Government asks doctors to not extract confessions in abortion cases

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Published On : Mon, May 19th, 2014

Case of a minor reported to police by a doctor after a home abortion gone wrong prompts Health Ministry to ask that doctors respect patient confidentiality.

Government asks doctors to not extract confessions in abortion cases

No legal options to terminate exist in Chile for women with unwanted pregnancies. Photo by Shannon Hazlitt / The Santiago Times

Last week the government issued a document to hospitals around the country urging doctors to not extract confessions from patients that have undergone home abortions, following the case of a minor who may face prison time after her doctor reported her to authorities.

Abortion is illegal in all cases in Chile — one of six states in the world to have such a hardline on the procedure — resulting in many women and girls to take matters into their own hands, where misuse of medication poses a significant health risk.

On May 6 a 17-year-old girl checked into hospital suffering from severe haemorrhaging. When it became clear that the girl had taken prohibited medication to force a miscarriage, the attending physician called police to report the minor, who now faces trial and a possible term of up to five years in prison.

This case prompted the Health Ministry (Minsal) to send out a document to all hospitals in which they ask doctors to respect patient confidentiality and also notified them of their right to abstain from testifying in criminal cases.

“Even though abortion is illegal, doctors and medical staff shouldn’t try to extract confessions from women who need medical attention as a result of the illegal act, as it violates their patient confidentiality,” the document reads.

The document, originally drafted by former Health Minister Alvaro Erazo in 2009 during President Michelle Bachelet’s first term, alludes to the International Convention against Torture, which Chile ratified. The convention says confessions can’t be extracted from women who need medical attention after an abortion and that doctors can maintain silence in criminal cases to protect patient confidentiality.

Alejandro Behnke, head of the Minsal’s Judicial Division, told press that in cases of doubt, the right to patient confidentiality should always win out over reporting cases to authorities.

Additionally, the head of the Chilean Medical Association (CMC) Enrique París said a minor cannot be reported to authorities as under the law medical professionals must first seek the consent of parents or legal guardians. Extenuating circumstances still require doctors to first consult with the ethical committee of the hospital.

Under Chilean law, the girl may receive a sentence of between three years and one day and five years. Throughout the trial she will received judicial and psychological help. Investigator Leslie Nicholls from the Social Studies Center of the Universidad Central said the girl suffers from depression and has a difficult home life, factors which she told press are “often the case” in juvenile clandestine abortions.

Traditional contraception and the morning after pill are permitted in the country, though Nicholls says that the real problem is a lack of sexual education in schools.

“That’s why young people, especially from vulnerable backgrounds, seek out other methods,” she said.

The Bachelet administration is in the process of drafting a sexual rights and reproductive bill which seeks to legalize therapeutic abortion — when the fetus is not viable or when the mother’s life is in danger — and abortion in cases of rape. Several similar bills have failed to find traction through Congress since abortion was made illegal in all instances during the military dictatorship, though public debate on the issue frequently flares up following cases such as the pregnancy of a thirteen-year old rape victim in November last year.

Black market medication

Carabineros, Chile’s uniformed police, arrived at the minor’s house where they uncovered evidence of the home abortion that included a plastic bag containing a placenta and items indicating she had used the medicine misoprostol, also known by brand names Misotrol and Cytotec. Until 2001 misoprostol was available with a prescription from Chilean pharmacies but nowadays only hospitals have access to it.

The World Health Organization (WHO) says the drug can be used to treat stomach ulcers as well as to accelerate labor and in certain doses it can lead to miscarriage.

Police are investigating how the minor obtained the drug — it is usually procured over the internet where it costs between US$90-125, and a black market for the medication exists in Chile where hand to hand purchases also occur.

Carabineros say they uncovered between 20 and 30 sales of prohibited abortion medications between 2012 and 2013. These figures pale in comparison to the number of abortions performed in Chile each year — thought to be between 60,000 to 160,000 — though no reliable data exists.

While there are risks associated with misuse of the drug, it can be used as a method for abortion without complications if administered following strict medical guidelines. Women’s organizations in Europe prescribe the drug online to women in Latin America who are under nine weeks pregnant and cannot achieve desired abortions at hospitals. There is a hotline in Chile that women can call to be walked through the steps required to administer the drug — usually inserted vaginally — and the Feminists and Lesbians for the Right to Information offers what is known as “The Manual” online that provides a guide and stories from women who have gone through the procedure in their homes.

By Belinda Torres-Leclercq
Copyright 2014 – The Santiago Times

About the Author

Belinda Torres-Leclercq
Belinda Torres-Leclercq
Belinda studied political sciences and Latin American studies in several European Universities. She wrote on food issues for Latin American news organization Noticias.nl and blogs about Chilean politics for MO*. Contact her at belinda@santiagotimes.cl or follow her at @BelindaMTL on Twitter.