Brazilian bioethics became consolidated in the 1990s. It was during
this time that teaching and research centers were instituted,
associative groups were created, and the first papers of Brazilian
authors were published. In Brazil, the first years of teaching and
research in bioethics were marked by a strong influence of the United
States, particularly in the theoretic and thematic fields. Among the
main topics of discussion were subjects related to the end of life and
to research involving human beings, and bioethics was then chiefly
influenced by Tom Beauchamp and James Childress's theory of the
four principles.1
Diniz D, Guilhem D,
Garrafa V. Bioethics in Brazil. Bioethics
1999;13(3/4):244–9; Anjos MF. Bioética no Brasil:
algumas notas. In: Barchifontaine C, Pessini L, eds.
Bioética: Alguns Desafios. São Paulo, Brazil:
Loyola; 2001:65–74; Pessini L, Barchifontaine C. Bioética:
do principialismo à busca de uma perspectiva Latino-Americana.
In: Costa S, Garrafa V, Oselka G, eds. Iniciação
à Bioética. Brasilia, Brazil: Conselho Federal de
Medicina; 1998:81–98.
This initial theoretic and thematic cornerstone marked Brazilian
bioethics to such an extent that for many years young researchers
considered the theory of the four principles and bioethics to be the
exact same thing.2
Diniz D, Guilhem D.
O Que É Bioética? São Paulo, Brazil: Ed.
Brasiliense; 2002.
This misunderstanding was not limited to
Brazilian bioethics; however, as countless other countries in the
periphery of bioethics underwent similar processes. This becomes clear
upon analyzing the first bioethical publications.
3 On the concepts of central and peripheral in bioethics,
see: Garrafa V, Diniz D, Guilhem D. Bioethical language, its dialects
and idiolects. Cadernos de Saúde Pública
1999;15(S1):35–43.
The initial influence of the theory
of the four principles conferred on Brazilian bioethics a thematic
characteristic that still persists.
The fact that the theory of the four principles is intended as a set
of tools to intervene in cases of moral conflict in health is an object
of continuous seduction to Brazilian bioethics practitioners. Unlike in
other countries, where the main agents of bioethics are social
scientists, philosophers, or theologians, bioethics in Brazil is
dominated by biomedical professionals. This difference establishes a
sort of task division between central bioethics and bioethics as
practiced in Brazil: scant space is reserved for theoretical
discussion, and emphasis is placed in judging the political strength
that results from bioethical intervention in health matters.
As a whole, Brazilian bioethics cannot be considered to be theory
producing, nor is this its true ambition. However, if on the one hand
the secondary role assigned to theory in Brazil has been one of the
characteristics of Brazilian bioethics since the beginning, on the
other hand an intense politicalization has made itself felt in the area
over the past few years. The curious thing is that such
politicalization of Brazilian bioethics has largely occurred in
subjects of international bioethics—that is, subjects that make
possible a dialogue between the bioethics of Brazil and that of other
countries. Topics such as euthanasia and research with humans that are
typical of bioethical debate in the United States are currently also on
the Brazilian bioethics agenda.4
For an
analysis of bioethics constitution process in the United States, see:
Andre J. Bioethics as Practice. Chapel Hill: University of
North Carolina Press; 2002.
As a consequence of the theoretic and thematic influence of other
countries, some subjects were left aside by Brazilian bioethics
research. Abortion is one of them. Save for rare exceptions represented
by feminist bioethics researchers, the subject of abortion is dealt
with as an issue of insoluble moral conflict—that is, a situation
in which bioethics serves as a mere instrument of reflection rather
than as an instrument of political intervention. Although abortion is a
topic of mandatory discussion in all Brazilian bioethics academic
programs, it is always dealt with in the context of moral-dilemma
rhetoric. As a result, the bioethical debate on abortion in this
country includes neither ethical serenity nor intellectual or political
commitment.
Brazilian bioethics tends not to consider it its duty to intervene in
the discussion of the illegality of abortion. This is evidenced by
priority given to the discussion of matters such as the regulation of
research with human subjects or the organ market, for
example—subjects that can certainly be considered as
controversial and challenging as abortion. Brazilian bioethics has so
far addressed abortion as mind exercise rather than as a situation that
demands an urgent bioethical reflection and intervention. In a context
of political and intellectual apathy, the matter turns into one of the
greatest challenges facing Brazilian bioethicists, particularly
considering the absence of international bioethical reflections that
foster dialogue or sustain intervention actions.
Abortion in Bioethics
It would be no exaggeration to say that the bioethical apathy that
exists regarding the challenges imposed by the subject of abortion is a
characteristic of international bioethics and is not restricted to
Brazilian bioethics. There are two basic reasons for this. On the one
hand, abortion was not included in the top list of situations of moral
conflict that propelled the rise of bioethics in the United States in
the 1960s and 1970s. Rather, it was the narratives of biomedical
experiments with human beings, particularly concerning the trials of
Nazi medical crimes, and research with vulnerable populations in the
United States that served as the central subjects for the political and
later academic structuring of bioethics.
Although abortion was a subject of fervent political discussion in
the 1970s, it was not a primary subject for bioethical discussion in
the United States, a fact that was reinforced by the Supreme
Court's decision to consider abortion an issue of intimate nature,
left unpunished in most situations. This does not mean that abortion
was never a subject of bioethical discussion in the United States;
rather, it became a relatively more important bioethical subject in the
1980s with the popularization of prenatal diagnosis and selective
abortion, and when the clinical genetics became a new specialty of
prenatal care. However, the point of view adopted by American
bioethicists differed radically from that which traditionally reigned
in the abortion debate, having at its argumentative basis the morality
of the fetus.5
Parens E, Asch A.
Prenatal Testing and Disability Rights. Washington, DC:
Georgetown University Press; 2000.
In many countries where
bioethics was first structured, the research and political approaches
on abortion were discussed in a context in which abortion was legal.
Although there was no ethical consensus regarding the morality of
abortion, a legal structure that allowed for the expression of
different moral standards was in place.
The second possible explanation for the distance of international
bioethics from the subject of abortion can be found in the
epistemological foundation of bioethics as a subject that is basically
anchored in moral and political philosophy. A large part of bioethical
theories are liberal in origin. In other words, whereas there is a
great consensus surrounding the importance of such ethical principles
as autonomy and equity, moral pluralism is continuously reviewed and
reinvigorated as a value in this context.
This does not mean that the subject of abortion is not present in
other moral negotiations. On the contrary: discussions on the morality
of abortion are among the most difficult and delicate moral thoughts,
but no one currently searching for an effervescence of ideas on the
subject need look at the community of bioethical practitioners.
Feminist bioethics researchers are certainly an exception to this
phenomenon, but this is owing more to an overlap between their
identities as feminists and bioethics practitioners than to their
considering bioethics to be a privileged space for the discussion of
abortion.
At the same time that feminist bioethics recognizes how important the
liberal principles of autonomy and equity are to bioethics, it brings
women's subjects to the center of bioethical discussion,
particularly those related to social and biological reproduction. As a
consequence, the abortion debate has become a feminist subject in
bioethics, especially of feminists in countries in the periphery of
bioethics.6
Diniz D, Ribeiro DC.
Aborto por Anomalia Fetal. Brasília, Brazil: Letras
Livres; 2003; Baltar MI. A questão do aborto no Brasil: o debate
no Congresso. Estudos Feministas 1996;4(2):381–98;
Católicas pelo Direito de Decidir. Aborto Legal:
Implicações Éticas e Religiosas. São
Paulo, Brazil: CDD; 2002.
Except in feminist bioethics and
women's movements, abortion is therefore mostly a subject
circumscribed to the legislative and religious spheres. And given the
incipience of Brazilian bioethics, and even more so of feminist
bioethics, debating abortion in Brazil is a dangerous and delicate
matter from a political and legal point of view because of the
influence and permanence of certain religious premises in this
field.
7 To illustrate how dangerous
discussing the issue of abortion in a Latin American context can be,
note that I was dismissed from my position as a Graduate Professor at
the Catholic University of Brasilia. The reasons presented to my peers,
as well as the rumors that circulated then, indicated that it was
“intolerable that a professor who discusses the ethics of
abortion be employed by a Catholic University.” A suit was filed
against the Brazilian State, demanding the enforcement of the
constitutional right of academic freedom.
Abortion in Brazil
Unlike what happens in countries where bioethics first developed, in
most Latin American countries abortion is considered a crime.8
Alan Guttmacher Institute. Aborto
Clandestino. New York. Alan Guttmacher Institute; 1994.
A
regional distinction exists regarding restrictive legislation on
abortion, and Latin America is one of the areas presenting the greatest
resistance to changing this prohibitive legislation. Specialists on the
subject consider the political and moral influence of the Catholic
Church in the region to be one of the explanations for this phenomenon.
The recent growth of certain Pentecostal churches, particularly in
Brazil, have served to strengthen this anti-abortion religious
intransigence. For peripheric bioethics researchers, especially Latin
American researchers, abortion is above all a continuous sociological
and epidemiological demand.
Reports of women caught in flagrante delicto in illegal
abortion clinics, high maternal mortality rates due to abortions
performed in unsafe conditions or to the lack of medical care, or
simply stories of women who become pregnant as a result of sexual
violence in their homes make the headlines in Latin American
countries.9
In Brazil, the sequelae
resulting from abortions performed under unsafe conditions are the
third most frequent cause of maternal mortality.
Abortion is a
daily subject in the Brazilian printed press, and a great
spectacularization can be seen in the way the subject is handled. In
this sense, in spite of the apathy of international bioethics on the
subject, in Latin America there is a social and cultural demand for the
inclusion of abortion among fundamental political and sanitary matters
that require the immediate attention of bioethics.
Abortion is a crime in Brazil except in two situations: when the life
of the mother is at risk, or when the pregnancy is the result of rape.
If on the one hand discussion on the ethical and sociological
anachronism of this regulation is growing due to the fact that it dates
from 1940, on the other hand there is also a movement that pushes for
legislative regression, proposing the total prohibition of abortion
with the end of the current exceptions. The Penal Code classifies
abortion as a crime against life, this being the main legal argument
used against women who procure an abortion or against those suspected
of having had one.
Even though both penal exceptions have been provided for in the Penal
Code for over 50 years, it was only at the end of the 1990s that the
country actually started discussing the importance and need of
implementing biomedical services for women who were victims of violent
sexual crimes to ensure their safe, fast, and dignified access to
abortion. During this time abortion was intensely debated, for it
coincided with the visit of Pope John Paul II to Brazil.10
Although the Brazilian State is officially
laic, the Catholic Church has a strong influence on State
decisions.
It is interesting to note that, although this was a
period of intense strengthening of Brazilian bioethics, very few
national bioethicists stood out as reference and consultation sources
for debate and political negotiation on the subject.
These two sides of the national political debate on abortion made
bioethics—and more specifically, feminist bioethics—take on
a strategic reflexive role. Bioethics has been slowly becoming a
necessary and indispensable legislative tool in many developed
countries. A paradigmatic example of the political strength this
subject has achieved can be found in the creation of national bioethics
consultation committees in the mold of the committee instituted in
France in 1983. In Brazil such a committee is yet to be created. An
effort was made to regulate such a committee through a presidential
administrative order in 2002; unfortunately, this merely resulted in
the temporary institution of an interministerial committee connected to
the Ministry of Health. This contrasted radically with the original
spirit of bioethics consultation committees that were intended foremost
as spaces of free reflection and discussion on subjects of fundamental
importance for the whole population, not just for the area of
health.
However, unlike other fields of knowledge, bioethics bases its
intervention in collective, plural, and democratic reflection
processes, thus rendering the decisionmaking process as representative
as possible. For this reason, in Brazil a national bioethics
consultation committee must necessarily confront the subject of
abortion, and, unlike what has happened in the country so far, this
must be a fraternal dialogue among different moral communities in which
the various premises of well-being of each are given equal
consideration. Some communities will certainly not find this an easy or
pleasant exercise. However, it is absolutely necessary to ensure the
full implementation of such constitutional principles as freedom and
dignity. I have no doubt that this process will allow bioethics to
become a meditative and pacifying instrument of the different moral
standards that participate in the discussion of abortion in Brazil.
