Bioethics and worker health: an interface

Abstracts

The aim of this paper is to propose an ethical approach in the health-work relationship, initially on the part of two historical landmarks that point to the interface between bioethics and workers' health. Focusing on the limits of corporate deontologies, the derived process of putting the blame on workers and the new bio-techno-scientific world of work. This reflection points out new modes of appropriation and possibilities for reshaping questions that reshape that encompass the field of workers' health, based on contributions offered by bioethics. It concludes mentioning the persistent and emergent problems in the world of labor, asking whether the interface of bioethics with workers' health finds a place as a contra-hegemonic thinking capable of establishing epistemological reference points that may contribute to shortening the path between consolidated theory and transformational praxis not yet experienced in the world of work.

Bioethics; Workers' health; Human rights; Ethics; Workers

O presente estudo tem como objetivo propor uma abordagem ética sobre a relação saúde-trabalho, inicialmente a partir de dois marcos históricos, que remetem à interface entre bioética e saúde do trabalhador. Enfocando os limites das deontologias empresariais, o decorrente processo de culpabilização dos trabalhadores e o novo mundo biotecnocientífico do trabalho, a reflexão aponta para novos modos de apropriação e possibilidades de redimensionamento das questões que povoam o campo da saúde do trabalhador, com base em contribuições oferecidas pela bioética. Conclui-se, identificando problemas persistentes e emergentes no mundo do trabalho e indagando se a interface da bioética com a saúde do trabalhador assenta-se como pensamento contra-hegemônico capaz de estabelecer referenciais epistemológicos que contribuam para encurtar o caminho entre a teoria consolidada e a práxis transformadora, não experimentada no mundo do trabalho.

Bioética; Saúde do trabalhador; Direitos humanos; Ética; Trabalhadores

El presente trabajo tiene como objetivo proponer un abordaje ético sobre la relación salud-trabajo, inicialmente a partir de dos marcos históricos que remiten a la interfaz entre bioética y salud del trabajador. Abordando los límites de las deontologías empresariales, el resultante proceso de culpabilización de los trabajadores y el nuevo mundo biotecnocientífico del trabajo, la reflexión apunta a nuevos modos de apropiación y posibilidades de redimensionamiento de las cuestiones que pueblan el campo de la salud del trabajador, a partir de contribuciones ofrecidas por la bioética. Concluye identificando problemas persistentes y emergentes en el mundo del trabajo, indagando si la interfaz de la bioética con la salud del trabajador se asienta como un pensamiento contrahegemónico capaz de establecer referencias epistemológicas que contribuyan a acortar la distancia entre la teoría consolidada y la praxis transformadora no experimentada en el mundo del trabajo.

Bioética; Salud del trabajador; Derechos Humanos; Ética; Trabajadores

For an ethical reflection on the labor world

We have noticed the constant emergence of ethical issues in the labor world. It is constant, but not clear. Death at work is an unethical event in itself. It affronts the moral premise that labor is expressed as the process of construction of humanity itself. A large part of the reflections that set out to deal with the relationships between ethics and work do not appropriate the moral and evaluative aspects relevant to them, and there are no general formulations indicating new stances dedicated to seeking solutions through ethical reflection.

Most of the scarce ethical analyses on the world of work found in the literature are developed based on the perspective of corporations, organizations and companies ¹. There is, therefore, a need for non-unilateral analyses and which propose an ethical approach on the labor-health relationship, so as to consider the interests of everyone affected in this reflection process, from the enhancement of the role of the workers themselves in the process.

Two landmarks and the possible relationship between bioethics and health of workers

In order to illustrate the relevance of the interface between worker health and bioethics, we chose to propose a relationship between two historical landmarks. First, we recall the influence of one of the most important events for the marking of the citizenship values of humanity: The Universal Declaration of Human Rights. In the set of values expressed by the document, dated 1948, we find, in Article 23 (§ 1), the definition of work as essential to man, stating that everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment ².

The second historical landmark has its location limited in the discussions about medical ethics, especially in relation to research and the clinic, and then converges on the field we now know as bioethics. Such an approach is justified, since the relationships between health and work are historically associated with medicine, taken in its infancy as a discipline capable of conforming bodies to work and, more recently, as part of a set of knowledge needed to development of favorable conditions of work ³.

In 1979, with the publication of “Principles of Biomedical Ethics”, Tom L. Beauchamp and James F. Childress ⁴ proposed a certain process perspective to the moral reflection in the biomedical field. This approach, known as principialism or ethics based on principles, is one of the most important and paradigmatic concept of bioethics sets. Proof of this is that it has served as a reference to a series of international pacts about research ethics, influencing even the Brazilian legal framework addressing these issues, defined by Resolution 466/2012 of the National Health Council (Conselho Nacional de Saúde) ⁵.

Taking into account the specification of ethics derived from the Belmont Report⁶, principialism is based on four principles, considered at face value, as they should not be taken as absolute, but correct “at a mere look”: respect for autonomy, non-maleficence, beneficence and justice. According to principialism, we must seek solutions to ethical problems and dilemmas drawing on a perspective of negotiating and operated by all the people involved in the process under scrutiny.

Our reflection, thus starts from the perception about the possible crossing between the two highlighted in historical events. We have been instigated by the implications that emerge from the correspondence of article 23 of The Universal Declaration of Human Rights with the four principles of Beauchamp and Childress highlighted as follows: everyone has the right to work, to free choice of employment (respect for autonomy), to just (justice) and favorable (beneficence) conditions of work and to protection against unemployment (non-maleficence). The approximation of the emergence of bioethics as a field and considerations about labor based on a common morality perspective as the concept described by Clouser ⁷, as it is possible to think through the prism of human rights is, in our view, the thread to identify other approaches at the interface between occupational health and bioethics, which we intend to establish in this work.

Corporate deontology and blaming the victims

Some of the greatest examples of this interface between bioethics and issues relating to the relationship between health and labor are found in the production of Giovanni Berlinguer ⁸, which, in 1993, distinguished emerging issues of the labor market also concerned the field of bioethics. In this article, the author, using the presentation of situations at the interface between labor-health dynamics and economics-human biology, highlights the lack of analysis guided by the ethical dimension of the relationship between health modes and the labor experiences of men.

Different from the propositions of Berlinguer, the so-called “corporate ethics”^9-12 turns to another moral perspective concerning the applicability of ethics to issues in the labor context. In this scenario of pressing technological changes and historical-political rearrangements, a certain threat was posed to the corporate sector, materialized in the upcoming of problems loaded with moral aspects such as corruption, fraud, abuse, harassment and exploitation at work, damage to the health of workers, to communities, to the environment, among others.

In a contradictory manner, such problems have managed to break the limits previously imposed by certain technical and organizational devices that that were exactly meant to avoid them. Now at the failure of organizational structures aimed at anticipating problems, it was necessary to compose a moral reflection purportedly able to transcend the simple very technical constraints of the working world, seeking to capture the subjective-moral dimension of those involved. Even the business sector starts to realize that to maintain their survival, they need to reflect and incorporate those moral structures in order to ensure its non-disruption due to the problems that the very logic of this system produces.

Thus, to the proportion that the prospect of business ethics takes shape, one can see the concomitant expansion of the deontological codes of ethics, which were perhaps better defined as moral codes or codes of conduct. For companies, corporations and organizations, these codes, however, focus their application and operationalization on workers. In order to fulfill this objective, they present themselves as disciplinary models, in the manner described by Foucault¹³, to the extent that they generate self and hetero surveillance regarding work conducts.

These deontological systems come from the thinking of management executive direction of these same institutions (and never from the perspective of workers and communities affected by production processes). Founded on values that are dear to business sectors, a moral framework was created that is intended to apply to all the world of work. In this sense, corporate ethics would be better named if it were called "corporate moral", serving as a moral structure, a critical-reflective ethical exercise able to glimpse the limits and obsolete points present in this morality.

As well as corporate ethics, throughout history some traditional fields have set out to analyze certain ethical aspects of human labor. However, Berlinguer ⁸ sheds light on the fact that, due to reductionism, or even to conservative political implications of some of these discourses the call to bioethics has become pressing for engendering critical reflections addressed to morals and conflicts in context of the work, giving way to the real role of workers in such discussions. Berlinguer indicates that the discourses that blame the victims of the situation in which the problems arise (workers, communities, environment, etc.) will always be inadequate.

When indicating possible solutions to such limits, Berlinguer ⁸ emphasizes the need to consider the concrete reality of workers and their prospects (and not the companies' or managers'), to the extent that, according to the author, these perspectives will constitute in a safe reference for reflections and interventions.

The new biotechnoscientific labor world

The hegemonic discourses on corporate ethics and the traditional professional deontology are characterized also by another difficulty, when they demonstrate in most cases, which are not sensitive to the influence of emerging vectors arising from biotechnoscientific scenario on the world of work. These same limitations, however, are not exclusive of those two areas.

Since its emergence, the field of occupational health, which in Brazil is enrolled in the large field of public health, has demonstrated its strength in creating fruitful propositions and interventions in the labor market, concerning the man-work-environment relationship. Despite many achievements, we realize, too, that this field began to be faced with some historical mishaps, which, in our opinion, have slowed and / or mitigated the power of his reflective-interventionist contribution to contribute to the discussion of problematic issues that it is present.

The emergence of these theoretical and practical limits, which refers to our hypothesis, is mainly due to a series of transformations in modern society since the mid-twentieth century. Schramm ¹⁴ argues that these transformations coalesce around a phenomenon called biotechnoscience. So, when we take into account the characteristics of this emerging scenario, we have noticed that much of the occupational health field has yet to appropriate the resetting effects established by biotechnoscientific scenario.

The intervention of science and technology in biological and human dimension has produced physical and subjective effects not only on employees but also on the labor world. Such effects, of course, need to be taken into account in the analyses relating to it. Aspects such as human improvement techniques, the unprecedented expansion of the pharmaceutical industry, the new capabilities of surgery, genetic screening, among many other possible examples that could be listed, established and continue to provide for new settings to the world in which, like it or no, we are immersed.

Paying attention not to fall into a certain nostalgic attitude towards biotechnoscientific paradigm, which became part of human life (and, subsequently, also part of human labor), our proposal is to see the biotechnoscience as primary interpretive key to the analysis of new settings that dwell on the field of occupational health. If on the one hand, we can see the ethical problem arising, for example, a model of recruitment and selection of workers who adopts the genetic characteristics of the candidates as a criterion to measure the odds of these individuals to come to generate future unwanted costs the company, because of absenteeism due to illness - this intervention that could be considered eugenic - on the other hand, we must also ponder the interesting possibilities that biotechnologies, for example, would offer to increase the quality and expectancy of human life in relationship to work.

The biotechnoscientific vector can be a power factor or weakening of man-work-production-environment relationship. In this sense, we understand that the fact that biotechnoscience be located in either end of the contest between power and weakening will depend fundamentally on our ownership pf as many vectors as possible related to this scenario, as well as our propositional implication to produce reflections that, by the ethical exercise, consider the transformations that make up the new biotechnoscientific world of work. Because of the reflective and practical route present in the bioethics framework, with regard to the questions that emerge from biotechnoscientific scenario, we believe that this ground interface to the field of occupational health can provide reflective and interventional ways hitherto unpublished.

Identifying persistent and emerging issues in the work world

Garrafa and Porto ¹⁵, when proposing bioethics originated from the perspective of the peripheral countries, highlighting relevant issues in this context, they indicated the division of the set of moral problems into two broad categories: persistent and emerging. In order to facilitate the teaching and understanding to provide better organization for future analysis and interventions, we will divide the ethical issues present in the labor world in these two categories.

Persistent problems relate to issues that contain endeared crossings into the field of bioethics, but which for a long time have already been placed in the labor world. Examples are, among others: the moral, sexual and racial harassment in the work context; professional deontology and its limits; the issue of dual loyalty of occupational health professionals; conflicts of interest and the secondary bearing on the application of management techniques, organizational climate research and recruitment and selection of employees; management and monetization of damage risks in production processes; dynamic employment-unemployment as vulnerability process; institution of speeches and taming practices designed to generate a process of identity subjectivity facing work.

Emerging problems have as main characteristic their origin, to the extent that these issues could arise from reconfigurations engendered by the biotechnoscientific scenario in the labor world. Other examples are: neurocognitive improvements concerning work; modifications of bodily functions and features oriented to work; medicalization of life in terms of work; hiring and evaluating employees through genetic screening; voluntary amputations for implantation of bionic limbs in order to increase performance at work.

Why a bioethical approach to workers' health?

Do the listed problems bring in themselves features both related to the bioethics field and to workers' health? Once we are convinced that the answer to this question is affirmative, a basal question about this interface immediately arises: would a bioethical approach be relevant for the world of labor?

Regarding these questions, some comments are needed. The academic and scientific environment has produced a very limited number of studies focused on discussion of the issues that cross the relationship between health and work, from the point of view of bioethics. Such discussions when proposed generally address the ethical and peripheral component, which is restricted to supporting one or more concrete and specific issues addressed there. In this context, the study by Berlinguer ⁸ was the exception we could find ¹.

The field of occupational health brings in itself a series of advances regarding the thinking about the relationship between work and health, in that it was able to overcome certain limits present in the fields of occupational medicine and occupational health ³. We believe that the main advance is precisely the consideration of the role of workers about the health of themselves. Concerning the relationship between work and health issues require a look that addresses not only the effects of the problems, but also the ethics of relations that are emerging issues (as bioethics allows us to think), and the lead role of workers is a precondition for effectiveness of reflections and interventions that promote health and disease processes in the labor world (as it allows us to think workers' health).

Thus, we believe that, to advance toward what we have proposed, we will not need to create a third field. Rather, our efforts will turn to the feasibility of processes that converge at the interface between these two sites. Therefore, to speak of work ethics or bioethics or corporate ethics or bioethics would not be enough; we need to think of a bioethics to worker health.

Bioethics interface with the worker's health as post-abyssal thinking

In order to establish a dialogue supporting such interface, we call upon the contributions of Boaventura de Souza Santos, through his work “Para além do pensamento abissal: das linhas globais a uma ecologia de saberes” (“Beyond abyssal thinking: from global lines to an ecology of knowledges”) ¹⁶. In this study, the author addresses a point that is very dear to us, considering the proposal we have made bioethics for worker health, namely: how to give their invisibility processes in the modern world.

Early in his text, Santos presents a baseline demarcation so that we can move towards this understanding: Modern Western thinking is an abyssal thinking. It consists of a system of visible and invisible distinctions since the latter underlie the former. The invisible distinctions are established through radical lines that divide social reality into two realms: the 'this side of the line' and 'the other end'. The division is such that 'the other end' vanishes as reality becomes nonexistent and is indeed produced as nonexistent ¹⁷.

For Santos ¹⁶, the modern world is in a process of production of "nonexistences" called "abyssal thinking." It is a radical exclusion that intends be final, when it makes certain existences invisible. Thus, the invisible, set across the abyssal line do not constitute even in those "others" to which the humanitarian processes of social inclusion turn. To maintain the logic of that it is necessary that the abyssal line when demarcate the limits of visibility, remain established. An order of the visible world in order to guarantee the impossibility of both sides coexist in an equitable way.

Santos ¹⁶ assures that in metropolitan societies, Western modernity is characterized by the tension between social regulation and social emancipation. However, when the abyssal lines are established, they become concurrent two distinct social modes: in addition to metropolitan societies constitute also the colonial territories (those who are made invisible). Thus, for the author, the colonial territories made invisible configure themselves in ways of historical and political relationship very similar to those found in the colonization processes - these processes that separated the Old from the New World.

The author points out that the nonexistence-producing asymmetries are so fierce in colonial territories that it was not yet possible to think about the dynamic regulation-emancipation, since this social order is operated in other dynamics, which presents the tension appropriation-violence. Reflecting on the main abyssal lines of our time, the author comes to the conclusion that they consist in the knowledge and modern law:Appropriation and violence take different forms in the legal and epistemological abyssal lines, but in general the appropriation involves incorporation cooptation and assimilation whereas violence involves physical, material, cultural and human destruction. In practice it is the deep connection between appropriation and violence ¹⁸.

The abyssal line of knowledge concerns an epistemological dimension that delegates to science the monopoly of the production of universal truths and the distinction between the real and the unreal. So, this same modern science is positioned above other excluded or alternative knowledges present in metropolitan societies, such as philosophy and theology - which establish visible and sharp tensions in what, says Santos ¹⁶, is present on this side of the line. However, the very visibility of this knowledge rests precisely in the invisibility and disappearance of tacit knowledge that are put across the abyssal line, even when they stand in terms of the true-false dichotomy, the dynamic between the knowledge localized visible side of the line:

In the realm of knowledge, appropriation ranges from the use of inhabitants as guides and local myths and ceremonies as instruments of conversion to the plundering of indigenous knowledge of biodiversity, while violence is exercised by prohibiting the use of languages themselves in public spaces, the forced adoption of Christian names, conversion and destruction of symbols and places of worship and the practice of all kinds of cultural and racial discrimination ¹⁸ .

In relation to modern law, second leading abyssal line, according to Santos ¹⁶, the visible side of the line also constitutes a normative-legal group founded in the official state and international law, both regarded as the only modes possible legal, so that the relations around these methods consider necessarily universal. In this sense, the author points out that the legal-illegal dichotomy is constituted through this abyssal perspective, making invisible certain organizational modes that disregard this kind of standardization of legality.

On top of this abyssal conception of law, the comprehension that the present chronological reality on this side of the line is also made invisible and that, in an epistemological action, the present of the colonial states is defined as past on this side of the line, and it is said that there is an evolutionary process that would supposedly, be natural. Thus, the hegemonic creation of a single future for the world takes place in which the concrete issues of the colonial territories now do not matter or even exist. Therefore, even if the legal principles of metropolitan societies do not apply to the other side, the belief in the universality of these principles remains. This way, for Santos, the tension between regulation andemancipation in metropolitan societies coexists with the tension between appropriation and violence in colonial territories:

Regarding the law, the tension between appropriation and violence is particularly complex because of its direct relation with the extraction of value: slave trade and forced labor, use of manipulation of the law and traditional authorities through indirect rule, pillage of natural resources, massive displacement of populations, war and unequal treaties, different forms of apartheid and forced assimilation etc. While the logic of regulation / emancipation is unthinkable without the matricial distinction between the right of people and the right of things, the logic of appropriation / violence only recognizes the law of things, be they human or not ¹⁸ .

Thus, is a process of objectification of everything that is inscribed in colonial territories, subhuman, invisible existences are created (and, therefore, dis-considered) even to the modern modes of social inclusion. According to Santos, modern humanity cannot conceive itself without a modern sub-humanity ¹⁹. In this same direction, the author indicates that the abyssal thought trivializes its destructivity, because it is in the exercise of creation of a supposedly universal humanity that the sacrifices of a portion of humans is engendered – which constitutes the denial of the humanity of the colonial beings.

To think about the central theme of our text (the production of reflective modes and interventional from the interface between bioethics and worker health), we found in this study by Santos ¹⁶, the indication of slave and child labor as abyssal lines. However, an issue remains: besides the indicative lines of this author, there would be other post-abyssal zones in the world of labor which are still in a state of invisibility? If the answer is affirmative, it is necessary to create ways to restore the visibility of abyssal lines related to human labor, in order that the active role of workers which until then were "colonized", we can think of other ways to ethical the working and production processes.

It seems to us that the thought of Santos on social injustice finds correspondence in he reflections proposed by Christophe Dejours ²⁰, according to which, the more people are affected by suffering producing processes, such as unemployment and poverty, the more there is of a cognitive scission that generates a certain resigned, fatalist comprehension of suffering. Such comprehension, in turn, makes impossible the understanding that this same suffering is, in fact, an injustice. For Dejours, this occurs due to the contemporaneous process of production of cleaved subjectivities, in which the tolerance thresholds to injustice have been expanded. The author describes such process as the trivialization of social injustice, which seems very similar to what Santos¹⁶ terms trivialization of the destructivity of the abyssal thought.

Santos ¹⁶ stresses that social fascism that occurs from the abyssal lines comes as an unprecedented and naturalized manner of social relationship, as it can establish its foundations apart from the social contract. The author argues that modern fascism is the means by which the invisible groups (and their interests) are in fact disregarded by the social contract. For him, workers and members of the popular classes become disposable, to the extent that their economic and social rights are canceled by the social contract which happens to attend to and to ensure only the hegemonic interests. In addition, citizenship becomes inaccessible to certain social groups who want to reach it, as in the case of young people, minority groups and the unemployed.

It is in this same sense that Santos ¹⁶ shows the advent of the phenomenon called "soft law", the legal form to which compliance is not mandatory for "some". The author points out that this device has mainly been applied to relations between capital and labor, when they are created, for example, codes of conduct aimed at establishing indicative guidelines for the large multinational corporations, and which operates a normative hardening to workers . At the same time, however, the application of those "laws" is mitigated in the case of employers, if not meet the commitments and guarantees that should prevent the negative consequences of production processes.

The author exposes the urgent need to engender a process of active resistance to the expansion and maintenance of the abyssal lines, proposing that political resistance is only possible when we are able to establish an epistemological resistance. That is, more than the indication of policy alternatives (many of them still founded on colonial logic), we lack make the transition to a post-abyssal thinking.

Santos also defends that no post-capitalist alternative will, in fact, be progressive while processes producing invisibility and nonexistence persist, which are characteristic of the abyssal thinking: A post-abyssal conception of Marxism (in itself a good example of abyssal thinking) will claim that the emancipation of the workers must be achieved together with the emancipation of all the disposable populations of the Global South, who are oppressed but not directly exploited by global capitalism . Similarly, he claims that the rights of citizens will not be secured as long as non-citizens suffer a sub-human treatment²¹.

From this perspective, we realize the need to consider the different prisms the other end has to offer. Invisible and nonexistent modernity can therefore offer the post-abyssal thinking possibilities that modern Western thought is situated in the area of the unthinkable. Post-abyssal thinking calls into question the one-way culture of the hegemonic science, since, according to Santos ¹⁶, it proposes an ecology of knowledge, to ensure the recognition and autonomy of heterogeneous, plural and singular knowledge.

Such a stance does not exclude modern science, but situates it in a horizontal plane, non hierarchical in relation to numerous other forms of knowledge. It must be emphasized that the autonomy of the knowledge should not be seen as synonymous with isolation; instead, the ecology of knowledge will foster communication and dialogue process among all forms of knowledge, including those that were marginal or even invisible. Thus, in order to think about the post-abyssal relations in the workplace, we must reflect and act on work on a dimension situated beyond work itself and, at the same time, to workers health in an aspect that is beyond the opposition between employer and employee.

A bioethics for workers health

Unlike other fields whose concern is directed to the population as a whole, the general entities, the look offered by the field of bioethics has as main characteristic the fact that it focus its attention on those who "escape", to the singularities, the invisible abyssal areas, those which, by definition, are put to the margin of the so-called "normal curve", according to Canguilhem ²² in describing the epistemological artifacts that support criteria of normality assimilated and made natural by common sense. These lives are inscribed in a real and concrete dimension of vulnerability and consist of a structural asymmetry in the face of capitalist relations of production. Such asymmetry is made up through the production of "disposable lives," which are suitable for productive relationships in order to objectify these men and women (in their singular and specific dimension) as mere instruments of profit and accumulation - a kind of life produced to be used and then discarded.

The world of labor seems to be, par excellence, the field of standardization and regulation. Commonly, we can see that production and analyses on theories of work management and labor relations, as well as identity models of the world of labor ²³, tend to settle on generalizations and totals. From this attitude, the multiple meanings that emerge in the unique experiences that come from work-life micro-dynamics are left lost, forgotten and invisible. But if our focus here turns to what differs from the ordinary, the usual, the family, the homogenized, the standard (and therefore tends to escape), it becomes clear that the privilege we grant to the unusual - not in a sense pathologizing, individualizing, or in any spectacular way, but rather in order to make room for previously unheard of possibilities of reflection about work.

We want to give visibility to the ethical issues related to the life-work-health dynamics, which look amazing and astonishing when sighted from a perspective embedded in the regular and the common. As we look at these issues in the dimension of the extraordinary (as bioethics allows us to think), also we realize the obscured and hidden aporias arising from these contexts. We invest in instruments provided by bioethics in the making of this interface with the field of occupational health, because we believe that it retains in its eyes an appropriation situated beyond pure and simple legal regulation devices to ensure rights and duties. Before, the bioethical look will again turn its attention to the field of invisibility, or to contexts that are initially perceived as insoluble precisely because the critical nodes of their problems are invisible.

In this sense, bioethics for health of the worker will have to share the premise of the dynamics of "un-making invisible" and exposition of abyssal lines in the workplace in order to create ethical processes of critical reflection about morals that lie there, and subsequent boost interventions in this field. As we follow this direction, our intent is to find possible ways (even if in this process the exercise of building paths becomes necessary) through the lack of "pores" that is characteristic of some emerging problems in production processes and work. Thus we see the production of post-abyssal forms of knowledge concerning the world of work - forms of knowledge such that they can overcome the dimensions of fundamentalism, heteronomy and injustice that still insistently affect workers.

The main difficulty that we will find, accordingly, will be the opening of a dialogue with those other epistemes that now take the place of hegemony in relation to ways of thinking and acting on the world of work. Such institutionalized knowledge since long undertake their energies to ensure the maintenance of an oppressive order in the world of work, for which the workers are merely disposable resources. Now the interface between bioethics and workers' health constitutes a convergence between fields, through the dialogue of their instruments, if rightly refer to dislodging and crystallizing the hegemonic pseudo-naturality assumptions about work.

However, we must understand that even in the process of hierarchical dismissal of the central epistemes through the applicability of knowledge of ecology in bioethics for worker health in no way we should disregard the knowledge that served to maintain the hegemonic order. The proposal of the knowledge ecology is not intended to exclude the knowledge that were previously hegemonic; before you should enter them in an equal and horizontal dynamics.

In the process, we may encounter many difficulties, since actors and knowledge aligned to the hegemonic powers have gotten used to investing their forces in the weakening of workers and other subjects made invisible by production processes. However, these same actors and knowledge not yet appropriated the fact that problems and issues characteristic of the working world (and which are reinforced by your actions) also concern themselves, affecting them directly and indirectly.

In relation to this difficulty to perceive issues and ethical problems that affect third parties as something that concerns everyone, we remember a reflection brought by Humberto Maturana, in his "Emotions and language in education and in politics" (“Emoções e linguagem na educação e na política”)²⁴. This author points out that our Western society produces numerous reflections of an ethical nature, even maintaining a pact of common morality, through theUniversal Declaration of Human Rights ². However, he continues, most of these reflections develop in purely rational grounds, and precisely because of this, they only convince those already convinced, warning that the reason why this inefficacy occurs lies precisely on the fact thatthe ethical concern will never emerge in a dimension that is purely rational ²⁵.

Maturana also states that the ethical concern is only possible by accepting the other. This way, he justifies his understanding: In 1955 I was a student in England. I visited, with several Chilean friends, an exhibition of paintings by a Japanese painter on the destruction and suffering generated by the atomic bomb dropped on Hiroshima. Upon leaving, one of my friends said: - What do I care that one hundred thousand Japanese died in Hiroshima, if I did not know anyone! - Listening to this gave me chills and at the same time, it seemed wonderful. I thanked my friend who said that, because it made me understand something fundamental: if I have no imagination to incorporate those Japanese in my world, accepting them as legitimate others in coexistence, I can not concern myself with what happens to them as a result of my actions ²⁶.

So Maturana concludes that ethics can never be based solely on rationality, and if it does, it will have frustrated its propositional claims. To that end, the author indicates that all ethical proposition that is to be fruitful must have its foundations based on a relational dimension between emotion and rationality. Thus, if we want to foster an ethical thinking that embraces everyone (not only those who are like us), we must transcend the pure rationality in order to create dialogic processes capable of achieving the existences in their full dimensions - integrality which mainly includes the affections that make up life in what we know as emotions.

Finally, by appropriating Maturana's contributions in this dialogic building between bioethics and worker health, we hope to mitigate the effect of sedentary forces seeking to prevent the transforming processes in the workplace. In implementing the ecology of knowledge that we have proposed, we can not give up, nor the size of the title role of workers (and other affected who are in the process of invisibility) reflections and ethical interventions in the workplace, or to insert in on the field of dispute what is put in order to create new alliances with actors and knowledge that in a process of appropriation and co-optation were previously devoted to the service of hegemonic powers. Thus, through a reflective process of acceptance and accountability to reach the completeness of existences - that is, both in the reflective plan, and in terms of human emotions - we intend to gain new allies in order to strengthen, on a horizontal and not hierarchical plan, the exercise of ecology of knowledges that can favor the composition of a bioethics for worker's health, since these new partners are able to consider those enrolled in the worker category as legitimate others.

Final considerations

From the perspective proposed and developed in this work, we intend to encourage the creation and consolidation of spaces that foster authentic emancipatory appropriation of senses and experiences by workers. Therefore, it is necessary critical reflective exercise about the morals that populate the world of labor - which, according to our proposal, will be made possible by the bioethics to worker health. In our view, such an exercise will be as important for bioethics as are other considerations made by that field about other issues that it focuses on. We venture to say that the emergence of bioethics for the health of the worker may constitute into a perspective which fully combines the propositions and actions taken by the field of bioethics over the past few years.

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• This paper is based in a dissertation produced within the Programa de Pós-Graduação em Bioética, Ética Aplicada e Saúde Coletiva in an association of th Universidade Federal do Rio de Janeiro(UFRJ), Fundação Oswaldo Cruz(Fiocruz), Universidade do Estado do Rio de Janeiro(UERJ) and Universidade Federal Fluminense(UFF) – PPGBIOS, Rio de Janeiro/RJ, Brazil.

Publication Dates

• Publication in this collection
  May-Aug 2015

History

• Received
  25 Mar 2014
• Reviewed
  20 May 2015
• Accepted
  3 June 2015