Experiencias de los equipos interdisciplinarios de los Servicios de Salud Sexual y Reproductiva en la evaluación del proceso del consentimiento informado de las adolescentes de 13 y 14 años para la IVE en Montevideo, Uruguay
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Zunino Pérez, Carlos Eduardo
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Buenos Aires
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Abstract
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En Uruguay, tras la legalización de la Interrupción Voluntaria del Embarazo (IVE), se estableció que los equipos de los servicios de Salud Sexual y Reproductiva (SSyR) debían
evaluar las competencias de las adolescentes para tomar decisiones, brindarles información adecuada y garantizar la voluntariedad de su elección. Sin embargo, estos equipos enfrentan múltiples dificultades para cumplir con dichas exigencias. Esta tesis explora los sentidos y prácticas de los equipos de SSyR —tanto públicos como privados— en Montevideo, centrándose específicamente en su abordaje de adolescentes de 13 y 14 años que solicitan una IVE. Mediante entrevistas semiestructuradas realizadas a 35
profesionales entre 2020 y 2021, cuyos datos fueron analizados con el software ATLAS.ti, se investigaron: los factores que los equipos consideran para validar el consentimiento informado y sus percepciones sobre la capacidad de este grupo etario para tomar tales decisiones. Los principales resultados evidencian que evaluar la validez del consentimiento en esta población constituye un arte clínico, que requiere combinar habilidades técnicas, sensibilidad ante problemáticas de género y comprensión de la situación particular de cada adolescente. Asimismo, se observa que los criterios clásicos de validez —capacidad, información y voluntariedad— resultan insuficientes para abordar la complejidad del proceso. Lejos de ser un acto estandarizado, esta evaluación es dinámica y está influida por factores clínicos, psicoemocionales y contextuales, donde la subjetividad profesional desempeña un papel determinante, especialmente al analizar la autonomía desde un enfoque relacional. El estudio también revela la necesidad de repensar los modelos de relación clínica en la
atención a adolescentes dentro de los servicios de SSyR. En este sentido, el modelo de toma de decisiones compartidas emerge como un enfoque integrador que permite equilibrar la protección del interés superior con el respeto a la autonomía progresiva de las adolescentes.
In Uruguay, following the legalization of Voluntary Termination of Pregnancy (VTP), healthcare providers in Sexual and Reproductive Health (SRH) services were required to: assess adolescents' decision-making capacity, provide them with necessary information, and ensure the voluntariness of their choice. However, these teams face multiple challenges in meeting these demands. This thesis examines the perspectives and practices of SRH teams—both public and private—in Montevideo, specifically regarding their approach to 13- and 14-year-old adolescents seeking VTP. Through semi-structured interviews with 35 professionals conducted between 2020 and 2021 (analyzed using ATLAS.ti software), the study explores: the factors considered by providers when validating informed consent and their views on this age group’s capacity to make such decisions. Key findings reveal that assessing valid consent with this population constitutes a clinical art, requiring professionals to combine technical skills, sensitivity to gender-related issues, and an understanding of each adolescent’s unique circumstances. Furthermore, traditional validity criteria—capacity, information, and voluntariness—prove insufficient to address the complexity of this evaluation. Far from a standardized procedure, this assessment is a dynamic process shaped by clinical, psycho-emotional, and contextual factors, where professional subjectivity plays a decisive role—particularly when analyzing autonomy through a relational framework. The results also highlight the need to rethink clinical relationship models in adolescent SRH care. In this context, the shared decision-making model emerges as an integrative approach that balances protecting the adolescent’s best interests with respecting their evolving autonomy.
In Uruguay, following the legalization of Voluntary Termination of Pregnancy (VTP), healthcare providers in Sexual and Reproductive Health (SRH) services were required to: assess adolescents' decision-making capacity, provide them with necessary information, and ensure the voluntariness of their choice. However, these teams face multiple challenges in meeting these demands. This thesis examines the perspectives and practices of SRH teams—both public and private—in Montevideo, specifically regarding their approach to 13- and 14-year-old adolescents seeking VTP. Through semi-structured interviews with 35 professionals conducted between 2020 and 2021 (analyzed using ATLAS.ti software), the study explores: the factors considered by providers when validating informed consent and their views on this age group’s capacity to make such decisions. Key findings reveal that assessing valid consent with this population constitutes a clinical art, requiring professionals to combine technical skills, sensitivity to gender-related issues, and an understanding of each adolescent’s unique circumstances. Furthermore, traditional validity criteria—capacity, information, and voluntariness—prove insufficient to address the complexity of this evaluation. Far from a standardized procedure, this assessment is a dynamic process shaped by clinical, psycho-emotional, and contextual factors, where professional subjectivity plays a decisive role—particularly when analyzing autonomy through a relational framework. The results also highlight the need to rethink clinical relationship models in adolescent SRH care. In this context, the shared decision-making model emerges as an integrative approach that balances protecting the adolescent’s best interests with respecting their evolving autonomy.
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Keywords
ADOLESCENCIA, DERECHOS DE LA NIÑEZ, SALUD SEXUAL, SALUD REPRODUCTIVA, CONSENTIMIENTO, AUTONOMÍA, VULNERABILIDAD, ATENCIÓN MÉDICA, HOSPITALES, ANÁLISIS DOCUMENTAL, ENTREVISTAS, URUGUAY
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Tesis de maestría
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136 h.
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Zunino Pérez, Carlos Eduardo (2025). Experiencias de los equipos interdisciplinarios de los Servicios de Salud Sexual y Reproductiva en la evaluación del proceso del consentimiento informado de las adolescentes de 13 y 14 años para la IVE en Montevideo, Uruguay. Tesis de Maestría. FLACSO. Sede Académica Argentina, Buenos Aires.
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