Deliberação Coletiva: Uma Contribuição Contemporânea Da Bioética Brasileira Para as Práticas Do Sus

Abstract

Re su mo Este ensaio teve por objetivo analisar a necessidade de nova excelência profissional pautada na deliberação coletiva, debatendo a ética aplicada às questões de saúde nas experiências de Brasil e Espanha. O funcionamento prático dos comitês de bioética na Espanha avança na constituição do método deliberativo como participação coletiva na decisão profissional, discutindo a importância da democracia deliberativa para a construção de nova civilidade ética. No Brasil, após as primeiras décadas de construção do Sistema Único de Saúde, amplia-se o leque de participação dos profissionais, primeiramente nos conselhos de saúde e, com a resolução CNS n. 196/96, também nos comitês de ética em pesquisa envolvendo seres humanos, aprimorando novas ações afirmativas, de organização e comprometimento coletivo com ampliação da responsabilidade na construção e efetivação das políticas públicas. A deliberação ética adquire centralidade: a decisão profissional que era paternalista e privada em ato é, paulatinamente, ampliada como deliberação coletiva e socialmente ativa, o que sugere a necessidade de uma nova excelência profissional, além do meramente técnico e clínico-individual. A bioética brasileira adquire papel preponderante na transformação da excelência profissional pautada numa solidariedade crítica e no comprometimento com o público-social, em coletivos de deliberação que considerem a qualidade de vida da população. Pa la vras-cha ve bioética; deliberação; excelência profissional; democracia deliberativa; solidariedade crítica. Abs tractThis essay aimed to analyze the need for new professional excellence guided by collective deliberation, debating the ethics applied to health issues in the Brazilian and Spanish experiences. The practical functioning of the bioethics committees in Spain is making progress in constituting the deliberative method as collective participation in professional decisions, discussing the importance of deliberative democracy to build new ethical civility. In Brazil, after the first decades of the construction of the Unified Health System, the professionals' participation has widened, primarily in the health councils and, with CNS resolution No. 196/96, also in the ethics committees for research involving human subjects, improving new affirmative, organization and collective commitment actions aiming to expand responsibility in the construction and execution of public policies. Ethical deliberation becomes a central feature: professional decisions that were paternalistic and private in act have gradually expanded to collective and socially active deliberation, suggesting the need for a new professional excellence, beyond the merely technical and clinical--individual one. Brazilian bioethics takes on a leading role in the transformation of professional excellence guided by critical solidarity and commitment to public-social matters in deliberation collectives that take the population's quality of life into account.

Validação de inventário de problemas éticos para a saúde bucal

“…It takes shape in the professional body that builds and puts public policies into practice, considering results, consequences and social breadth, that is, the ability to include vulnerable individuals or groups. In this sense, the construct validated in this research, besides serving as a source of information, can open debates that amplify ethical reflection and collective deliberation 4 .…”

“…In this sense, social bioethics converges with the sanitary and public health movement to build an epistemological and practical framework, with important advances in the construction of Brazilian bioethical knowledge. In clinical bioethics, the challenge is to consolidate bioethics committees 4 ; in PHC, the task is to expose and solve "naturalized" ethical problems due to their relation with organizational and structural issues.…”

“…Ethical problems must be perceived as challenges that require collective deliberation, going beyond particular solutions to seek contextualized and creative, long-range responses, based on the professionals' commitment 4,6 . In addition, we must face a sub-citizenship 17 socially introjected in the SUS user, which denies rights and quality of care due to their (non) purchasing power.…”

“…In the context of SUS and of a bioethics of resistance 19 , the need for ethical and political engagement of health professionals in the various levels of power is increasing. In this perspective, the IEP-PHC-OH can help cultivate values such as critical solidarity, political participation, and social entrepreneurship 4 . The construction of an ethos based on daily moral practice fulfills the role of educating a new civility.…”

Moral Deliberation by Nurses and Members of the Assistential Ethics Committee in a Clinic of Magallanes, Chile

“…19 Collective deliberation configures itself as a constructing power of professional excellence oriented to the ethical debate applied to health themes. 20 The CEA members recognize that the clinical professionals are instrumental in caring for the patients, they are empathy personified, the element favoring communication which consists in the ability to place oneself in the other's situation, and understand what they feel. This is fundamental to understand the other's feelings and emotions.…”