Portal de Periódicos da CAPES

Carta Acesso aberto Produção Nacional Revisado por pares

BIBTEX RIS

Ethical analysis in public health

2002; Elsevier BV; Volume: 360; Issue: 9330 Linguagem: Inglês

10.1016/s0140-6736(02)09590-9

1474-547X

Riccardo Baschetti,

Female Genital Mutilation/Cutting Issues

Marc Roberts and Michael Reich (March 23, p 1055),1Roberts MJ Reich MR Ethical analysis in public health.Lancet. 2002; 359: 1055-1059Summary Full Text Full Text PDF PubMed Scopus (170) Google Scholar in concluding their discussion about utilitarianism, liberalism, and communitarianism as proposed guides of public-health decisions, state that we might well ask which of these three ethical positions is correct and what arguments are available to select one ethical view over another.Evolutionary arguments suggest rejection of the ethical positions that would cause the extinction of small communities, such as those of our ancestors, who lived in groups consisting of a few tens of members.2Wilson DS Human groups as units of selection.Science. 1997; 276: 1816-1817Crossref PubMed Scopus (35) Google Scholar Evolutionary arguments also suggest selection of the ethical view that reason or, in doubtful cases, mathematical models will prove to be the most effective strategy for ensuring the survival and the wellbeing of those small theoretical communities.As a paradigmatic example, there is no need of mathematical models to realise that a little community will be destroyed by liberalism's individualistic decision to allow a few members infected with a fatal contagious disease to move freely within the community. This social group will be saved only by the communitarianism's decision to isolate its infected members. Since what destroys small communities will hardly benefit public health in great societies, we should answer affirmatively Roberts and Reich's question "Can we systematically quarantine people with HIV to restrict the spread of the disease, as was done in Cuba?" It is probably too late now for espousing Cuba's public-health policy, but there is no doubt that, if adopted worldwide 20 years ago, it would have saved millions of lives, since, per head, there have been 35 times more deaths from AIDS in the USA than in Cuba.3Burr C Assessing Cuba's approach to contain AIDS and HIV.Lancet. 1997; 350: 647Summary Full Text Full Text PDF PubMed Scopus (10) Google ScholarThe biological ethic that has wisely guided humankind for millions of years4Baschetti R Use of embryonic stem cells.Lancet. 2002; 359: 2037Summary Full Text Full Text PDF PubMed Google Scholar gave greater importance to the wellbeing of the community than to that of the individual,2Wilson DS Human groups as units of selection.Science. 1997; 276: 1816-1817Crossref PubMed Scopus (35) Google Scholar, 4Baschetti R Use of embryonic stem cells.Lancet. 2002; 359: 2037Summary Full Text Full Text PDF PubMed Google Scholar, 5Baschetti R People who condemn eugenics may be in minority now.BMJ. 1999; 319: 1196Crossref PubMed Google Scholar because evolution rewarded the ethical—ie, socially beneficial—decisions of a group by favouring its survival, and punished the unethical—ie, socially harmful—decisions by hastening its extinction.4Baschetti R Use of embryonic stem cells.Lancet. 2002; 359: 2037Summary Full Text Full Text PDF PubMed Google ScholarUnlike in the case of the little ancestral communities, today's unethical social decisions could hardly be punished by extinction, because social groups are currently represented by entire populations, in which the members damaged by those unethical decisions are scattered among millions of untouched individuals. Therefore, the immorality of some social decisions is less easily recognisable socially than it was in small primitive groups. In these communities, moreover, all the members knew each other, which allowed them to condemn unitedly the immorality of some social choices, because their undesirable effects, contrary to what frequently occurs in today's enormous societies, harmed relatives and friends, not strangers and remote individuals.Human beings' morality, moulded as it was to be of social benefit in the small communities that have characterised humankind for the 99% of its evolution,4Baschetti R Use of embryonic stem cells.Lancet. 2002; 359: 2037Summary Full Text Full Text PDF PubMed Google Scholar tends to fade in the present immense societies, thereby becoming unreliably short sighted as an ethical guide of public-health decisions,5Baschetti R People who condemn eugenics may be in minority now.BMJ. 1999; 319: 1196Crossref PubMed Google Scholar which, therefore, should be made on the basis of their predictable effects on the well-being and survival of small theoretical communities. Marc Roberts and Michael Reich (March 23, p 1055),1Roberts MJ Reich MR Ethical analysis in public health.Lancet. 2002; 359: 1055-1059Summary Full Text Full Text PDF PubMed Scopus (170) Google Scholar in concluding their discussion about utilitarianism, liberalism, and communitarianism as proposed guides of public-health decisions, state that we might well ask which of these three ethical positions is correct and what arguments are available to select one ethical view over another. Evolutionary arguments suggest rejection of the ethical positions that would cause the extinction of small communities, such as those of our ancestors, who lived in groups consisting of a few tens of members.2Wilson DS Human groups as units of selection.Science. 1997; 276: 1816-1817Crossref PubMed Scopus (35) Google Scholar Evolutionary arguments also suggest selection of the ethical view that reason or, in doubtful cases, mathematical models will prove to be the most effective strategy for ensuring the survival and the wellbeing of those small theoretical communities. As a paradigmatic example, there is no need of mathematical models to realise that a little community will be destroyed by liberalism's individualistic decision to allow a few members infected with a fatal contagious disease to move freely within the community. This social group will be saved only by the communitarianism's decision to isolate its infected members. Since what destroys small communities will hardly benefit public health in great societies, we should answer affirmatively Roberts and Reich's question "Can we systematically quarantine people with HIV to restrict the spread of the disease, as was done in Cuba?" It is probably too late now for espousing Cuba's public-health policy, but there is no doubt that, if adopted worldwide 20 years ago, it would have saved millions of lives, since, per head, there have been 35 times more deaths from AIDS in the USA than in Cuba.3Burr C Assessing Cuba's approach to contain AIDS and HIV.Lancet. 1997; 350: 647Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar The biological ethic that has wisely guided humankind for millions of years4Baschetti R Use of embryonic stem cells.Lancet. 2002; 359: 2037Summary Full Text Full Text PDF PubMed Google Scholar gave greater importance to the wellbeing of the community than to that of the individual,2Wilson DS Human groups as units of selection.Science. 1997; 276: 1816-1817Crossref PubMed Scopus (35) Google Scholar, 4Baschetti R Use of embryonic stem cells.Lancet. 2002; 359: 2037Summary Full Text Full Text PDF PubMed Google Scholar, 5Baschetti R People who condemn eugenics may be in minority now.BMJ. 1999; 319: 1196Crossref PubMed Google Scholar because evolution rewarded the ethical—ie, socially beneficial—decisions of a group by favouring its survival, and punished the unethical—ie, socially harmful—decisions by hastening its extinction.4Baschetti R Use of embryonic stem cells.Lancet. 2002; 359: 2037Summary Full Text Full Text PDF PubMed Google Scholar Unlike in the case of the little ancestral communities, today's unethical social decisions could hardly be punished by extinction, because social groups are currently represented by entire populations, in which the members damaged by those unethical decisions are scattered among millions of untouched individuals. Therefore, the immorality of some social decisions is less easily recognisable socially than it was in small primitive groups. In these communities, moreover, all the members knew each other, which allowed them to condemn unitedly the immorality of some social choices, because their undesirable effects, contrary to what frequently occurs in today's enormous societies, harmed relatives and friends, not strangers and remote individuals. Human beings' morality, moulded as it was to be of social benefit in the small communities that have characterised humankind for the 99% of its evolution,4Baschetti R Use of embryonic stem cells.Lancet. 2002; 359: 2037Summary Full Text Full Text PDF PubMed Google Scholar tends to fade in the present immense societies, thereby becoming unreliably short sighted as an ethical guide of public-health decisions,5Baschetti R People who condemn eugenics may be in minority now.BMJ. 1999; 319: 1196Crossref PubMed Google Scholar which, therefore, should be made on the basis of their predictable effects on the well-being and survival of small theoretical communities.