1. Ethics & Rights as a
meaningful relationship:
6th Annual A. David Kline Symposium
on Public Philosophy:
Exploring the Synergy between Pediatric Bio Ethics and Child Rights
March 6th, 2014
In Collaboration With:
University of Florida College of Medicine-Jacksonville
Florida Blue Center of Ethics
College of Arts and Sciences
A Latin America view
Irene Melamed
MD, MSc.
Pediatric and
Adolescent Care

2. Pillars of the presentation
Briefly describe the history of
bioethics.
Analyze Latin America’s view and
its context.
Share some concerns, challenges
and ideas.
Recognize the importance of building
bridges between ethics & rights.

3. Bioethics: History
Latin America: Bioethics is a boom in the region:
Frequent conferences, Master Degree Programs.
Coexistence of a secular and a religious approach.
Emerging local biomedical laws  recognize health
as a human right.
US: Bioethics  perspectives of the law,
medicine, public policy, philosophy, sociology
and anthropology.

4. A Latin American View ?

5.  The South.
 Developing countries.
 Non industrialized countries.
 Latin America.
A Latin America view:
The Context

6. A Latin America view:
The Context
 Bioethics is rooted in reality.
 Specific regions and cultures perspectives.
 Ethical issues: health technologies/lack of access.
 Approaches to vulnerability: a broader concept
(Florencia Luna, layers vs labels*) address people’s
situation (impoverishment, helplessness, oppression).
Failure to approach the social determinants of health.
* Luna F. Elucidating the concept of vulnerability. Layers not labels. IJFAB. 2009; 2(1):121-135

7. The Context
 Heterogeneity.
 Great variety in size and natural resources.
 Composition of their populations is quite different.
 Ethnic, cultural, historical and social diversity.

8.  Social class and power inequalities.
 Coexistence of wealth and pervasive poverty.
 High-grade healthcare vs lack of basic public
services (no drinking water and sewer
system).
 Health sector: Fragmentation and
Segmentation.
The Context: Common features

9. Health Sector

10. Health Sector
"… Equity is an Ethical Imperative …”
Halfdan Malher
Buenos Aires, Argentina 2007

11. Rights-based Equity Policies
Child Health
Margaret Whitehead; Göran Dahlgren
Concepts and principles for tackling social inequities in health: Levelling up Part 1
Child Health
Worse off
Better off
Child Health
Child Health
Worse off
Better off
ChildHealthimprovement

12. … in this regard
 Need to construct a moral/rights language
 Build bridges between ethics and rights.
to fit the reality of
multiculturalism and diversity.

13. The “rights” language
Used in different but overlapping ways.
Set of entitlements under
international laws.
Aspirational or
rhetorical qualities.
Gostin Lawrence O. PUBLIC HEALTH ETHICS: TRADITION, PROFESSION, AND VALUES. Acta bioeth. [revista en la Internet].
2003 [citado 2014 Feb 22] ; 9( 2 ): 177-188. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S1726-
569X2003000200004&lng=es. http://dx.doi.org/10.4067/S1726-569X2003000200004

14. When “rights” language is invoked to
 Convey the fundamental importance of the claim.
“Rights”  symbol  reverence and respect.
 Adhering to certain standards or services by the
government.
Gostin Lawrence O. PUBLIC HEALTH ETHICS: TRADITION, PROFESSION, AND VALUES. Acta bioeth. [revista en la Internet].
2003 [citado 2014 Feb 22] ; 9( 2 ): 177-188. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S1726-
569X2003000200004&lng=es. http://dx.doi.org/10.4067/S1726-569X2003000200004

15. Pillars of the presentation
Briefly describe the history of
bioethics.
Analyze Latin America’s view and
its context.
Share some concerns, challenges
and ideas.
Recognize the importance of building
bridges between ethics & rights.

16. Is this effort an attempt to build strong connections
between moral values and rights?
Is this link  ethics & rights source of additional
commitment and enforceability?
There is a clear need to incorporate the “rights”
perspective on child health care daily issues…
Is this approach a good starting point?
Bridges between
Ethics & Rights

17. Ethics & Rights
Common Aspects
Subjective construct
 it is hard to conceptualize.
Valued and respected.
Importance not only of “having rights” but also
its perception.
Legal frameworks in both cases are in need of
an ethical interpretation.

19. * Required

20. #1. 5/8 Neither disagree or agree International Declarations on
Human Rights, such as the CRC do not consider, in particularly,
medical bioethic principles.
(2/8 Disagree, 1/8 Agree)
#2. 3/8 Neither disagree or agree Medical bioethics has its own
standards and they seldom mention or refer to either Rights of
the Child’s principles and/or to the Convention text.
(2 Disagree, 1/8 Do not know, 2/8 Agree)
#3. 7/8 There are many connections between the Medical
Bioethic principles and those of the International Convention
on the Rights of the Child.
(1/8 Do not know)
Answers

21. Answers
#4. 7/8 As a member of a Clinical Ethics Committee or Pediatric
Research Ethics Committee, do you think you apply the Right of
the Child’s perspective when conducting the analysis and/or
ethical review? “It is possible I do”.
(1/8 If I do, it would be imperceptibly)
#7. 5/8 Absolutely Establishing a strong connection between
Bioethics and Rights’ perspectives will give the latter more
legitimacy an enforceability.
(2/8 I do not think so, 1/8 “I think that Rights’ perspective is
more relevant as the mandate to Rights fulfillment”)
#8. Professional background
 Philosophy:1  Health Sciences:8  Law  Other
Acknowledgments to the colleagues from FLACEIS that kindly answer the questions.

22. In summary:
Bridges between Ethics & Rights
Avoid options White and Black
…contribute Gray area
to understand the reality.

23. … The gray area
• What is the gray area?
• Complexity due to the number of variables involved.
• Dilemma: pros and cons of both options.
• Where are the limits and/or frontiers of the gray area*?
*Dominic Wilkinson, Shedding Light on the Gray Zone, 6th Annual Pediatric Bioethics Conference, Seattle, 2010

24. … Gray areas
Dominic Wilkinson, Nuffield Medical Research
Shedding Light on the Gray Zone, 6th Annual Pediatric Bioethics Conference, Seattle, 2010
0
0
0

25. Challenges/Ideas

26. 1. Moral Value of Actions
Vulnerability
Actions

27. Ethics of Omissions

28. 2. Integrating paradigms
for moral reasoning
 Morality of rights
 Morality of care  takes care of others
(real world conflicts & contexts).
 Deepen the ethical discussion.
 Produce more nuanced strategies.
 Identify and reinforce a more responsive professional
viewpoint to health disparities and changing needs.

29. 3. Challenges/Ideas
 Mainstream the ethics/rights perspective.
 Pose new questions:
Which are the rights that are not acknowledged?
Which are the ethical principles that are not visualized?
How do I gather evidence that allows a better
understanding of the children’s best interest?

30. 4. Challenges/Ideas
Clarifying Myths:
The speech of rights is associated in the wrong way
with that of responsibility.
Children’s rights ARE NOT consequent to the exercise of
responsibilities. The responsibilities are being gradually
acquired while they develop greater abilities.
(Article 5, 12, CRC)

31. 5. Challenges/Ideas
(1) María Casado, Observatory of Bioethics, University of Barcelona
To bring to the debate the flexible and pluralist (1)
Bioethics.
Reduce gaps between words and actions
(Implementation research)
Ethics committees?
Are they fulfilling the duties expected from them?

33. To conclude ...

34. Acknowledging the stories,
the wills, the contexts…
…to enlighten the “gray area”
Ethics & Rights

35. Thanks for
your attention
Irene Melamed
Pediatric and
Adolescent Care
dramelamed@gmail.com