Will a doctor inform my parents?

After frequent questions about gynaecological examinations, keeping and terminating pregnancy in minors and doubts regarding when you need the consent of parents / guardians and when not, we bring this article taken from the Analysis of the situation and recommendations for dealing with cases of minor pregnancies and parenthood jointly created by Parents’ Association “Step by Step” and the UNICEF Office for Croatia.

As an introduction, it is necessary to point out that the relevant regulations in force in the Republic of Croatia, in the field of health care, the Health Care Act, the Medical Treatment Act, the Health Care Quality Act, the Patients’ Rights Protection Act and the Act on Health Measures for Exercising the Right to Free Decision-Making on Birth of Children.

The Patients’ Rights Protection Act is based on the principles of humanity and accessibility and protection of patients’ rights. The principle of humanity of protection of patients’ rights is achieved by ensuring respect for the patient as a human being, ensuring the right to physical and mental integrity of the patient, protection of the patient’s personality including respect for patient’s privacy, worldview, and moral and religious beliefs. The principle of accessibility implies equal possibility of protection of the rights of all patients in the territory of the Republic of Croatia. According to the provisions of the Patients’ Rights Protection Act, the patient expresses the acceptance of an individual diagnostic or therapeutic procedure by signing a consent form. For an unconscious patient, for a patient with a severe mental disorder and for an incapacitated or minor patient, the consent referred to in Article 16, paragraph 2 of this Act shall be signed by the patient’s legal representative, i.e. guardian.

If the interests of the patients referred to in paragraph 1 of this Article and their legal representatives, i.e. guardians are opposed, the healthcare professional is obliged to immediately inform the competent social welfare centre. 

The Act on Health Measures for Exercising the Right to Free Decision-Making on Birth of Children of 1978 is the only regulation that regulates the issue of pregnancy termination. This law recognizes the right of an individual to freely decide on the birth of children. This is a right that is not explicitly recognized by the Constitution of the Republic of Croatia as a constitutional right, however, since it is an important part of private life, Article 35 of the Constitution of the Republic of Croatia, which protects the privacy of citizens, is fully applicable in relation to situations related to pregnancy termination. The right guaranteed by the cited law is not absolute but is subject to restriction determined by the Act itself, and it is a matter of health protection. Pregnancy termination is defined by law as a medical procedure.

Apart from the Act mentioned above, the term medical procedure can be found only in the Criminal Code of the Republic of Croatia, in the legal description of the criminal offense of arbitrary treatment, while the Patients’ Rights Protection Act uses the terms diagnostic and therapeutic procedure, and the Act on Medical Fertilisation uses the term medical procedure, so that the terminology of the Act on Health Measures for Exercising the Right to Free Decision-Making on Birth of Children is not in line with the laws that have entered into force in the last few years. The Act contains provisions on pregnancy termination and on the procedure that precedes the medical procedure of pregnancy termination, and it begins with the request of a pregnant woman. 

In addition to a request for pregnancy termination submitted by a minor under the age of 16, the consent of a parent or a guardian with the consent of the guardianship authority (social welfare centre) is required. This means that minors over the age of 16 will not need consent, but the question is whether the provisions of this Act conflict with the provisions of the Patients’ Rights Protection Act, according to which the consent of a minor patient is required to accept a particular diagnostic or therapeutic procedure. Therefore, the question can justifiably be asked which of these legal provisions doctors will give priority to in practice, i.e. whether they will apply the Patients’ Rights Protection Act, as a law that later entered into force (lex posteriori), or the Act on Health Measures for Exercising the Right to Free Decision-Making on Birth of Children, which is a special act in relation to pregnancy termination (lex specialis). In such a situation, it would be difficult for a doctor to advise how to proceed, however, bearing in mind that the Family Act prescribes that parental care lasts until adulthood, it would certainly be more appropriate to apply the law that came into force later (Patients’ Rights Protection Act) and which prescribes consent in a more restrictive way. It should not be forgotten that the terminology of the two acts is not harmonized, and while one speaks of a medical procedure, the other speaks of a therapeutic procedure, which opens the door to further doubts. The implementing regulation to the Patients’ Rights Protection Act is the Ordinance on the consent form and the form of statement the refusal of an individual diagnostic or therapeutic procedure.

However, if a doctor acts in accordance with the provisions of the Patients’ Rights Protection Act, it is not excluded that in civil proceedings he/she could be liable for damages for violating the personal right to privacy of a minor who requested pregnancy termination. 

Experience from practice shows that the treatment in such cases is not completely uniform, and that a larger number of health care institutions require the consent of parents when it comes to pregnancy termination in minor patients. 

Consequently, the legal and institutional framework relating to minors’ pregnancies and parenthood needs to be improved as a matter of priority.

The rule is that pregnancy termination can be performed until the expiration of ten weeks from the day of conception, and after the expiration of ten weeks from the day of conception only with the approval of the commission, under the conditions and according to the procedure established by the Act. Experience from practice shows that often pregnancy in minor girls is determined after ten weeks from the day of conception. Late detection of pregnancy is mainly associated with insufficient information in young girls, non-recognition and denial of signs of pregnancy. In addition, girls sometimes hide the fact that they are pregnant and postpone the moment when they will inform the family.

If it is determined that ten weeks have elapsed from the day of conception or that pregnancy termination could seriously impair the woman’s health, the pregnant woman is referred to the commission of the first instance, and in the case of a minor who has reached 16 years of age, but did not marry, the parents or guardian of the minor will be notified about the referral of the minor to the commission of the first instance. Notification to parents in such situations will not affect the pregnant woman’s decision to terminate the pregnancy, as she can make her own decision at the age of sixteen, but it will certainly be interference in her intimate life and possibly have far-reaching consequences for her future relationship with the family.

Experience shows that in the moments after the discovery of pregnancy in underage girls, family relationships are disturbed the most, and in such cases, it is necessary to provide help and support that the family needs to overcome difficulties and responsibly accept the new situation.