Nowadays, cultural diversity seems to be a value that cannot be ignored in bioethical reflection. Recognition and respect for cultural diversity are now standard components of bioethics. At the same time, despite divergent social conditions, it is clear that no country is exempt from the issues explored by bioethicists: abortion, informed consent, euthanasia, assisted reproduction, and distribution of healthcare resources, to name but a few.

In Latin American countries, problems related to medical ethics have received a great deal of attention during the last few years. We are participating in something that could be characterized as a regional “bioethics boom.” Yet, many people within this context still consider bioethics as the application of Catholic values and aim at their perpetuation. That is one reason why public debate in Latin America over the ethics of these controversial issues is, in many cases, severely limited and inadequate. At the same time, bioethical discourse in Latin America sometimes suggests a level of homogeneity that does not exist, ignoring the reality of multiculturalism. Latin Americans do not constitute a homogeneous group: Different voices and perspectives exist about all of the issues.

So far, many initiatives implemented in order to cope with these particularities show guidelines that are highly influenced by Anglo-American concepts and perspectives. Indeed, most of the currently existing educative literature is based on a principalist paradigm, which fosters contents and methodologies not necessarily adequate for Latin America. The main problem is that this viewpoint sometimes excludes issues stemming from the region's socioeconomic reality, characterized by a number of people living in extreme poverty and by massive lack of access to health services.

I am convinced that it is necessary and urgent to provide a framework for bioethics within a Latin American perspective that attends to the particularities of this cultural scenario.

In Bioética: Nuevas Reflexiones sobre Debates Clásicos (Bioethics: New Reflections on Classic Debates), Florencia Luna and Arleen L.F. Salles present some of the bioethical challenges this region faces today. Far from providing simple solutions (which are almost impossible to find in this field) their main goal is to “promote critical thinking” (p. 11) upon ethical issues emerging from the field of life and human health. The issues included in this analysis are highly complex and controversial, showing arguments that emerge from groups and populations with very different perspectives.

This 12-chapter book is divided into four parts plus an appendix and begins with an exhaustive analysis of the theoretical foundations of practical bioethics. In the first part, the most philosophical of all, Luna presents the classical ethical distinction between deontological and utilitarian theories embraced by early bioethics. Next, she moves on to explore Beauchamp and Childress’ Principlism, providing a view far from the simple analysis that, in many cases, accompanies this perspective. She analyzes the reasons that lead to this phenomenon and tries to answer why this seems to be the paradigm that dominates so much bioethical consideration. Finally, she articulates the evolution of this proposal through the many editions of the influential Principles of Biomedical Ethics.

Challenging the adequacy of the previous perspective, Salles presents some alternative views against the classic deductivist models of moral reasoning that, according to her, due to their “individualistic character, the preeminence attributed to reason over other ways of moral knowledge … and the lack of attention to particular and concrete elements present in each situation” (p. 79), have recently lost the central role that they used to play.

According to Salles, approaches based on moral particularism introduce a wide range of cultural, economic, and gender considerations that lead to a much more contextualized reflection on bioethical issues. These alternative approaches come hand in hand with diverse philosophical perspectives—some ancient such as virtue theory and some newer such as care ethics or feminist ethics—and have had significant impact on the current bioethical discourse. For Salles, this does not suggest that the classic approach has been overcome. It merely shows the transformations in this ever-changing discipline and how these new elements have enriched and made more complex the analysis of these issues.

The second through fourth parts of this anthology rely on specialists in the field such as María Victoria Costa, Graciela Vidiella, and Susana Sommer to focus the analysis upon concrete problems. The second part is mainly about the physician–patient relationship and the basic moral obligations of healthcare professionals. The authors analyze issues such as informed consent and confidentiality. Paying special attention to the problems of medical attention in Latin American countries, Costa defends informed consent and confidentiality, even though she is aware of the difficulties raised by the lack of economic resources and staff in these particular medical systems, as well as cultural differences between practitioners and patients.

In the third chapter of this second part, Luna analyses euthanasia and assisted suicide from a Latin American perspective, exploring the possibility of applying these practices in some Latin American societies.

The four chapters included in the third part of the book deal with reproductive and family planning practices such as assisted reproduction, birth control, abortion, genetic information, and cloning.

The fourth and last part of this anthology is dedicated to the analysis of research ethics. This section emphasizes the importance of paying attention to and respecting the particularities of working with peripheral societies and vulnerable populations involved in research studies. The final chapter, written by Vidiella, questions whether there is a valid state obligation to provide healthcare for all citizens. She does this through the lenses of three paradigmatic theories of justice: those of Nozick, Rawls, and Waltzer.

The second, third, and fourth parts of this book cover a wide spectrum of bioethical issues and provide good analysis of the present state of affairs in bioethics. The individual essays result in achieving a unified goal. Further, in compiling papers written by a variety of Latin American authors, this book might help increase a regional and interdisciplinary dialogue that might enhance a bioethical perspective profoundly committed to the needs of vulnerable populations (illiterates incapable of protecting their own interests, women in societies that disregard their reproductive rights, and research subjects in contexts where resources are scarce).

The book culminates with an appendix written by Susana E. Sommer, who presents a global view on the situation of women in the healthcare context, emphasizing the activist dimension of the feminist movement and its accomplishments.

I firmly believe Bioética: Nuevas Reflexiones sobre Debates Clásicos is a valuable contribution to understanding classic bioethical problems from a Latin American perspective and to the ongoing debate in multicultural bioethics. The theoretical framework offered, combined with the analysis of practical concerns, results in an appealing and useful compendium. One small objection I would like to point out is that it is not entirely clear who the book is primarily intended for, a point the authors seem to acknowledge in the Introduction when they state: “[this book] allows a flexible use: it can be used as a basic text for a first general approximation to bioethics, but also constitutes a rich resource for a deep analysis of more specific subjects within this discipline” (p. 19). Overall, the vast bibliography provided both in footnotes and in the last pages makes this book a great starting point for further investigation.

This is an original bioethics book that raises important questions regarding the recognition of sexual, gender, ethnic, and national diversities. It is influenced by studies about multiculturalism and pluralism and, if not directly, also addresses the impacts of exclusion, discrimination, and poverty in developing countries.