The historical setting of Latin American bioethics

The historical stages through which Latin American society has passed are at least four: the first, dominated by a particular sort of ethic I have termed the "ethic of the gift;" then the period of conquest, in which the prevalent ethic was one of war and subjection by force, which I call the "ethic of despotism;" followed by the colonial age, in which a new ethical model of "paternalism" emerged; and finally the stage of the "ethic of autonomy," which began with the independence movements of the 18th and 19th centuries and is far from ended. Independence was won by the criollos from European domination with very little participation by the Indian population. The latter was left out of the democratic process and saw itself relegated to a worse situation than in the centuries of colonial rule, for it was no longer protected by the paternalism of the Laws of the Indies of 1542. This is the reason for the division of the Latin American society of the last century into two quite different social strata: one bourgeois, which has assimilated the liberal revolution, and enjoys a health care quite similar to that available in any other Western country and hence faces the same bioethical problems as any developed Western society; the other a very poor stratum, without any economic or social power and hence unable to exercise its civil rights, such as the rights to life and to humane treatment. In this population sector; which is numerically the larger, the major bioethical problems are those of justice and the distribution of scarce resources. The study of Latin American medical ethics can earn for these subjects, whose deplorable condition has been essentially ignored in the bioethics of the first-world countries, the importance they merit.