Heteronomy in adolescent health: an integrative literature review

Abstract Adolescents’ health rights are not restricted to having their demands understood, but require their being respected as autonomous subjects and the agents of their own care. However, considering adolescents’ rights in terms of their autonomy in the day-to-day of the health care service, the situation is precarious as a result of heteronomy, subjection of the individual to the will of others. A search for articles was conducted in the Scopus, PubMed and BVS databases, cross-referencing with the descriptors: “saúde do adolescente” (“adolescent health”) , “responsabilidade civil” (“civil responsibility”) and “responsabilidade parental”, (“parental responsibility”). After inclusion and exclusion criteria were applied, 32 studies were analysed. The results indicated that adolescents are generally not consulted in parents’ or guardians’ decision making about their health care, and also that the family relationship is established under rules maintained by punishment, accountability and control, while dialogue is neglected. In that light, there is a need for measures to protect and promote autonomy, while academic discussion of the relation between adolescent health and heteronomy, considering the fields of human rights and health, requires more in-depth evaluations with a view to providing legal guidance on parent’s day-to-day role in adolescent health care.

摘要 青少年的健康权利绝非仅止于其诉求得到理解，更要求其作为自主主体与自身健康照护的执行者获得尊重。然而，若从健康照护日常场景中的自主性视角审视青少年权利，由于他律（heteronomy）、个体屈从于他人意志的现状，相关处境岌岌可危。本研究检索了Scopus、PubMed、BVS数据库，采用交叉检索策略，检索术语包括葡萄牙语"saúde do adolescente"（对应"青少年健康"）、"responsabilidade civil"（对应"民事责任"）以及"responsabilidade parental"（对应"亲职责任"）。经纳入排除标准筛选后，最终对32项研究展开分析。研究结果显示，在父母或监护人就青少年健康照护作出决策时，通常未征询青少年本人的意见；同时，家庭关系的维系依赖惩罚、问责与管控规则，而对话沟通被忽视。有鉴于此，亟需出台相关措施以保护并提升青少年的自主性；同时，结合人权与健康领域的视角，针对青少年健康与他律之间关系的学术讨论，仍需开展更深入的评估，以期为父母在青少年日常健康照护中的角色提供法律指引。