This article proposes to analyze the moral dilemmas and ethical conflicts related to the COVID-19 pandemic in Brazil, focusing on workers and healthcare work, using the theoretical framework of bioethics, defined as an “applied ethics, concerned with analyzing the moral arguments for and against certain practices that affect the quality of life and well-being of humans and other living beings, as well as the quality of their environments, and in making decisions based on these analyses”¹1 Rego S. Contribuições da bioética para a saúde pública. Cad Saude Publica 2007; 23(11):2530-2531..

By rescuing documents and research results that addressed such conflicts, the author offers a panoramic view of a current and insufficiently explored theme in public health - the debate on bioethical issues in times of health emergencies. He cites, as an example, the greater the impact of the pandemic on so-called “invisible healthcare workers”; harassment of workers by health plans by imposing the obligation to prescribe the “Covid kit”, including sending medicines directly to the users’ homes; conduction of researches without ethics board approval; manipulation of data from death certificates and breach of confidentiality of patient data. They also bring the shocking report of a patient who had been referred to palliative care without the family consent, who intervened and saved him.

The author also sheds light on the omission and denialism of the federal government in facing the pandemic which, by discouraging measures of protection and social isolation, postpones the start of vaccination, exempts itself from protecting social and vulnerable groups and from the actions necessary to strengthen the Unified Health System (SUS, in Portuguese), increase the overload, illness, and deaths of health workers. At the same time, it also describes the fundamental action of other sectors of the State, especially the legislative and judiciary, which sought to act in a way not only to minimize the government’s omission, but also to determine the responsibilities of public and private agents and find alternatives aimed at greater physical and psychosocial protection of health professionals and the population. With due regard, they address the role they played in denouncing and seeking better actions during the pandemic: the Federal Senate Parliamentary Committee of Inquiry into the COVID-19 (Covid CPI), the Front for Life (Frente Pela Vida, in Portuguese), an entity created in the midst of the COVID-19 pandemic, marking the union of various civil society entities in defense of democracy, science and the Unified Health System (SUS), the Supreme Court and the National Council of Municipal Health Secretaries’ code of ethics. The Covid CPI, for example, revealed several conflicts and ethical violations by public and private health agents.

By performing the praxis of confronting such realistic data with bioethical theory, the article brings fundamental concepts to understand the dynamics of political actors and the impact of the pandemic on the world of work and on the well-being of the population, in the Brazilian context. One of these is misthanasia - the death of people due to a lack of adequate health care or omission by the State. Many families, societies, orphaned children, social movements, and all Brazilian men and women who have some empathy will find a certain comfort in this concept, knowing that what happened in Brazil has a name.

The Ethics of Responsibility, by the philosopher Hans Jonas²2 Jonas H. O Princípio Responsabilidade: ensaio de uma ética para a civilização tecnológica. Trad: Lisboa M, Montez LB. Rio de Janeiro: Contraponto; 2006., is also debated, which brings, as an ethical imperative, actions guided by the need to build the necessary conditions for the permanence of future generations on the planet in the face of the challenges faced by the techno-scientific society. In this sense, the article draws attention to the need for public managers to guide their actions with an ethics of public responsibility, characterized as a moral act whose main principle is care.

The author sought and managed to produce an excellent synthesis of the moral dilemmas and ethical conflicts that emerged during the COVID-19 pandemic in Brazil, bringing theoretical elements of bioethics that can serve to guide not only new research on the subject, but also decisions and practices of political actors in the health sector. The pandemic has shown us how much humanity needs to advance in search of solidary and socially responsible relationships on the part of governments and individuals in times of global health emergencies, and how good or bad choices, as well as actions or omissions by the State can result in the protection of the health of the population or lead to catastrophic results, as in the Brazilian case, when the number of deaths was multiplied due to disdain and indifference towards not only individual human suffering, but also of the very destiny of humanity and our planet.

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