Fragments of urban bioethics : an essay on power and asymmetry

The aim of this essay is to describe the role of bioethics in relation to urban problems. The paper presents a brief history of the concept of bioethics, taking the Potter perspective as its starting point, and proposes a mode of operation through method, production and application, considering ethnography and the peodution of principles and the application of these concepts to the conflicts in focus.

Fragments of urban bioethics: an essay on power and asymmetry http://dx.doi.org/10.1590/1983-80422015231050 This brief essay intends to rescue the discussion of an urban bioethics, updating the concept and advocating the idea that urban conflicts emerge from the encounter between an abstract model of city and the one that is continuously built on the streets, in the slums, in poor neighborhoods and in urban occupations.This means that the urban agents are more than the formal agents -governments and owners, regarded as legitimate -also including those who sometimes are referred to as "the problems of cities".Considering the urbanization of the last four decades as a planetary phenomenon, to a greater or lesser extent, the importance of conducting the bioethical reflection by this theoretical perspective, toward the identification and interpretation of conflicts from the context in which they emerge and as to the contemplation of the various modes of existence involved in the conflict is pointed out.This is because urban dynamics and changes both change the city physically and transform the different life experiences within the urban space: What counts, with today's cities, is less their aspects of infrastructure, communications and service than the fact that they engender, through material and immaterial facilities, human existence in all aspect one may want to consider it 1 .From this broad dimension involving objective and subjective aspects of existence, the present paper rescues perspectives from Potter's theory, inserting them in an analytical proposition specifically approaching the that induce and are induced by urbanity.

Urban bioethics
In equating the asymmetrical relationships in which certain human actions can cause changes recognized as significant and/or irreversible in other modes of existence, the current bioethics has focused -necessarily -on urban problems.This realization, however, transcends the idea that, for being contextualized in a specific place, the problems identified and focused on by bioethics are inscribed in the urban space as if this space were tabula rasa, a mere surface for events.On the contrary, in the reflection the city stands out as an active element in the production of conflicts, conditioning and being conditioned by the interactions and anthropic relationship.
Redefining the idea of city, raising it to the condition of active agent does not imply that urban problems or events can only be analyzed in the light of bioethics if they are related to the more strict sense of health, as Blustein suggests in his defini-tion of urban bioethics: In its most straightforward sense, urban bioethics can be defined as the study of ethical problems relating to medicine and health care that arise in urban contexts 2 .Also in this aspect there is the intention to grant bioethics a broader, more complex sense, emphasizing the expanded proportion both in what concerns ethics and in what concerns the idea of health, considering the effect that multiple relationships of causality, increased by the urban environment, may cause in reality.
Although the idea that the formal reflection based on urban bioethics is still incipient is endorsed here, it is not advocated that approach of urban problems by bioethics is completely absent from the analysis of this field.In the revisiting the proposition that originated bioethics, it is possible to find the genesis of this worldview, which converges to the recognition of the complexity of the interactions between humans and their habits in the urban habitat.Thus, the concern about the virtual absence of the urban context from the formulation of almost all bioethical problems 3 is considerably reduced as we insert the problem in the intricate design of this broader frame.Urban bioethics, as sketched out here in small fragments, must be able to reflect the dynamics of the relationships in the urban space, granting a voice to every party in the social space in order to bring to light, criticize and propose solutions to the asymmetries of power 4 .

History and functioning of the concept
In his article "Social responsibilities of bioethics" of 2001, Albert R. Jonsen introduces the possibility of urban bioethics.The author criticizes the bioethics focused on individual autonomy at the expense of social aspects and conflicts.For him, urban bioethics surfaces cases of life in the city that, in order to be approach, it must be careful not to sanitize them, strip them of their urban origins, and convert them into standard bioethical cases of personal autonomy 4 .
From this finding by Jonsen, the issue of qualification of bioethics to constitute the expression urban bioethics emerges.This question refers not to the creation of one more theoretical or disciplinary unit, but to an analytical proposition articulating heterogeneous elements in transient relationships, according to the problem to be addressed.A welcome obstacle arises form this, to the intention to create another closed field in bioethics, with its own experts and specific theoretical systematization.

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Fragments of urban bioethics: an essay on power and asymmetry http://dx.doi.org/10.1590/1983-80422015231050Adding the adjective "urban" to the term "bioethics", the aim is not to qualify of provide an exhaustive declaration, but to create an intrusion, that is, through this adjective, a new approach is opened in the scope of bioethics.As conceived here, the new field however, does not fit this scope but starts a process in which both the analytical instrument -bioethics -changes the target field -urban conflicts -and is modified by the target field.That is because the target field demands a different approach from that centered on the autonomy principle, thus forcing the search and the development of other theoretical tools to deal with the variables that emerge from the urban conflicts.This way, there is a decrease in the speed 5 toward the hasty production of answers to urban problems such as, for instance, those obtained through the subsumption of the complexity of such social questions about the principle of autonomy as an individual proposition for the solution of conflicts originating from the urban environment and/ or to the appeal to an intervening/protective State, which would have the ability to act in the collective dimension.Subsuming the speech those who actually experience the complexity of social conflicts in their everyday life in the discourse of the dysfunction in relation do the dominant pattern, this type of analysis does not promote a priori the dialogue or emancipation 6 .
The juxtaposition of the terms "bioethics" and "urban" also refers to the communication among different realms of existence, called cross-cut section.In other words, as Van Rensselaer Potter put it, what it is intended is the function similar to that of a bridge, but not only between biological and human sciences, but also among several modes of existence, different types of knowledge and practices that share consensus or dissensions in associations or battles.
Formally, this intrusion of urban problems in relation to bioethics appears briefly in his 1971 book "Bioethics: Bridge to the future" 7 , in which Potter enumerates several problematic fields in which the respective ethics should work and would -necessarily -involve bioethics, which, according to the author, is a science of survival: We are in great need of a Land Ethic, a Wildlife Ethic, a Population Ethic, a Consumption Ethic, an Urban Ethic, an International Ethic, a Geriatric Ethic, and só on […] All of them involve Bioethics 8 .
Despite the generality and initial lack of definition of the term "survival" 9 , Potter, in subsequent papers 10,11 , seeks to detail it through a typology based on the idea of survival: mere survival; miserable survival; idealistic survival; irresponsible survival; acceptable survival.The latter of these categories would be the objective of bioethics.
The detailed categorization of the idea of survival proposed by Potter does not point exclusively to the survival of the human species in general but mainly stimulates the scanning all possible knowledge about the relationships between the various modes of existence, their respective risks of extinction/extermination, as well as their possible actions which may increase or decrease the risks to other modes of existence and cause them damage.
Urban problems extend and increase the complexity of the term "survival" applied by Potter from the intrusion of the types of knowledge and respective practices in the ways of urban existence in focus.These are closely -materially and immateriality -related to the inhabited territory considering that the "territories are connected to a subjective individual and collective order (...) territory works in intrinsic relation with the subjectivity that delimits it" 12 .This means that taking into account the risks concerning certain modes of existence though their own perspectives implies the understanding that these risks and possible damages do not concern only the corporal existence but also the incorporeal existence, that is, the signs, relationships, habits, references that constitute a singular way of existingin the world.

Such definition comes close to what Isabelle
Stengers 13,14 calls the etho-ecological perspective, in which the habit and habitat are inseparable.This does not mean any functional dependency that could lead to a turn toward determinism but a relationship in which where and how one lives work as agents of each other.In an urban sense, thus, such perspective would not designate the individual or group identity, also constituted by the belonging to a territory, but would consist in an outlook that seeks to learn from these forms of existence.An outlook that scrutinizes a certain way of living, a certain inhabiting and a certain where one inhabits which are not only elements that comprise a specific set, but elements that feedback and interconnect continuously and consequentially, constituting a way of existing that keeps a certain coherence without, however, being hermetic or closed in itself.
From this perspective, one can understand the city as being in a permanent process of creation and transformation.This process is not limited to action on the part of the living, specifically those who study the "problems" of the city, city planners, architects

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Fragments of urban bioethics: an essay on power and asymmetry http://dx.doi.org/10.1590/1983-80422015231050and official managers of space.In addition to these and other actors who have appropriated the space and conditioned hegemonic the forms of existing, urban life also experiences the actions of people whose place of speech echos in the periphery or power, those living in slums, in urban occupations, that inhabit poor neighborhoods and the homeless; everyone who also construct their own existence in the existence of the city.This perspective also reveals a crossroads in the scope of the decision process on how to deal with urban problems, from which one may seek solutions that privilege symmetry or asymmetry.On this crossroads, the alternative passes either by the consolidation of the institutional places of speech, endorsing the status quo, or by daring to resonating the voices of other parties that live in the city, starting new ways for dialogue.
The first path, paved by oral discourse, imposes itself by the action of the government and the State, resting on technical-scientific assumptions.The second path grows like a stubborn herb in a crack of the pavement, insisting in existing and in taking the world it is allowed to live in.For both, the problems of urban space are immanent and, paradoxically, transcendent to everyday life because the individual experience is modulated by the collectivity which overlays the speech of all, often perverse and randomly.
As a starting point, it is stated that the relationship with these problems may result from a practical choice between two extremes or "poles": complexity and complication 15 .The latter refers to the city as a whole that can be broken into simpler parts.There are, as a principle, predefined urban actions materialized in specific urban facilities.The facility "sidewalk" exemplifies, simply, the principle of moving.Such facilities are understood as organized from the part to the whole in a crescent process, starting from the sidewalk to gradually comprehend the street, the neighborhood, until it reaches the limits of the urban unit.The "verification" of problems in the pole of complication occurs when there is a deviation or subversion of the functions planned, be it due to malfunction or misuse of certain facilities which may cause harmful effects in the linear chain or urban organization.
In turn, on the pole of complexity, both alliances and divergences or battles are situated in networks comprehending all urban agents -human and non human.This way, a city, in the territorial-administrative sense, is an abstract reference crossed by concrete fluxes and relationships that constitute networks.This aspect does not imply the absence of principles and functions, but makes them consequent, that is, associated in these networks of relationships and their mediate or immediate consequences.Thus, urban problems are no longer linked to the deviation or subversion of predefined aspects to configure themselves from practices, consequences and, perhaps most important, the pointing out of problems by people interested in their solution.
As a practical choice, the poles of complexity and complication are separated but it is possible that aspects belonging to different poles may get mixed up during the interaction.With this, the possibility of postulating answers to the problem is enhanced and, thus, also the possibility of interacting with it.Therefore, this binary structure is not ranked, the complex pole is not an example of progress in the knowledge, as pointed out by Stengers   15   , but a choice, a stance relating to a problem; in other words, it is a way to opt for the complexity of the problem.This way, we move on to the question concerning the possible functioning of bioethics termed urban; that is, how bioethics may act in making urban problem complex and in approaching them.In principle, two elements of Potterian bioethics emerge: the first is related to wisdom and the second to the bridge.Wisdom, for Potter, is knowledge of how to use knowledge 16 .This means that [s]cience is knowledge, but is not wisdom.Wisdom is the knowledge of how to use science and to how balance it with other knowledge 17 .Wisdom works then, as a element that controls knowledge, especially the one the author considers dangerous: knowledge can become dangerous in the hands of specialists who lack a sufficiently broad background to envisage all of the implications of their work 18 .A piece of knowledge is not intrinsically dangerous, buy it is through its use: knowledge is power, and once knowledge is available, it will be used for power whenever possible.(…) No one worries about knowledge that is not used.It is the uses to which knowledge is put that make it dangerous or helpful 19 .
Thus, there are two questions about the functionality of a knowledge -or workability, according to Potter 20 .The first one refers to the question is the thing working now? 20, and relates to short-range pragmatism.The Second question may be associated to how does the thing affect our society? 20.The latter is what Potter terms long-range pragmatism.
Being a regulating element, wisdom, when not used to its whole extent, may also become danger-

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Fragments of urban bioethics: an essay on power and asymmetry http://dx.doi.org/10.1590/1983-80422015231050ous and this occurs when the pragmatic questions are asked and answered by only a fraction of the people involved in the problem, and when these questions are directed only to the product (knowledge) and not also to the processe of production.In this sense, as dangerous knowledge can never be put back into the laboratories from which it came 21 , a dangerous proceeding can never be completely undone.
A knowledge and/or its production constitute dangers when they hazard or damage to certain modes of existence.This way, besides the fact that the diverse modes of existence are part of the domain of an urban problem, they must also participate in the elaboration of the issues about the processes they in which they are involved.This means that a certain way of existence is implied in an exogenous process/knowledge must be capable of putting this same knowledge at risk.Wisdom is not exclusive, but collective.
Considering that "dangerous knowledge" is defined as the one that knowledge that has produced a temporary imbalance by outpacing other branches of knowledge 22 , and also considering wisdom as a controlling collective principle, the need arises to reach situations of "equilibrium" between the "branches of knowledge" in focus.Therefore, one of the aims of bioethics is to search for a balance point between scientific knowledge (or disciplinary knowledge, including urbanism, architecture, and other institutional subjects and practices formally involved in how to modify and think the city) and other non institutional forms of knowledge, such as the ones produced permanently on the streets, in the slums and urban occupations.
For this, another priority element for Potter reveals its importance.That is the element that predicts that Bioethics must work as a bridge: We might build a 'bridge to the future' by building the discipline of Bioethics as a bridge between the two cultures, science and the humanities 8 .Bioethics, to Potter, would be the interdisciplinary key connecting biology, social sciences and philosophy.However, in relation to urban problems, it is the case of multiplying the bridges and not limiting them to the ones linking the disciplines recommended by Potter, for the decisions and productions regarding the city work through other types of knowledge and practices that affect the survival of different modes of existence.Therefore, the questions that can guide the sketch of theses bridges may the ones formulated by Stengers: How can those who are affected by what is being produced be "invited" to participate in its production?How can they become concerned parties, multiplying questions, objections, and requirements? 23.
One may objection that this process of increasing the number of people who can intervene in the processes of production and decisions relating to the city may foster chaos or disorder.On this respect, it should be noted that complexity and chaos are strictly related or, better, chaos inhabits complex and complex inhabits chaos ("Le chaos habite le complexe, le complexe habite le chaos") 24 .It is about relating to chaos, to disorder, seeking to make the traces of the problems in focus emerge.Such complexity opens a new field of possibilities that would hardly emerge in the hasty search for a solution.In this sense, it is necessary to consider the statement by Potter that disorder is a force to be utilized, the raw material for creativity 25 .That is to say that, in order to develop authentic processes and to find adequate solutions to bioethical dilemmas, it is necessary to follow the proposal made by Nietzsche, who considered necessary to have chaos within oneself to give birth to a ballerina star 26 .

Final considerations
Provisionally, and in conclusion, elements of a systematic pattern are pointed here, by which a bioethics termed urban, that puts to work these aspects pointed from Potter.The first element is related to a possible method; the second, with the process of variation and creation of principles; the third, with its application.So, first, in what refers to the method, urban co-habitation does not allow for the existence of a neutral observer.The permanent construction and the development of the city comprehend the subjectivity and the body of who dwells in it.This way, any method to be used in the realm of urban problems assumes that the researcher is not an external observer, but is included in the social-political processes 27 around the conflicts considered.It is in this sense that the ethnographic work looks interesting to bioethics: in it, one contacts the discourses and the problems created in action by who is not involved in the interaction.
The ethnographic study may, thus, be an ethical-political operation: a situation of which unprivileged types of knowledge and practices are allowed not only to speak for themselves but also to affect the knowledge of one who is in role of the ethnographer and, once to this disciplinary knowl-

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Fragments of urban bioethics: an essay on power and asymmetry http://dx.doi.org/10.1590/1983-80422015231050edge, they can affect, through a bridge a broader range of types of knowledge ans practices, even the institutional ones, formally responsible for the management and transformation of the city.Associated to bioethics, the ethnographic work would not be a way to approach concrete situations and, thus, better answer the question what would you do in this situation? 28, but it would be a way to expose other variables of the problem -those exposed voluntarily, verbally or not 29 , by who is involved -, aiming at extending or creating a field of possibilities beyond the probabilities given, relative to the problem in focus.Perhaps this association between ethnography and bioethics will, in fact, make possible for bioethics to occupy the position related to that of the production of new fields, besides the predominant role of prescriber/proscriber.
The second element, the process of variation and creation of principles, results form the method in the sense that the researcher does not check if principles formulated previously may be or are applied to the network of relationships in focus.In general, these principles are taken as axioms and, thus, are never put to question.Otherwise, in the performance of urban bioethics, there is no attempt to apprehend the action of exogenous principles to the conflict in focus, but, first, to understand how the conflict generates variations on a previously established principle, recreating it through its concrete application; and, on the other hand, bringing to surface the principles generated in the act -voluntarily or involuntarily -to account for the different variables that emerge in the conflictual relationships considered.This way, there is a leap of perspective 30 , like the one promoted by the appearance of principlist bioethics which, as it multiplies the principles to be taken into account in the analysis of a problem, allows for the abandonment of an absolute principle, specifically that of the sacredness of life.The same way, an enhancement of the field of action is identified, as the one promoted by the bioethics produced in Latin America, which seeks to place health-related conflicts in its social context 31 , decentralizing itself from the biomedical model, recommended by the principlist current.Here, there is a leap that permits, on the one hand, the disconnection from previously established principles and, on the other hand, the connection to principles created or recreated in act with their consequences.The latter engender new meanings that permanently modify the principles.
Lastly, from the work to make such principles visible, the aim of making them work in the problems under consideration arises, seeking to balance them and establishing bridges between the principles that direct actions that may potentially or effectively cause damage to the several modes or urban existence.Such bridges are interconnections that admit not only consensual communication but also possible collisions and dissensions which must not be regarded as obstacles, but as material for new urban possibilities.