Chapitre 4. Autonomy of minors questioned: Russian case with the loss of medical secrecy.

Abstract

What is the value of confidentiality? Russian society faced this issue in 2020, when minors aged 15 to 18 lost their privacy. The amendment to the Federal Law, caused the situation, was received ambiguously, but quickly ceased to be the subject of public discussion. In my article, I study this event in a bioethical context, considering the topics of privacy, autonomy and relativity. Social discussion was not productive, since the arguments of both sides contained a double-edged argument: depending on existing relations in a family, the amendment will have a positive or negative meaning. By pointing out all the weaknesses of this shift in emphasis to relationships (that also implies the uselessness of the concept of relational autonomy here), I designate a real problem. A conflict situation has evolved both within bioethical principles and within the single principle – respect for autonomy. Due to the lack of confidentiality, the opportunity to act according to one’s own personal plan, presupposed by informed consent, is devalued. Autonomy turns out to be incomplete, twofold: it exists only for onetime decisions, and it is not in the long-term perspective because of a possibility of interference by others (parents, guardians) in this decision-making process. Since such criteria of autonomous action as intentionality and noncontrol may be violated, the autonomy of minors becomes contradictory. To avoid this, the autonomy should be either established as partial, or, by insisting on the return of confidentiality back to minors of the specified age, restored as full. Partial autonomy is a paradox, and a teenager should be endowed with what I call, considering the age criteria, the “presumption of autonomy”. If we do not give up autonomy completely, then we must restore its context consistently and non-contradictory: the ability of minors of this age category to make medically significant decisions requires the restoration of confidentiality and vice versa. Additionally, I investigate privacy’s impact on confidentiality: in Russian bioethics and medical practice, privacy is not considered as a source of other rights, the initial principle organizing the discourse.