Bioethical pluralism: Latin American contributions to bioethics from a decolonial perspective

Abstract

This essay presents benefits of a bioethical proposal from a decolonial perspective as part of the expansion of epistemic, political and aesthetic projects in Latin America beyond European-centered hegemonic projects. To that end, the work begins with a brief discussion on the self-representation that European-produced knowledge makes of itself, questioning its “will for power” and the structures by which it justifies epistemicide. The debate continues by exploring some of the common elements in the decolonial perspective to then provide its contributions to the contemporary bioethical debate, arriving at the so-called bioethical pluralism as the source for alternate thinking.

Bioethics; Latin America; Cultural diversity-Ethnic groups; Cross-cultural comparison-American native continental ancestry group; Culture-Conscience

Resumo

Este ensaio pretende apresentar subsídios para proposta bioética em perspectiva decolonial como parte da expansão de projetos epistêmicos, políticos e estéticos latino-americanos para além dos projetos hegemônicos eurocentrados. Para tanto, o trabalho inicia com breve discussão a respeito da autorrepresentação que o conhecimento produzido na Europa faz de si mesmo, problematizando sua “vontade de poder”, além das estruturas pelas quais se legitima(ra)m epistemicídios. O debate avança no sentido de expor alguns dos elementos comuns à perspectiva decolonial para, então, aportar suas contribuições para o debate bioético contemporâneo, desaguando no chamado pluralismo bioético como potência para um pensamento outro.

Bioética; América Latina; Diversidade cultural-Grupos étnicos; Comparação transcultural-Grupo com ancestrais nativos do continente americano; Cultura-Consciência

Resumen

Este artículo tiene como objetivo presentar elementos para una propuesta bioética en perspectiva decolonial como parte de la expansión de los proyectos epistémicos, políticos y estéticos latinoamericanos más allá de proyectos hegemónicos eurocentrados. El trabajo comienza con una breve discusión sobre la autorrepresentación que el conocimiento producido en Europa hace de sí mismo, cuestionando su “voluntad de poder”, así como las estructuras mediante las cuales se legitiman epistemicidios. El debate prosigue exponiendo algunos de los elementos comunes a la perspectiva decolonial para, a continuación, aportar sus contribuciones al debate bioético contemporáneo, sobre todo, al llamado pluralismo bioético como potencia para un pensamiento otro.

Bioética; América Latina; Diversidad cultural-Grupos étnicos; Comparación transcultural-Grupo de ascendencia continental nativa americana; Cultura-Conciencia

The expression “latin american bioethics” is the name given to a diversity of heterogeneous problems, encompassing contradictory and conflicting aspects. Regardless, in all of them, there seems to be effort to construct bioethics based on historical concreteness, on the common reality of plural and historically situated men and women. Therefore, the so-called “latin american bioethics” do not assume principles universally applicable to distinct historical timeframes and/or different ethnic-cultural formations, which is what occurs in the anglo-saxon-based principlism paradigm. Nor does it promote a position of moral relativism.

It deals with sensibility for specific aspects of local realities and those of private societies whose ethical production must occur with the participation of diverse and pluralist subjects. This production intends to question, for example, Europe’s privileged position in the enunciation of truths about the other, therefore broadening horizons on post-Western and non-colonized understanding of life. Latin american bioethics are not only concerned with the knowledge produced in certain geographical regions of the globe, but with a perspective according to which knowledge cannot dispense comprehension anchored on particular conditions. In the case of decolonial bioethics, one also cannot disregard the history of colonialisms and their processes of economic, political socio-racial and epistemic hierarchies.

The ethical exercise ceases to be exclusively on white males, christian, heterosexual, of liberal political culture and enlightened to fall within the pluralism of values and feelings produced by diverse social actors of equally diverse moral communities. The recognition that all individuals are capable of exercising ethics – not because they share ethically universal principles, but because they are constantly challenged by concrete situations that awaken their moral sensibility – this seems to be the main contribution for a decolonial bioethics project and to expand post-Western literature about life and existence.

As such, this essay presents some bioethics proposal elements from the decolonial perspective as part of the expansion of epistemic, political and esthetic Latin American projects that go beyond Euro-centered projects. Thus, the work begins by discussing the self-representation that Western scholars, especially the modern ones, make of themselves. The calling of these disciplines to the “will for power” creates even more problems, as well as the structures through which epistemic violence is justified as a result of this calling.

The discussion proceeds to present some common aspects of the decolonial point of view to then extract theoretical discussion points for the modern bioethical debate. Finally, it culminates in discussion about “bioethical pluralism” as a force to contemplate political, epistemic, esthetic and other projects. The text is based on the idea that a plurality of experiences from social actors inserted in concrete moral communities becomes the setting for formulations whose competition with others reveals a dynamic whereby targeted and historically situated fundamentals become possible, alterable and corrigible.

Elements for epistemic violence criticism

Current interpretation of the beginning of western philosophy teaches subjugation of mythical thinking as related to rational, legitimizing the latter as a privileged access route to the reality of the world. A study of thought production in ancient times, such as greek communities or empires in Egypt and oriental cultures, like the chinese, creates the idea of a lack of distinct support for thinking, be it religious, literary or scientific. A poem or literary work could contain both religious specifications and investigations on the root causes of the things that be.

The philosophy that emerges in Ancient Greece, which opposes mythology and the sophist, believes in differentiation and radical ascendency of knowledge based on the principle of reason in search of causes, consequences, cornerstones and ultimate truths that may not only speak to the world, but flow in its praxis. This would give cause to the fantasy that the only way to gain access to reality would be he who was informed in philosophical-scientific knowledge. The principle of reason would be, therefore, the new path to conformation of thought that should be measured according to logical truth criteria. As such, classic aristotelean logic emerges, as well as that of the Socratic maieutic, which intend to attain the ultimate truth through exhaustive inquiry.

Obviously, reason will not be questioned in its instrumental use in search of knowledge and wisdom, but the idea that reason has the quality to attain, through persuasion and dialogue, a common certainty about reality and the best definition of how good living should be.

If the emergence of philosophy gives cause to the differentiation between esthetic-religious-mythical knowledge and rational-principle-scientific knowledge, relegating affectivity, subjectivity, corporeality and multiple correlated affectations to second place, the thinking that engenders modern science will establish the necessity to divide the different fields of the discipline to possibly execute specialized research. Therefore, curricular subjects are another side of metaphysics (western philosophy) initiated with Aristotle and finalized with Descartes’ philosophy.

When Martin Heidegger ¹ and, in his Wake, Jacques Derrida ² – just as Maria Zambrano ³ and Octavio Paz ⁴, among others – condemn the technical implementation of thinking, and look to think of deconstruction as the necessary path to launching the individual through speech, in fact, they are circling another thought process, which does not intend to objectify reality through metaphysical assertions. This is because thinking about anything is never passive, but contains the active aspect of the “object”, is partial and limited, since it doesn’t end with the idea of the object when scrutinized, holding multiple forms of ascension. Moreover, the agencies that acquiesce it and that acquiesce views about the “object” are never static, but in differentiation, lending traces of differences to reality, as stated by Derrida.

Even though the principal of universal reason works with parameters, standards, repetitions – that is, in search of codification and predictability -, reality escapes the attempt at conformity and shows itself always to be different from any and all sought standard. The metaphysic condemned by Heidegger ¹ and Derrida ² is that same that imagines categorization of thinking through possible disciplinary means, considering that there will be objects of proper knowledge and their corresponding knowledge fields. Under such concept, the hard sciences (biological sciences, mathematics, physics and chemistry) and the soft sciences (human sciences, history, sociology, anthropology, literature, philosophy, linguistics) cannot produce discourse about the same objects in reality, since, in theory, they would not be speaking to the same reality.

The movement of thought occurs in specific space-time, that referring to a determined West, which constructs itself in opposition to the other historical differences with which it already came in contact ⁵. According to studies on coloniality, Europe, as we imagine it to be - white, Christian, modern, enlightened -, was only possible because identity rhetoric prevailed as to the European individual and the other individual. This other is expelled from the conformation that we came to know as Europe, whose ethnic and cultural constitution resides in the people from the North, in the phoenicians, egyptians and later in the western german-latins and arabic-Islams. But also, the others subjugated in the two great colonial acts – conquering America in the 15th Century and imperialisms of the 19^th Century – are extirpated for illusionary European constitution, original and eugenic.

Beyond the obvious findings that economic and human spoliation allowed for a rich and prosperous Europe, with its corresponding nation states that arise from the fictitious homogenization of cultural differences, the privileged place of enunciation of this modern Europe comes from a colonial organization of the world. The Peruvian thinker Aníbal Quijano ⁶ argues it impossible to understand modernism without the possibility of mentioning its creator, coloniality. The modern colonial world aligned due to the two colonial acts that not only subjugated continents, empires and people, but established the belief that the historical European project would be the single, ultimate end for all humanity.

Modernism/coloniality met with success in its colonization project, since it manages to be imperative over the various existing historical projects. Emerging from modernism, there would be only one epistemic, political, economic, cultural and esthetic project for all people. This conception ranks the communities’ historical narratives, their spaces and times, disciplines, languages, memory and imagination to the hegemonic discourse related to the unique, globalized and universal civilizing model. The colonial ⁷ difference created by modernism/coloniality will be established among unmeasurables. Or, once again, the other’s reason (barbaric, primitive, uncivilized). This conforms modern subjectivity that will be in agreement with the universal project for the human being: white-european, christian, heteronormative, liberal, literate and credulous as to enlightenment and the value of science.

The phrase “coloniality of knowledge”, coined by studies on coloniality, refers to epistemic racism that intends to delegitimize and preclude all types of knowledge that are not Euro centered, characterizing them as irrational, primitive, underdeveloped and unqualified while projecting a persecuted self. Another form of control of the colonies will be relegated to the sciences, beyond that exercised by territorial and political control. Knowledge-power devices that rank the ways to see the world, establishing colonial differences between “rational” and “primitive” disciplines, serve to control other epistemic projects. They serve to construct social representations and legitimize knowledge desubjectified for being objective, disembodied for being universal and decontextualized for being valid for any time and place.

Therefore, the so-called “eurocentrism” promotes epistemic violence to which we are subjected today. Knowledge produced outside the hegemonic centers and in non-hegemonic languages may be disregarded or judged to be parsimony, due to being seen as regional or traditional knowledge. This occurs even if they are in dialogue with the principal hegemonic centers irradiating philosophies, theories and scientific practices. Eurocentrism becomes responsible to present the historical narrative of modernism/coloniality with objective, scientific and universal knowledge, thereby seen as the only epistemic project capable of handling all forms of existing knowledge.

This project is given the name “universalism”, or “modernism project”: capitalist, neoliberal, Eurocentric, Christian, heteronormative. This concept would have given opportunity for the idea that only one political-economic project would exist, only one moral conformation, as well as a single way to learn and relate to the world - only one possibility for existence. As such, the colonial project did not only motivate the subjugation of land, bodies and cultures. It is a project in flux, since it continues promoting epistemic racism against other conceptions of the world. Bioethics emerges within this context, amid the imposition of a global project for humanity.

Gaps in the hegemony of the international bioethical movement

In the 1970s, at the time it emerged, bioethics appeared as a new epistemological perspective about how to gain access to a determined reality, the global reality, by considering the ethical consequences resulting from the development of biomedical, biotechnological and industrial sciences. These sciences shielded themselves behind the right to no self-criticism, advocating the principle that they attended to the common good, the good of human development, ignoring consequences thereafter very well-known: objectification and destruction of nature and of biodiversity ⁸.

What became known as “Potter bioethics” ⁹ – as a tribute to the first formulator of the term – or life ethics had, therefore, the intention to unify the diverse knowledge areas in order to impede ecological catastrophes caused by the development of capitalism and technoscience. It related not only to questions seen as exclusive to hegemonic bioethics, like biomedicine and biotechnology, but also those related to environmental health, social issues, and species preservation ⁸. Due to its original mission, and despite the hegemonic attempt to deter bioethics at the disciplinary limits of biomedicine, Débora Diniz states that Bioethics is a field of knowledge at the interface of different disciplines. Since it is an emerging field, one of its characteristics is the disagreement among specialists about its epistemological foundations and object of study¹⁰.

It can then be said that bioethics falls under this context as movement of disciplinary convergences, since it claims an impossibility to part with reality. It is understood that, since it was originally constituted by the necessity to look at the global context holding all the existing instruments (or at least those produced by hegemonic centers), bioethics emerged due to the observation of a necessity to change the way thought is produced in modernism and, therefore, what should be the nature of the agency in the world. At least it seems as such for emerging Latin American bioethics.

The case of Brazilian bioethics is paradigmatic as to its necessity to look beyond the ethical issues of clinical health and authorization of research subjects, due to the health reform in the 1980s ¹¹. From then on, health was thought to be a universal right, based on social, political and economic contexts, with access to health benefits, information and sanitation. Or, according to Porto and Garrafa, stemming from consideration of the importance of the environment, geographical conditions, access to water, food, housing; of constraints related to the socioeconomic dimension, like income, work, education and personal habits, and also factors resulting from access to health services¹². This transformed not only health policies in Brazil, giving rise to the Unified Health System, but also Brazilian and Latin American bioethics almost thirty years ago.

Intervention bioethics (BI), a theoretical milestone of Brazilian bioethics, is nothing more than the fruit of the aforementioned health reform. BI emerges as a critical counterpoint to hegemonic bioethics of central countries that do not look to the macrostructural problems related to social justice on their horizons (theoretical and practical). Therefore, BI is concerned with persistent situations (social exclusion, violence, discrimination, restriction to healthcare access) that structure the way we deal with ethics, politics and with issues related to life ⁹. As such, BI repoliticizes moral questions (biotechnoscientific, health, social and environmental conflicts) and thinks of the necessary politicization of epistemology itself from Latin American reality (and, we could also say, from the perspective of decoloniality of the discipline) ¹³.

From there, bioethics will be developed not only as a new epistemological multi-, inter- and transdisciplinary field, but also as a social movement ¹⁴. Synonyms that will be found for the word “bioethics” intend to handle their “political and practical” calling, like “life ethics”, “applied ethics” (term originating in philosophy) and “practical ethics”. The bioethical politicization and internationalization movement ¹⁵, referred to in the Universal Declaration on Bioethics and Human Rights¹⁶ by Unesco, gave opportunity to what has been called “Latin American bioethics”. But that’s not all: the fourth moment of bioethics as a discipline that, according to Garrafa and Azambuja ¹⁷, refers to the conceptual amplification of its theoretical bases, through new epistemological bases for bioethics, assisted in the emergence of Latin American bioethics.

Its conceptual bases fall back on the respect of moral pluralism; the necessity for deeper reflection on the ethical universalism-relativism contradiction; the approach to bioethics as practical or applied ethics; an approach not only multi- and inter-, but essentially transdisciplinary; the perspective of the issues from the paradigms and the concrete complexity and totality¹⁸.

It arises from dialogue with biomedicine, philosophy and sociology and through the constant updates through new biotechnoscientific knowledge. Due to its peculiar origin and for being trumpeted in recent years as an advantageous arena to contemplate moral conflicts related to social and health issues, Latin American bioethics may be seen as “epistemic insurgency” ¹⁹ which takes place outside the other fields of knowledge.

Hence, it is true that bioethics may deflagrate greater movement than that which considers philosophical, social and environmental issues only related to health, and that may help us execute the decolonial program for expansion of epistemic, political and other esthetic projects beyond the Eurocentric hegemonic project. As such, two metaphysical review movements emerge: the first refers to the prevalence of technoscientific thinking over the others, promoted to the category of “literature”, and the second refers to the attempt for (un)masking of projects and historical alterities registered under the stigma of coloniality. Considering both, we see that bioethics emerges in the face of the urgency for revocation of dualisms, binarisms, objectification and technification present in the heterodoxy of contemporary thinking.

Bioethics, due to its working topics and the diversity of the scholars attracted to its scope, allows for movement of thinking beyond the disciplinary fields. This is because it embraces traditional and popular knowledge and multiple possibilities for ethical affluences in issues regarding life (beginning and end), the health-sickness process, the body - concerning gender and sexuality -, ethnic-racial and ecological issues. It alludes, consequently, to the different ways of living and coexisting related to other historical-cultural projects that are not only modern-colonial.

For this purpose, if hegemonic bioethics and bioethics that speak for the South, but not from the South ¹³, no longer desire to be a tool for geopolitical rule and epistemic violence, they will have to revise their foundations, suppositions and purposes. Even though they are, with their declarations, codes and standards, the “discipline” that looks to organize the framework of reflections on ethical conflicts related to health, biotechnology and health issues, they still run the risk of taking place beginning with the global hegemonic project.

Nascimento and Garrafa ¹³ criticize the use in the South of the theoretical and conceptual instrumental produced in the North, in addition to its discourses on universal human rights and the common good. One of the attempts to not incur in this criticism refers to the constant citation of Andean good living as a horizon from the original populations of Latin America about other ethical conceptions that are not registered in the hegemonic project. In the words of Fulgêncio and Nascimento:

The notion of “good living” emerges as the principle that structures the material production of life, regulation of social relationships, from a moral and political perception that acts both as criteria for redistribution of socially produced wealth and the reproduction of a sense of belonging for the people of the community ²⁰.

Therefore, for the purposes of example, it is also important to problematize values considered common like “quality of life” and “good living”, which may only be understood in the specific contexts that forged them, so as not to give us the illusion that we may know what is best for each of us. Thus, we think of quality of life programs for public employees or those of great private businesses that offer workplace exercise, health club subsistence and nutritional guidance for its workers without considering that quality of life may refer to something more. That is, diminishing the work day or, more radically, methods of producing wealth that do not remain in the hands of the capital, but are produced only to the extent of the collective necessities, which would inevitably lend more time for community relations.

Something of this sort could recover social ties of solidarity that may influence issues such as safety, raising offspring and self-management of resources and time. In addition, it could encourage reflection about moral projects, therefore resulting in the exchange of information and guidance related to health beyond that produced by the medical institution of the modern-colonial society. Hegemonic bioethics, therefore, present as affirmative perspectives on what would be the best mechanisms for protection, survival and good living, even when they represent the point of view of those that suffer social neglect.

Costa and Diniz call this perspective “illusion of ethical tranquility”, wherein theoretical foundations are sought in “philosophical traditionalism” ²¹, since the references of values considered for good living are found in generic ethical principles supposedly applicable and extended to humanity. Principlism is not a simplistic approach because it addresses bioethical issues using four principles (autonomy, justice, beneficence, nonmaleficence). That is exactly why it intends to resolve moral conflicts using principles, as if it were possible to gain access to the “greater good” from one abstract conception about right and wrong, isolated from its historic and ethnocultural conceptions. That is, as if the principlism concept could think and guide in a universal manner the ways of being and acting regarding life, body, death, health, sexuality and reproduction.

“Asymmetric bioethics” are the “antiracist and feminist” bioethical theories and those “of epistemological foundation with Latin American roots”, such as bioethics “of intervention” ²², “of protection” ²³, narrative bioethics” ²⁴, “decolonial bioethics” ¹³ and also “existentialistic and/or radical bioethics”, as formulated by Julio Cabrera ²⁵. They are movements from the perspective of dislocation of hegemonic bioethics, whether produced by great centers that irradiate and impose disciplines, or those referring to moral codes that have served moral imperialism of the global North over the South for some time ²⁶.

It is understood that they occur in the gap left by the principlism bioethical project ²⁷. These theoretical proposals are attributed to the prerogative to condemn the hegemonic bioethical project produced from the coloniality of knowledge, consequently from the ideas about neutral, objective and universal science. The presumptions of asymmetric bioethics are, therefore, in the wake of criticism made by studies on coloniality, since they indicate the fallacy of a project that wishes to be scientific and ethical-practical and that disregards historical, local, social and ethnical-cultural realities.

Latin American bioethics: construction of a decolonial perspective

The pluralism proclaimed by bioethics in the 21^st century is present in the diversity of aforementioned bioethical projects, as well as in the attempt to include the perspective of coloniality and of discussions on race, gender and decolonization of thought. The discussions on biopolitics also head in this direction. They look to understand how the knowledge-power devices, from the incipient configuration of the nation states, attend to the control of the bodies. The feminist perspective, in turn, becomes relevant because it aggregates theoretical concepts to discuss the production of subjectivities in modernism/coloniality, since it shows to be compatible with rigid standards of gender definition and heteronormativity never seen before. The limits and non-limits between humans/animals and their relationship with nature are equally relevant ²⁸.

Finally, the attempt to deconstruct the notion of the person, of absolute value of life and of its sense integrate the bioethical pluralism field. It uses the framework of existentialistic European philosophy, but also the recovery of Latin American philosophical thinking, which has Cabrera ²⁵ in Brazil as one of its main enthusiasts. Furthermore, it reconfigures the notion of vulnerability present in bioethics from the South, repoliticizing the moral issues to be able to execute projects that face the persistent situations related to the political-economic conditions of social and community weaknesses.

Understand, consequently, that bioethics should consider the uprising of forms of social oppression that hinder or impede the majority of collective projects. Something that Latin American bioethics and BI, with the assistance of decolonial bioethics, already teach upon suggesting that bioethics think not only about the South, but from the South, for the South and with the South ¹³, so that the decolonial tools criticize hegemonic biopolitics that conform coloniality of life. It is exactly this hegemony that creates an ontology of life that authorizes the thinking that some lives are more important than others, from the political point of view, therefore founding hierarchy and justification to dominate, exploit and submit, under the pretext of this being the path for development of less favored life ¹³.

From everything shown herein, understand that there is a pressing necessity to recover the initial expectations about what bioethics should be, in order to affect the transposition of the concept of bioethical movement beyond disciplinary disputes. There is a desire to think of bioethics, therefore, as support for thought, as a pre-Socratic poem that accommodates esthetic, religious and ethical normative reflections about the “good living” of each existing communitarian project. In this sense, to think of bioethics should be to think of the multiplicity of bioethics and in the flow from the beginning of communitarian projects for humanity.

To the contrary, it is inevitable to think of global projects about universal rights in which the certainties about good living of the people are registered in modernity/coloniality – despite the intersectionalities. In the South, social and economic vulnerability are related to questions of race and gender: a project of bioethical decoloniality should verify the inter-relations between the diverse vulnerabilities ²⁹. It is therefore related to the emergence of the category of race, of directing productive work to the capital, of epistemic racism and of expansionist fallacy. If the different intersectionalities are not taken into consideration, there is no way to attend to the most diverse demands of that which we are calling “bioethics”, but may also be understood as a claim to the right of one’s own life.

In this sense, BI assumes the task of condemning and demystifying the colonized image of life, which affirms itself by imperialisms of diverse orders (political, economic, moral, biomedical etc.) and that end up not only structuring social inequalities, but contributing to that which maintains them. Coloniality of life – as an aspect of coloniality of power - has silent reproduction devices that, without a doubt, liaise with many progressive ideas of hegemonic thoughts ¹³.

Now, plural bioethics should be those unconcerned with the latest foundations based on the principle of reason and zealous to be able to serve as universal standards for morality. Unless it were possible to think of bioethics as an epistemic project for each historical alternative, one would not have to speak in search of the original and ultimate purposes of thought. This is why the experience of thought would be from localized experiences - which should also give opportunity for greater social and gender equilibrium in the different communities. Bioethics is therefore concerned with the situations of life, especially of human beings, situations that are amongst different moral choices about the standards of good living³⁰.

From all this, understand that different historical projects may always constitute survival mechanisms and internal social adjustments, conquered as long as there is also a favorable external environment. Will Kymlicka ³¹ names this situation “ethnocultural justice” – the right to land, to culture and to language, as well as the possibility for development in contact and in confluence with the others of the culture. And maybe there were bioethics that also looked to handle, in a private manner, daily moral conflicts.

In this manner, bioethics whose concern is based on the search for universal standards for access to health and to good living develops in context that we cannot ensure full development of different historical projects, nor the socialization of the goods and services laid out by biotechnoscience for the insignificant portion of humanity. For some bioethicists, moral plurality is registered once bioethics is configured, since it rules in opposition of moral imperialism, and from the certainty that there is not only one ethical project common to all of humanity:

With the recognition of moral plurality of humanity and, consequently, the idea that different beliefs and values govern topics like abortion, euthanasia or organ donation, the structuring of a new academic discipline becomes imperative, that mediates these day-to-day conflicts, common not only to the medical practice. And it is over this tolerant spirit that bioethics does not determine moral certainties for humanity. The definitive response for the conflicts is not in any bioethicist or current theory, but in the unfolding itself of the moral history of societies and individuals ³².

From there, beyond the certainties of an academic pluralism or even the idea that moral pluralism could incur the prerogatives of liberal multiculturalism, anthropologist Rita Segato ³³ looks to develop the idea of “bioethical pluralisms”. More than the conformation of a new paradigm, and from decoloniality, the concept of bioethical pluralism converges to the necessity to recognize that there are innumerous other historical projects, fluid and in constant transformation, that have the prerogative to influence their own moral issues, which the author calls “internal deliberation” ³³. Beyond the idea that there are moral pluralisms in opposition to a single global project, Segato cautions of the need to not incur in moral relativisms, proclaiming the idea that they are from historical projects, when the revision, transformation and alteration of the course of their history as a community is possible ³³. Nevertheless, this recognition differs from the idea of moral relativism and/or pluralism.

Final considerations

This essay proceeded with the intention to affirm the idea of bioethical pluralism as a force to expand contemporary epistemic, political and esthetic projects, offering other horizons beyond those centered in the European experience. For this purpose, it indicated, for example, the emergence of studies, debates and reflection with respect to different grammar for social recognition ³⁴, of distinct conceptions of the “common good” ³⁵, of alternative principles of human dignity ³⁶ and of diverse conceptions of justice ³⁷. In this sense, bioethics will continue to be, for a very long time, the most apt tool to condemn injustice touted and reified by the modern-colonial project and its call to impose universal standards of good living on the different historical alternatives throughout the world.

Bioethical understanding and respect for the limits of rationalistic and scientific discourse and its diverse implications give opportunity for certain movement towards a dialogue with the other that inevitably seeks symmetry. Despite being something impossible, as cautioned by Jacques Derrida ³⁸, this symmetry is the condition through which the asymmetry is and can be placed in question. It is in this sense, however, that the idea of Latin American bioethics gains intelligibility. Not as something that concerns the knowledge produced in certain geographic regions of the world, but the ethical, political and esthetic body according to which knowledge cannot relinquish to a reading of historical, local and ethno-cultural realities, conflicting, contradictory and, maybe, at some points, irreconcilable and relentless, but that conform distinct ethical projects.

The decolonial perspective as an option to expand post-Western readings of reality is found at the center of inquiries on moral imperialisms, confirming that there is not only one common ethical project for all humanity. To carry out something like this requires, above all else, recognition of the alternatives as bearers of their own project, whose properties are not in a supposed essence, but in the meanderings of history, in their unfolding. Dislocating the modern philosophy of conscience that retains absolute and sovereign power for itself, Enrique Dussel ³⁹ says that the best critical conscience possible would not manage to have current conscience of all the others excluded in the present, that will be discovered as excluded in the future.

The vision arises therefrom that bioethical proposals are always on the horizon of history and, therefore, subject to revision. Who is being left behind in our discourses? How do the social standards of recognition hide forms of violence and exclusion? The answers to such questioning, always temporary, are only possible through the pain and pleasure of relationships with one another, in abandoning the certainties produced from experience centered on white, Christian, heterosexual males, of liberal political culture and enlightenment. The abandonment makes it possible for the excluded to emerge, for their projects, their ways of life and their moral sensibilities. The “situation of exceptionality of the excluded”, using the expression by Dussel ³⁹, has opened paths that for centuries were obstructed by hegemonic narratives, promoting not only the visualization and resolution of moral conflicts, but also more justice and access to good living.

Referências

• ¹
  Heidegger M. A caminho da linguagem. Petrópolis: Vozes; 2003.
• ²
  Derrida J. Margens da filosofia. Campinas: Papirus; 1991.
• ³
  Zambrano M. Filosofía y poesía. 4ª ed. Ciudad de México: Fondo de Cultura Económica; 1996.
• ⁴
  Paz O. Signos em rotação. 3ª ed. São Paulo: Perspectiva; 1996.
• ⁵
  Segato R. La nación y sus otros. Buenos Aires: Prometeo; 2007.
• ⁶
  Quijano A. Colonialidad y modernidad-racionalidad. In: Bonillo H, organizador. Los conquistados. Bogotá: Tercer Mundo; 1992. p. 437-49.
• ⁷
  Mignolo W. Histórias locais/projetos globais: colonialidade, saberes subalternos e pensamento liminar. Belo Horizonte: UFMG; 2003.
• ⁸
  Garrafa V. Da bioética de princípios a uma bioética interventiva. Bioética. 2005;13(1):125-34.
• ⁹
  Potter VR. Bioethics: bridge to the future. Englewood Cliffs: Prentice-Hall; 1971.
• ¹⁰
  Diniz D. Bioética e gênero. Rev. bioét. (Impr.). 2008;16(2):207-16. p. 207.
• ¹¹
  Porto D, Garrafa V. A influência da reforma sanitária na construção das bioéticas brasileiras. Ciênc Saúde Coletiva. 2011;16(1 Suppl):719-29.
• ¹²
  Porto D, Garrafa V. Op. cit. p. 723.
• ¹³
  Nascimento WF, Garrafa V. Por uma vida não colonizada: diálogo entre bioética de intervenção e colonialidade. Saúde Soc. 2011;20(2):287-99.
• ¹⁴
  Oliveira F. Feminismo, luta anti-racista e bioética. Cadernos Pagu. 1995;(5):73-107.
• ¹⁵
  Garrafa V. Ampliação e politização do conceito internacional de bioética. Rev. bioét. (Impr.). 2012;20(1):9-20.
• ¹⁶
  Organização das Nações Unidas para a Educação, a Ciência e a Cultura. Declaração universal sobre bioética e direitos humanos. Brasília: Unesco; 2005.
• ¹⁷
  Garrafa V, Azambuja LEO. Epistemología de la bioética: enfoque latino-americano. Rev Colomb Bioét. 2009;4(1):73-92.
• ¹⁸
  Garrafa V, Azambuja LEO. Op. cit. p. 74.
• ¹⁹
  Feitosa SF. O processo de territorialização epistemológica da bioética de intervenção: por uma prática bioética libertadora [tese]. Brasília: UnB; 2015.
• ²⁰
  Fulgêncio CA, Nascimento WF. Bioética de intervenção e justiça: olhares desde o sul. RBB. 2012;8(1-4):47-56. p. 49.
• ²¹
  Costa S, Diniz D. Bioética: ensaios. Brasília: Letras Livres; 2001. p. 26.
• ²²
  Porto D, Garrafa V, Martins GZ, Barbosa SN. Bioéticas, poderes e injustiças: 10 anos depois. Brasília: CFM; 2012.
• ²³
  Schramm FR. Bioética sem universalidade? Justificação de uma bioética latino-americana e caribenha de proteção. In: Garrafa V, Kottow M, Saada A, organizadores. Bases conceituais da bioética: enfoque latino-americano. São Paulo: Gaia; 2006. p. 143-57.
• ²⁴
  Grande LF. Bioética narrativa. Bulletí del comitè de bioètica de Catalunya. 2013;(9):1-7.
• ²⁵
  Cabrera J, Salamano MC. Heidegger para a bioética. Rev Latinoam Bioét. 2014;14(2):118-27.
• ²⁶
  Santos BS, Meneses MP, organizadores. Epistemologias do Sul. Coimbra: Almedina; 2009.
• ²⁷
  Beauchamp TL, Childress JF. Principles of biomedical ethics. 7ª ed. New York: Oxford University Press; 2013.
• ²⁸
  Haraway DJ. Manifesto ciborgue: ciência, tecnologia e feminismo-socialista no final do século XX. In: Tadeu T, organizador. Antropologia do ciborgue: as vertigens do pós-humano. Belo Horizonte: Autêntica; 2009. p. 33-118.
• ²⁹
  Nascimento WF, Martorell LB. A bioética de intervenção em contextos descoloniais. Rev. bioét. (Impr.). 2013;21(3):423-31.
• ³⁰
  Costa S, Diniz D. Op. cit. p. 18-9.
• ³¹
  Kymlicka W. Direitos humanos e justiça etnocultural. Meritum. 2011;6(2):13-55.
• ³²
  Costa S, Diniz D. Op. cit. p. 19.
• ³³
  Segato R. Antropologia e direitos humanos: alteridade e ética no movimento de expansão dos direitos universais. Mana. 2006;12(1):207-36.
• ³⁴
  Honneth A. Luta por reconhecimento: a gramática moral dos conflitos sociais. São Paulo: Editora 34; 2003.
• ³⁵
  Walzer M. Spheres of justice: a defense of pluralism and equality. New York: Basic Books; 1983.
• ³⁶
  Santos BS, Chaui M. Direitos humanos, democracia e desenvolvimento. São Paulo: Cortez; 2013.
• ³⁷
  Fraser N. Scales of justice: reimagining political space in a globalizing world. New York: Columbia University Press; 2010.
• ³⁸
  Derrida J. Força de lei: o fundamento místico da autoridade. 2ª ed. São Paulo: Martins Fontes; 2010.
• ³⁹
  Dussel E. Ética da libertação: na idade da globalização e da exclusão. Petrópolis: Vozes; 2000. p. 417.

Publication Dates

• Publication in this collection
  Jan-Apr 2017

History

• Received
  18 Feb 2016
• Reviewed
  13 Feb 2017
• Accepted
  16 Feb 2017