This work consists of a set of of essays dealing with ethical issues
related to health-care and medical procedures in Latin America.  Although a diverse range of material is
presented, there is a fairly consistent viewpoint guiding the essays:  that of post-Rawlsian liberal theory.  Most of the theorists wish to ground their
analysis of just medical practice and just distribution of health care with
reference to an ideal of autonomy rooted in the broadly Kantian approach that
Rawls champions.  In a number of essays,
this approach is then related to more recent work by theorists, such as Martha
Nussbaum and Amartya Sen, who offer capability-centered accounts of social
goods to be distributed, and of internal goods to be developed within agents.

The overriding theme of the anthology is the suitedness of such ideals
of autonomy within a Latin American framework. 
One of the philosophically strongest pieces in the anthology, Bertomeu
and Videiella’s ‘Moral Person and the Right to Health Care,’ makes the case
that universal norms of autonomy and human capabilities need to be adapted to
local conditions.  But even here, the
aim is to suggest that such adaptations are possible, thereby justifying
appeals to extra-local norms.  The view
that Latin American ethical principles are radically different from prevailing
Western principles is harshly criticized by a number of authors.  The lead essay, Salles’ ‘Autonomy and
Culture:  The Case in Latin America,’ is
in fact devoted to arguing against claims that Latin American cultures do not,
at heart, have the same respect for individual autonomy that North American
cultures do.  By reading this essay in
conjunction with others that have a similar perspective, a convincing case for
the importance of the ideal of autonomy within Latin American bioethics is
made.   

We find the essayists insisting on patients’ rights to make informed
decisions about their health care; to receive contraceptives, abortions, and
sterilization procedures (and to reject abortions and sterilization); and to
voluntary euthanasia.  Lopez’s ‘What is
(exactly) wrong with selling your body parts?’ even offers a limited defense of
the legal right to sell one of one’s kidneys (unfortunately, however, this
essay confuses the issue of whether it ought to be legal to sell one’s body
parts with the issue of whether it is ever morally justified to sell one’s body
parts).

Given the Rawlsian background, there is also a prevalent focus on
positive rights to medical procedures, and not merely discussion of rights to
be free of coercive interference with the individual’s attempts to get access
to various types of medical procedures. 
Although this discussion might be of interest to those who would like to
argue for social changes based on such alleged positive rights within
particular Latin American countries, it is otherwise somewhat lacking in
originality, in that it does not seem to offer any insights not found in Rawls,
Nussbaum, Sen, or other liberal theorists cited in support the view that social
policy should recognize such positive rights.

Also, the discussion of abortion lacks depth.  One author claims that Roman Catholic religious teaching on
abortion are irrelevant to whether the state ought to limit abortion, because
‘democracy’ is based on the ‘moral’ perspective, not the ‘religious’
perspective.   Other essayists make a
similar claim.  There is no attempt made
to distinguish pure majoritarian democracy from liberal democracy, nor even a
nod offered to the fact that many prominent philosophers argue that moral
principles can be understood as divine commands, and visa versa.  In general, the exclusion of an avowedly
Roman Catholic perspective mars an anthology devoted to ethical reasoning about
an area that has been so profoundly influenced by this church.

A more interesting problem with the anthology lies in its repeated calls
for meeting the alleged positive rights of Latin Americans to health care —
the problem here being that there is almost no discussion concerning whence the
needed resources are to come.  Are Latin
American nations to sacrifice future economic growth, due to increased government
debt and taxation, in order to pay for needed medical care now?  If not, how is the health care to be paid
for?  If so, what are the procedures for
determining the proper balance between resource-producing investment by the
private sector, and present-day government spending on medical care?

Terming both access to health care and freedom from coercive removal of
property as ‘rights’ leaves very little room to develop non-arbitrary
principles for balancing property rights against the obligation to provide
health care to the needy.  And, unfortunately,
the essays in this collection do nothing to make use of what room there is.

© 2003 Marcus Verhaegh

Marcus Verhaegh is a Ph.D.
student at Emory University.  Verhaegh’s
work focuses on Kant’s understanding of art and religious symbolism as
contributors to cognition; where, in the case of religious symbolism, the focus
is on practical cognition.  Verhaegh is
further engaged in contrasting Kant’s moral and political philosophy with the
accounts offered by Rawls, and by discourse ethicists such as Habermas.  Finally, Verhaegh is interested in the
import of the ‘Critique of Teleological Judgment’ for ethics, the discipline of
history, and the social sciences (particularly economics).

Categories: Ethics