Bioethics publications in Brazil. A study of topic preferences and tendencies

- Cl·udio Lorenzo, M.D.
Federal University of Bahia Medical School,
Salvador, Bahia, Brazil
Email:lorenzo@svn.com.br

- Eliane S. AzevÍdo, M.D., Ph.D.
Nucleus of Research and Transdisciplinary Education in Bioethics, State University of Feira de Santana - UEFS,
Feira de Santana, Bahia, Brazil
Email:elisa@svn.com.br

Eubios Journal of Asian and International Bioethics 8 (1998), 148-9.


The interest in bioethics in Brazil, according to Clotet (1) arose from the contact between Brazilian investigators and their colleagues in the technically advanced countries. The year 1988 marks the Brazilian beginning of institutional actions in bioethics teaching: the PontifÌcia Universidade CatÛlica do Rio Grande do Sul Medical School offered the first bioethics course in Brazil. Five years later the Federal Council of Medicine made a further step ahead by creating a new Journal entitled BioÈtica which has been regularly published twice a year, since. In 1995, a group of Brazilian scholars founded the Brazilian Society of Bioethics. This society promoted two congresses (1996 and 1998), organized four seminars on different topics of Bioethics and, at present, holds nearly two hundred members from all over the country and from various professional backgrounds. Thus, the growing of Bioethics in Brazil already reached a point of no return.

From the country's own history, the present day Brazilian society remains highly heterogeneous in social and economic make up. Thus, the bioethics conflicts here rise from situations indistinguishable from those of technically developed countries as well as from those of underdeveloped and medically non-assisted societies.

Assuming that bioethics publications by any country, if not tendentious, should be some overall reflection on the reality of the country's ethical problems, we decided to investigate topic preferences and tendencies of Bioethics publications in Brazil. In the present work we show the results of the analysis, from 1982 to 1997, of all the available Bioethics publications in Brazilian journals with the objective of studying topic preferences and theoretical tendencies.

Method

Bioethics publications in Brazil were ascertained by three approaches: First, searching through the word "bioethics" in both MEDLINE and LILACS reference list of indexed Brazilian journals. Second, by the same procedure using the word "ethics" followed by a second selection for papers dealing specifically with patient-physician relationship; research on humans; medical intervention on patients of questionable autonomy; abortion; treatment refutation and health care politics. By selecting for these topics we intended to avoid papers dealing with deontology or traditional Medical Ethics. Third, by reading every paper published in the two Brazilian journals dedicated to Bioethics: "BioÈtica" and "Cadernos de BioÈtica". Seven papers published on a general informative journal named Medicina, and also edited by the Federal Council of Medicine, were analyzed and joined to the results of the Journal BioÈtica.

The publications were classified by institutional origin into six categories: 1- Federal Council of Medicine; 2- Catholic Institutions; 3- Medical scientific associations; 4- Medical professional associations; 5- Research associations, and 6- Others.

The bioethics topic preferences in the paper's text were grouped by five entries: I- Poor health cares in Brazil; II- Brazilian social, economics and cultural reality; III- Related to technical advances; IV - Philosophy; V- Theology and/or religious. According to the relevance of the topic in the text, it was classified as either brief citations or great emphasis.

Table 1: Frequencies of topic preferences classified as brief citation and great emphasis in each group of Bioethics publications in Brazil (%s).
ThemesQua-ntityIndexed Papers as "Bio-ethics" (n=25) Indexed Papers as"Ethics" (n=49) BioÉtica (n=77)Cadernos De BioÉtica (n=29 )
Poor healthBrief20.0 24.520.827.6
careGreat16.0 14.37.820.7
Social, econ. &Brief 20.043.028.6 44.8
cultural

reality

Great 16.020.417.7 27.6
Adv. of biomed-Brief 76.034.749.4 48.3
ical tec-hnologyGreat 44.016.318.2 20.7
Philos-ophyBrief 72.046.955.8 69.0

Great24.0 24.531.141.4
Theol-ogyBrief40.0 20.420.851.7
and/or religiouGreat24.0 2.09.151.7

Results

25 papers were identified by the word-entry "bioÈtica" (2). Out of 132 identified by the word-entry "Ètica", seven were also identified by the word "bioÈtica", 76 were rejected by the second selection criteria and 49 were accepted (3). It is relevant that the two Brazilian journals dedicated to Bioethics are not indexed by MED-line, something true of most bioethics journals world-wide. Thus, by direct review of these two journals, a total of 102 papers were analyzed. The results are:

a) Among the 25 papers ascertained by the word "bioÈtica" (2), 16% gave great emphasis to the precarious health care in Brazil and 16% to its social, economic and cultural reality. 44% of these papers focus on the advances of technology.

b) Among the 49 papers ascertained by the word "Ethics" (3) plus its second selection criteria, the precarious health care in the Brazil was the major subset in 14% of them, and social, economics and cultural reality in 20%. The advances of technology were a major topic in 16%.

c) The 77 papers in the BioÈtica Journal and Medicine Journal (4) took the precarious health care and the social, economic and cultural reality as major topic in 8% and 18%, respectively. 18% took advances of technology as major topic. Philosophy and theology were major topics in 31% and 9%, respectively.

d) Finally, among the 29 papers published in Cadernos de BioÈtica (5), precarious health care and social, economic and cultural reality were major topic in 21% and 28%, respectively. However, philosophy and theology topics were treated as a major subset in 44% and 52%, respectively.

The Fisher-Freemam-Halton test showed that the "advances of technology" topic in the group of indexed papers and the topic "theology and/or religious" in the Journal Cadernos de BioÈtica had significant preference (p < 0.01 and p < 0.00001, respectively).

Discussion

From our analysis we detected 131 papers published between 1982 to 1997 on bioethics in Brazil. A further 49 papers on ethics with topics related to bioethics, added up to 180 papers. The statistical analyses showed that only the topic "technical and scientific advances", in the group of indexed papers, obtained statistical significance for topic preference. The other highly preferred topic was "theology and/or religious" in the Journal Cadernos de BioÈtica, which is edited by a Catholic institution.

It is relevant that citations on the topic " Poor health care" ranged from 20% to 27%, and on the topic "technical and scientific advances," from 34% to 76%, among the four publications groups. Two causes, at least, are behind that findings: first, the intellectual influences from the scientific literature of developed countries, and second, special attention to a wealthy and powerful minority of Brazilian with standard of life, and the type of health bioethics conflicts, similar to those of advanced countries.

The topic "Philosophy," as a brief citation, occurred with frequencies ranging from 47% to 72%, and as great emphasis, from 16 to 41%. This finding is rather surprising mainly because mostly of the bioethics publications are from medical area (65.7%) and, traditionally, the cooperation between medicine and philosophy, in Brazil, is apparently non existent. However, the interdisciplinary forces that build and sustain bioethics knowledge may be the major cause for the approximation between philosophers and physicians in Brazil. This fact by itself must be taken as a great achievement on the behalf of Brazilian science in general, not only of Bioethics.

The finding that only 5.4% of the papers came from medical or scientific associations, 1.5% from medical professional associations and 1.5% from research institutions show that, so far, there is no special preferences for bioethics topics in the Brazilian's scientific journals, in general. The institutions that traditionally deal with ethical discussions, as Council of Medicine (59%) and Catholic institutions (30%), were the most frequent origin of bioethics publications in Brazil. Outside of these groups only 2.6% came from other authors.

Conclusions

Presently, Brazilian bioethics publications privilege ethics conflicts originated by the techno-scientific advances of medicine and nearly neglect factors related to the social and economic reality of the country. The majority of the country's publication were mainly from deontological and religious areas, with a small contribution of scientific institutions and medical scientific associations. Although Brazil has, in its mains cities, a large number of services well equipped with the latest generation biomedical technology, its poverty and inhumane medical public health care is considerable larger. Thus, its greater bioethics conflicts must be coming come from the area that Berlinguer (6) designates as "Diary Bioethics", as malnutrition, illiteracy and deficient health care, for example. However, as the present results show, bioethics publication in Brazil is, yet, to be identified with these problems.

Finally, the results showed here may be of help for a critical reflection on the priorities of bioethics actions in countries social and economically heterogeneous as Brazil.

References

1. Clotet J. Por que bioÈtica? BioÈtica; 1(1) : 13-9, 1993.

2. Indexed papers searched through the word "bioethics": CiÍncia e Cultura - 42 (12) : 1144-8, 1990 ; Anais do II Congresso Bras. de Epidemiologia; 249-55 ,1992; Hosp. Adm. Sa_de; 16(5) : 218-24, 1992 / 17 (4) : 224-34, 1993 / 18(5) : 295-7, 1994 ; Rev. bras. crescimento desenvolv. hum.; 3(2) : 79-85. 1993; J Bras. Ginecol.; 103(6) : 189-91, 1993; Rev. Ginecol. Obstet.; 4(3) : 147-50, 1993 / 4 (2): 55-6,1993; Sa_de em Debate; 43 : 53-9, 1994 / 45: 32-7, 1994; Braz. j med. biol. res., 27(12): 2701-4, 1994; Rev. Assoc. Med. Bras.; 41(1): 67-76, 1995; J. Pediat.; 71(1) : 6-10, 1995; Mundo Sa_de; 19(10) : 347-9, 1995 / 19(2) : 84-91, 1995 / 19 (3) : 116-9, 1995 / 19 (5) : 164-6, 1995 / 19 (1) : 50-6, 1995 / 19 (9) : 309-12, 1995 / 19 (4) : 149-55, 1995 / 20 (3) : 119-22, 1996 / 20 (4) : 149-53, 1996 / 20 (2) : 84-6, 1996; Folha med.; 112(2) : 157-61, 1996

3. Indexed papers searched through the word "ethics": Pediatria ( S„o Paulo); 3 : 157-9, 1981; J Bras. Psiq.; 30(1) : 93- 100, 1981 / 45(2) : 81-3, 1996; Rev. Bras. de Cancerologia; 3(30) : 41-5, 1984; Rev. Ass. Med. Brasil.; 32(7,8) : 141-2, 1986 / 35(2) : 75-8, 1989 /38(2) : 75-9, 1992 / 40(4) : 231-2, 1994/ 41(1) :23-33, 1995/ 41(4) : 274-6, 1995; Rev. Psiq. RS; 9(1) : 15-23, 1987; Rev. Col. Bras. Cirurg., 1987; Rev. Sa_de Publ. S„o Paulo; 22(3) : 221-32, 1988/ 27 ; 388-90, 1993; Rev. Paul. Med.; 107(4,5,6) : 195-7, 1989 /109(3) : 131-3, 1991; Rev. Ginecol. Obstet. S„o Paulo; 2(1) : 44-8, 1991 / 6(2) : 69-74, 1995; Medicina RP; 24(2) : 70-7,1991; Mem. Inst. Oswaldo Cruz; 87(Supl IV) : S45-S53, 1992; Rev. Inst. Med. Trop. S„o Paulo; 34 ( Supl.9) S31-S32, 1992 / 34 ( Supl.9) S 25-S 29, 1992 / 34 (Supl. 9) : S2-S5, 1992; Sa_de em Debate; (36): 30-6, 1992; J. Liga Bras. Epilepsia; 5(1) : 19-22, 1992; Rev. Med. Minas Gerais; 3(1) : 52-3, 1993; Rev. Soc. Bras. Med. Trop.; 26(3) : 187-92, 1993; Desafios …ticos 1: 17-23, 1993 /1 : 24-58, 1993 / 1: 59-72, 1993 / 1: 80-9, 1993 / 1: 90-110, 1993 / 1: 83-6, 1993 / 1: 104-11, 1993 / 1: 134-45, 1993 / 1: 146-71, 1993 / 1: 172-8, 1993 / 1: 179-92, 1993 / 1: 203-11, 1993 / 1: 212-8, 1993 / 1: 219-28, 1993 / 1: 261-9, 1993; Anais do XXXI Cong. Bras. de Educ. MÈd.; 22-6, 1993; Cad. RH Sa_de; 1(3) : 9-18, 1993 / 1(3) : 19-22, 1993 / 12(1) : 103-7, 1996 / 12(3) : 417-22, 1996; Rev. Bras. Cresc. e Desenv. Hum.; 4(1) : 28-33, 1994; Rev. Bras. Ginecol. Obstet.; 18(4) : 293, 1996

4. Papers in the Journal BioÈtica and Journal Medicina:

BioÈtica; 1 (1) : 13-9, 1993 / 1 (1) : 13-9, 1993 / 1 (1) : 23-8, 1993 / 1 (1) : 39-48, 1993 / 1 (1) : 49-54, 1993 / 1 (1) : 55-60, 1993 / 1 (1) : 61-8, 1993 / 1(1) : 67-70, 1993 / 1(1) : 71-74, 1993 / 1(1) : 75-83, 1993 / 1 (1) : 91-95, 1993 / 1 (2) : 115-23, 1993 / 1 (2) : 129-38, 1993 / 1 (2) : 139-44, 1993 / 1 (2) :145-56, 1993 / 1 (2) :157-64, 1993 / 1 (2) : 165-72, 1993 / 1 (2) : 173-83, 1993 / 1 (2) : 191-3, 1993 / 2 (1) : 7-12, 1994 / 2 (1) : 13-18, 1994 / 2 (1) : 19-24, 1994 / 2 (1) : 29-36, 1994 / 2 (1) : 37-42, 1994 / 2 (1) :43-52, 1994 / 2 (1) : 53-60, 1994 / 2 (1) : 61-6, 1994 / 2 (1) : 67-72, 1994 / 2 (1) : 73-80, 1994 / 2 (1) : 81-5, 1994 / 2 (1) : 93-9, 1994 /2 (2) : 117-22, 1994 / 2 (2) : 123-8, 1994 / 2 (2) : 129-35, 1994 / 2 (2) : 139-46, 1994 / 2 (2) : 147-50, 1994 / 2 (2) : 151-62,1994 / 2 (2) : 163-74, 1994 / 2 (2) : 175-82, 1994 / 2 (2) : 183-9, 1994 / 2 (2) : 199-201, 1994 / 3 (1) : 157- 63, 1995 / 3 (1) : 29-36, 1995 / 3 (1) : 37-42, 1995 / 3 (1) : 43-50, 1995 / 3 (1) : 51-60, 1995 / 3 (1) : 61-8, 1995 / 3 (1) : 69-71, 1995 3 (1) : 07-16, 1996. / 4 (1) : 17-30, 1996 / 4 (1) : 31-43, 1996 / 4 (1) : 47-52, 1996 / 4 (1) : 53-64, 1996 / 4 (1) : 65-70, 1996 / 4 (1) : 71-8, 1996 / 4 (1) : 79-86, 1996 / 4 (1) : 87-95, 1996 / 4 (1) : 119-21, 1996 / 4 (2) : 131-44, 1996 / 4 (2) : 145-58, 1996 / 4 (2) : 159-66, 1996 / 4 (2) : 167-72, 1996 / 4 (2) : 175-88, 1996 / 4 (2) : 189-94, 1996 / 4 (2) : 195-202, 1996 / 4 (2) : 203-8, 1996 / 4 (2) : 209-16, 1996 / 4 (2) : 217- 20, 1996 / 4 (2) : 221-6, 1996 / 4 (2) : 235-8, 1996; J Medicina CFM; 77 : 8-9, 1997 / 78 : 8-9, 1997 / 79 : 8-9, 1997 / 80 : 8-9, 1997 / 81: 8-9, 1997 / 82 : 8-9, 1998 / 83 : 8-9, 1997.

5. Papers in the Journal Cadernos de BioÈtica; 1(1) : 9-16, 1992 / 1(1) : 17-26, 1992 / 1(1) : 27-58, 1992 / 1(1) : 59-62, 1992 / 1(1) : 63-90, 1992 / 2(1) : 9-26, 1993 / 2(1) : 27-42, 1993 / 2(1) : 43-6, 1993 / 2(1) : 47-64, 1993 / 2(1) : 65-6, 1993 / 2(1) : 67-124, 1993 / 2(1) : 125-51, 1993 / 3(1) :7-12, 1995 / 3(1) :13-20, 1995 / 3(1) :21-8, 1995 / 3(1) :29-44, 1995 / 3(1) : 45- 56, 1995 / 3(1) :57-62, 1995 / 3(1) :63-70, 1995 / 3(1) : 71-8, 1995 / 3(1) : 79-90, 1995 / 3(1) :91-4, 1995 / 3(1) : 95-100, 1995 / 3(1) : 101-22, 1995 / 3(1) :123-30, 1995 / 3(1) :131-50, 1995 / 3(1) :151-62, 1995 / 3(1) :163-72, 1995 / 3(1) : 173-84, 1995.

6. Berlinguer G. Quest¦es de vida: Ètica, ciÍncia, sa_de. 1.ed. ¡tica, S„o Paulo, 218p, 1995


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