Abstract
The aim of this study was to contribute to a deeper understanding of intercultural conlicts within the ield of bioethics, and to idenify problems associated with using human rights as a theoreical normaive that media
-tor of bioethical conlicts characterized by interculturalism. The methodological steps adopted in this study were: an analysis of the concept of intercultural conlict in bioethics, from the percepion of the Colecivo Amani; a study of human rights as tools of human culture based on Bauman’s theory; and an invesigaion of the tools human rights ofer for the solving of intercultural conlicts in bioethics. It was concluded that inter
-cultural bioethics must apply the norms and insituions of human rights to its prescripive and descripive dimensions so as to ensure the paricipaion and social integraion of individuals from communiies in cultural conlict. Such measures will act as tools for the soluion of intercultural conlicts.
Keywords: Bioethics. Human rights. Cross-cultural comparison. Culture-social control, informal.
Resumo
Perspeciva bioéica intercultural e direitos humanos
Este arigo tem como objeivo contribuir para o aprofundamento da relexão acerca dos conlitos culturais na esfera bioéica e problemaizar o emprego dos direitos humanos como referencial teórico-normaivo, me
-diador dos conlitos em bioéica que apresentem elementos de interculturalidade. Os passos metodológicos adotados neste estudo foram: análise do conceito de perspeciva bioéica intercultural e de conlito cultural em bioéica, a parir da acepção desenvolvida pelo Colecivo Amani; exame dos direitos humanos como ins
-trumentos da cultura da humanidade, com base na teoria de Bauman; invesigação acerca dos ins-trumentos que os direitos humanos fornecem para a solução de conlitos culturais em bioéica. Concluiu-se que a pers
-peciva bioéica intercultural deve incorporar às suas dimensões prescriivas e descriivas os instrumentos dos direitos humanos, que concorrem para a solução de conlitos culturais, bem como as normas e insi
-tuições de direitos humanos, que asseguram a paricipação e integração social dos sujeitos integrantes de comunidades culturais em conlito.
Palavras-chave: Bioéica. Direitos humanos. Comparação transcultural. Cultura-controles informais da socie
-dade.
Resumen
Perspeciva bioéica intercultural y los derechos humanos
Este arículo iene como objeivo contribuir a la profundización de la relexión sobre los conlictos culturales en la esfera bioéica y discuir el uso de los derechos humanos como un referente teórico y normaivo, media
-dor de conlictos en materia de bioéica que presentan elementos interculturales. El proceso metodológico uilizado en este estudio fueron: análisis del concepto de perspeciva intercultural bioéica y del conlicto cultural en bioéica desde el senido desarrollado por el Colecivo Amani; examen de los derechos humanos como instrumentos de la cultura de la humanidad, basado en la teoría de Bauman; invesigación sobre los instrumentos de derechos humanos que plantean soluciones para los conlictos culturales en bioéica. Se con
-cluyó que la perspeciva intercultural bioéica debe incorporar en sus dimensiones prescripivas y descripivas los instrumentos de los derechos humanos que buscan la solución de los conlictos culturales, y también las normas e insituciones de derechos humanos, con vistas a garanizar la paricipación y la integración social de los sujetos de las comunidades culturales en conlicto.
Palabras-clave: Bioéica. Derechos humanos. Comparación transcultural. Cultura-controles informales de la sociedad.
Doutora alineaoliveira@hotmail.com – Secretaria de Direitos Humanos da Presidência da República, Brasília/DF, Brasil.
Correspondência
SQSW 302 Bloco F 105 CEP 70673-206. Brasília/DF, Brasil.
Declara não haver conlito de interesse.
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In the course of its theoreical, insituional and normaive construcion, bioethics has not em
-phasized cultural conlicts, despite the numerous conlict-laden situaions involving cultural elements as a source of confrontaion, controversy, and even wars, in the most varied regions of the planet. As an example, Koenig and Gates-Williams 1 highlight cultural disincions about life and death that are relected in themes such as the donaion of organs, the response of paients to pain and the deiniion of the beginning of the human person. In the same sense, Searight and Gaford 2 stress the impact of culture on paient-physician communicaion in the course of the deliberaive process, in the clinical arena and in the care of paients at the end of life. In fact, Porto notes that the cultural issue began in the mid-sixies to be incorporated into the debates about the quality of life of the populaions, especial
-ly of groups or segments with diferent sociocultural characterisics 3.
In this way, it is argued that bioethics, in the sense of applied ethics of a prescripive nature, ded
-icated to the soluion of concrete disputes in a variety of contexts, must deal with the consequences of the encounter between diferent cultures in the ield of medicine, the life sciences and technology. Such a bioethical focus on cultural conlicts is essenial to expanding its sphere of acion, to the extent that by incorporaing an intercultural dimension when deal
-ing with conlicts between individuals or groups of diferent cultures, bioethics becomes an essenial tool in the soluion of issues that arise in the hospi
-tal or in the context of public policies and programs. Thus, this aricle aims to contribute to the theoreical elaboraion of an intercultural bioethi
-cal perspecive (IBP), understood as the branch of bioethics that appropriates the foundaions of inter
-cultural studies to scruinize conlicts marked by the clash between diferent cultures, in order to simu
-late relecion on the consituent aspects of conlicts and contexts involved, as well as to make prescrip
-ions and contribute to conlict resoluion. In fact, it is understood that the IBP is characterized not only by its speciic object, i.e. cultural conlicts, un
-derstood as conlicts between diferent persons or cultural groups, but also by its normaive character, in that it defends respect for diferent cultures, over -coming the failures of ethnocentrism and cultural
relaivism, in search of an encounter in equality 4.
In this way, in addiion to being characterized by descripion of culturally based moral conlicts, the IBP also stands out by reason of its normaive
arguments in defense of respect for cultures and
human rights. For that to happen, i.e., with the pur
-pose of transposing its postulates to the pracical plane, IBP needs tools capable of insuring that the decision-making process in the context of cultural
pluralism is not permeated by ethnocentrism and
cultural relaivism. On the other hand, such tools
should also ensure the strengthening of
intercul-turality, the premises of which are as follows: 1) Do not look at other cultures using your own cultural paterns; 2) seek encounter and equality between cultures; 3) promote a criical view of the cultures, with some of their elements deserving criicism 4.
These tools to aid in decision making and me
-diaion have both a procedural character, since they relate to the rules of decision-making procedures, and a substanive character, limiing as they do the space for deliberaion, posiing principles that are not at stake in this procedure. Thus, in this ari
-cle, we argue that the tools menioned are human rights, in their condiion of universally shared rules of acion - which corresponds to a true culture of
humanity in the sense proposed by Bauman 5.
The methodological steps adopted in this
study were: 1) Analysis of the concept of IBP and cul
-tural conlict in bioethics, in the sense developed by the Amani Collecive 4; 2) an examinaion of human
rights as an instrument of the culture of humanity,
based on Bauman 5, with contribuions from Rorty 6;
3) research about the instruments that human rights provide for the soluion of cultural conlicts in bioeth
-ics, in order to develop a concepion of IBP based on human rights. Subsequently, the topic is approached from the viewpoint of IBP, emphasizing the related moral conlicts.
The Intercultural Bioethics Perspecive: descripive and normaive dimensions
Under this topic, we discuss the concepts of
culture adopted in this aricle, formulate a proposal for IBP, and inally, demarcate the noion of cultural
-ly based bioethical conlict.
The study of IBP requires dealing with the previous quesion related the concept of culture. Considering the scope of this work, we decided to dis
-cuss the issue within a single theoreical framework,
that of Bauman 5. Our theoreical consideraions
commence with an approach to culture as a
con-cept, recognizing the ambiguity of the term because of the existence of various schools of thought that historically converge around the same term. Accord
-ing to Bauman, there are three diferent concepts of
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culture that systemaize its content and emphasize the diferent aspects that consitute it: culture as an hierarchical concept; culture as a diferenial con
-cept; and the generic concept of culture.
Staring with a brief allusion to the hierarchi
-cal concept, culture means a quality of a person, the
“educated”, and thus correlates with the following
terms: educated, polite, courteous, reined 7. Turn
-ing to culture as a diferenial concept, its use sheds light on the visible diferences among communiies of people. The diferenial concept is incompaible with the idea of cultural universals, and the only universal that its this concept concerns the human characterisics common to the species.
According to Bauman, the plurality and sin-gularity of cultures became such a paradigm
among anthropologists that it consituted a “fact” requiring no veriicaion or proof. On the oth
-er hand, the dif-erenial concept is ied to the
understanding of culture as a closed system
of characterisics that disinguish one community from another, so that if each culture consitutes a
closed, cohesive, singular enity, the disagreements
between cultures are seen as a clash between
dis-incive and coexising cultural totaliies, making the idea of “cultural shock” an “evident truth” 8.Thus
those who cling to the diferenial concept of culture cherish the uniqueness of the cultures and judge the mixture of cultures to be something abnormal and
reprehensible 5.
The generic concept of culture connects to
atributes shared by all members of the human species, disinguishing it from the others. This per
-specive includes culture as something inherent to
the human being, and therefore a concept
encom-passing universal human aspects. For example, man is the only animal who laughs, makes tools, and pro
-duces art, moral prohibiions and symbols; that is to say, there is a set of elements consituive of the human species that are universal, and which can be deined as human culture.
In this sense, the culture of humanity is one, and the cultures that are forged in diferent social, economic, and environmental spheres are por
-ions of the whole. The generic concept of culture
is also anchored in the understanding that despite
the speciiciies of each human community, human
beings share a list of basic needs that if not met,
precludes the existence and the very survival of the species. Thus, regardless of idiosyncraic character
-isics of human groupings, it is well known that the language and the producion of symbols consitute
the universal basic core of human culture 8.
Based on the concepts of Bauman, this study
adopts speciically the diferenial and the gener -ic concepts of culture, understanding that human
communiies have paricular cultures; however, this empirical observaion does not lead to a denial of the existence of a culture of mankind, into which the individual cultures converge and with which they share their elements.
The study of the IBP entails a prior disincion between non-normaive and normaive approach
-es to bioethics 9.The non-normaive, descripive
approach to bioethics deals with the factual
descrip-ion and explanadescrip-ion of behavior and moral views. The normaive approach focuses on basic principles that govern moral life and on the design of stan
-dards of conduct for acion. Taking into account this disincion, the IBP, from a non-normaive point of view, takes as its object of study the descripion and
understanding of culturally based bioethical
con-licts, through the analysis of the moral behavior of diferent cultures and their disagreements. This be
-ing the case, the descripive IBP is anchored in the diferenial concept of culture, i.e., that difereniat
-ed communiies feature natural moraliies, as well as approximaing an understanding of mulicultural
-ism as a social phenomenon 4.
From the normaive viewpoint, the IBP as -sumes a system of moral principles and prescribes
ways to accomplish its implementaion 9. Thus it is
grounded in both the meaning of interculturalism, as
reference to the equal value of each culture 10, and the generic concept of culture. The principles and moral guidelines governing the IBP can be subdivided into principles of interculturalism, the in
-tercultural dialog and the equal value of all cultures, and principles of human rights.
Staring with the descripive IBP, the deiniion of conlict shows itself to be an arduous task, to the extent that there are diferent approaches, such as
the social psychological and the sociological 4. In the
light of social psychology, conlicts can be deined as situaions in which the actors are pursuing diferent goals, defend contradictory values, have opposing or diferent interests, or are simultaneously and compeiively pursuing the same goal. Using a socio
-logical prism, the sociology of conlict deines it as a situaion in which there coexist purposes and values
that are irreconcilable between people or peculiar
to each. Thus culturally based conlict, in general, can be understood as a situaion of conlict between people or groups of people of diferent cultures.
Culturally-based conlict is to be found in sit
-uaions explicitly marked by cultural difereniaion
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between the paries involved. In such cases, we must pay special atenion to the cultural factor,
which will interfere directly in the process of
interac-ion and communicainterac-ion between those concerned
4. From the point of view of the IBP, culturally based
bioethics is understood as a divergent moral situa
-ion involving paries from diferent cultures, related
to medicine, the life sciences and associated tech-nologies when applied to human beings, as in the
descripion of the object of bioethics in the Univer-sal Declaraion on Bioethics and Human Rights 11.
The IBP of a non-normaive nature is not only anchored in the fact of moral diversity, but also
brings to bear as guiding principles intercultural
dialog and the equal value of the cultures, as well
as human rights, which will be treated later in this
paper. Intercultural dialog surpasses ethnocen -trism, which implies approaching a culture from the
perspecive of one’s own culture, causing lack of understanding, paternalism and unequal treatment among the paries involved in cultural conlicts 4.
In the same sense, interculturalism outweighs cultural relaivism, understood as the analysis of a culture taking into consideraion only standards of internal evaluaion. The risk of relaivism is that it may abort any criical view of a paricular culture, prevening the rejecion of certain tradiional prac
-ices or the struggle against them; establishing that each tradiional community remains limited to its
own space, secluded from the possibility of
en-counters between cultures 4; and inally, endorsing
discriminatory or ethnocentric cultures.
In upholding the principle of the equal worth of cultures, interculturalism advocates the disman -tling of the whole idea of cultural superiority, thus
limiing the ethnocentrism of the paries to the conlict 12. Along these lines, to the extent that it problemaizes the employment of the tools of one
culture to understand another, the diatopian
her-meneuic contributes to meeing in equality and to bridging gaps between two diferent cultures 13. For Santos, the scope of the diatopian hermeneuic in
-cludes expanding to the maximum the awareness of mutual incompleteness, through a dialog that takes place, so to speak, with one foot in one culture and the other in another 14; i.e. , the author is dealing
with intercultural dialog, which will be covered later.
Thus, as regards the principle of intercultur-al diintercultur-alog, it should be noted that interculturintercultur-ality
denotes the construcion of spaces of collecive
par-icipaion between diferent cultures 15, within which will occur intercultural dialog, of a dialogical nature. In fact, Panikkar 16 proposes dialogical dialog as a
way to deal with a pluralisic conlict, which presup -poses mutual openness toward the other and the
recogniion of the incompleteness of the cultures. Intercultural dialog goes beyond mere tolerance or formal respect 10; moreover, it implies a cooperaive
aitude among the paricipants, who are sincerely
trying to reach agreement 17.
According to Panikkar, the search for “homeo
-morphic equivalents” 16 forms a part of the
intercultural dialog, because the dialogical
con-versaion between people or groups of diferent cultures demands not only the literal translaion of the language, but mainly the creaion of methods
to promote the understanding of symbols 4 of one
determined cosmovision in another, through the
search for terms whose meaning is closest to the
meaning in the language of another culture 13. In
-tercultural dialog requires understanding between the paries involved in the conlict through taking an open stance toward the diferent and building bridg
-es across the interpretaive schem-es of culturally apprehended reality, with a view to the construcion of shared symbols and meanings.
The IBP - whose focus is on culturally based conlicts, relecing on them, normalizing them and mediaing them through instances of the in
-situional dimension - as will be seen later in this paper - requires both respect for equality between
cultures and intercultural dialog, with the fair and
balanced paricipaion of all the paries involved 18. Next, human rights will be discussed as principles and universal standards, consituents of the culture of humanity.
Universal human Rights: consituent aspects of the culture of humanity
Currently, it is striking that people live with a plurality of cultures, not belonging to just one cul
-tural community 19. Even tradiional communiies
interact with those who do not belong to them and
who act as transmiters and receptors of beliefs, val
-ues, customs and other components of culture. Thus arises the noion that culture is a device of adapta
-ion, since cultures change historically and are not something staic, and changes may come to enrich
them 4. Likewise, cultures are experienced difer
-ently by their members; the members of a cultural
community are never homogeneous in all aspects, because each brings muliple social ideniies 20.
Thus, given that cultures modify themselves and change through the inluence of other cul
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tures, and that their members share diferently in
the cultural elements that comprise them, an
in-exorable openness of cultures and their members to elements external to them is to be noted. The movement of openness provokes the incorporaion
of non-original languages - which, by itself, cannot
be seen as posiive or negaive for the maintenance of the social texture of that social group.
In addiion to the vision of diferences between
cultures, there is a culture of humanity, composed of aspects widely shared by members of the human
species. Among these common elements are mor -al norms which are basic for soci-al fellowship and which crisscross cultures - which does not imply the
observance of these norms by everyone, without disincion. Anchored in this understanding, this aricle sustains that human rights, anicipated in internaional treaies, are norms of conduct wide
-ly shared by the diferent cultures, in such a way that they consitute the culture of mankind; never
-theless, it recognizes that some of those rules are having problems being put into pracice. Without aiming to refute the varied arguments against the universal concepion of human rights, it it oppor
-tune to cite philosopher Richard Rorty, in an atempt to add theoreical underpinning to the sense of hu
-man rights as the culture of -mankind. Diferently from the Western tradiion, Rorty does not anchor them in raionality, but rather in human seniments common to all the members of the species.
Actually, Rorty 6 points out that to overcome the view of the other as “quasi human”, not deserving of the same respect and consideraion, implies search
-ing for what we all have in common: our humanity, a shared consituent element considered criical for in
-tegraing the other into the moral community. Thus despite their trivial diferences, whites and blacks, men and women, Chrisians and Muslims, hetero
-sexuals and homo-sexuals, have something that unites them and makes them equal, permiing the construcion of a moral community in which every
-one has the same intrinsic value. According to Rorty,
the accomplishment of this result is only possible
through afecive educaion, not by a simple uilitar
-ian calculaion or engagement in a process of public deliberaion. By producing generaions of gentle, tol
-erant, secure persons, respecing others, the culture of human rights will be strengthened.
In this aricle, we have sought to assess Rorty’s contribuion to the concept of a culture of mankind developed by Bauman; there has been no atempt to discuss the complexity of puing human rights into efect. In contrast to Santos’s 14 proposal, universali
-ty is not quesion of Western culture speciically, but rather an aspect which is fundamental for all vulner
-able individuals, regardless of their culture. Women,
children, indigenous people and economically
mar-ginalized groups are the bearers of human rights,
and recourse to these instruments with the purpose
of demanding that naional governments and inter
-naional organizaions put them into pracice is an undeniable advance. In the next topic, the theme or
human rights as norms of conduct underlying the
IBP sill be discussed.
The Intercultural Bioethical Perspecive based on human rights
The scope of this part of the aricle is a contri
-buion to the development of a IBP based on human rights. The proposal takes as its staring point the assumpion that human rights are not the only theoreical reference point capable of dealing with culturally based moral conlicts. As Lorenzo 20 pro-posed, ethical decisions in intercultural contexts can be grounded in the Habermasian model of dialog. While recognizing the suspicions that universalisic claims provoke in certain schools of contemporary
philosophy 3,21,an IBP based on human rights neces
-sarily takes as its staring point its universality and transcultural acceptance.
Because of undue associaion, the biomed
-ical paradigm is imposed in a generalized manner,
reinforcing the asymmetry of power among the
interlocutors, in cases in which the cultural paric
-ulariies of the minoriies do not correspond to the parameters accepted by the majority. In this sense, human rights are the foundaion of a IBP which is procedural and substanialist 22. The focus of the IBP, with its three dimensions (theoreical, insituional and normaive) 23, is the insituional dimension; that is, bioethical insituions such as ethical re
-view commitees, hospital ethics commitees and naional bioethics commitees, that cooperate with those involved in moral conlicts, seeking a soluion
through intercultural dialog 11.
From a procedural viewpoint, prescripions of
concrete moral contents are not sought, but rather
the introducion of procedures that make it possible to legiimize or de-legiimize procedural norms that underly processes of resoluion of culturally-based moral conlicts. In the light of substanialism, the IBP opts for shared norms of conduct 22. Thus via
the procedural bias, human rights rest on a series of
norms of conduct that must be observed by the par
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icipants in the decision making process in concrete cases, or moral conlict mediaion through adopion of intercultural dialog. Thus determined human rights are to set the agenda for the bioethical insitu
-ions menioned above, when adoping procedures designed to resolve culturally based moral conlicts. In efect, the cultural rights of those involved, deined in Aricle 27 of the Universal Declaraion of Human Rights 11 and in Aricles 13 and 15 of the
Internaional Pact on Economic, Social and Cultural Rights (IPESCR) 24 are to be respected by all con-cerned in the dialogic procedure. The cultural rights are fundamental to the protecion of individual
members of minority groups, in that they permit the defense of their life style against the incursions of
other communiies, especially the State 25.
People’s right to paricipate in decisions that concern and afect them, their right not to be dis -criminated against and the right to freedom of
expression should be highlighted. The right to par
-icipaion implies that those involved in conlict can take part in decision making or mediaing processes.
The right not to be discriminated against implies
re-spect for their beliefs, religion, values and life style. For example, people of African descent in Brazil have been sufering discriminaion because of the pracice of candomblé26. This discriminaion is re
-lected in culturally based moral conlicts, in which
the followers of candomblé demand recourse to
tra-diional pracices that help them in the treatment of diseases, in contrast to pracices considered correct by the majority.
Through a substanialist prism, the principle that governs the human rights based IBP is what is found in Aricle 12 of the Universal Declaraion of Bioethics and Human Rights: the principle of respect
for cultural diversity and pluralism, with the provi
-so that such consideraions must not be invoked to violate human rights 11. The same idea is found in
the Universal Declaraion on Cultural Diversity, also
by UNESCO, signed in 2012 27. In efect, as Beuchot 28 points out, the human rights serve as a limit for determined cultural pracices; nevertheless, it must not be forgoten that an ambient of respect for cul
-tural diferences and those of other orders is a sine qua non for the lourishing of human rights.
Determined pracices which are harmful to
women and children, such as early marriage,
collec-ive rape as a form of jusice between communiies,
and homicide of women in the name of honor,
must not be tolerated under a cover of being cul
-tural pracices. Among other things, because certain cultural pracices relect patriarchy, asymmetrical
power relaionships, discriminaion against wom
-en and subjugaion of childr-en. Thus ethical review commitees, hospital ethics commitees and naion
-al bioethics commitees must adopt human rights as the backdrop for the ethical analysis of the jusice and correctness of a determined conduct. Although the importance of legiimate dialogical procedures anchored in human rights is recognized, it is admit
-ted that they are insuicient for reaching efecive decisions, the fruit of agreement among the paries. There exist limits that are imposed on the paries involved in culturally based moral conlicts; i.e., cer -tain conducts are a priori unacceptable, inasmuch as
they are in conlict with the norms of human rights. In the resoluion of culturally based mor
-al conlicts, it is important to disinguish between two types of conlict: conlicts in which there is no presence of violaion of human rights and conlict in which there is violaion of human rights. In the irst type of conlict, there is moral disagreement on determined conducts, but situaions of violaion of human rights are not present. In the second case, besides moral disagreement, the pracices regarding which there is disagreement consitute a violaion of human rights. It is important to clarify that violaion of human rights is characterized as conduct perpe
-trated by the State, through acion and omission, in infringement of internaional human rights treaies.
According to the typology of human rights
ob-ligaions, the State has three obligaions: to respect, to protect and to promote; thus violaion presup -poses noncompliance with one or more of these
duies. One example of noncompliance, in this case with the duty to respect, is when the State acts in direct violaion of human rights, torturing ciizens for poliical reasons or any other other reason, or when the State is remiss in failing to adopt measures of protecion of the populaion designed to impede the violaion of their human rights; and lastly, with regard to the duty to promote, it is when the State fails in the execuion of programs and policies and in the creaion of administraive and legislaive mea
-sures aiming to put human rights into pracice. A certain degree of subjecivity is recognized in the ideniicaion of a determined pracice as a violaion, or not, of human rights. However, the are oicial declaraions by UN human rights bodies in that sense, such as the resoluion adopted in De
-cember 2012, calling upon all member countries to eliminate female genital muilaion 28. There are global consensus, achieved at the venues of dia
-logical construcion of the UN, regarding conduct in violaion of human rights. Considering that con
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licts can be analyzed casuisically or in the abstract, the bioethical insituions responsible for such ex
-aminaion must take into account the previously established internaional standards, as well as the principle of maximum protecion of human rights. At any rate, consideraions regarding the presence or absence of human rights violaions in a determined conlict must precede the applicaion of the IBP in
-struments proposed in this aricle, because such deiniion will determine the subsequent manner of treatment of the culturally based bioethical conlict
To illustrate a conlict in which there is no viola
-ion of human rights, consider the case of Lorenzo 20,
concerning a child of Tucano ethnicity who was bit by a
jararaca snake and interned in a health unit in Manaus. At that unit the child’s father requested the entrance of the shaman, so that the child might be submited to treatment in accordance with his own culture. As the request was denied, the father took legal acion to withdraw the child from the health unit. The direc -tor of a hospital in the region proposed to the father
that the child be interned in the intensive care unit (ICU) and submit to Western medical treatment, along with the tradiional forms ministered by the shaman.
The proposal was accepted by the father, and the
re-port culminates with the healing of the child. In this example, we see that there was a culturally based bio
-ethical conlict concerning the treatment of the child; however, it is clear that none of the paries involved praciced any act in violaion of the human rights of the child. Both acted to safeguard his health.
In contrast, in conlicts of the second type, as in the case of indigenous infanicide and female gen
-ital muilaion, there is violaion of the human rights of children and women, even though the contexts in which such pracices occur are clearly diferent. In these cases, the principle of respect for cultural diversity and pluralism is respected, according to which cultural diversity and pluralism must not be invoked to jusify the violaion of human rights. Thus such pracices are rejected, even though the fact of conceiving them as violaions of human rights may not consitute an incenive for immediate cultural changes; rather, efecive intercultural measures in that direcion are required.
Thus with regard to the resoluion of cultur
-ally based moral conlicts by bioethical insituions, two kinds of procedure are disinguished, depend
-ing on the type of conlict. Conlicts in which there
is no violaion of human rights may be resolved
through Habermas-based intercultural dialog 20, and the adopion of human rights as a yardsick for the procedure of deliberaion among those concerned.
Among these rights are the right to express them
-selves in their own language, the right to choose and exercise their cultural pracices, the right to par
-icipate in decisions that concern and afect them,
the right not to be discriminated against, and the
right to freedom of expression.
Conlicts in which there is the presence of
violaion of human rights depend, in addiion to en -couragement of intercultural dialog, on measures of
another nature, in view of the very violaion of the human rights of vulnerable groups. Nevertheless,
it should be stressed that these measures must
re-spect the cultural rights of those involved, and all those menioned above. It is important to point out that the determinaion of the measures depends on the veriicaion of the type of pracice which is the object of conlict, i.e. 1) whether it is a tradi
-ional pracice of a cultural minority, 2) whether the tradiional pracice is that of a hegemonic cultural majority. In the irst case, intervenionist measures, without respect for cultural speciiciies, are to be rejected, at the same ime that the intercultural approach calls for percepion of the culture under
analysis, cleansed of an ethnocentric way of
see-ing, eliminaing negaive stereotypes and seeking a relaionship of empathy with the culture. Thus it
is understood that strategies based on intercultural
mediaion 4 are appropriate for conlicts in which vi
-olaion of human rights has been detected.
In the second case, when tradiional pracic
-es relect the posiion of inferiority of women and children in a given patriarchal society, intercultural dialog and mediaion are insuicient for the resolu
-ion of culturally based moral conlicts. Employing the strategies of the United Naions Fund for Popu
-laion Aciviies (UNFPA) to deal with female genital muilaion, the following measures stand out: 1) alteraion of naional legislaion to prohibit the prac
-ice, without necessarily criminalizing it, signaling its disapproval by the State; 2) promoion of public cam
-paigns; 3) empowerment of communiies to debate the issue and reach an internal consensus; 4) inform
-ing the communiies regard-ing the consequences of the tradiional pracice for health; 5) public decla
-raions of inluenial members of the communiies, as a form of persuasion; 6) paricipaion of religious
and community leaders as change agents 29.
As for the aciviies of the bioethical insi
-tuions, it can be veriied that the ethical review commitees and the hospital ethics commitees fre
-quently deal with conlicts in which there has been no violaion of human rights, and that most of these conlicts concern the relaionship between the sub
-Upda
ject of research and the researcher or sponsor, and between the paient and the health professional - relaionships which despite being asymmetrical, are
usually permeated by the ethical performance of the
paries involved. As for conlicts in which there has been violaion of human rights, they will be handled by naional bioethics commissions, because they in
-volve pracices in violaion of the human rights of vulnerable groups.
Thus the IBP deals with culturally based con
-licts, with or without violaion of human rights. Consequently, the bioethical insituions that are to apply it in the resoluion of this kind of conlict must be atenive to the diferent ways of dealing with them. Nevertheless, their behavior must always be oriented
by the human rights norms, whether in terms of
pro-cedure or from a substanialist perspecive.
Final consideraions
Culturally based moral conlicts are a reality in a large part of the globe. Diferent cultures give rise to medical or sanitary pracices, or those relat
-ed to the life sciences, that are also difereniat-ed
- which may lead to dissensus regarding their
mo-rality. It is extremely important that bioethics, as
ethics applied to moral issues, concern itself with
such quesions, demonstraing its connecion with the world of life and its role as a relevant instrument for ordering social life. Designed to make speciic theoreical contribuions for dealing with cultural
-ly based moral conlicts, the equality of cultures in intercultural dialog, as a precept oriening decision making and intercultural mediaion, implies reject
-ing ethnocentrism and cultural relaivism.
The theoreical-normaive reference point for
human rights as an ethical agenda which is both
procedural and substanive, given its condiion as an
integral element of the culture of mankind, and its role in the defense of diferent cultures, especially those in a minority, is essenial. Thus human rights, which are universal in that that all members of the human species are enitled to them, reveal them
-selves to be a unique instrument in the defense of vulnerable groups and the rejecion of authoritar
-ian governments and pracices. This is expressed
in the use of human rights by indigenous peoples
to enforce their rights before the InterAmerican System of Human Rights, and by nongovernmental organizaions in countries where there are harmful tradiional pracices, such as child weddings, female genital muilaion and honor killing of women.
It is by virtue of their universality in the de
-fense of vulnerable groups that the construcion of the IBP based on human rights, through which culturally based moral conlicts and intercultural mediaion, procedurally grounded in the cultural rights, the right to paricipaion, the right not to
be discriminated against and the right to freedom
of expression, was proposed. In the case of cultur
-ally based moral conlicts in which there has been violaion of human rights, beyond the human rights that orient dialog and cultural mediaion, it will be necessary to have recourse to the principle of prev
-alence of human rights, thus rejecing arguments of
authority in terms of the predominance of the
cul-tures over the rights of any human being not to be submited to torture, cruel, inhuman or degrading treatment, and others of the same nature.
Finally, it should be noted that strategies for the resoluion of culturally based moral conlicts,
which, regardless of their nature, are anchored in
human rights, start from the assumpion that there is no hierarchy among cultures and that protecion of the vulnerable, regardless of the cultural commu
-nity of which they are members, is the inexorable duty of the State.
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Recebido: 23.1.2015 Revisado: 12.2.2015 Aprovado: 26.2.2015
