This article analyzes Brazilian and Italian general practitioners' discourses on the potential to boost autonomy among subjects-users who are cognitively competent with regard to their care decisions, through primary health care actions, from the bioethical perspective. Qualitative research with an exploratory approach, carried out in 2007, in Florianópolis, Santa Catarina, Brazil, and in the Province of Rome, Lazio Region, Italy, with 15 Brazilian general practitioners, 15 Italian general practitioners, and 1 health director of the Italian National Health Service (SSN). Semi-structured interviews and a field diary were used as data collection instruments. Processing and systematization of messages' content have generated two analytical categories: "biomedical rationality versus emancipatory rationality" and "from the historical condition of minority to the wish to be autonomous." In both countries, testimonies have revealed: a) poor materialization of autonomy in face of the contemporary risk-prevention biomedical imperative; and b) emancipatory movements that generate concrete and symbolic strategies in order to cope with deconstruction of the medical practice, historically produced through the path of obedience. Brazilian discourses pointed out productivist protocols, imposed by administrations, as an instrument for the preservation of the minorities. Italian general practitioners suggested greater recognition of subjects-citizens of rights when providing care. The research revealed there is a need the Brazilian Primary Health Care (APS) dialogue with humanities theories and invest in mechanisms to boost ethical behavior to review the sense that has been occupying the adoption of the risk prevention biopolicy in the continence of actual health at this time.
Autonomy; Primary health care; Brazil; Italy; Risk prevention; Bioethics