Renewal and reflections about 2020

While the world is experiencing major social, behavioral, economic, and institutional changes due to the severe covid-19 pandemic, Revista Bioética arrives in 2021 with new proposals, a new layout, and new internationalization goals. The “covid-19” topic continues to be part of the journal and of our lives. Ethical anxieties, doubts, and dilemmas become increasingly evident. Countries experience their dramas, each with its own particularities, although they resemble each other in many situations.

In countries where economic liberalism is stronger, limitations to individual freedoms has been more felt by the population and less accepted. But the pandemic increases the responsibility of the State over peoples’ lives, especially regarding the organization of the public health system. This is observed in the fact that the best results have been obtained in countries whose health system is universal, reaching a larger number of citizens. If any conclusion can be drawn from this terrible pandemic, it is that countries must strengthen social welfare, especially in terms of collective health. Moreover, the planet needs to unite around common causes such as global health.

According to Rocha ¹ , we must develop an ethical approach to the tension between individual and collective issues. It is a State responsibility to create and enforce legal measures to stop the disease, defending the common good rather than individual rights, as Pellegrino and Thomasma point out ² . We must reflect on the allocated resources and their use according to bioethical principles, especially autonomy, justice and beneficence ³ .

Solidarity and the dignity of every human being must never be forgotten, even if inequality becomes increasingly evident in extreme situations like the pandemic. In this sense, as Nohama, Silva and Simão-Silva point out ⁴ , the dilemma between health and the economy reveals a simplistic view. When it comes to public health, equity is key. We all should be involved in the same solidarity effort, since health is an individual good, but also a collective one. A more cohesive society is a more productive society ⁵ .

In democratic societies, it is normal to have diverging interests and values. We not always have consensus about which services should be offered, with what resources, and to whom. Amidst these disputes, in this special moment experienced by humanity, one cannot forget the great questions of bioethics – more pressing than ever – addressed by the articles of this journal.

Political action has long-term impacts and must weigh risks and benefits, guided by lucidity and compassion; the physician’s action has impact in the immediate future, in the life of those being treated. The doctor-patient relationship, however, has undergone major changes in recent decades. Reflecting on these changes, in “Physicians as choice architects: paternalism and respect for autonomy,” Lima and Machado resort to the concept of “libertarian paternalism” coined by Thaler and Sunstein ⁶ to propose that the physician respects patients’ autonomy, while helping them make the best decision.

In another article, Joaquim Clotet highlights the concept of “moral craft” – a construction that each social group makes in practice, based on their experiences –, by Parker ⁷ , to argue that morals can only be understood in context.

Pereira, Siqueira-Batista and Schramm discuss the decision-making process in intensive care unit admissions in the context of scarce resources. The authors approach the issue from the principlist and utilitarian standpoints, concluding that technical and ethical criteria should be articulated and that random selection would be the most feasible and fairest.

Barros and collaborators, in turn, reflect on the forensic sciences, a set of knowledge and techniques that assist the public security system and criminal justice and are governed by ethical principles and practices. The article thus reflects on some of these principles and the biases involved in the performance of forensic science professionals.

Another study, by Lucía Ciccia, questions the dimorphic interpretation that supports modern science’s androcentric reading of bodies. Showing how social practices associated to gender roles fit into this reading, the author proposes that the correlations between genitalia and biological differences are not necessarily due to sexual differentiation processes, but to normative stereotypes.

In turn, the article by Laura Helena Caicedo López and collaborators addresses the scientific and ethical perspective of research projects on the use of elicitors as substitutes for chemical compounds in agriculture. The authors conclude that elicitors appear to respect the bioethical principles of beneficence, non-maleficence, justice, and autonomy, which makes promising the studies that seeks to understand the interactions of these products with the environment.

Another 14 texts, besides those cited, make up this edition, with a wide variety of topics. In summary, we conclude that, despite the pandemic and its harrowing consequences for many people’s health, bioethical discussions must continue, firm and determined, as to make it through this special moment of humanity, projecting a better world.

Enjoy and have a pleasant reading!

The editors

Referências

• ¹
  Rocha DM. Pandemia, bioética e distanciamento social: relação entre interesses coletivos e individuais. Aufklärung [Internet]. 2020 [acesso 20 fev 2021];7:37-50. DOI: 10.18012/arf.v7iesp.55342
  » https://doi.org/10.18012/arf.v7iesp.55342
• ²
  Pellegrino ED, Thomasma DC. Para o bem do paciente: a restauração da beneficência nos cuidados de saúde. São Paulo: Loyola; 2018.
• ³
  Gonçalves L, Dias MC. Discussões bioéticas sobre a alocação de recursos durante a pandemia da covid-19 no Brasil. Diversitates [Internet]. 2020 [acesso 20 fev 2021];12(1):17-36. Disponível: http://bit.ly/37DvTYS
  » http://bit.ly/37DvTYS
• ⁴
  Nohama N, Silva JS, Simão-Silva DP. Desafios e conflitos bioéticos da covid-19: contexto da saúde global. Rev. bioét. (Impr.) [Internet]. 2020 [acesso 20 fev 2021];28(4):585-94. DOI: 10.1590/1983-80422020284421
  » https://doi.org/10.1590/1983-80422020284421
• ⁵
  Guimarães C. A importância de um sistema de saúde público e universal no enfrentamento à pandemia [Internet]. Rio de Janeiro: Escola Politécnica de Saúde Joaquim Venâncio; 2020 [acesso 20 fev 2021]. Disponível: http://bit.ly/3sosoO5
  » http://bit.ly/3sosoO5
• ⁶
  Thaler RH, Sunstein CR. Nudge: improving decisions about health, wealth and happiness. London: Penguin Books; 2009.
• ⁷
  Parker M. Ethical problems and genetics practice. Cambridge: Cambridge University Press; 2012.

Publication Dates

• Publication in this collection
  21 May 2021
• Date of issue
  Jan-Mar 2021