Chamber keeps the bioethics council project in the drawer

Brazil has around 20 national public policy councils, created to discuss issues that directly affect society, but the lack of interest in creating one of them is noteworthy — the National Bioethics Council, an organization that would allow debates on topics to be brought to the public sphere sensitive issues such as reproductive rights and the confrontation of Covid-19.

For 16 years, the Chamber of Deputies has kept in its drawer a proposal for the creation of the body prepared by a commission of experts, submitted to public consultation and delivered at the end of the first Lula (PT) government.

As it belongs to the Executive, the project gained priority in the process, which is a great advantage —92% of the federal laws passed are government proposals.

Since then, the proposal has stalled. The single special commission that would evaluate the text was never set up due to the lack of nomination of the parties.

According to the text, the council would have 21 unpaid members and chosen mainly from bioethicists, appointed from triple lists for a term — that is, replacements by the current governor would not fit. The collegiate could be convened by the presidency of one of the powers, by the majority of the members or by the undersigned of 1% of the electorate.

The council’s main task would be to prepare opinions to support policies on matters of social relevance, including public consultations. His performance could take out major national discussions from under the rug, and perhaps therein lies the lack of interest in approval.

“About PL [projeto de lei] provided for an advisory council, which has no formal power, but which, in situations like the one the country is going through, acquires moral power. You can see the importance of this”, says Volnei Garrafa, coordinator of the UNESCO Chair in Bioethics at UnB (University of Brasília) and one of the project’s creators.

For him, the action of the council would have qualified the public debate in the pandemic.

In European countries like France, Spain and Italy, these councils centered the controversial discussions of the pandemic. “They allow governments to clarify to the population why they are considering unpopular measures”, says the Dutch physician Henk ten Have, a professor at the University of Duquesne (USA) and a bioethicist with experience at Unesco and several national committees.

A recent debate has been over whether it would be ethical to restrict the movement of unvaccinated people, as Austria and Germany did this month. The National Council of Bioethics of Italy concluded that yes, as long as the restriction affects those who are not immunized by choice, not for lack of vaccines.

Bottle says he has not understood until today what took the impetus for the approval of the law. “At the time it seemed that everyone was in favor,” he says. The professor says that he tried to “resurrect” the process in 2014, in a conversation with Ricardo Berzoini, then chief minister of the Institutional Relations Secretariat.

For Berzoini, the second government of Dilma (PT) could do little because it was already facing a crisis in its relationship with the Chamber.

Currently, the bill is attached to another one, by Deputy Ivan Valente (PSOL-SP), from 2004. He claims that the Executive did not make any effort to approve it in the past, but believes that now would not be the time to return to the issue. “If we return to democratic normality, then we can return to the issue, which remains important. Not in this moment of crude polarization.”

Over the past 10 years, countries in Latin America have approved bioethics councils, including Argentina, Bolivia and the Dominican Republic.

The first two have a more advanced history than Brazil in discussions on reproductive rights, according to Andréa Freitas, coordinator of Unicamp’s Nipe-Cebrap (Nucleus for the Study of Political Institutions and Elections). The Dominican Republic, on the other hand, has a reverse trajectory, with conservative laws.

Andréa says that the council’s project runs into issues that Brazilian politics, focused on reelections, traditionally prefer to avoid. It is a more technical topic, difficult to communicate to society and one that expends political capital.

“Those who control the political agenda, the Executive and the presidents of the houses, give up what is controversial to their bases in order to be able to approve what they consider a priority, which may or may not be in line with social demands.”

At least 37 bills that mention the word bioethics have been proposed in the last 21 years — 16 of them (40%) have been filed as of 2018. Although the topic is on the rise, the concept is often used superficially, according to experts .

In general, bioethics is mentioned in passing, as an aspect and not a foundation for the projects, says Renata Rothbarth, a lawyer specializing in hospital medical law and a doctoral student in public health at USP (University of São Paulo).

The most recurrent subject is the regulation of reproductive rights, which includes pregnancy termination and assisted fertilization. Then come professional regulations, patient rights (includes end of life) and minorities, issues that are still very basic.

“International discussions on bioethics are focused on other themes. For example, the use of artificial intelligence in health, the monetization of health data, genetic selection and editing, xenotransplantation [uso de órgãos de animais em seres humanos] and the allocation of resources during the pandemic,” says the lawyer.

In the assessment of biologist José Roberto Goldim, head of the Bioethics Service at HC Porto Alegre, most projects use the term vaguely and do not make explicit bioethical arguments. References range from the Danish philosopher Peter Kemp, author of a principle according to which the vulnerability of the living being must be considered in bioethics, to the Catholic theorist Gregory Pyke, a well-known anti-abortion activist.

There are still conceptual errors. This is the case of the proposal by then-deputy Eduardo Cunha (MDB-RJ) to punish doctors who perform abortions outside the law or those who criminalize the “theft” of germ cells. According to Goldim, the justification for these projects is not bioethical, but punitive aspects of the law.

Initiatives to create the National Bioethics Council did not advance in the Chamber

– Idea emerged in 1990s, is an advisory forum to capture the needs of populations and expert views on ethical issues in biology.

– It would be up to the council, for example, to forward discussions on genetic manipulation, reproductive rights, public policies and the relationship between doctor and patient

– They already work in countries like France, Spain, Italy, USA, Argentina, Dominican Republic, Ecuador, El Salvador and Bolivia

– No Brazil, decree of 2002 President FHC created the National Commission on Bioethics in Health, in support of the Ministry of Health. august 2020, in the middle of the pandemic, by the Bolsonaro government

– In 2004, the first legislative project for the creation of a National Bioethics Council, proposed by deputy Ivan Valente (PT-SP) reached the Chamber

– In october 2005, the Executive submitted its own proposal to the Chamber, with priority in the processing; the text was appended to Valente’s project. No progress since then

Number of projects mentioning bioethics has grown since 2018

At least 37 bills that mention the word bioethics have been proposed in the last 21 years, 16 (40%) of them have been filed as of 2018. Although the topic is on the rise, the concept is often used superficially, according to experts.

Content of some of the projects

Abortion, the champion

There are proposals to punish doctors who carry out illegal abortions (prison from 6 to 20 years of age and cancellation of registration), to regulate voluntary abortion up to the 12th week (a citizen’s suggestion) and to create a “day to raise awareness about the risks of abortion”. Another three are reactions to government ordinances that tried to make legal abortion difficult in 2020

spiritual assistance

Deputy Giovani Cherini’s (PL-RS) project proposes that health services and hospitals offer services of “spiritual assistance” provided by “religious people, mediums and good people”. In practice, the PL makes room for these providers to even sign an agreement with the State

bug editing

Draft Legislative Decree 889/2018, by PT members Nilto Tatto (SP) and Patrus Ananias (MG), proposes to limit genetic editing techniques in insects because gene modification would be a “very powerful” tool

Zygote theft

PL 3461/2021, by Paulo Eduardo Martins (PSC/PR), creates the crimes of theft, robbery and misappropriation of germ cells, embryos or zygote (cell formed in the union between male and female gametes), to curb the use unauthorized reproductive cells

Delivery menu

Contrary to the encouragement of normal birth, Carla Zambelli (SP), Alê Silva (MG) and Filipe Barros (PR), all from the PSL, mention bioethics to give pregnant women the power to choose the type of birth. There are identical texts in the legislative assemblies of Rio de Janeiro and Maranhão

bioethical rodeo

Captain Augusto’s 2017 project (PL-SP) wants rodeo organizers to commit to “maintaining the precepts of bioethics”, prohibiting and punishing “excessive and aggressive conduct towards animals”​

Sources: Chamber and Senate press offices and bills; historical series until 4/11/21.