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ABSTRACT. The bioethics of the so-called 'peripheral countries' must preferably be con- ... to central countries; lack of culture consolidation (or of effective policies) in .... mined by the State and not defined by the open market. So, with all the ...
Bioethics ISSN 0269-9702 (print); 1467-8519 (online) Volume 17 Numbers 5–6 2003

INTERVENTION BIOETHICS: A PROPOSAL FOR PERIPHERAL COUNTRIES IN A CONTEXT OF POWER AND INJUSTICE VOLNEI GARRAFA AND DORA PORTO

ABSTRACT The bioethics of the so-called ‘peripheral countries’ must preferably be concerned with persistent situations, that is, with those problems that are still happening, but should not happen anymore in the 21st century. Resulting conflicts cannot be exclusively analysed based on ethical (or bioethical) theories derived from ‘central countries.’ The authors warn of the growing lack of political analysis of moral conflicts and of human indignation. The indiscriminate utilisation of the bioethics justification as a neutral methodological tool softens and even cancels out the seriousness of several problems, even those that might result in the most profound social distortions. The current study takes as a theoretical reference the fact that natural resources (which all of us are) are finite, and that corporeal, pleasurable and painful matters (which affect us all) are relevant. Based on these premises, and on the concept that equity means ‘treating unevenly the unequal’, a proposal of a hard bioethics (or intervention bioethics) is introduced, in defence of the historical interests and rights of economically and socially excluded populations that are separated from the international developmental process. From the 90s, new critical and theoretical perspectives emerged in the bioethics context.1 This questioning has brought to 1

D. Clouser & B. Gert. Critique of Principlism. J Med Phil 1990; 15: 219–236; S. Holm. Not just Autonomy – the Principles of American Biomedical Ethics. J Med Ethics 1995; 21: 332–338; B. Gert, C. Culver & D. Clouser. 1997. Principlism. In Bioethics: a Return to Fundamentals. New York/Oxford. Oxford University Press: 71–92. © Blackwell Publishing Ltd. 2003, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.

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international debates matters that had only been tangentially considered by traditional approaches.2 Persistent problems, which have been verified in the daily lives of people in peripheral countries – such as: social exclusion and concentration of power; poverty; misery and delinquency; international economical globalisation and the dramatic evasion of exchange from poorer countries to central countries; lack of culture consolidation (or of effective policies) in defence of universal human and citizenship rights; no access of economically vulnerable groups to the conquests obtained from scientific and technological developments; inequality of access of poor people to basic goods, which are essential to human survival with dignity; among other aspects – have come to be compulsory in the agenda of those scholars and researchers who want to work with a bioethics that searches for transformation, that is worried and attentive to the reality of the so-called ‘developing’ countries.3 These undesirable indicators of social imbalance end up in unsustainable ethical paradoxes. Having this as a starting point, the search for practical and ethical answers, based on more appropriate theoretical references, has become a priority for the poor countries in the Southern Hemisphere. Dilemmas that have been routinely detected by bioethics peripheral specialists may be more objectively faced by a new critical and epistemological analysis, which is dialectically linked to the needs of the majority of populations that are excluded from the developmental process. Therefore, the objective of this paper is to try to move forward in the international context, having Latin America as the starting point, with a proposal for discussion of a hard bioethics, an intervention bioethics, as a peripheral perspective to the traditional bioethics approach, considering that principlism has a strong Anglo-Saxon connotation. This proposal has already been previously introduced by one of us in bioethics congresses held in Brazil (1998), Argentina (1999), Panama (2000), Bolivia (2001), Mexico (2001) and Colombia (2002). In this sense, hard bioethics defends as morally justifiable, among other aspects: a) in public 2 V. Garrafa, D. Diniz & D.B. Guilhem. Bioethical Language and its Dialects and Idiolects. Cadernos de Saúde Pública 1999; 15 (supp. 1): 35–42. 3 V. Garrafa. 1995. A Dimensão da Ética em Saúde Pública. São Paulo. Fac. Saúde Públi. USP/Kellogg Foundation: 74; V. Garrafa. Bioética, Salud y Ciudadania. Salud Problema y Debate 1997; 9: 26–33; E. Granda. Salud: Globalización de la Vida y de la Solidariedad. Saúde em Debate 2000; 24: 83–101.

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and collective fields – priority for policies and decisions that may privilege the largest number of people and for the longest time possible, even if this may hamper individual situations, with special exceptions to be discussed; b) in private and individual fields – search for feasible and practical solutions for conflicts identified in the context where they take place. So, this new theoretical proposal poses a concrete alliance with the historically more fragile part of society where the conflict happens, including the re-analysis of several dilemmas, such as: autonomy versus justice/equity; individual benefits versus collective benefits; individualism versus solidarity; omission versus participation; superficial and temporary changes versus concrete and permanent transformations.

SYSTEMATISING CONCEPTS AND JUSTIFYING THE PROPOSAL Several words and categories were introduced into the present study without specific definition. The first one of them refers to a large classification of the most common themes related to bioethics, which is used as a referential basis for the organisation of the courses and subjects offered by the Center for Studies and Research in Bioethics at the University of Brasilia, Brazil, for graduate and postgraduate levels. Bioethics of persistent situations is related to those conditions that have persisted among human societies since ancient times, such as gender discrimination, social exclusion, racism, inequity in the allocation and distribution of sanitary resources, child and elderly abandonment, abortion, and euthanasia, among others. Bioethics of emerging situations refers to issues arising from the hasty scientific and technological development of the last fifty years, among which are the new reproductive techniques – including reproductive and therapeutic cloning – the Human Genome Project, and the advances in the field of genetic engineering, human organ and tissue transplantation. Other previously used expressions are those that mention central countries and peripheral countries. In this case, central countries means those where the basic problems of health, education, feeding, housing and transport have already been solved and/or have been reasonably well managed in relation to their solution. Peripheral countries, on the other hand, are those that international organisations usually call ‘developing’ countries, where the

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majority of the population is still fighting for minimum conditions of survival and dignity and, mainly, where the concentration of power and income are in the hands of a small and less representative number of people. Internationalisation of the economy by the globalisation phenomenon, instead of resulting in fewer differences between the rich and the poor on the planet, has exaggerated the contradictions even more, stressing the problems. At this point, it is also important to mention the existing differences in the poor countries themselves, where socially ‘central’ citizens are becoming more and more distant from the socially ‘peripheral’ others. Bioethicists who work in one or the other type of country, or even with one or the other type of social group (privileged/ included and unprivileged/excluded), hence, have to face conflicts and problems of diverse origins, as well as of completely different dimensions and complexities. Thus, the answer to the facts, their interpretation, and the decisions taken to solve them, or at least to favourably deal with them, cannot be the same. In thirty years, bioethics has been working out theoretical and methodological tools to mediate conflicts and to reinforce the most fragile side of interrelations. What bioethicists of peripheral countries cannot accept anymore – and particularly those of Latin America – is the growing lack of political analysis of moral conflicts. What has often happened is the utilisation of a bioethical justification as a methodological tool that ends up serving as a neutral way of reading and interpreting conflicts, no matter how dramatic they might be. In this way, the seriousness of several situations of conflict is softened (and even annulled, erased), and this happens mainly to the collective ones that, therefore, result in the most profound social distortions. To reinforce that bioethics needs to dedicate itself more vigorously to the theme of social inequalities, it is enough to remind oneself of the fact that there are places like Sierra Leone or Burkina Faso in Africa where life expectancy is barely 30 years old, while in Japan and in other European countries it is almost 80, more than double. A poor person born in the Northeast region of Brazil, the most deprived of the country, lives about fifteen years less than the poor born in the Southern region, the most developed region. In the same way, while in Uganda the per capita investment in health reaches a few dollars per year and in Latin America it ranges from US$200 to US$400, in the majority of the East European countries it surpasses US$2000 and in the USA it is already nearly US$3000. © Blackwell Publishing Ltd. 2003

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In addition, in 1998, the expenses in medical research against HIV/AIDS were fifty times more than that of combating malaria, although it is known that both diseases killed, in that same year, a similar number of people (approximately 2 million) in the whole world. The difference in this absurd inequity in the investment of resources is in the fact that AIDS, a pandemic that causes enormous harm and damage in rich and poor countries indistinctly, has achieved public international visibility; while malaria, a characteristically ‘Third World’ disease, almost exclusively confined to poor countries, does not arouse the economic interests of the private or public laboratories of central countries in terms of investing in expensive immunisations and medicine for those who cannot pay for them. What establishes priorities is not the demand or the needs detected in social reality, but the market. And the market has shown itself more and more perverse as years go by. Its rules are more protective for rich countries, the most insensitive ones. If we consider it in terms of genetic configuration and remember that all human beings – Eskimos of Greenland, white Russians of Caucasus, Australian natives, ‘maya quiches’ of Guatemala, Anglo Saxons, Chinese, Polynesians, Latin people or Brazilian ‘xavantes’ – are absolutely equal, the conflicts about disparities, inequalities and inaccessibility to goods increase. Confronted with the pandemics and death verified in Africa in the 20th Century, and shown live and in colour to the whole world through television – when ‘development’ had presumably reached the five continents – Peter Singer’s4 fair preoccupations with animal defence sound anachronistic, out of place. And the ‘moral strangers’ proposed by H.T. Engelhardt Jr.5 run the risk of being named ‘the morally incapacitated’ or ‘the morally excluded’, since ‘strangers’ become a word that is too soft (or too fragile) to reflect the absurd existing inequalities between the rich and the poor, the included and the excluded, the ‘central’ and the ‘peripheral.’ It is important to remember that the true meaning of equity does not mean the same as equality. Equality is the desired consequence of equity, the latter being only the starting point for the former. That is, it is only by recognising the differences and different needs of social subjects that one can reach equality. Equality, which France included in its symbology over 200 years ago, is no longer an ideological starting point seen in an exclusively horizontal form, which tended to annul differences. Equality is 4 5

P. Singer. 1999. Liberación Animal. Third Edition. Madrid. Trotta. H.T. Engelhardt Jr. 1998. Fundamentos da Bioética. São Paulo. Loyola.

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the arrival point of social justice, a reference to the most elementary human rights, where the future objective is the recognition of citizenship.6 This way, equity (that is, the recognition of different needs, and also of different subjects, to reach the same objectives) is one of the ways to achieve applied ethics and the accomplishment of universal human rights. Among these is the right to a dignified life, represented in this discussion by the possibility of access to health and other goods essential to human survival in the contemporary world. An example for the vertical concept of equity, defended above, can be given by what happens in Sweden, where the child mortality of the rich and of the poor is exactly the same, that is, three deaths in a thousand children born alive. In other words, the children of the poor and of the rich have the same probability of survival in that country. In Sweden, the responsibility for priority areas such as education, health, and others, are determined by the State and not defined by the open market. So, with all the sharp international questions mentioned here that refer to the field of ethics, we have decided to propose to peripheral countries a new focus to bioethics, beginning with interventionist practices, direct and strong, in the sense of searching for diminishing observed inequities. In a meeting of the World Health Organisation (WHO) that took place in Geneva in 2001, the Brazilian government gave a concrete example by proposing to the Assembly – by the way, the proposal was approved – that in cases of risk to public health, access to medicine by countries should be considered a matter of human rights, a tenet that was further accepted after tough debates in meetings of the World Trade Organization (WTO) developed in Doha, Qatar (November 2001). THEORETICAL FOUNDATIONS A number of philosophers identify ethics and morality as synonyms. Both terms are related to the ideal behavioural pattern that can achieve an optimum social life. Even though it is not the objective of this discussion to analyse the historical concepts of these two words, we think it necessary to establish a distinction between them, starting from the way we understand and value these concepts. 6 V. Garrafa, G. Oselka & D. Diniz. Saúde Pública, Bioetica e Eqüidade. Bioética 1997; 5: 27–33.

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In the collective understanding and use of these categories, we perceive that the main difference lies in the fact that one attributes to ‘ethics’ a wide character, which grants it the quality of a universal and general phenomenon. Concerning ‘morality’, one attributes characteristics of a specific cultural phenomenon, related to the values of each social group. We recognise morality as being plural, while we credit to ethics the characteristics of unity and of being transcendental. According to the belief of western civilisation, the values that support the idea of ethics imply its recognition and application by social groups with different moral patterns. Ethics represent a proper pattern to a set of different societies and moralities, expressed by the intersection of elements that are common to all of them. The existence of a true ethical discussion implies transcending partisanship and interests of groups. If the ideas of ethics and morality seem more or less clear in the symbolic level, what has been verified in practice is the enormous difficulty in establishing these intersection points. The comprehension of moral diversity of human societies has only started to be understood in the last decades. Before that, moral differences between them or between groups in the same context were systematically silenced. The evolutionist perspective, which consubstantiates contemporary ideology and morality in western societies, minimises the idea of difference and legitimates domination. Societies, cultures, ideologies and moralities are classified by a strictly materialistic perspective, which only considers technological developments, and thus are understood as levels of a monolithic evolutionary process. Nevertheless, in this levelling view the moral differences of each society subsist as a backcloth to capitalism. Based on scientific and technological development, capitalist logic has transformed the diverse societies in markets, and moralities have become obstacles to its unlimited growth project. The proposals of a ‘double standard’ to test new medicines in rich and poor countries, which have given rise to so many discussions and international protests in recent years are proof of this, since the essence of the proposals is to make flexible the ethical parameters for research with human beings.7

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V. Garrafa & M.M. Prado. 2001. Mudanças na Declaração de Helsinki: Fundamentalismo Econômico, Imperialismo Ético e Controle Social. Cadernos de Saúde Pública.

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Power concentration, technological development and moral pluralism The technological development reached during the 20th Century was unprecedented in history, and divided humanity, beyond political frontiers, in two distinct groups: a small group that retains power and technology, represented by central countries, and a large group consisting of peripheral countries that submit themselves to the smaller one. In these groups, the division of the Earth’s population follows the same proportionality. In the group where power is concentrated, we find the minority of the population, while in the group that submits itself to the central power the majority of the inhabitants of the planet is concentrated. Wealth distribution and the consumption of resources are inversely proportional to the numerical division of population. But even being numerically the minority, dominant societies tried to annul, ideologically and morally, the legitimacy of the others, trying to impose themselves as the only pattern. In practice, the different moralities were subjugated in the process of economic expansion and domination. Food production in the current world, for instance, supplants in hundred millions of tonnes the nutritional needs of the 6 billion inhabitants of the planet. However, due to problems in distribution, the contingent of people that still die of hunger or of its consequences is uncountable. If technology developed by the hegemonic power of central countries – from warlike power to means of communication – has reached a planetary dimension with the qualitative and quantitative expansion of the capitalist economical model, this expansion of influence brought about the conscience of moral particularities in each society, making clear their differences. From World War II on, contemporary reality has been more and more marked by the interchange between regional and global scopes, and the contact between these contexts has brought about, sometimes violently, conflicts in various sectors. This conscience of moral pluralism, which has intensified especially in the second part of the 20th Century, has brought to light the paradox hidden in the representation of ethics as a universal phenomenon. The belief of each social context in its inherent morality, which organises its vision of the world and gives sense to social practice, incites the conscience of antagonism. The power relation that underlies moral conflicts reinforces intolerance to differences in daily behaviour. The lack of respect is present in the relations between societies or in the interrelations among individuals. These conflicts make clear that the search of © Blackwell Publishing Ltd. 2003

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each morality for recognition and legitimacy in a global dimension symbolises real and daily conflicts for power. They show in a moral dimension the resistance to the hegemonic perspective. There is a need to admit differences in the symbolic level and, mainly, to transform in practice the structure and the relations of power. According to Engelhardt Jr.,8 all the attempts to establish a universal concept of ethics base themselves in the transposition to the global scope of the specific characteristics of the moralities of social groups. Everything we define as ethics would be only the reflection of our moral positions. Globalisation, moral pluralism and asymmetry – the fragile argument of tolerance If a broad knowledge of moral differences between world societies has highlighted the idea of plurality, at the same time it reinforced the idea of interdependence and totality. Technologies that were developed increased the possibilities for communication and exchange of information, creating a mass culture that is ready to answer to increasing consumption demands. The belief in the capitalist logic that the ends justify the means has legitimised the appropriation of natural and human resources of peripheral countries, enlarging inequality and mining the possibilities of surging political and economical autochthonous strategies. Dissemination of capitalism at a planetary level has pointed out the collision between the perspectives of international contexts and of the local ones. If on the one hand, differences had been perceived and made relative, on the other hand mass culture established a notion of totality. This contrast has provoked an intense friction between the two spheres. At a regional level, mass culture subverts moral values. At an international level, this ambiguity is felt in the insurgency of organised faction conflicts that seek to grant ways of life and moralities diverse from the hegemonic patterns. In the discussion considered by this study, this is related to the fact that the more we seek a universal ethics, the more we face apparently insurmountable obstacles. As cultural groups in the same social context, or in different societies, increase contact, the moral diversity and economical interests of each of them become evident, creating true abysses to understanding. 8

Engelhardt Jr., op. cit. note 5.

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Even with this evidence, the need subsists, and the will for establishing universal behavioural guide patterns is intensified. The multiple shocks seen show us that it is necessary to urgently establish bases for a new ethical discussion: patterns that allow bilateral and symmetric dialogue between moralities of different societies and also that make possible a balanced life for the ones that retain power and for those who are submitted to it, between central and peripheral countries. Although the urgency of this discussion may show different levels of necessity for the two groups, it seems to be vital not only for the ones who wish to minimise unnecessary confrontation, as it occurs in central countries because it leads to instability and economical losses, but also for those that need to prevent unsustainable conflicts, which is the case of peripheral countries, where confrontation is an effective way of survival. Despotic belief in absolute certainties, which marks scientific development and capitalist expansion, reveals the partiality of its premises, making itself more and more unbearable. The strong efforts to find ethical patterns that may standardise relations at a global level have proved unfruitful. When one tries to apply moral propositions that direct behaviour in a special context to a broader level, the resulting conflicts reveal themselves to be difficult to judge. Mediated by the restraining force of the hegemonic power, the attempts to put an end to the conflicts increase differences and make inequalities larger. Even the idea of equality, seeded randomly in a soil parched by injustice, has become another tool used to maximise profits and to justify domination. So, how is it possible to legitimise ethics in the face of so many and such varied expectancies? How to judge conflicts without making the strong one win? Which arguments may validate, in face of the strong hegemonic power, the minimum bases for a fair life that may limit the abuses and arbitrariness of those who have power, and may reduce the vulnerability of the ones who possess nothing? The difficulty seems so large that we are tempted to declare it impossible to find a contact point between moralities. A contact point that enables the existence of ethics, in the way western civilisation views and conceptualises it: a set of behavioural patterns that unites moralities of specific cultural contexts and that may transcend the hegemonic morality. The anguish and the resignation in the face of this obstacle lead us to declare not only the inexistence of ethics, but also a total impossibility of its creation. Banished to the condition of utopia, in relation to the future, or a mythical image, when we anxiously search for a way out in the

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past, it seems to us that it is a dream that becomes bitter as we awaken to a disenchanted and nihilist existence. The inexistence of this starting point to the construction of ethics paralyses the efforts to transcend this impasse. Our hands and consciences are tied in a knot that circumscribes our sight to the same limits that we are trying to transcend. For not having yet found the minimum patterns to establish a universal ethics that we need, we try to soften the conflicts through palliatives like the idea of tolerance in relations and inter-relations.9 Even though tolerance may be the obvious minimum for the production of a dialogue in the conflicts of differences, it is incapable of suppressing inequalities. If it makes possible the deepening of the dialogue in the cases in which there is symmetry of power between the interlocutors, it stops the real possibility of an exchange every time that asymmetry is evident. Tolerance facing asymmetry leads to relativism at unbearable levels, transforming the dialogue into acceptance and subservience. THE FINITENESS OF NATURAL RESOURCES Another way of leaving the web knitted by the human necessities of power and belief, which are at the core of this discussion, sends us to a totally different point. Conscious of the difficulty in mediating the dialogue between differences, and in establishing limits to the insane search of expansion of the hegemonic power, we abandon the search for contact points to the establishment of ethics in the exclusive scope of human relations. If capitalism is supported by theories that prescribe the necessity of unlimited growth, our recently acquired consciousness of the finiteness of natural resources mobilises us to try to establish limits in the name of the preservation of our house/planet. Facing the strictness of dogmatisms that make unviable the dignity of human existence and that mine equity and respect for differences, we have decided to transfer the focus of our worries exclusively to the scope of the environment around us. The fact that natural resources are limited and their extinction can reach not only western civilisation’s way of life, but all societies, seems to be a sufficiently solid point of support to provoke the flexibilisation of arbitrary and inconsequential positions. We trust that the incontestable truthfulness of the ecological argument, will, we believe, sooner or later provoke transformations in 9

Ibid.

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economical policies of central countries, even in those where the leaderships are evidently obtuse. Although it might be unquestionable that the limits of ecological argument need to be discussed and the aims of the triad economy/science/technology have to be reconsidered, using this perspective as the only point of possible contact and transforming it in a universal panacea to establish ethics in relations and inter-relations, means to accept the entirely abject condition of being, as a species, irremediably submitted to narcissistic ethnocentrism. The determination with which we make ecological discourse the piece de resistance of our attempts of finding universal ethical patterns only reflects our anguish, impotency and incapability of transforming our knowledge of the world in the face of a situation apparently marked by absolute imperatives. As the natural resources are finite and belong to all of us, it is not possible to passively accept that developed (and rich) countries continue their aggression towards nature, as has been the case up to now. Ten years after the United Nations Earth Summit Eco 92 (about environment and development) that took place in Rio de Janeiro in 1992, where agreements about the access and use of biological diversity and also about climate and anti pollutants were set under way, the situation has become significantly worse in 2002. On that occasion, 144 countries ratified the convention, excluding the US. They went on to be the only country that refused to sign the agreement called the Convention of the United Nations on Climate Changes in Kyoto, Japan, in 1997. All the developed nations made compromises to reduce the gas emissions contributing to the greenhouse effect to 5.2%. In the year 2000, the emissions not only had not diminished, but had increased to 10%. Countries like the US, Japan and France emit respectively 19.8, 8.8 and 6.3 tonnes per capita of CO2 per year; on the other hand in Brazil, India and Sierra Leone the emission is 1.4, 0.9 and 0.1 respectively. If human beings are characterised as moral animals, diversity must not be suppressed, but valued, since it expresses at a symbolic level the creativeness proper to evolution. And, if the values that guide the construction of moralities seem not to have contact points, we should extend our sight to beyond the behaviour guided by specific moral rules in each society. We must concentrate our efforts in the search for relation patterns between human beings and their cultures. We need to focus on human beings and not on the dimensions of societies and morality. We need to focus on the common characteristics of humanity that © Blackwell Publishing Ltd. 2003

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serve to build culture, societies and different moralities: pleasure and pain. CORPOREALITY, PLEASURE AND PAIN The search for definitions taking corporeality as reference is not a new strategy. At different times and with different objectives, philosophers like Jeremy Bentham, Vilfredo Pareto, Charles Darwin, Karl Marx and Sigmund Freud had already noticed that pleasure and pain are marks of the sensorial perceptions that orient the social valuation of facts and behaviours. More recently, Michel Foucault and Peter Singer have produced studies that show that pleasure and pain may condition behaviour not only at the level of thinking and of moral notions that prescribe the correct action to a specific system of values, but above all in concrete practice, in people’s bodies, in the knowing and doing, in the form and in the content, in the thinking and in the feeling. The varieties that cultural interpretations bring to the perceptions of pleasure and pain do not annul their function as a sensorial component to the perception of environment and survival. On the contrary, the condition of measuring sensorial elements of the environment and of relations confers to pain and pleasure the role of basic mechanisms of social control in all cultures. The possibility of instigating pleasure with or inflicting pain on others is the basis of power relations. Justified by its own practice, power legitimises itself with the reward and punishment that are the basis of the idea of justice. Fear, force and pain indicate the relations between the exploiters and the exploited, legitimising the social use of power and conditioning behaviour. The social pact, whatever it might be, derives from the use of sensorial parameters. We know that pleasurable and painful sensations are common to various species. In relation to human beings, they are the basis from which culture establishes moralities and conditions behaviour. Even being perceived in a different way in each social context, pain and pleasure are inherent to all human groups. In each one of them in different ways and by several associations, pleasure has been related to award while pain means punishment. The recognition of these marks is entirely generalisable. As a species, whatever the cultural criteria adopted to define them may be, we avoid pain and search for pleasure. We fear and run away from death, identified with pain, and we wish for life, represented by pleasure. We face pain as heroes, ascetics, saints and martyrs, © Blackwell Publishing Ltd. 2003

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only when it is considered a necessary step to the acquisition of further pleasure. Taking sensorial marks as parameters for the construction of ethics may, at first sight, be interpreted as an extreme reductionism. The mechanistic Cartesian paradigm that directs the vision of the world and the conception of science is based on the separation and hierarchy between mind and body. Using, for a discussion that one intends it to be abstract and profound, as a parameter a pattern inherent to corporeality may seem to be, at least, a blasphemy or even another unusual attempt to give reality a purely biological perspective. However, if we abandon prejudice of the determinist perspective that forms the contemporary scientific view, it may seem clear that, if in the level of ideas it is impossible to find a contact point for the establishment of an ethics that may gather diversity and may produce a dialogue between moralities, it is palpable at the level of corporeality. The utilisation of parameters based on sensibility conveys ethical discussion to the individual level. If human bodies are culturally built, it is in the bricks and the cement of these constructions that we will find the dust and the clay common to any humanity because it is from this organic equality that the voices of plurality raise. Thus, what seems to be reductionism, if seen through the lenses of the mechanistic Cartesian paradigm, and that determines a fragmented approach of reality, may become the synthesis when focused on a systemic perspective. HUMAN RIGHTS, POWER AND INJUSTICE The recognition of the intrinsic right to life, which is considered an experience beyond mere survival, allows the construction of ethical parameters to relations in which the differences between human beings do not necessarily mean asymmetry of power and inequality. Since the quality of our conscience does not allow us to dignify the pleasure of another human being, taking his right to life as a goal for a fair and just living together, we should at least consider the power of imposing pain on someone to be abominable. If violence is part of human psyche, pain that can result from it, involving human beings, should not be perpetrated without contradicting the interests and desires of the individuals that are submitted to it. The physical experience of pain only justifies itself when it is freely agreed upon, when feeling it means a choice that considers autonomy and not a submission due to vulnerability. © Blackwell Publishing Ltd. 2003

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And it is exactly the possibility of committing abuses, of perpetrating suffering and of imposing pain on somebody, which in the post war period made the Human Rights Declaration possible, the only ethical instrument of social control of behaviour built in the name of humanity. The geographical dimensions and the magnitude of the perpetrated damages in that conflict sharpened the sensation of vulnerability, making clear the necessity of creating ethical parameters for relationships. The pain and sorrow of millions of human beings victimised in the conflict have their origin in the conceptual fallacy of the superiority of a ‘race’ over all others – of a culture, a society and a morality. The impact of this corrupted thinking caused the wish for equality to emerge. The shock of experiencing pain has stimulated the consciousness of the need for instruments that would be able to establish a humanity criterion. The Human Rights Declaration recognises wo/men’s equality. Even though it is abstract, relative to a generalised me, this Declaration introduced for the first time the idea of a human identity, which is beyond all differences. It stipulates a common principle: the belonging to the same humanity in which one has an inalienable right to life. Nowadays, even in relation to noble values such as equality, we see a sad picture. The concrete pain and suffering of people involved in the conflict becomes more and more far-off, and the physical marks that war introduces to the bodies and in the minds of people become static images attached to the past. The horror derived from barbarism and from the senseless waste of human lives vulgarises itself as a fiction as time goes by. The echoes of the terror cries and of the horrified silence lose themselves in the mass culture murmur. We consume pain as merchandise, seated in our armchairs. Vulnerability and oppression perpetuated daily in the name of equality and freedom by the western civilisation are, until they do not touch our flesh, only distant images that can be forgotten by a simple movement of our fingers that changes television channels. Anaesthetised, we morally justify our inertia towards misery and death, because of the differences that make them, the other human beings, less human than we are. Above ideologies, this division of humanity into two groups of unequal proportions concretely introduces the ideas of humanity and ‘sub humanity.’ The planet’s inhabitants (humans!) are, in quantitative terms, the small part that consumes human and material resources, those to whom freedom and equality are important and to whom there is the possibility of experiencing the plenitude of existence, those to whom life may be pleasurable. © Blackwell Publishing Ltd. 2003

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The other part of the inhabitants (humans?) has their existence characterised by the experience of suffering. For those, freedom and equality join to their everyday life the weight of a slave like life, lacking the most basic needs of existence. This immense majority of helpless people, in different levels of loss of power and subjugation, should donate themselves to the holocaust that victimises them. They are consumed by the voracity of a system that feeds itself with their bodies, by sucking the vitality of their souls, and that uses the ideas of freedom and equality for domination and the maintenance of an unsustainable growth. Associated, knowledge and power have established the Sacred Trinity of the new belief imposed by the dominant minority. Knowledge and science are the Father. Power and technology are the Son, embodied in the technological artefacts that transform, wonder and fear daily life. And the Holy Spirit is the invisible hand that touches among them, and with the economical system claws bodies and souls. Efficiency sanctifies the belief in the ideology that guides the path of knowledge and that feeds the power of the minority of the inhabitants of the planet. The association between efficiency and good, and between science and truth, sustains the exploitation of the economical system and political oppression. The technology driven forward by this belief amplified the asymmetry of power since the post war period, making relationships totally unequal. The material reality of the dominant group does not exemplify the true daily life of the peoples of the world. The desires of some, the minority that dominates, and the necessities of others, the majorities that submit themselves, are at different levels of importance and values. The harmful human and environmental consequences of the hasty expansion of technology are shared in the name of equality. The tragic political and economical effects of a system that makes vulnerable and that has victimised the daily lives of millions of people for over half a century are imposed in the name of freedom. The spurious appropriation of the ideas of liberty and equality transformed them into ideological instruments for domination and exploitation, legalised by political measures and economic sanctions. The dissemination of the belief in this freedom and of this equality imprisons in dark caves the majority condemned to blindness. The myth that those values are, above all, human prerogatives, fruit of a profound personal desire, expressed in the idea of an individual and unrestricted freedom, eliminates the possibility of any type of agreement except the law of the strongest. Imposed © Blackwell Publishing Ltd. 2003

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as a burden in the name of equality, the ethnocentrism of central countries has become a fetter. By agreeing with the world point of view of the ones that oppress us, we naively believe that freedom and equality if applied to life essentially means parameters of undoubted justice. Even facing evidence that the association of these parameters to the strategies of oppression alter the essence of their meaning, we continue to believe in its ethos, considering that they are in fact instruments which are used only for the good of people. FINAL CONSIDERATIONS The regional limiting of bellicose conflicts shows the differences between moral perspectives of different contexts. Intolerance to diversity marks the exposed fracture in the shock that characterises moral confrontation and ethical conflict. Having given up their bodies and their souls, the majority of the peoples of the world are consumed, carried off by desire, by curiosity, by belief and by fear. Being adrift, they do not recognise their own power to deny and to silence injustice, forgetting their individual right and the belief in autonomy. The self-esteem that is essential to the recognition of oneself is daily murdered and curiosity is hampered by the fear of being beaten, used by the constituted power to cut our minor attempts. The minority, castled in the centrality of their exercise of power, does not only use bodies when transforming the sweat of others into water for watering their deserts. It sells all their land and life, transforming them into objects of consumption and of benefits, which may be exploited or neglected without any punishment. This predatory use of the Earth and of all its fruits, including human beings, enslaves the womb of the future for the delight of a few that do not hesitate in using violence to maintain their privileges. This uneven world, in which some have the possibility of feeling pleasure while it is left for the others the probability of being immersed in suffering, configures the panorama that, in our understanding, justifies an intervention bioethics. A proposal that breaks the enforced paradigms and re-inaugurates a utilitarism orientated to the search of equity amongst the segments of society, and capable of dissolving this centre-peripheral structural division of the world and of assuming a consequentialism based on solidarity, on the overcoming of inequality. A proposal that brings equality to the daily life of human beings and that gives to the idea of humanity its full dimension. It is exactly about this inhuman © Blackwell Publishing Ltd. 2003

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panorama that we propose to discuss, and these are the questions we are putting to be debated with Bioethics, Power and Injustice. Volnei Garrafa Núcleo de Estudos e Pesquisas em Bioética Universidade de Brasília Campus Universitário Darcy Ribeiro Gleba A – Reitoria Brazil – DF – CEP 70910-900 [email protected] [email protected] Dora Porto Núcleo de Estudos e Pesquisas em Bioética Universidade de Brasília Campus Universitário Darcy Ribeiro Gleba A – Reitoria Brazil – DF – CEP 70910-900

© Blackwell Publishing Ltd. 2003