By PAULO CAPEL NARVAI*
The Federal Council of Medicine accuses Ligia Bahia, a doctor and professor of social medicine, of doing what the autarchy should do and which, for political-ideological reasons, it does not do, violating its own code of ethics
Charged by law with overseeing the practice of the medical profession in Brazil, the Federal Council of Medicine is taking legal action against Ligia Bahia, a physician, researcher, and professor at the Federal University of Rio de Janeiro (UFRJ), accused of slander and defamation against its directors. The lawsuit is directed against the professional, but it directly violates the Code of Medical Ethics, approved in 2018 by the Federal Council of Medicine itself. Furthermore, this lawsuit against her stems from a notorious contradiction: as habitual violators of ethics and deontology, which they should uphold, counselors of the Federal Council of Medicine base their case on pseudoscience, which they should combat, as part of their professional duties.
The tactic used by the Federal Council of Medicine against Ligia Bahia is a classic of unethical political practices: accusing opponents of doing what the accuser does. In the 2024 São Paulo election campaign, the candidate for reelection, and then mayor of the capital of São Paulo, Ricardo Nunes, who had an advisor in his office suspected by the police of maintain connections with the criminal organization known as PCC, accused his opponent Guilherme Boulos of having links with the… PCC.
Os medical advice, Federal Council of Medicine and regional bodies, were established by Getúlio Vargas, in 1945 and, in 1957, Juscelino Kubitschek sanctioned the Law No. 3.268, which governs the actions of these bodies, federal agencies with legal personality under public law, with administrative and financial autonomy. These agencies, says the law, “are the supervisory bodies of professional ethics throughout the Republic and, at the same time, judges and disciplines of the medical profession, and are responsible for ensuring and working by all means within their reach for the perfect ethical performance of medicine and for the prestige and good reputation of the profession and of those who practice it legally”.
According to art. 15 of the law that defines the mission and regulates the actions of medical boards, the attributions of the Federal Council of Medicine include several administrative procedures internal to these bodies and “voting and amending the Code of Medical Ethics”.
To comply with this legal requirement, in 2018 a resolution of the Federal Council of Medicine approved, as a “Code of Medical Ethics”, the code of ethics required by Law No. 3.268. The document contains “the standards that must be followed by doctors in the exercise of their profession, including in activities related to teaching, research and administration of health services, as well as in any other activities that use knowledge arising from the study of medicine”, and is composed of “25 fundamental principles of the practice of medicine, 11 dichotomous standards, 118 deontological standards and four general provisions”.
It is therefore based on Law No. 3.268/1957 and the code of ethics that regulates it, within the scope of the Federal Council of Medicine, that the agency took legal action against Ligia Bahia. In doing so, however, the Federal Council of Medicine acts against the “Code of Medical Ethics” that it approved in 2018.
Otherwise, let's see: Among the 25 principles mentioned, the following are violated by the legal action against Ligia Bahia: V, X, XIII, XIV, XV, XVIII, XXI, XXII, XXIII and XXVI.
These principles state that: “it is the physician’s responsibility to continually improve his/her knowledge and use the best of scientific progress for the benefit of the patient and society” (V); “the physician’s work cannot be exploited by third parties for profit, political or religious purposes” (X); “the physician shall report to the competent authorities any forms of deterioration of the ecosystem that are harmful to health and life” (XIII); “the physician shall strive to improve the standards of medical services and to assume his/her responsibility in relation to public health, health education and legislation related to health” (XIV); “the physician shall be in solidarity with movements defending professional dignity, whether through fair and just remuneration or working conditions compatible with the ethical-professional practice of medicine and its technical-scientific improvement” (XV); “the physician shall show respect, consideration and solidarity towards his/her colleagues, without refraining from reporting acts that contradict ethical postulates” (XVIII); “in the process of making professional decisions, in accordance with the dictates of conscience and legal provisions, the physician shall accept the choices of his patients regarding diagnostic and therapeutic procedures expressed by them, provided that they are appropriate to the case and scientifically recognized” (XXI); “in irreversible and terminal clinical situations, the physician shall avoid performing unnecessary diagnostic and therapeutic procedures and shall provide the patients under his care with all appropriate palliative care” (XXII); “when involved in the production of scientific knowledge, the physician shall act with impartiality, independence, truthfulness and honesty, with a view to the greatest benefit for patients and society” (XXIII); “medicine shall be practiced using the available technical and scientific means that aim at the best results” (XXVI).
Among the diceological norms are included the rights of the physician: “I – To practice medicine without being discriminated against for reasons of religion, ethnicity, color, sex, sexual orientation, nationality, age, social status, political opinion, disability or any other nature; II – To indicate the appropriate procedure to the patient, observing scientifically recognized practices and respecting current legislation; (…) IX – To refuse to perform medical acts that, although permitted by law, are contrary to the dictates of one's conscience”.
Dentre as 118 normas deontológicas incluem-se as que vedam ao médico: “causar dano ao paciente, por ação ou omissão, caracterizável como imperícia, imprudência ou negligência; acumpliciar-se com os que exercem ilegalmente a medicina ou com profissionais ou instituições médicas nas quais se pratiquem atos ilícitos; deixar de esclarecer o trabalhador sobre as condições de trabalho que ponham em risco sua saúde, devendo comunicar o fato aos empregadores responsáveis; deixar de esclarecer o paciente sobre as determinantes sociais, ambientais ou profissionais de sua doença; deixar de assegurar, quando investido em cargo ou função de direção, os direitos dos médicos e as demais condições adequadas para o desempenho ético-profissional da medicina; permitir que interesses pecuniários, políticos, religiosos ou de quaisquer outras ordens, do seu empregador ou superior hierárquico ou do financiador público ou privado da assistência à saúde, interfiram na escolha dos melhores meios de prevenção, diagnóstico ou tratamento disponíveis e cientificamente reconhecidos no interesse da saúde do paciente ou da sociedade; deixar de colaborar com as autoridades sanitárias ou infringir a legislação pertinente; deixar de denunciar prática de tortura ou de procedimentos degradantes, desumanos ou cruéis, praticá-las, bem como ser conivente com quem as realize ou fornecer meios, instrumentos, substâncias ou conhecimentos que as facilitem; participar, direta ou indiretamente, da execução de pena de morte; usar da profissão para corromper costumes, cometer ou favorecer crime; deixar de usar todos os meios disponíveis de promoção de saúde e de prevenção, diagnóstico e tratamento de doenças, cientificamente reconhecidos e a seu alcance, em favor do paciente; deixar de informar ao paciente o diagnóstico, o prognóstico, os riscos e os objetivos do tratamento, salvo quando a comunicação direta possa lhe provocar dano, devendo, nesse caso, fazer a comunicação a seu representante legal; prescrever tratamento e outros procedimentos sem exame direto do paciente, salvo em casos de urgência ou emergência e impossibilidade comprovada de realizá-lo, devendo, nesse caso, fazê-lo imediatamente depois de cessado o impedimento, assim como consultar, diagnosticar ou prescrever por qualquer meio de comunicação de massa; ao utilizar mídias sociais e instrumentos correlatos, o médico deve respeitar as normas elaboradas pelo Conselho Federal de Medicina ; usar de sua posição hierárquica para impedir, por motivo de crença religiosa, convicção filosófica, política, interesse econômico ou qualquer outro que não técnico-científico ou ético, que as instalações e os demais recursos da instituição sob sua direção sejam utilizados por outros médicos no exercício da profissão, particularmente se forem os únicos existentes no local; acobertar erro ou conduta antiética de médico; utilizar-se de sua posição hierárquica para impedir que seus subordinados atuem dentro dos princípios éticos; o exercício mercantilista da medicina; exercer a profissão com interação ou dependência de farmácia, indústria farmacêutica, óptica ou qualquer organização destinada à fabricação, manipulação, promoção ou comercialização de produtos de prescrição médica, qualquer que seja sua natureza; exercer simultaneamente a medicina e a farmácia ou obter vantagem pelo encaminhamento de procedimentos, pela prescrição e/ou comercialização de medicamentos, órteses, próteses ou implantes de qualquer natureza, cuja compra decorra de influência direta em virtude de sua atividade profissional; estabelecer vínculo de qualquer natureza com empresas que anunciam ou comercializam planos de financiamento, cartões de descontos ou consórcios para procedimentos médicos; participar de qualquer tipo de experiência envolvendo seres humanos com fins bélicos, políticos, étnicos, eugênicos ou outros que atentem contra a dignidade humana; deixar de utilizar a terapêutica correta quando seu uso estiver liberado no País; realizar pesquisa em uma comunidade sem antes informá-la e esclarecê-la sobre a natureza da investigação e deixar de atender ao objetivo de proteção à saúde pública, respeitadas as características locais e a legislação pertinente; manter vínculo de qualquer natureza com pesquisas médicas em seres humanos que usem placebo de maneira isolada em experimentos, quando houver método profilático ou terapêutico eficaz; permitir que sua participação na divulgação de assuntos médicos, em qualquer meio de comunicação de massa, deixe de ter caráter exclusivamente de esclarecimento e educação da sociedade; divulgar informação sobre assunto médico de forma sensacionalista, promocional ou de conteúdo inverídico; divulgar, fora do meio científico, processo de tratamento ou descoberta cujo valor ainda não esteja expressamente reconhecido cientificamente por órgão competente”.
In the dozens of expressions of support and solidarity for Ligia Bahia, published at the end of January and February 2025, from entities in the health sector, teaching and research institutions from various areas of the scientific field, among which Brazilian Society for the Advancement of Science (SBPC) and the Brazilian Academy of Sciences (ABC), it was emphasized that the statements made by the doctor, researcher and professor were given to a news program (“In details”, on the ICL News on YouTube) and which expressed widely recognized scientific consensus, in Brazil and abroad.
As the Federal Medical Council is calling for the professor to retract his statement and seek compensation, the action is being considered legal intimidation by an organization that should, on the contrary, defend her against social segments that defend denialist positions on medical practice, related to vaccination and the use of chloroquine during the COVID-19 pandemic. For the Brazilian Association of Public Health (Abrasco), the accusation is “unfounded and arbitrary” and “represents an attempt to silence the professor in her statements in defense of science and the Unified Health System (SUS)”. For this reason, the organization “expresses its full support for the professor and repudiates the authoritarian and anti-scientific actions promoted by the management of the Federal Medical Council” which “has historically adopted positions contrary to consolidated scientific knowledge, such as the admission of the use of ineffective medications against COVID-19, including chloroquine. Furthermore, it has maintained inhumane perspectives by defending the criminalization of abortion even in cases of child pregnancy. Professor Ligia Bahia is the target of this process for her defense of the best scientific and health practices, as well as for her commitment to civilizing principles and human rights.”
The formal reason for the Federal Council of Medicine's accusation against Ligia Bahia is that the UFRJ researcher had criticized the Federal Council of Medicine Resolution No. 4/2020, a document in which the Federal Council of Medicine admitted the prescription of chloroquine and hydroxychloroquine as a treatment against covid-19. The document states that these “two drugs” “have been widely used for the treatment” of covid-19, “alone or associated with antibiotics [however] there are currently no good quality clinical studies that prove their effectiveness in patients with COVID-19. This situation may change quickly, because there are dozens of studies being carried out or in the planning and approval phase.”
There is no room for doubt, therefore, that the statement that the Federal Council of Medicine consented to and validated the use of medicines for which there was no scientific basis expresses an unquestionable fact.
However, the Federal Council of Medicine’s action against Ligia Bahia goes further, as she expressed agreement with the decision of the Federal Supreme Court (STF) that considered that there had been “abuse of regulatory power” by the Federal Council of Medicine, when approving Resolution No. 2.378/2024, prohibiting medical professionals from performing the fetal asystole procedure to terminate pregnancies, in the situations provided for by current legislation in Brazil. For the STF, the Federal Council of Medicine exceeded its powers by “establishing a rule not provided for in the legislation to prevent the procedure in cases of pregnancy resulting from rape”. For the Federal Council of Medicine, the professor of social medicine could not express her agreement with the STF on this matter.
Despite being widely rejected by Brazilian society, as a ridiculous initiative, driven by senselessness, recklessness and impertinence, the Federal Council of Medicine continues to pursue a legal action that should be suspended by the agency as a matter of urgency. Whether for these reasons or not, it is because, ultimately, the Federal Council of Medicine is acting against itself, which reveals incompetence, disturbs intelligence, even mediocre intelligence, and affects the very credibility of the agency – which becomes a problem for the entire Brazilian society.
However, it is unlikely that the Federal Council of Medicine will back down and stop the legal action. It is not difficult to understand the reasons. In recent decades, the agency has been run by right-wing and far-right segments of the political-ideological spectrum, which succeed one another with each renewal of the national councilors.
The Federal Council of Medicine has gradually transformed itself into a kind of “bunker” of authoritarian thinking and political extremism in the medical field. To prove this, it is enough to record that shortly after the terrorist acts of January 8, 2023, which had the purpose of launching a coup d'état in Brazil, the then 2nd Vice President of the Federal Council of Medicine published videos of the moment when the invaders, after violently breaking through the police blockade, climbed the ramp of the National Congress. It also released an image of the sculpture 'Justice', located in front of the Supreme Federal Court, vandalized with the phrase "you lost, man".
Although very active on social media, the Federal Council of Medicine does not participate in the National Health Council or the National Health Conferences, bodies that ensure space for “community participation” in decisions about public health, as enshrined in the 1988 Constitution. Nevertheless, the Federal Council of Medicine often sets itself up as decision maker on public health policies, publicizing positions on public health issues, taking into account only medical criteria – still, without consensus within the medical community itself.
This way of participating in national life, ignoring what is important to society and prioritizing issues related to morals and customs, has led many people to consider these boards to be fascist, neo-fascist or Nazi-fascist. Hence the recurring violations of their own “Code of Medical Ethics”. The current board of the Federal Council of Medicine, with 27 councilors elected in August 2024, includes 18 directors who are affiliated with political parties (which is a right of these directors) and who are against Brazilian legislation that deals with abortion. As citizens, they have the right to oppose any law, but they have the duty to comply with it while it is in force, so as not to commit crimes.
As directors of a federal agency, which acts under delegated power of the Brazilian State, they do not have the right to violate the country's legislation. And their actions, as directors of the Federal Council of Medicine, must be based on scientific knowledge, which they do not have the right to ignore or disrespect.
However, regarding fascism, neofascism or Nazifascism, it is worth taking into account Roberson de Oliveira’s reflection (“Nazifascism as a ruse”), published on the website the earth is round.
Based on the observation that “for some decades now, the tendency to name various factions of the Brazilian right and extreme right as Nazis, fascists, Nazi-fascists, neo-Nazis, neo-Nazi-fascists, etc. has been consolidated among progressive and left-wing sectors that are active at various levels of political struggle in Brazil” and that, on many occasions, “these factions of the right and extreme right reproduce attitudes and symbolism that directly refer to this ideology”, Oliveira argues that the Brazilian right and extreme right do not “have the slightest interest in contesting the name given to them, reacting in some situations with indifference and in others, with derision”.
For this reason, the author considers that the terms Nazis, fascists, Nazi-fascists, neo-Nazis, neo-Nazi-fascists, etc. are inadequate (“an oceanic error”, he says) to explain the Brazilian case, because if, in the beginning, Nazi-fascist projects (Germany and Italy, specifically) are linked to imperialist projects, the opposite occurs in Brazil: here “a reprimarized vassal state is installed, governed by local, native oligarchic leaderships, but protected by imperial powers that support them” through an “equipment of the Armed Forces (…) practically reduced to a Praetorian Guard” at the service of the empire (American, in this period).
This “submissive State” should not be confused with “Nazism, fascism or neo-fascism”. It is “simply agents who intend to fulfill the role of henchmen of the empire”, whether through the “democracy that really exists in the country” (liberals) or through a dictatorship (far right)”. According to Roberson de Oliveira, “the far right believes that the best way is to establish a dictatorship, exterminate the left and definitively adapt the country to the designs of the empire”. Thus, for the author, “the word that defines the far right in Brazil is not fascism or Nazism or anything similar.
The Brazilian far right does not have the slightest connection with Nazi-fascism. The barbarity that characterizes it is a direct heir to our colonial and slave-owning tradition. It plays a role equivalent to that of the colonial sugar mill owner's henchman. It exists to guarantee order for the slaves on large exporting properties, in the hope of protection and rewards. The nickname "jagunço", "captain of the woods", "henchman" or, for those who prefer a more up-to-date terminology, "proxy of the empire", suits it well, because it is a paid agent, fierce in the position of command, but submissive and dog-like in obedience to the manager of the empire, always in the hope of protection and rewards."
The Brazilian right-wing and far-right medical elite, which currently holds the leadership of the Federal Council of Medicine, has its class origins in social segments that are symbolically heirs to the possessions and powers of the owners of hereditary captaincies and sesmarias. They are, symbolically (but in some cases also literally), children, grandchildren, great-grandchildren and great-great-grandchildren of the “colonial sugar mill owner”, the “unproductive landowner” and the “slave-owning farmer” accustomed to dealing with gunmen, thugs and henchmen. In order to pursue the legal action against Ligia Bahia, these leaders of a federal agency feel protected by the power they have accumulated and do not hesitate to exercise it.
Therefore, they will not back down, as they continue to comfortably play a role that is equivalent to a kind of thug, bush captain, or institutional henchman.
Now, all that remains is to follow the developments of the case and, until the judiciary decides, continue acting to inform society, because if the process is formally against the doctor, professor and researcher Ligia Bahia, it affects, insults and attacks us all.
We are all Ligia Bahia!
*Paulo Capel Narvai is senior professor of Public Health at USP. Author, among other books, of SUS: a revolutionary reform (authentic). [https://amzn.to/46jNCjR]
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