Print version ISSN 0034-8910
Rev. Saúde Pública vol.39 n.3 São Paulo Jun. 2005
Lucilda SelliI; Volnei GarrafaII
de Pós-Graduação em Saúde Coletiva. Universidade
do Vale do Rio dos Sinos. São Leopoldo, RS, Brasil
IIFaculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
study proposes "critical solidarity" as a value to be incorporated into the
21st century's bioethics agenda and as an instrument to guide people
and associations in volunteer praxis.
METHODS: To explain how solidarity materializes itself, the motivations for engaging in volunteer activities in associations that integrate the corps of volunteers of the Instituto Nacional do Cancer [National Cancer Institute] in Rio de Janeiro, Brazil, are analyzed. The data for analysis were obtained by applying two instruments. The first one consists of a questionnaire divided into two parts: one part identifies the socio-economic profile, and the other identifies solidarity as a value that motivates volunteer activity. The second instrument comprises of semi structured interviews utilized to collect supplementary data for analysis.
RESULTS: The results indicate that volunteering is based on three basic motivations: a) personal motivations related to life as a volunteer, b) motivations resulting from professed beliefs, and c) motivations aroused by the feeling of solidarity.
CONCLUSIONS: It was concluded that the incorporation of critical solidarity requires a rupture with the detected model of patronizing volunteering; it implies explicating the common selfish interests that permeate volunteer activities and qualify an organic volunteering, that is, volunteering which is politically aware and committed to responding to the specific demands of the present time.
Keywords: Bioethics. Consumer participation. Community development. Human rights.
Bioethics, translated as life ethics, is a concept originally derived from the Greek, bios = life and ethos = ethics, traditions, conduct. It designates the branch of ethics that disciplines human conduct in issues that involve life in general, from human life to that of the ecosystem as a whole in which the human being is integrated. The concept was created by the american physician Van Rensselaer Potter, developed in his book "Bioethics: bridge to the future".13
Bioethics emerges in the horizon of growing awareness of the great transformations that characterize the social and historical situation presently constituting reality. These transformations, in the spheres of science, economics and law, had a profound impact on social life which were felt with greater intensity during the second half of the XXth century. From the angle of science and its influence on daily life, these led to substantial changes, due both to the adoption of new technology and to its alternative forms of application.
Among other consequences, this period led to profound changes in values that had served as a reference to humanity, bringing forth issues related to moral diversity, respect towards diversity, with emphasis on tolerance as a new emergent value, among others.6 In this sense, the 19883 Brazilian Constitution placed the country in syntony with the western world, which had already brought this issue to the center of the political agenda in the '60s and '70s within these societies. In Latin America, particularly in Brazil, there is much to be done in order to assure that individual and collective rights, guaranteed by the Constitution be upheld. Garrafa7 defends the radicalization of democracy from the social and political point of view as a means of assuring that laws are carried out and that people may take pleasure in the victories they have obtained.
Bioethics, in its origins consecrated principles of conduct based on traditional values of western ethics, constituting a parameter for guiding the distinct moral communities that emerged in post-modernity.1 Brazil, examined in historical perspective, was traditionally associated to paternalistic and authoritarian values.
The interest in the critical solidarity proposal, as an instrument to guide organic volunteering services and as a value in the bioethics agenda, has, among other justifications, motivations proceeding from social reality. Critical solidarity and organic volunteering are two poles that implied with one another and that intercept each other. In order to clarify this discussion, comprehension of these concepts must be established. The adjectivation critical refers to the capacity of the agent to discern, that is, to possess criteria capable of helping him/her to discriminate the social and political dimension indissociably present in the solidary relationship. Thus solidarity does not deplete itself as a typical relationship in civil society. On the contrary, it possesses a political element that has the State as its reference. The capacity to understand this political dimension, that refers to citizenship and to the possibility of interfering in an active manner in the definition of public policies, also characterizes this critical dimension.2 The concept of organic volunteering, in turn, was constructed by analogy to the concept of organic intellectual developed by Gramsci8 and refers to politicized participation, committed, active and beneficial to the people who develop the volunteer service in constructing the necessary conditions for effectively democratizing the State, in this particular case, within the field of health.
In the field of health, the principles and values that regulate the conduct of professionals was based on the binomial beneficence and charity. Beneficence synthesizes the Hippocratic medical deontology and charity represents the classical values of the Christian tradition in the field of health. As exemplified in the doctor-patient relationship, the active pole was represented by the figure of the physician and the passive pole was incarnated by the figure of the patient. The legal norms, in turn, crystallized these representations juridically. The decisive mark that modified the status quo, in the midst of the process of secularization of Brazilian society, was the Constitution of the Confederate Republic of Brazil, promulgated in 1988.3 In the field of health, the impact was felt with the introduction of new forms of relationship in general, and in the doctor-patient relation in particular. These transformations in the intersubjective relations were the consequence of the process of secularization allied to the expansion of liberal individualism and democracy in the country. These are consentaneous with the paradigm represented by the civilized world and may be synthesized by the classical values of Equality and Liberty.
The progressive changes in political and social culture have led Brazilian society to embark upon a period of valorization and enlargement of the space of civil society.18 The emergence of new social organizations, allied to those in existence traditionally, the expansion of the quantity of volunteers and of sites for volunteering practices signals the innumerous social problems in existence in Brazil. Therefore, the new agents of transformation are the social organizations, within the space of civil society.14
The present study attempts to propose, among the new principles and values associated with modern sociability, that which coadunates with interpersonal relations guided by equality and liberty, that is, solidarity. This proposal sustains itself on the belief that volunteering activity within the framework of solidarity is an important element for those that seek social justice, as well as on the interest in comprehending the phenomenon. Furthermore, the World Health Organization (WHO) expands social action by declaring 2001 the International Year of Volunteering and thus, "legitimizing interest in the other".
The objective of this study is to "propose critical solidarity" as a value to be incorporated into the 21st century's bioethics agenda and as an instrument in volunteer praxis, by identifying the volunteers' motivation.
Research was conducted in five volunteering associations working within an institution that combats cancer, located in the Municipality of Rio de Janeiro and founded in 1938. This institution, directly administrated by the Ministry of Health, is linked to the Department of Health Assistance of the above mentioned municipality.
The population study from which the sample was taken, was composed of 731 volunteers, legally registered according to the law n. 9.608, of the 18th of February, 1998 that belonged to five associations chosen to constitute the sample. The exclusion criteria were: volunteers from religious associations (119); volunteers going through a period of adaptation (120); summing up to 239 volunteers that were excluded. The final population was composed of 492 subjects. The sample was calculated utilizing the following parameters: 95% level of confidence; estimated prevalence of the outcome, 10%, resulting in a sample size of 105 persons. In order to prevent possible losses, five volunteers were added on, resulting in a sample composed of a total of 110 volunteers.
Data was collected in the period between October and December, 2000. In order to address the subjects, a questionnaire with 16 closed questions was chosen as the research instrument. This questionnaire was divided in two parts: na introductory part, composed of seven items, in which general information concerning the interviewee were solicited; the other part referred to their motivations with respect to the theme of solidarity. A total of 110 questionnaires were distributed and 106 were returned, being that one subject refused to participate in the study. The second phase of the study consisted of the application of a semi-structured taped interview that was conducted with only seven volunteers. These were chosen because, during the process of approaching the subjects and applying the questionnaires, these volunteers showed greater involvement with the theme, with particular capacity to interpret the facts and, above all, they manifested uneasiness with respect to the theme.
RESULTS AND DISCUSSION
The descriptive analysis, based on the variables: sex, age, schooling, occupation, income and civil status, indicated that the most prominent characteristics of the volunteers are the following: they are predominantly women (89.5%), over 40 years of age (79.0%) retired (28.6%), liberal professionals (23.8%) or housewives (30.4%). Although people with undergraduate degrees predominate (41.9%), there is a representative portion that has the lowest level of schooling in high school (37.2%). As to their civil status, the majority of them do not have a partner (40.5%), but there are also a significant portion of married women (34.3%). As to their income, 32.4% receive five to 10 minimal wages and 21.9% receive much more than 10 minimal wages. The number of single, widowed or divorced volunteers (50.5%) is very representative and, doubtless to say, is a factor that influences adherence to volunteering. Distribution of volunteers according to civil status: married 36 (34.3%); single 21 (20%), widowed 18 (17.1%); divorced 14 (13.4%), stable union 7 (6.7%); no reply 9 (8.5%). Among the volunteers in this sample, 89.5% are females and 10.5% are males.
The high percentage of women in volunteer work illustrated the weight of their participation in volunteering. Based on work legislation in vigor in Brazil, women retire, on the average, with approximately 15% less time in activity then men and have a 10% larger life expectation. This may explain, partially, the greater participation of women in volunteering activity. Furthermore, occupations in the field of health, in Brazil, are carried out, in large part, by women and this also influences the significant participation of females in volunteer activities. This conception places women, once again, in the place they've always occupied, reiterating patterns of oppression and subordination impregnated in men and women by the eminently masculine tradition.16 It would be women's responsibility to confront such deep rooted conceptions. They should assume the onus of rebellion both individually and collectively.11 Critical solidarity, as a value, should be regulated by a practice that is capable of evaluating and approaching the discourse on equality, incorporating it into daily practice, and producing more egalitarian relations between men and women.
Motivations for volunteering
According to the information obtained in this study, the fundamental reasons that establish the motivations for volunteering maybe resumed to three types of basic motivations: a) personal motivations related to volunteering lifestyle, b) motivations related to professed faith, and c) motivations aroused by the sentiment of solidarity.
Motivations related to volunteering lifestyle
The reasons given as justification for exercising volunteer activity have, as their central interest, the volunteer's quest for personal fulfillment. He volunteers so as to "make life meaningful", to "occupy his/her time", "so as to be able to communicate", "so as to overcome the emptiness of being", "in order to feel better as a person". It was noted that 10.4% of the interviewees, when establishing the relations between their personal definition of solidarity and the characteristics that identify it, indicated that gaining their "own well-being" was a factor related to personal motivations.
The open interviews made it possible to observe the emphasis attributed to personal issues as a strong influence in the movement towards volunteering activity. According to Roca,14 the motivations that have, as their backdrop, existential dilemmas, mobilize people in search of personal achievement. The volunteer searches for answers to his own anxieties and the cure for his existential pain that emerges from the empathetic relation established with respect to other people's suffering. An explicative approach for such experiences is made possible by Imoda10 as well as for the silent, partaken assimilation of the phenomenon of pain due to empathetic attachment. Cortina,5 in turn, follows the same perspective, aggregating a crucial element, that is: "reliving the experience of the other within yourself". Familiarity with one's own vulnerability revives awareness with respect to others' vulnerability.9 The volunteer, according to these perspectives, is revealed as someone who should come to terms with his own desert so as to recognize and harbor others' deserts.
Motivations related to professed beliefs
Motivation is impregnated by the philosophy of life that a faith proposes to its followers. The focus of motivational interest is the person of the volunteer that, like the faithful, follows the precepts that sustain his faith. Within this typology of motivations, the subject is a volunteer in order to "conquer perfection" by means of "exercising charity", of "loving his fellow men" and of "compassion" as well as "good deeds".
Love towards ones' fellow men is a basic value both in the Christian doctrine and in Kardecist Spiritualism, and its foundation is established in Mathew, 25, 34-40.* The majority of interviewees (56.2%) considered it was the motivation par excellence for volunteering activities. This value represents the supreme virtue in both doctrines Kardecist Spiritualism as well as Christian Catholicism. In addition, the fact that the majority of the volunteers are older than 40 years of age (82.9%), contributes towards the greater influence of religious values within this population. Therefore, age is an intervening variable that effects volunteer's motivations. It was found that a representative segment of the volunteers (27.6%) are more than 60 years of age and 41.9% are college graduates or have a graduate school degree. Complying with the mandates of God's Laws confers a degree of tranquility to these agents, for it establishes what are considered true moral patterns to be followed. The volunteer that appeals to God either for inspiration or for legitimacy, as well as the one that finds space, within volunteering, to deal with existential issues, contributes significantly to the characterization of volunteering activity at present time.14 It is understood that motivations based on religious philosophies characterize solidarity by similarity, according to which its adepts partake of the same values. Solidarity for the current period, with its multiple moralities, includes all those who participate in the human condition.
Motivations based on solidarity
Solidarity was the second most cited motivation among interviewees, being present in 22.9% of the sample. Within this motivational typology, volunteer activity, has, as a central interest, the other's well being. The subject is a volunteer in order to "help people", "make people more autonomous", "contribute towards the construction of justice", reduce social disparities", "do one's share as a member of society". The majority of the interviewees (69.5%), recognized that motivation was a spontaneous act. However, they do not perceive that, beyond their internal disposition, critical solidarity is a practice that presupposes subjects who are engaged, politicized and committed with a social cause. The driving force of volunteering activity is the recognition of the other as a human being, like each of us and, as such, honorable. Ethical dignity transforms human beings into subjects that create values and, are thus capable of lending significance to their existence.17 The results of our research made it evident that reciprocity and alterity are fundamental indicators of solidarity or for whom the relation "me-you" is a relation of reciprocity.4 Solidarity is a human value that must be learned. The idea of "constructing" solidarity discussed by Rorty15 accentuates the fact that solidarity is a socially learned conduct. It evokes the responsibility we have in upholding this construction. Parker,12 stresses that the word of command, in a rortyana interpretation of solidarity, is evident: there can be no efficient struggle with respect to the social issues that affect human beings if there is no concern for life and for the ideals of justice and moral tolerance. The more one is aware of civil rights or simple human rights, the more prepared one is to confront the malign effects of power or of oppression, for as Sartre said17 "When I declare that liberty, through each concrete circumstance, can have no other purpose than to desire itself, if at anytime man has recognized that he establishes values when he abandons liberty, he can no longer desire anything but liberty as the foundation of all values". Solidarity, just as the principle of liberty, dispenses with and transcends prescriptions and impositions of any kind; on the contrary, its praxis expresses the exercise of liberty.
A rupture with the social assistance model detected, notwithstanding the fact that the majority of the volunteers were found to be basically traditional, pressuposes consciousness raising. It should make it possible for members of the different associations to become aware of the interests that permeate their practices and create conditions to confront these with the assumptions that qualify a truly politicized volunteering activity, appropriate and committed to attending the specific demands of the present time. Critical solidarity is proposed as a value on which to base organic volunteering so as to lend continuity to volunteering activities. The merits of charitable, humanistic social assistance that have been present throughout the history of volunteering and that characterize the volunteering activity in this study are recognized. However, critical solidarity identifies and denounces the fact that, in order to fulfill the demands of societies in the post-modern world, such activity is insufficient and inadequate. It visualizes the need to create a rupture with the present model of volunteering based on charitable social assistance. Accordingly, it proposes organic volunteering as a transitional mechanism of mobilization and transformation, for confronting the charitable social assistance model detected in this study.
The process of change depends, in part, on the comprehension and assimilation that volunteering associations have of their potential role in such a process. It should constitute itself in a social instance with its own identity, a specific theoretical framework and a locus for actions and interventions that radically privilege respect for moral pluralism and the construction of inclusive social transformations. Critical solidarity's identity is centered on the subject's commitment to his/her organic actions and interactions, aiming to help the "other" to conquer his/her autonomy, without any paternalism or other kinds of authoritarian attitudes or forms of charitable social assistance. It's historical expression is materialized in the Human Rights Charter and in the current (1988) Brazilian Constitution. Organic volunteering constitutes one more site for promoting the exercise of individual and collective liberties. In order to confront social problems, governmental dispositions must be articulated to social initiatives; institutional resources must be associated to communitarian dynamics; technical competence must be associated to human ability. By proposing that solidarity should be the value that guides the associations in their organic voluntary praxis, it is understood that it will act as an aggregating factor of civic, political and social forces.
This proposal offers organic volunteering, in general, the opportunity to reflect on its practice, to perfect it and make it more efficient with regard to its aims. Organic volunteering praxis as regulated by critical solidarity is revealed by its agents' capacity to arouse people to participate, critically and consciously, in issues that involve social problems. The culture of participation is essential towards education, awareness, and personal commitment of social subjects in processes of transformation and social inclusion. Organic volunteering interacts in the construction of the participative social dynamics seeking the essence of true collective welfare. It became evident that critical solidarity should be understood as a condition for securing social justice and as a complementary measure for its achievement. In a country marked by profound cultural and material inequalities, it befits bioethics to attempt to enlarge people's ray of action within their particular spheres of activity, and thus contribute towards the search for greater social justice.
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Rua Castro Alves, 614 Bairro Teópolis
93260-460 Esteio, RS, Brasil
Received on 5/4/2004. Approved on 17/11/2004.
Based on doctoral
thesis presented to Universidade de Brasília, em 2001.
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