Conscientious Objection to Legal Abortion in Minas Gerais State

Abstract

Objective The aim of this study was to verify the existence of conscientious objection to comprehensive health care for the victim of sexual violence, as well as to understand the service structure of institutions authorized in the health care system for victims of sexual violence in the state of Minas Gerais.

Methods This is a quantitative, cross-sectional, descriptive, and analytical field study aiming to collect data from institutions authorized to assist victims of sexual violence in the state. The instrument was handed in to the coordinators of these services.

Results It was found that 11% have no physician in service and that 31% had no training for this type of care. It was revealed that 85% of these institutions have already encountered patients wishing to have a legal abortion, but 83% of them have not had their request granted. There was a 60% presence of conscientious objection by the entire medical team, the main reason being religious (57%).

Conclusion The assistance system is not prepared for comprehensive care for victims of sexual violence, especially in terms of legal abortions, with conscientious objection being the main obstacle. A functional referral and counter-referral system is needed to alleviate such a serious and evident problem. It is hoped that the research results will promote dialogues in the state that favor appropriate actions on legal abortion, and respect the medical professional, in case of conscientious objection.

Resumo

Objetivo O objetivo do estudo foi verificar a existência da objeção de consciência na atenção integral da saúde à vítima de violência sexual, bem como conhecer a estrutura de atendimento das instituições credenciadas na rede de atenção à vítima de violência sexual no Estado de Minas Gerais.

Métodos Trata-se de um estudo de campo de caráter quantitativo, transversal, descritivo e analítico, com proposta de coleta de dados das instituições credenciadas ao atendimento às vítimas de violência sexual no estado. O instrumento foi entregue às(aos) coordenadora(es) destes serviços.

Resultados Verificou-se que 11% dos serviços não possuem médicos e 31% não fornecem treinamento para este tipo de atendimento. Foi revelado que 85% dessas instituições já encontraram pacientes que desejam fazer o aborto legal, mas 83% destas não tiveram seu pedido atendido. Houve 60% da presença de objeção de consciência por parte de toda a equipe médica, sendo o principal motivo religioso (57%).

Conclusão O sistema de assistência no Estado não está preparado para o atendimento integral às vítimas de violência sexual, principalmente no quesito resolução do aborto legal, sendo a objeção de consciência o maior obstáculo. Se faz necessária uma rede de referência e contra referência funcionante para amenizar problema tão sério e evidente. Espera-se que o resultado da pesquisa crie espaços de diálogos dentro do estado que favoreçam ações adequadas sobre o aborto legal, e o profissional médico respeitado, se houver objeção de consciência.

Keywords

bioethics - legal abortion - sexual violence - induced abortion - ambulatory care facilities

Palavras-chave

bioética - aborto legal - violência sexual - aborto induzido - instituições de assistência ambulatorial

Contributors

All of the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.

Publication History

Received: 08 September 2020

Accepted: 19 October 2020

Article published online:
30 November 2020

• References

• 1 Santos VC, Anjos KF, Souza R, Eugênio BG. Criminalization of abortion in Brazil and implications for public health. Rev Bioet 2013; 21 (03) 494-508
• 2 Garrafa V, Porto D. Intervention bioethics: a proposal for peripheral countries in a context of power and injustice. Bioethics 2003; 17 (5-6): 399-416 DOI: 10.1111/1467-8519.00356.
• 3 Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas. [Humanized abortion care: technical norm]. 2nd ed.. Brasilia (DF): Ministério da Saúde; 2011. . Portuguese
• 4 Decree-Law no. 2,848, 1940 December 7. [Penal Code]. Diário Oficial da União, 1940 Dec 31;Sect. 1:23911. Portuguese
• 5 Law no. 11,340, 2006 August 7. [It creates mechanisms to curb domestic and family violence against women, under the terms of § 8 of art. 226 of the Federal Constitution, the Convention on the Elimination of All Forms of Discrimination against Women, and the Inter-American Convention to Prevent, Punish and Eradicate Violence Against Women; provides for the creation of Courts for Domestic and Family Violence against Women; amends the Code of Criminal Procedure, the Penal Code and the Law of Penal Execution; and make other arrangements]. Diário Oficial da União, 2006 Aug 8;Sect. 1:1. Portuguese
• 6 Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas. [Prevention and treatment of injuries resulting from sexual violence against women and adolescents: technical norm]. Brasília (DF): Ministério da Saúde; 2012. . Portuguese
• 7 Rocha WB, Silva AC, Leite SML, Cunha T. Perception of health professionals about legal abortion. Rev Bioet 2015; 23 (02) 387-399 DOI: 10.1590/1983-80422015232077.
• 8 Godoi AMM, Garrafa V. Bioethical reading of the principle of non-discrimination and non-stigmatization. Saude Soc 2014; 23 (01) 157-166 DOI: 10.1590/S0104-12902014000100012.
• 9 United Nations Educational, Scientific and Cultural Organization. Universal Declaration on Bioethics and Human Rights. Paris: Unesco; 2006
• 10 Secretaria de Estado da Saúde de Minas Gerais. Resolution SES/MG no. 4,596. [Establishes the guidelines for the Specialization Course in Health Management, in the distance and semi-presential modalities]. Diário Oficial de Minas Gerais, 2014 Dec 20. Cad. 2014; 1: 24 Portuguese
• 11 Madeiro AP, Diniz D. Legal abortion services in Brazil--a national study. Cien Saude Colet 2016; 21 (02) 563-572 DOI: 10.1590/1413-81232015212.10352015.
• 12 Carvalho J, Gonçalves DWPO, Carvalho H. [The legalization of abortion in cases of anencephaly in Brazil]. Rev Inst Direito Bras. 2013; 2 (04) 2791-2830 Portuguese
• 13 Secretaria de Estado da Saúde de Minas Gerais. Resolution SES/MG no. 4,590, 2014 December 9. [Regulates the operation of the Attention Service for People in Situations of Sexual Violence, by health establishments qualified as references in the Health Region, within the scope of the Unified Health System (SUS) in the State of Minas Gerais and takes other measures] [Internet]. 2014 [cited 2020 Aug 10]. Available from: https://www.saude.mg.gov.br/images/documentos/resolu%C3%A7%C3%A3o_4590.pdf. Portuguese
• 14 Ruibal A. [The constitutional controversy of abortion in Brazil: innovation in the interaction between the social movement and the Federal Supreme Court]. Rev Direito Práx. 2020; 11 (02) 1166-1187 DOI: 10.1590/2179-8966/2020/50431. Portuguese
• 15 Andalaft Neto J, Faúndes A, Osis MJD, Pádua KS. [Outline of care for sexual violence in Brazil]. Femina 2012; 40 (06) 301-306 Portuguese
• 16 Adesse L, Jannotti CB, Silva KS, Fonseca VM. [Abortion and stigma: an analysis of the scientific literature on the theme]. Cien Saude Colet 2016; 21 (12) 3819-3832 DOI: 10.1590/1413-812320152112.07282015. Portuguese
• 17 Conselho Federal de Medicina. [Resolution CFM no. 2,217]. Provides for the code of medical ethics. Diário Oficial da União. Sect. 2018; 1: 179 Portuguese
• 18 Provides for mandatory and comprehensive care for people in situations of sexual violence. Diário Oficial União 2013
• 19 Darze OISP, Barroso Júnior U. [An educational proposal to address conscientious objection in reproductive health during medical education]. Rev Bras Educ Med 2018; 42 (04) 155-164 DOI: 10.1590/1981-52712015v42n4rb20180021. Portuguese
• 20 Marquardt M, Ribas JR. [Abortion in Brazilian legislation]. In: Urbanetz AA. coordenador. [Gynecology and obstetrics Febrasgo for the resident doctor]. Barueri: Manole; 2016: 787-803 . Portuguese
• 21 Gonçalves L, Dias MC. [The abortion debate in Brazil: bioethics, biopolitics and the functionings approach as a horizon of justice]. METAXY 2017; 1 (02) 1-15 Portuguese
• 22 Silva MCO. [The body's crucis way: conscientious objection, abortion, and health practices in a potiguar maternity hospital]. Proceedings of the International Seminar on Gender 11 & 13th Women's Worlds Congress; Florianópolis; 2017. p. 1-12. Portuguese
• 23 Potter VR. Bioethics: bridge to the future. Englewood Cliff: Prentice-Hall; 1971
• 24 Muniz I, Lins L, Menezes MS. Use of documentary in medical school and reflection on ethical issues associated with abortion. Rev Bioet 2018; 26 (04) 606-616 DOI: 10.1590/1983-80422018264279.
• 25 Brock DW. Conscientious refusal by physicians and pharmacists: who is obligated to do what, and why?. Theor Med Bioeth 2008; 29 (03) 187-200 DOI: 10.1007/s11017-008-9076-y.