By RENATO STECKERT DE OLIVEIRA*
Considerations on ethics, medicine and politics in Brazil
In an article published in the newspaper Folha de S. Paul On the 24th of this month of August, under the title “Clinical Humanoids”, Muniz Sodré puts his finger on one of our wounds: “the worrying qualitative gap between the level of practice and that of the institution” in Brazilian medicine.
The article draws attention to the recent restructuring of the Federal Council of Medicine, which brought to the body responsible for ensuring the ethical and scientific standards of the profession some supporters of modern charlatanism, defenders of chloroquine in the fight against Covid and the like, in addition to notorious representatives of the far right, which amounts to the same thing.
Worrying is the least that can be said. But the phenomenon is not new. Ever since the Brazilian Medical Union was founded in 1927, authoritarian and totalitarian ideologies have haunted the positions of Brazilian doctors. Some early conspirators in 1930, in the name of political commitments inherent to the medical profession, were also the first to support the 1937 coup d'état, explicitly defending their alignment with Nazi-fascism. During this period, the Union's magazine began to adopt the swastika as a decorative graphic element on its pages.
Eugenics movements followed what was happening around the world, giving it a local color. Among other proposals, they defended the compulsory sterilization of those with “social defects” (obviously the mentally ill, but also the deaf, mute and “disabled” in general), in addition to opposing Japanese immigration, alleging its “prolificity, competition and incompatibility with the white race”.
Just like the Estado Novo, the Medical Union also lost support with the end of the war. A Post-War Brazilian Medical Congress, organized in 1945, established a new hegemony in the medical field, aligned with what was discussed in Nuremberg and focused on public health problems with a democratic vision of society.
In the early 1950s, a national strike by doctors in the federal public service (the first national strike by a professional category) led to the founding of the Brazilian Medical Association, which had a distinctly liberal character. This liberalism was not lacking in its Cold War vocation: its leaders enthusiastically supported the 1964 coup, again in the name of political commitments inherent to the medical profession.
From the 1970s onwards, the practice of medicine began to suffer from the disorganization of the dictatorship's health policies and the expansion of private medical institutions (this was the period when a health market was formed in Brazil) without adequate regulation. Cases of errors and ethical transgressions multiplied, to the point that the weekly The Quibbler dedicate a section to the topic, entitled “The White Mafia”, edited by none other than Millôr Fernandes.
The reaction of some state medical unions began to change the situation. By denouncing the lack of a national health policy as the cause of the problem, they started a movement that culminated in the approval, by the Constituent Assembly, of the Unified Health System. The First Brazilian Congress on Medical Ethics, held by the Federal Council of Medicine in 1988, not coincidentally the year in which the new Constitution was enacted, sealed the commitment of the new leaders of the profession to democracy. Once again in the name of commitments inherent to the profession. “Health is democracy, democracy is health” was the slogan at the time.
It is interesting to observe the effects of this back-and-forth on the successive codes of ethics enacted in Brazil. Where is the moral of this story? From my point of view, it is that Brazilian medicine has failed to develop an ethic of professionalism, remaining stuck in an ethic of engagement.
Professional ethics are the ethics of liberal societies, of competent and “disinterested” fulfillment of a social function configured in a profession. Articulated with the civic culture of political tolerance and a minimum equalization of social opportunities, it is the foundation of modern democracies.
The ethics of engagement, on the other hand, is the ethics of great causes. Its crude version (let us respect Pascal and Sartre!) can be translated as follows: my knowledge allows me to distinguish good from evil, and therefore to do good, and if someone disagrees, it is due to ignorance, reactionism, communism or whatever. In short, it should be eliminated, at least from public debate.
The social roots of this phenomenon are complex. Muniz Sodré points out some of them. But, also from my point of view, it cannot be separated from the fact that, despite undeniable advances in the institutional design of health care, the structural problem has not been resolved: the majority of the population remains without adequate medical care, to say the least. And, in the absence of a national policy on medical training, the way has been paved for the indiscriminate commercialization of medical courses.
Since this is the government's job, none of this will be resolved by doctors. But the resulting professional tensions transform what would be normal ideological differences into sectarian conflicts that reproduce the growing divisions in society. The core of professional ethics, which is the relationship between the medical profession and the population, is thus compromised.
More than “an outbreak of national brutalism”, the fissure pointed out by Muniz Sodré reveals something of the very essence of Brazil. It has always been there.
*Renato Steckert de Oliveira He is a retired professor from the Department of Sociology at UFRGS. He was Secretary of Science and Technology of Rio Grande do Sul (2001-2002).
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