la Ciudad Autónoma de Buenos Aires, Argentina.Dada la situación actual de aislamiento social preventivo obligatorio en el marco de la pandemia de Covid-19, conside-ramos quienes integramos equipos de salud debemos estar más atentos/as que nunca a las situaciones de violenciapotencial que podrían suceder en este contexto, para dar las respuestas pertinentes -entre las que se incluyen las ILE-, alas víctimas de embarazos no deseados consecutivos a situaciones de coerción. (AU)

In the context of the publication by the Argentine Ministry of Health of the Protocol for the comprehensive care of people withthe right to legal termination of pregnancy (LTP), summarized and commented on in this same issue of EVIDENCIA, thiseditorial article offers: 1) a broad perspective of what abortion means, from a strictly biological point of view to definitionsbased on the gender approach; 2) a description of the different legal frameworks regarding abortion that currently prevailin Latin America and Argentina, with special emphasis on LTP; 3) epidemiological information on maternal mortality inArgentina and that associated with unsafe abortion; 4) statistics on the realization of LTP in the Autonomous City ofBuenos Aires, Argentina.Given the current situation of mandatory preventive social isolation in the framework of the Covid-19 pandemic, we considerthat those of us who are part of health teams should be more alert than ever to situations of potential violence that couldoccur in this context, to give the relevant responses - including LTP- to victims of unwanted pregnancies following coercivesituations. (AU)

Muerte de un producto de la concepción. ¿Aborto ilícito o asesinato? / Death of a product of conception. Illegal abortion or murder?

Introducción: Cuando ocurre la muerte del resultado de la concepción, con la realización de la necropsia médico-legal se deben precisar aspectos importantes que definirán las conductas a seguir con los presuntos responsables de un delito. Para ello es necesario precisar si existió vida extrauterina o no, que le dará a este resultado, la definición de persona, según lo establecido en la legislación civil. Objetivo: Establecer el posible tipo de delito y enmarcar la posibilidad de que se trate de un aborto ilícito o un asesinato, además de precisar las causas y circunstancias en que la muerte se produjo. Presentación del caso: Se trata de un cadáver resultado de la concepción que fue hallado en una vivienda, dentro de un envoltorio, junto a la placenta y el cordón umbilical, cuya madre había mantenido su embarazo oculto. Durante el acto de la necropsia se demostró que era un producto viable que había presentado vida extrauterina. Conclusiones: Se presenta un caso poco frecuente en la práctica forense. Se determinó que se trataba de una recién nacida, por haber presentado vida extrauterina, cuyas causas de muerte estuvieron en relación con un traumatismo craneoencefálico(AU)

Introduction: When the death of a product of conception occurs, important aspects resulting from the completion of the medico-legal necropsy that define the behaviors to be followed with those presumed responsible for a crime must be specified. To achieve this, it is necessary to establish whether extrauterine life existed or not, which will give the definition of person to the mentioned product, as it is established in the civil legislation. Objective: To establish the possible type of crime and consider the possibility of an illegal abortion or a murder, as well as to specify the causes and circumstances in which the death occurred. Case Presentation: A corpse that was considered a product of conception was found in a dwelling house, wrapped up next to the placenta and the umbilical cord. The mother had kept a hidden pregnancy. During the act of performing a necropsy, it was demonstrated that it was a viable product that had had extrauterine life. Conclusions: A rare and unusual case is presented in forensic practice. It was determined that she was a newborn baby girl because she had had extrauterine life, whose causes of death were related to a traumatic brain injury(AU)

Anti-legal attitude toward abortion among abortion patients in the United States.

OBJECTIVE: To measure the prevalence of believing that abortion should be illegal in all or most cases among women obtaining an abortion in the United States and to identify correlates of holding this belief. METHODS: Study population was drawn from the nationally-representative 2008 Abortion Patient Survey. The primary outcome was having an anti-legal abortion attitude, defined as agreeing that abortion should be illegal in all or most cases. We assessed potential correlates in bivariable and multivariable analyses using weights to account for the complex sampling. RESULTS: A total of 4769 abortion patients completed the survey module containing the question on abortion legality, of which 4492 (94.2%) had non-missing data for the outcome. Overall, 4.1% of patients (N=183) reported an anti-legal abortion attitude. Correlates of having anti-legal attitude included being married, at <200% federal poverty level, fundamentalist, contraception non-use, no abortion history, perceiving the pregnancy with ambivalence or as unintended, and using misoprostol or another product on their own to bring back their period or end the pregnancy. CONCLUSIONS: Abortion patients who do not believe abortion should be legal appear to differ substantially from women who are more supportive of legality. Findings raise important questions about this subset of patients, including whether possible discordance between patient beliefs and behavior could influence their use of medical abortion or other products. IMPLICATIONS: Some abortion patients do not agree with abortion legality, and this subset could experience a degree of cognitive dissonance, which could influence the method by which they seek to abort.

Conscientious objection in Italy.

The law regulating abortion in Italy gives healthcare practitioners the option to make a conscientious objection to activities that are specific and necessary to an abortive intervention. Conscientious objectors among Italian gynaecologists amount to about 70%. This means that only a few doctors are available to perform abortions, and therefore access to abortion is subject to constraints. In 2012 the International Planned Parenthood Federation European Network (IPPF EN) lodged a complaint against Italy to the European Committee of Social Rights, claiming that the inadequate protection of the right to access abortion implies a violation of the right to health. In this paper I will discuss the Italian situation with respect to conscientious objection to abortion and I will suggest possible solutions to the problem.

Birth, meaningful viability and abortion.

What role does birth play in the debate about elective abortion? Does the wrongness of infanticide imply the wrongness of late-term abortion? In this paper, I argue that the same or similar factors that make birth morally significant with regard to abortion make meaningful viability morally significant due to the relatively arbitrary time of birth. I do this by considering the positions of Mary Anne Warren and José Luis Bermúdez who argue that birth is significant enough that the wrongness of infanticide does not imply the wrongness of late-term abortion. On the basis of the relatively arbitrary timing of birth, I argue that meaningful viability is the point at which elective abortion is prima facie morally wrong.

A tutela constitucional da vida humana e a criminalizaçao do aborto no brasil / The constitutional protection of human life and the criminalization of abortion in Brazil

A discussão da temática sobre o aborto no Brasil é delicada, pois envolve preceitos éticos, morais e legislativos, envolvendo também os preceitos das políticas públicas relacionadas à questão da saúde pública da mulher. A criminalização do aborto no Brasil propicia sua prática de forma clandestina e/ou insegura, podendo acarretar graves consequências à saúde das mulheres. Nessa perspectiva, este estudo tem como objetivo geral discorrer sobre os princípios que regem a tutela constitucional da vida humana e relacioná-los com as práticas criminosas de aborto no Brasil; como objetivos específicos analisar a proteção constitucional da vida humana, relacionando-a ao princípio da dignidade humana, ao direito à liberdade e à autonomia dos indivíduos, bem como ao direito fundamental à saúde, como também identificar os principais motivos que levam determinadas mulheres a praticar o aborto no Brasil, além de distinguir os tipos de aborto considerados legais dos ilegais, segundo o Código Penal e a Constituição Federal. Por fim, realizar um estudo sobre a defesa da vida e considerá-la relativa e positiva quanto à proibição do aborto. A princípio, através de revisão de literatura, pesquisa em sites de órgãos sobre o debate do aborto no Brasil e revistas que abrem as portas para novas discussões, observa se que é necessária uma maior preocupação por partes de entidades governamentais, bem como dos poderes judiciais, a perspectiva de que devem ser dadas às mulheres mais respeito e dignidade, pois estão sujeitas a várias questões, sejam psicológicas ou negativas de sua vida, levando-as a praticarem o aborto inseguro e clandestino. Para tanto, é preciso que as políticas públicas sejam mais eficazes e tentem manter uma melhor qualidade em seus serviços da saúde à mulher, dando mais atendimento com relação ao aborto seguro, que ainda está sendo uma prática ilegal no Brasil, mas que por várias razões deve se tornar legal

The discussion of the issue on abortion in Brazil is delicate because it involves ethical, moral and legal precepts, also involving the precepts of public policies related to public health issue for women. The criminalization of abortion in Brazil providesits practice of illegal and / or insecure way and can have serious health consequences for women. In this perspective, this study aims to describe elaborate on the principles governing the constitutional protection of human life and relate them to the criminal practices of abortion in Brazil; and specific objectives to analyze the constitutional protection of human life relate to the principle of human dignity, the right to freedom and autonomy of individuals, as well as the fundamental right to health, as well as to identify the main reasons why certain women to practice abortion in Brazil besides distinguish the types of legal abortion considered illegal under the Criminal Code and the Federal Constitution and finally conduct a study on the protection of life and regard it as positive and relative to the prohibition of abortion. At first, through literature review, research organ of the abortion debate in Brazil and magazines that open doors to new discourses sites, thus leveraging a better position that concern parts of governmental entities is necessary and judicial powers of the view that women more respect and dignity that they are subject to a number of issues be they psychological or negative in your life, causing them to practice unsafe and illegal abortion, should be given to both is necessary that public policies are more effective and try to maintain a better quality in their services to women's health by giving them more attention to them in relation to safe abortion, which is still being an illegal practice in Brazil, but for reasons that should become cool

Conflicting duties over confidentiality in Argentina and Peru.

The medical duty of confidentiality represents a key element for the provision of reproductive and sexual health services. In some Latin American countries, such as Argentina and Peru, the legal systems impose­or are interpreted as imposing­on health professionals the duty of confidentiality, but also the duty to report the commission of a public order offense that they know about owing to the practicing of their profession. In these countries, the conflicting duties and the criminalization of abortion cause severe public health and human rights problems when health professionals assist their patients for post-abortion treatment. Typically, patients are deterred from seeking prompt medical care, and their privacy, autonomy, and dignity are violated. A 2010 ruling from the Supreme Court of Argentina and a 2004 ruling from the Inter-American Court of Human Rights emerge as important instruments that grant a more adequate protection of medical confidentiality.

Invoking conscientious objection in reproductive health care: evolving issues in Peru, Mexico and Chile.

As Latin American countries seek to guarantee sexual and reproductive health and rights, opponents of women's rights and reproductive choice have become more strident in their opposition, and are increasingly claiming conscientious objection to providing these services. Conscientious objection must be seen in the context of the rights and interests at stake, including women's health needs and right to self-determination. An analysis of law and policy on conscientious objection in Peru, Mexico and Chile shows that it is being used to erode women's rights, especially where it is construed to have no limits, as in Peru. Conscientious objection must be distinguished from politically-motivated attempts to undermine the law; otherwise, the still fragile re-democratisation processes underway in Latin America may be placed at risk. True conscientious objection requires that a balance be struck between the rights of the objector and the health rights of patients, in this case women. Health care providers are entitled to their beliefs and to have those beliefs accommodated, but it is neither viable nor ethically acceptable for conscientious objectors to exercise this right without regard for the right to health care of others, or for policy and services to be rendered ineffectual because of individual objectors.

El derecho a la objecion de conciencia en el supuesto del aborto / The right to the objection of conscience in the assumption of aAborto

La objeción de conciencia consiste en el incumplimiento de una obligación de naturaleza legal, cuya realización produciría en el individuo una grave lesión de la propia conciencia. Desde los mismos orígenes del Estado de Derecho, el respeto a la libertad de conciencia ha sido considerado uno de los derechos más fundamentales, ya que se presupone que la libertad y la dignidad humanas se encuentran por encima del mismo Estado.El derecho a la objeción de conciencia puede entenderse como la dimensión externa de la libertad ideológica y de conciencia. Este derecho, pilar esencial en todo Estado de Derecho, posee especial relevancia en el debate bioético, al tratarse de una vía muy adecuada para solucionar, en un sistema democrático, los inevitables conflictos que genera la tensión entre legalidad y justicia.En las últimas décadas, el derecho a la objeción de conciencia ha desarrollado toda su virtualidad en aquellos países en los que se han aprobado leyes despenalizadoras del aborto. Las profesiones sanitarias tienen un horizonte y un sentido claros: el cuidado y el respeto de la vida, la salud y la integridad de todos los seres humanos. En consecuencia, cuando una norma legal vulnera o contradice este principio, surgen sólidas razones para fundamentar el derecho a la objeción de conciencia de los sanitarios

Human rights dynamics of abortion law reform.

The legal approach to abortion is evolving from criminal prohibition towards accommodation as a life-preserving and health-preserving option, particularly in light of data on maternal mortality and morbidity. Modern momentum for liberalization comes from international adoption of the concept of reproductive health, and wider recognition that the resort to safe and dignified healthcare is a major human right. Respect for women's reproductive self-determination legitimizes abortion as a choice when family planning services have failed, been inaccessible, or been denied by rape. Recognition of women's rights of equal citizenship with men requires that their choices for self-determination be legally respected, not criminalized.

Reproductive tourism as moral pluralism in motion.

Reproductive tourism is the travelling by candidate service recipients from one institution, jurisdiction, or country where treatment is not available to another institution, jurisdiction, or country where they can obtain the kind of medically assisted reproduction they desire. The more widespread this phenomenon, the louder the call for international measures to stop these movements. Three possible solutions are discussed: internal moral pluralism, coerced conformity, and international harmonisation. The position is defended that allowing reproductive tourism is a form of tolerance that prevents the frontal clash between the majority who imposes its view and the minority who claim to have a moral right to some medical service. Reproductive tourism is moral pluralism realised by moving across legal borders. As such, this pragmatic solution presupposes legal diversity.