© Springer International Publishing Switzerland 2016
Alireza Bagheri, Jonathan D. Moreno and Stefano Semplici (eds.)Global Bioethics: The Impact of the UNESCO International Bioethics CommitteeAdvancing Global Bioethics510.1007/978-3-319-22650-7_1515. The Impact of the UNESCO International Bioethics Committee on Latin America: Respect for Cultural Diversity and Pluralism
(1)
Deontology and Bioethics, Faculty of Medicine, University of Panama, Panama, Panama
(2)
School of Medicine, Universidad de la República, Montevideo, Uruguay
(3)
University of Brasilia, Brasilia, Brazil
(4)
Santiago Technological University, Santiago De Los Caballeros, Dominican Republic
Abstract
In Latin American bioethics, cultural diversity and pluralism is a critical issue. Due to the importance of human rights in Latin America, bioethicists in this continent worked hard to apply and implement the UNESCO Universal Declaration on Bioethics and Human Rights. Currently, social bioethics and research ethics are important themes of congresses, educational programs and publications. However, the main topic is bioethics and health. The aim of Latin American Bioethics is to provide the countries, Latin Americans and people in the Caribbean with an additional new instrument for improving democracy, citizenship and human rights, which is derived from the construction of an expanded and more politicized concept of Bioethics. This also includes promoting a wide trans-disciplinary exchange of information and experiences, at regional as well as international levels.
Sadly, Dr. Peralta passed away before the publication of this book.
15.1 Introduction: Cultural Diversity and Pluralism in Latin America
The history of Latin America is intimately tied to the recognition of the importance of cultural diversity and pluralism after a long period of colonial domination and denial of Indigenous and African participation in the process of national empowerment. The development of bioethics scholarship in Latin America has been influenced by this historical context and coincides with the work of the bioethics unit of UNESCO and of the International Bioethics Committee (IBC) on these themes. In the specific field of health, Latin American bioethic s emphasizes fairness, equity, comprehensiveness and quality of health services to comply with human rights in health. For this purpose, it has been necessary to develop educational programs in bioethics and UNESCO has been both a source of knowledge and a support.
The recognition of cultural diversity in Latin America has been the product of political, anthropological and social work with the different Indigenous population s, their struggle and the struggle of Afro-American groups for the recognition of their human rights in the middle of the twentieth century. Next, women fought for their rights from a gender perspective and currently homosexual groups are demanding non-discriminatory treatment and equity. Inequities although social class remains the main divide in the most unequal region of the World, Indigenous and/or African descendants are grossly overrepresented in the lower classes in most countries. The colonization of Latin America has caused traumas in societies, especially the denial of the human qualities of Indigenous people s. The best intentioned approaches were justified by the values of beneficence and protection, similar to what would be applied to children and individuals with diminished capacities, and ignored the autonomy of these individuals and populations. Following the South American wars of independence, Indigenous groups or nations were relegated and forgotten. Then the works of Levy-Strauss and Latin-American anthropologists demonstrated the different social organization of Indigenous groups and their distinctive world view, bringing new interest for these groups. However, the greatest obstacle for the recognition of their human rights has been their historical loss of independence.
Latin America is considered as a whole entity yet there are large cultural differences among countries, despite the many similarities in history and dominant language. It is possible to distinguish some larger groups of cultural unity: México and Central America, the Latin Caribbean group (Spanish speaking islands, the Atlantic coast from Florida, United State s to Venezuela), Brazil , the Southern Cone and the Andean countries. Although there are differences within these communities, cultural similarities have impacted Latin American societies and permitted the recognition and respect of the different groups. For Mexico , Central America and the Andean countries, the problem of equality and justice for the indigenous communities is still significant, most of them live in poverty and have the lowest indicators of human development (UNDP 2012). Therefore, bioethicists of these countries work earnestly to incorporate the topic of human rights to bioethics. Some progress has been made, for example, in Bolivia, where the majority of citizens belong to indigenous communities, “multiculturalism is pluralistic” as defined by Diaz-Couder (1998) and the various native languages and cultures are protected by Bolivian legislation and these native languages are publicly used at the same level as Spanish. Dialects, however, have been used to discriminate against native peoples in some countries such as Panama, and reinforce all other forms of discrimination. It should be noted that the linguistic definition of “dialects” for native languages is that which is locally used for private activities and excluded from public forms of communications. However, reflection about the impact of technology on the environment has opened the dialogue between Indigenous community and the dominant ones (Diaz-Couder 1998).
The Afro-American movement of Civil Rights in the United State s has also influenced the Afro-American groups in the Caribbean and their claims for the right to education and political recognition. Access to universities has allowed new professionals to re-claim and re-write the historical memory of their participation in the different moments of the construction of the new independent States of Latin America or the Panama Canal. Another aspect of this educational integration is the recognition that they are as good professionals as those in the dominant groups. This recovery of their memory and self-esteem has been associated with the promotion of their culture in all aspects. The high level of education and their academic relations with the Pan-American Health Organization in the beginning of this century helped an early development of bioethics in these countries. Santo Domingo and Cuba are examples of this academic work. In The Southern Cone, the different migratory waves brought together various cultures from European and Mediterranean countries, contributing to a specific culture that is above all multicultural. The advanced level of educational and economic development of these countries has prompted the early participation of philosophers in discussions about various topics of bioethics, including recognition of the problems created by advanced technologies. Brazil is peculiar as it embraces all the cultures of America and is economically developed. Therefore, bioethicists in Brazil have risen to the challenge of considering both the problems of equity and justice, as well as the problems created by the technological advances.
The UNESCO Declaration on Race and Racial Prejudice of 27 November 1978, the UNESCO Universal Declaration on Cultural Diversity of Countries of 27 June 1989, the International Labour Organization Convention N° 169 concerning Indigenous and Tribal Peoples in Independent Countries of 27 June 1989, and the Declaration of the United Nation s on the Rights of Indigenous Peoples have all contributed to the empowerment of discriminated groups to claim their rights. Gender differences represent the historical sequels to the patriarchal colonialist and indigenous societies. Although many States of Latin America participated in the meetings promoted by the United Nations in México , Cairo and Beijing and incorporated the final Declarations into their legislations, much remains to be done for the recognition of women’s rights in a pluralistic society. The greatest achievements have been in education, and more women have access to the university and in some countries there are more women than men enrolled in and graduating from universities. Unfortunately women’s salaries are still generally lower than men’s. Health policies have always incorporated the protection of mothers and children, however, the World Health Organization (WHO) and UNICEF have recognized that there is a gap between the objectives and actual reality (UN 2015). For many societies, the concept of pluralism does not include gender as a social category different from sex, so they do not recognize the need to act upon these criteria. Likewise, homosexuality is discriminated in most countries. Finally, the dominant model is influenced by the technological revolution and the perception of its capacity to solve health and social problems. No one can ignore the benefits of technology for human health and quality of life, but academics and societies have to examine technology’s negative impacts on society and health within the precautionary principle and understand its limited ability to solve social problems.
15.2 Bioethics, Latin America and UNESCO1
In Latin America, bioethics was introduced by Professor José Alberto Mainetti, in Argentina in the 1970s. However, only in 1994 when the Second World Congress of the International Association of Bioethics (IAB) was held in Buenos Aires, did bioethics become definitively rooted in this region. Later, in 2003, the Bioethics Network for Latin America and the Caribbean (REDBIOÉTICA ) was founded in Cancun, México , in parallel with an international meeting of the Human Genome Project . The IAB World Congresses in Japan (1998) and Brazil (2002) were very instrumental in its creation. The official themes chosen for the two events “Global bioethic s” and “Bioethics, power and injustice” encouraged the start of discussions relating to the search for appropriate ethical responses to moral conflicts in this region. From the beginning, it was evident that the bioethical agenda needed to be expanded beyond the biomedical and biotechnological questions. Since the outset, UNESCO has decisively supported the Network’s activities and actions, initially through its Regional Office in Mexico and currently through the Social and Human Sciences Sector of the Regional Science Office for Latin America and the Caribbean, which is based in Uruguay, as well as by UNESCO’s Division for Ethics in Science and Technology. It should be noted that the University of Chile, with the contribution of the Pan-American Health Organization (PAHO) and the Complutense University of Spain, had initiated bioethics education in the early 1990s with educational courses on bioethics taught in Chile, Colombia, Cuba and the Dominican Republic. The educational program was divided in two streams, one on research ethics, as a response to the research development in many countries, and the other one on clinical bioethics to respond to the difficulties of doctor-patient relationships in the new technological world. Some bioethicists organized the Latin American Federation of Bioethics Institutions (FELAIBE) to promote bioethics education through conferences (Lolas 2010). Committees on Research Ethics were formed in many countries, and some of them joined in the Forum of Latin American Research Ethics Committees (FLACEIS). The Bioethics Network, REDBIOETICA, has a portal that is currently hosted in Buenos Aires (www.redbioeticaunesco.org), and the REDBIOÉTICA UNESCO Journal, a biannual online publication, has been available on the portal since 2010 onward. This network and the UNESCO’s Program of Permanent Bioethics Education have developed a model of permanent education in bioethics by means of distance learning courses and offered it to health professionals, social science experts, members of ethics committees, community and political leaders and members of NGO’s. Since 2006 more than 1000 participants from more than 20 countries in the region have taken these courses.
An interesting contribution that originated in Latin America is the concept of “Living Well ”. This is based on an ancient philosophy of life among indigenous societies of the Andean region, especially in Bolivia, and which has been incorporated into the Bolivian Constitution. In this concept, what counts is not so much wealth, i.e. the things that people produce, but rather how the things produced concretely contribute to people’s lives. In formulating the “philosophy of living well” not only the material goods but also other factors are acknowledged, such as social and cultural recognition, knowledge, ethical and spiritual codes, relationships with nature, human values, and visions about the future. Within this context, the economy should be governed by living together in solidarity, without misery and without discrimination, while ensuring a minimum of necessities for everyone to survive in a dignified manner. “Living Well” expresses an affirmation of rights and social, economic and environmental guarantees. Everyone equally has the right to a decent life with assurances of health, food, clean water, pure air, adequate housing, environmental sanitation, education, work, employment, rest and leisure time, physical exercise, clothing, a retirement pension, and so on.
It is encouraging that many bioethics ideas expressed by REDBIOÉTICA in Latin America have contributed to the development of UNESCO’s Universal Declaration on Bioethics and Human Right s in 2005. The IBC meeting that was held in Mexico City in November 2009 was an opportunity for Latin America to share the idea of including health and social issues within the context of the Declaration. The book entitled, UNESCO Universal Declaration on Bioethics and Human Rights: background, principles and application (Ten Have and Jean 2009) recounts the history of the Declaration, and REDBIOÉTICA takes the view that this is the most important collective and historical document ever constructed by Bioethics, because of its openness and significant repercussions. Article 14 of this Declaration, in particular deals with “Social Responsibility and Health”, and has special value for the Network because of the Network’s tireless advocacy since the start of the debates that healthcare is everyone’s right and that States have a duty to provide access to health for all. This has been emphasized in the above-mentioned book in a chapter written by Martínez-Palomo, a Mexican scientist who is a member of the Board of Directors of both REDBIOÉTICA and former UNESCO’s IBC member (Martínez-Palomo 2009).
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