Bioethics: an invitation to walk on a bridge...



... It is in this sense that I invite you to read the papers that constitute the Dossier on bioethics in this issue of Interface.

In the 1970s, bioethics reintroduced itself to the world, especially in the health area, as a bridge to interconnect spheres of human knowledge - or, we might say, of life itself - which perhaps had not been really separated in the academic production, but it seemed that there had been attempts to promote such distance: to separate biology (bio - facts) from humanities (ethics - human values).

The rich confluence of facts and values was forgotten. Scholars did not consider that facts without values become blind and values without the support of facts are empty.

Bioethics, the vital bridge between bio and ethics, interconnects these two fields of life and challenges us to question the reality we are building for the current times and for the future of the Earth and of mankind.

Thus, we see that bioethics is not limited to debates on the latest advances of biotechnology, nor to assistance, healthcare, professional ethics or research ethics. On the contrary, it encompasses them but is not restricted to them; rather, bioethics penetrates them in a contextualized way, extending them to the complexity of life, questioning them to find solutions whenever possible.

The reader will be able to confirm this through the spectrum of the three papers that integrate the dossier. Together, they present the professional being connected with the labor world by a bridge and the labor world connected with the institutional dimension and with public policies, in a two-way road between the sphere of lived reality (facts) and the sphere of should (the fulfillment of all the positive values), to find, on another bridge, the sphere of can, that is, what is possible to fulfill of values in the real, lived world, aiming to improve the health practices. Thus, we understand possible as opposed to necessary, that is, as that which can be modified, transformed by human action, in order to put reality into favorable conditions so that we can live in it as people. And we must remember that the sphere of should is the North direction that we must not miss in our ethical horizon.

Ramos and Do Ó discuss the healthcare professional's identity as "modes of being professional" learnt in education, in a "network" where the bioethical reflection can occur in "multiple connections" in different "points or intersections" with "political and technological processes", which makes ethics go beyond "traditionally standardized contents and experiences".

Taking the doctor-user relationship as a "social space" marked by solidarity and "constructed by symmetrical relations between two moral subjects who have reached full age", Lima and Verdi present a challenge to bioethics when they propose solidarity as a principle to family medicine.

Junges understands "bios" as moral and political life, discusses the intervention of the market's symbolic power in biopower and in the understanding of the right to health as consumption of biotechnological products, and defends the incorporation of the human rights perspective into a public health bioethics.

As it can be seen, there are many bridges in several directions, but always with a compass to guide those who propose to walk on their trails. The compass is that of good life, full life to all the living beings.

But... what is good life? What is full life? You, dear reader, may be wondering: In a plural world like ours, with so many conceptions of good, what is good life? Would there be 'one' good life or several good lives? Is it possible to combine them? In the midst of so much diversity concerning what is considered good, are there any limits? Limits to be respected, broken or discussed? Is it possible to reach a consensus? What values ate ethically valid? Are all morals equally respectable? Are fair and good the same? That is, to where should we point our compass? What values should we integrate into our North?

These and others are open questions to the bioethics trail. Due to this, bioethics is not only a cognitive task, but an enterprise to the human spirit. It requires, as equipment for treading the bridges: dialog between valid interlocutors, active tolerance, understanding of complexity, mutual respect, intersubjective hearing, paying attention to and valuing the other as an end in itself, friendly curiosity about what is different, humbleness to recognize that we may be wrong, discernment, and planetary and ecological consciousness.

And the shoes for the trail are those of responsibility. To bioethics, the ethical issues are not restricted to pending individual rights of living people or groups, but are threats to the network of mutual responsibilities deriving from our intersubjectivity and interdependence, and on which depends the maintenance of all forms of life.

Justifying acts, choices and their impacts on life is what responsible individuals do. They justify choices after interconnecting obligations, convictions, what they should do, positive values they should fulfill, with circumstances, context, and predictable consequences of acts and options. They know that ethics happens in real, daily life, as a complex construction, shared and constant, in a dialectical spiral between our convictions, values, facts, circumstances and consequences, which ponder and indicate what is possible in a given moment or situation. All this without getting lost in relativism or pragmatism, because responsible individuals have convictions and strive to fulfill them. They have strong convictions, but they are neither fundamentalists nor indoctrinators; they know how to discuss and they want to do it so as to find courses of action that are not extreme or tragic to deal with problems and ethical questions.

Bioethics implies the joint construction, in a deliberative manner, of practical knowledge. Knowledge about how to use knowledge for social welfare, being fair and careful. By expanding discernment through the dialog-based confrontation of facts and values involved in practical problems, in the different areas of the life and health sciences, bioethics proposes to be a responsible attitude in the fulfillment of values that allow us to live in a human way.

When I open this Dossier dedicated to bioethics, I feel as if I were talking about an interface to Interface. Therefore, I could not conclude this text without registering the sensitiveness and modernity of its editors when they recognize one more interconnection between different fields of reality that emerges in Health, Education and Communication.

Enjoy your reading! In fact, enjoy your crossing!


Madrid, April 21st, 2009.

Elma Lourdes Campos Pavone Zoboli
Nurse, School of Nursing, Universidade de São Paulo

UNESP Botucatu - SP - Brazil