Remarks on the Nature of Bioethics and the Bioethicist

Going Back to the First Inquiry

It is uncertain to date exactly the time and place of the birth of the neologism bioethics, and equally uncertain is to predict its future exactly. Words have their own life and destiny: while some are born and soon die, others acquire new meanings, diverse and even opposite to that of their initial creation. We can consider words as an old city: With straight and rectangular streets and alleys, as well as squares, old and new houses, built at different times, and surrounded by a number of new suburbs. In this city, some buildings are born and others disappear giving new life to the old city. And still other words develop: they build their own meaning, no longer being mere neologisms, to occupy an autonomous space. In these cases, they transcend geographical and cultural boundaries, so that the different senses and meanings serve a multiplicity of contextualized uses. As T. Engelhardt: “Ideias have life and power of their own. An idea can shape or reshape the ways in which we understand and experience reality encountering a fruitful idea, we say, Ah- ha! And see the world anew and cannot imagine it otherwise. The ideas that shape our vision of ourselves and our reality structure the very taken- for-granted character of everyday life. The same at limes happens with new words. A new word often allows us to name elements of reality in a way that conveys new control over our Cultural environment. It is often not the precision of a word that is the source of its power end usefulness. In fact, it is often the imprecision, the lack of clarity, that allows us to name and bring together at on time many areas of interest. An apt word can assemble a rich set of images and meanings and thus help us to see relations between elements of reality that were previously separated in our vision and thought of only as disparate. Such a word has a fertile or strategic ambiguity. This has been the case with ‘bioethics” [3]. We have reached an important and decisive phase for the future of bioethics, in which a profound reflection is required of all those involved with this new field of study and reflection. This is a return to some of the conceptual and doctrinal bases that gave birth to bioethics and that seek to sustain it. On the one hand, the rapid and enormous growth of bioethics should be highlighted as a fact, occupying more and more relevant spaces in human activities every day. It should also be noted that the neologism bioethics has been growing, with a certain freedom, acquiring several meanings, and incorporating to its ambitious list new concepts and new ideas. In this sense, bioethics was born and is growing without having faced and overcome deeper conceptual questions, and even without a definition of what bioethics is.

A slight reading of some of the various books, manuals, and articles published on bioethics reveals another fact, namely, that although the authors compose articles and books with several chapters dealing with bioethical topics, they do not present a roughly consensual definition, and hardly position themselves clearly on what they mean by the term “bioethics”. This reveals that bioethics does not have one definition. It has many definitions. These two statements which perhaps torment those who deal with this field of reflection and bring arguments to justify its denial lead us to the philosopher Wittgenstein to say that a finding of this kind is a positive point because it gets rid of the incorrect modal ways of asking and answering a question.

And if we are correct that bioethics was born and is growing without a definition, could we say that sooner or later it will need a definition? It would be better to say that it must mark its definitive presence in current human activities, demanding that it be seen as its own area of knowledge. And this demand presupposes a detailed and deeper reflection on its meaning, its body of doctrines, without a straitjacket “definition” that provides it with ideal and real conditions to continue growing without incurring the risks of being destroyed before its maturity. The risks can be external, when those who are outside bioethics see it as a nuisance, a hindrance, and an invasion in their activities and personal interests. And the internal risks may come from the bioethicists themselves, when they are intoxicated by unpreparedness, selfishness, vanity, fads, and incompetence.

The reflection to which we are alluding, instead of trying to define, should seek to affirm that the essential characteristics of bioethics are necessary elements for its strengthening as a recognized field of knowledge, and that each of its component parts, such as, for example, bio direction, biotechnology, biomedical ethics, bio ecology, taken separately, are not equivalent to the whole.

It is, therefore, an opportunity to resume the question made by the precursors more than 30 years ago, and repeated during their short life history: what does bioethics mean? If at that time there were not enough conditions for a definition and evaluation of it as a specific area, because the doubts concerning the contextualized problems were different, today we can ask whether bioethics can or should be a specific area of human knowledge? Is its acceptance by several areas of knowledge and fields of society, as well as its growing acceptance reflected by a clear delimitation of its field and by a univocal sense of the term? Are there necessary and sufficient elements to affirm its own, autonomous space, independent from ethics, although intimately related to it? Questions of this nature may represent today a good reason to continue the reflection on the definition, meaning, and identity of bioethics and the bioethicist. And it is precisely the consideration of these points that we intend to bring into play in this discussion on the characteristics of bioethics and the bioethicist. But first, let’s ask ourselves what bioethics is.

What is Bioethics?

What is bioethics? This question has raised a huge variety of answers throughout its history, and still continues to drive many reflections today. Of the various attempts, we can mention that bioethics has been called by some “a discipline” [4, 5, 6, 7]; of “an applied discipline” [8], of “a demi- discipline” [9, 10], of “a sub discipline” [11] and of “a second order discipline” [12]. Others suggest that bioethics cannot be placed within the traditional framework of disciplines, and consider it a “multidiscipline” [13], an “interdiscipline” [14, 15, 16, 17, 18, 19, 20, 21, 22, 23] or “trans discipline” [10]. Others suggest that bioethics cannot be placed within the traditional framework of disciplines, and consider it a “multidiscipline”, an “inter discipline”, or “trans discipline”. Still others more cautiously refer to bioethics simply as “a field”. Other authors have presented significant definitions for the term “bioethics”, among which we can highlight the following:

1. Bioethics is “the systematic study of human conduct in the life sciences and health care examined in the light of moral values and principles” [24].
2. Bioethics “(is a) new discipline (with) the task of devising the method to assist physicians and scientists in selecting ‘good decisions’ from a sociological, psychological, and historical point of view” [25]. And:
3. Bioethics “is the systematic study of the moral dimensions-including moral vision, decisions, behaviors, and policies-science, life, and health, using diverse ethical methodologies with an interdisciplinary approach” [25].
4. Bioethics “studies the morality of human conduct in the field of life sciences. It includes medical ethics, but on the other hand it exceeds the classical problems of medicine, since it also concerns the set of ethical problems posed by the biological sciences, which are not primarily medical in nature” [26].
5. The Bioethics “is a field of ethics that studies the problems of protecting physical life and, in particular, the ethical implications of the biomedical sciences” [27].
6. Bioethics is “ethics applied to new problems developing at the frontiers of life” [28].
7. Bioethics “is concerned with the ethical issues of birth, life, and death following the latest developments and possibilities in biological and medical research and therapies. It studies, among other things, the moral issues related to abortion, sterilization, birth control, genetic manipulation, euthanasia, and human experimentation” [29].
8. The Bioethics is as “systematic science of ethical man that investigates the techno genetic spheres of the biological world” [30].
9. The Bioethics “is a discipline with a rational epistemological status, open to theology understood as a supra-rational science and finally, ‘Horizon of meaning’. Bioethics from the description of scientific, biological and medical data rationally examines the legality of man by man’s own intervention.” [31]. Also:
10. The Bioethics “can be conceived as part of moral philosophy that considers the legality or otherwise of interventions on human life, and in particular those related to the practice and development of medical and biological sciences” [31].
11. The Bioethics “in its specificity is defined by the ethical aspect that concerns man in his totality and radicality [...] in all his values and in all his needs” [32].
12. “The term ‘bioethics’ refers to “the systematic, plural and interdisciplinary study and resolution of ethical issues raised by medicine, life sciences and social sciences, when applied to human beings and their relationship to the biosphere, including issues related to the availability and accessibility of scientific and technological developments and their applications” [33].

These definitions exemplify, on the one hand, that defining bioethics and its purpose is no simple task, and on the other hand, that some consider it a science, others a branch of general knowledge, others an autonomous discipline, and others a traditional branch of ethics.

But would the definition (or definitions) be an effective compass to guide us in the direction of understanding what bioethics is? Under the guidance of the Austrian philosopher Ludwig Wittgenstein (1889-1951) in this question, it can be said, initially, that the question was posed “What is bioethics?” it is the result not of a genuine problem, but of confusion, felt as a problem. This is a misleading formulation that expresses our lack of clarity, and it is one of the great sources of confusion for many philosophers, so that a statement as an answer would be the result of a grammatical mistake. Referring to the grammar of the word “time” in the confessions of Saint Augustine, he observes: Consider as an example the question “What is time?” as Saint Augustine and others have asked it. At first sight what this question asks for is a definition, but then immediately the question arises: “What should we gain by a definition, as it can only lead us to other undefined terms?” And why should one is puzzled just by the lack of a definition of time, and not by the lack of a definition of “chair”? Why shouldn’t we be puzzled in all cases where we haven’t got a definition? Now a definition often clears up the grammar of a word. And in fact it is the grammar of the word “time” which puzzles us. We are only expressing this puzzlement by asking a slightly misleading question, the question: “What is …?” This question is an utterance of unclarity, of mental discomfort; and it is comparable with the question “Why?” as children so often asks it [34].

So, from Wittgenstein’s point of view, could we say that the author’s attempts to define bioethics would be the result of a latent and still unresolved confusion? For now, we can raise suspicion in this regard. But if so, what kind of confusion is it? And then how should we orient ourselves in understanding bioethics?

The Area of Acting

The Bioethics conceived in a comprehensive or broad way can be understood as ethics related to the sciences of life, health and the environment, or even as “a systematic study of human conduct within the life sciences and health care, as such conduct is examined in the light of moral values and principles” [35]. Thus, the first characteristic is its own area of acting. M. H. Parizeau tried to systematize the main concerns of bioethics, in the following aspects:

1. The doctor-patient relationship largely covered in medical ethics codes;
2. The problem of regulating experiments and research with human beings;
3. Analysis from an ethical point of view of the techniques concerning procreation and peaceful death or euthanasia;
4. Ethical analysis of interventions on the human body (organ and tissue transplants, sports medicine and transsexualism);
5. Ethical analysis of interventions on the genetic heritage of the human person;
6. Ethical analysis of the repercussions of the use of personality manipulation techniques and intervention on the brain (psychosurgery and behavioral control in psychiatry);
7. Ethical evaluation of genetic techniques and their impact on the animal world [36].

Even so, Sarmento and Sgreccia state that this area is extremely wide, and has not yet been completely delimited [37, 38].

The Pluralist Requirement

The pluralist requirement is another of its characteristics without which it is not possible to speak of bioethics. According to Elio Sgreccia, “it is up to bioethics to discuss and examine moral values and principles, with an awareness of a plurality of philosophical approaches” [38]. For Engelhardt, “bioethics is a plural noun”. Ferrer and Álvarez, explain the noun: This plurality or pluralism of bioethics is directly linked to what Engelhardt calls postmodern philosophical predicament (“the postmodern philosophical predicament”). In the current situation it is impossible to discover a secular morality with contents. This situation is difficult to accept because our intellectual tradition has accustomed us to have an exaggerated confidence in the possibilities of reason. The failure of the modern philosophical project to find a morality with concrete contents, based only on reason, constitutes the fundamental catastrophe of contemporary secular culture and is the point of reference for understanding contemporary bioethics [39].

However, many of those involved with bioethics, ignoring that plurality constitutes the root of contemporary thinking, adopt and apply specific moral principles and norms as if they were obvious, and provide advisory and consulting services as if there were only one bioethics with specific contents. Concrete is a standard bioethics able to guide all secular moral decisions and to guide health policies. These professionals function like religious ministers who are unaware of the sectarian character of their position. Furthermore, they present themselves as spokesmen for reason, and without acknowledging that the particular moral commitments that guide them claim canonical validity for anyone, at any time or place. Certainly sooner or later they will have to admit that there is no bioethics with concrete contents outside a particular moral perspective, and assume that we have bioethics, in the plural.

Effective Participation of Actors

Another characteristic of bioethics is the need for the involvement and effective participation of all possible actors and agents of society in the discussion of ethical issues. More generally, Zaboli, et al. mention that, both in bioethics and in other sectors, [...] for political advances to take shape [...] it is essential for society to engage in transformative proposals that benefit the collective through conscious and consequent popular participation. This participatory process, however, must get rid of paternalism and support for ignorance. It is not enough just to guarantee the quantitative presence of the population in democratic events [...] or in pluralist organizations [...]. Popular participation, in any political process aimed at achieving objectives, requires the indispensable prerequisite of information, knowledge, preparation, education [40].

More narrow, and in relation to public policies for the defense and promotion of the rights of the elderly, Junges states: Brazilian legal culture is prodigal in creating beautiful laws, but which often remain innocuous due to lack of application. For this reason, it is necessary to promote awareness-raising groups on the rights of the elderly and create mechanisms for monitoring and evaluating compliance with the Statute [41]. Thus, with these observations, it appears that the effective involvement in bioethical discussions is of fundamental importance for the progress towards its realization.

Evaluation between Ethics and Scientific Areas

Another important characteristic of bioethics concerns the need for analysis and evaluation between ethics and the areas of life sciences, health and the environment, in order to understand how a given decision in one area interacts with others.

After having identified and specified the various ethical dilemmas or conflicts of values involved in a given case, a skill that is only acquired through practice, they must be analyzed and deliberated on them separately, without mixing them up, so that the deliberation is not confusing, thus hindering a reasonably satisfactory conclusion. For this to happen, Ferrer and Álvarez observe that it is very useful to create a tree of problems and attitudes. In general, human beings see extreme attitudes very well: yes or no, black or white, all or nothing, calling the judge or voluntarily releasing a patient, etc.; but it’s hard for us to see the shades of grey, the hues, the attitudes in between. And it is among them that the best (or least bad) solution is usually found, the solution that best respects moral principles and the greatest number of values. Therefore, we must specify all possible attitudes, not only those that seem desirable or that we like, but all that can be Ferrer JJ, et al. [39].

It can be seen that this way, it will be easier to analyze the possible consequences of each attitude and identify the ethical conflicts to which each one leads us. Circumstantially, attitudes can be complementary to each other, and we can choose more than one, as they coincide or temporarily succeed each other. Or, on the other hand, they can be mutually exclusive, with two choices being incompatible. Therefore, to get a sense of how a given decision in one area interacts with others in the field of bioethics, it is necessary to analyze and evaluate each of the current problems identified, as well as each and every one of the possible attitudes.

The Relevance of the Sum of Specifics on the Consequences of Bioethical Options

Another characteristic of bioethics is about the sum of the specificity of the field of action on the relevance of the consequences of bioethical options on the human being (individual) and on all humanity and its world (human beings). The establishment of scenarios of the different alternatives and their consequences is fundamental for the orientation and verification of the adequacy or not of possible actions to be taken in bioethics. This is because the action that is carried out at an individual level will have its social or collective consequences. An intervention, for example, for genetic testing, for termination of pregnancy, or for reproductive decision, is done on a person (individual) but its outcome will have an impact not only on the individual but also on his family, the population, and the world, such as the discussion of social issues related to discrimination, prejudice and exclusion, etc. In addition, it is important to consider the intergenerational issue. And this means that the actions that are carried out in the present have long-term consequences and can affect individuals who do not yet exist. Thus, all the good or any harm done to the individual will have a social repercussion and its probable expansion to a larger collective sphere.

The characteristics presented above (the area of activity, the pluralist requirement, the effective participation of the actors, the evaluation between ethics and the scientific areas, the relevance of the sum of the specificities on the consequences) can, not in isolation, but only together, support itself, reinforce and justify the recognition of bioethics as an autonomous, necessary and robust field within ethics.

For Bioethics to be a Subdiscipline

Some authors have argued in favor of bioethics being understood as a subdiscipline. According to this proposal, bioethics would be subsumed within a particular discipline and would be a “property” only of this already constituted discipline. Consequently, the standard of rigor in bioethical research would simply be the same standards that the discipline had already established. R.M. Green, for example, argues that bioethics is a subset of moral philosophy, to which it applies the methods of philosophical analysis [16]. Powers, in turn, understands bioethics as “an intrinsically political competition” and that this type of research must be approached through the lens of political science [43]. And Callahan sees (or has at least seen) bioethics as a new subdiscipline that, as a peculiar enterprise, professional for some and one of uncertainty and suspicion for others, shares a fate similar to that of ethics [11]. However, these perspectives and similar ones would probably be nothing more than a debate about the relative value of established disciplines, in which bioethics would still be without the achievement of autonomy.

For Bioethics to be a Discipline

As for “disciplinarity”, there is no universal agreement on the definition of an academic discipline. Despite this, Becher says that many scholars understand that disciplines have two components. The first component is sociological characteristics, and this includes institutional structures such as journals, research centers, academic programs and conferences, in addition to social practices such as shared language and identification with a unique intellectual tradition [44]. In this sense, it would not be difficult to conceive of bioethics as a discipline. The second component is epistemological characteristics, because the desire to better understand the world will allow the emergence of academic disciplines. Latttuca notes that disciplines allow us to divide the world into smaller and smaller parts, hoping that in understanding these parts we can understand the whole [45].

Each “discipline” aims to understand a particular feature of the world, and each understanding takes place through a set of tools, methods, procedures, examples and theories that count coherently for a set of objects or themes [46]. Thus, the epistemological characteristics of a discipline focus on its object, on the methods and instruments used, and on a standard of rigor that determines the correct use or not of the methods and tools. And it is precisely on these characteristics that bioethicists sharply disagree. And it is also these characteristics that seem to exclude the possibility of distinguishing bioethics as a discipline in itself. What they do not seem to exclude is the possibility of being merely a subdiscipline within other disciplines.

Jonathan Baron, in his book Against Bioethics, outlines aspects of bioethics as a distinct discipline, and proposes to develop it as a unique and exclusively empirical discipline [8]. But there are those who challenge the notion that academic disciplines can be clearly categorized and distinguished, by claiming that the sociological characteristics of the disciplines are flexible and historically and geographically variable [44], since they are long and complex social constructions [46, 47, 48, 49], and that are equally flexible or not- fixed are the epistemological criteria of academic disciplines, both in theory and in practice [50]. This leads us to conclude that there is no single method of investigation, no standard verification procedure, and no definitive set of concepts that uniquely characterizes each particular discipline.

For Bioethics to be a Multidisciplinary

The “multidisciplinarity” (or pluridisciplinarity), in turn, refers to the set of disciplines to be worked on simultaneously, under a common theme, in which each discipline remains with its own methodology, and without revealing the relationships or cooperation that could exist between disciplines. Multidisciplinary, “The simplest and most frequently used form” [...], “Consists of the simple juxtaposition of disciplines, without any assumption of connection between them being required” [51]. Abortion, for example, can be studied from the perspective of medicine, biology, law, sociology, or psychology. According to Nicolescu, the multidisciplinary analysis brings “something more” to the discipline in question (in this case, bioethics), enriching the object of study (abortion), but it is only at the service of this same discipline, that is, this approach “multi” goes beyond the discipline, but its result remains limited to the structure of the disciplinary study [52].

For Bioethics to be an Interdisciplinary

The “interdisciplinarity” refers to the mutual exchange and interaction of diverse knowledge in a reciprocal and coordinated manner. There is a methodological perspective common to all and an integration of results. Although the interests of each discipline remain, there is a search for solutions to their own problems through articulation with other disciplines. In summary, in interdisciplinarity there is cooperation and coordinated action.

M. A. M. Wachter is perhaps the author who outlined the most extensive interdisciplinary model for research in bioethics. He begins his text Interdisciplinary bioethics: But where do we start? Saying that no single person can acquire adequate training in all relevant disciplines of bioethics. And even if that were possible, says Wachter, that individual’s work would not necessarily be interdisciplinary. For this reason, he argues that bioethicists should define “the ways and methods of doing bioethics as an interdisciplinary” and argues that interdisciplinary research depends on and reinforces the independence of disciplines. To integrate the constitutive disciplines in bioethics research, Wachter proposes a process composed of five phases: 1. The starting point is the acceptance of the methodological Epoché, that is, that all disciplines must refrain from approaching the topic following their own monodisciplinary methods; 2. The second point is the interdisciplinary formulation of a global question that recognizes the possible aspects and their totality;

3. The third point is the translation of the global question into the specific language of each participating discipline; 4. The fourth point is that the answer to this translated question must be constantly checked in view of its relevance in answering the global question; 5. The fifth point is agreement on a global response that should not be produced by a particular discipline, but that integrates all the particular responses available [53].

As for the evaluation of aspects referring to Wachter’s proposal for an interdisciplinary bioethics, such as its adequacy, originality, relevance, arguments, quality, reliability, applicability, negligence, etc., it has already been widely discussed by Daniel Adler and Randi Zlotnik Shaul (2012), who concluded by pointing it out as a path full of risks and challenges.

For bioethics to be a Trans disciplinary

On “Trans disciplinarily”, some authors, by rejecting the conceptual category of “discipline”, defend a Trans disciplinary approach to knowledge [54, 55]. Although there is disagreement as to its meaning, it generically refers to the defense of the development of a holistic worldview [45], in which all knowledge must become unified, and disciplinary boundaries no longer exist [48]. According to Nicolescu, with the prefix “trans”, trans disciplinarily refers to “what is at the same time between disciplines, across disciplines, and beyond any discipline”. The literature on Trans disciplinarily is quite recent, and highly theoretical, and it is still not sufficiently clear how this epistemological approach can be applied in practice and how it would prove beneficial in bioethics research.

Identification

Who can be identified as a bioethicist? We will focus on this main question at this point. Bearing in mind that on the one hand the identification, characterization, affirmation and consolidation of this figure can mean the consolidation of the recognition of bioethics as a specific and autonomous area of human knowledge. And on the other hand the lack of characterization or the improper characterization of the bioethicist figure can lead to a mischaracterization or banalization of bioethics as a specific and autonomous area of human knowledge.

How can one case or the other happen? If today anyone can declare themselves a bioethicist, probably not everyone would have the necessary characteristics that such a figure should demand. In this way, there is an open space for the most diverse interested figures, which could lead bioethics (as well as any other area of knowledge) to be a kind of umbrella that shelters, and shelters all types, and even worse, leading to the aforementioned mischaracterization or trivialization of bioethics.

Although there is not a ready and finished answer to the question, it must be made and submitted for discussion by all, given that we are at a stage in which there are still no conditions and competences to give adequate and complete answers to it. But, as Kant referred to the aufklärung in German society, we are evidently moving towards that. In this sense, what seems to us to be one of the starting points in the search for prolific answers is to try to preliminarily answer another question, namely: what is the characteristic and specific type of activity of the bioethicist?

It is advanced that there is no human activity that is not related to the other, that is, one is carried out in sharing with the others, even those carried out individually. He will always act taking into account otherness, another. Even Robson Cruzoé, who can think and feel completely isolated, and whatever his activity, has a father and a mother, and everything that is done affects one another and the whole.

In the case of bioethics, it is, by its very nature, a “set” activity. And even if the bioethicist thinks he is acting in isolation, in reality he is acting in harmony or not, with a set of people, disciplines and perspectives. The affirmation of the existence of a bioethicist depends on the existence of another bioethicist. No single bioethicist is complete.

Carl Elliot raised the following question: how does the bioethicist act (or should act) in the face of a case? As an lawyer or as an philosopher [56]. As an answer to this question, we can say that the bioethicist, when evaluating any question of bioethics, acts in several ways: accuses (lawyer), defends (lawyer), judges (judge), analyzes (jurist or philosopher), chooses (juror), assists (advisor), and makes the report (expert). The bioethicist does not exclusively or predominantly have any of the roles, but he acts in any of the roles mentioned. It will depend on the situation involved and the area of competence in which he finds himself. Thus, it is up to the bioethicist to identify the situation and work towards the ethical equation of the values in demand, at which time he puts all reasoned wisdom into practice (capacity, competence, understanding, criticism, knowledge, etc.), aimed at his own good and of otherness.

Word (vocabulary)

The Brazilian dictionaries consulted (Aurélio, Houaiss, Michaelis, AB) do not register the terms “bioethicist” and “ethicist”. The first term, bioethicist, is understood as a derivative of the term bioethics. That is, bioethicist is the result of the sum of the terms “bio”, “ethics” and the nominal suffix “ista” (bio + ethics + ista = bioethicist).

According to the dictionary Aurélio B. de Holanda F., the nominal suffix “ista” appears as an indicator of:

1. Partisan or sectarian of a doctrine, school, sect, theory or artistic, philosophical, political or religious principle;
2. Practice, craft;
3. Having an occupation.

It is verified that the suffix “ista” has a positive semantic charge, that is, one who is in favor of a line of work, of a principle for the execution of his tasks, as a critic, violinist, socialist, artist.... Based on the description in the aforementioned dictionary, a bioethicist could be a “partisan”, “sectarian” or “practitioner” of bioethics. As the expressions “sectarian” and “partisan” can also refer to someonebelonging to a religious sect or political party, someone intolerant, intransigent, and bioethics cannot be treated as a sect or a party, it seems advisable, when speaking of the bioethicist, exclude these terms, and stick with the meaning of “practitioner” of a philosophical “doctrine” or “office” (which by its very affiliation, bioethics is ethics, and ethics is philosophy). Thus, seeking a definition based on the Aurélio Dictionary, the bioethicist neologism refers to one who is a supporter of a doctrine or a body of philosophical doctrines, identified and unified under the previously described characteristics of bioethics.

Legislation

The Current discussions on the inclusion of bioethics teaching in high school courses advocate the incorporation of bioethics into the ethical training and intellectual development of academics [42]. It is clear that bioethics is directly related to the teaching and training needs of the Brazilian citizen, clearly outlined in the Law of Directives and Bases of Brazilian Education [57]. For Masseto, values such as democracy, participation in society, commitment to its evolution, the contextualization in time and space of its civilizing culture, as well as ethics in its broader conceptions (referring to personal, professional, group and political) need to be learned in our higher education courses [58].

Bioethics, due to its interdisciplinary character that encompasses themes from different areas, today attracts the attention of professionals with different backgrounds. They are engineers, doctors, journalists, administrators, lawyers, philosophers, pedagogues, biologists, among others. And everyone believes that in the near future this will be a successful profession, although it is not yet regulated in the country. In Brazil, bioethicists are still few. There are around 10 centers with training programs in the area of bioethics, while in the United States this number is around 400. At the graduate level, for the time being, there are less than half a dozen courses. In Brazilian hospitals, the Bioethics Committee (CB) is still a rarity. For this reason, specialists get opportunities to work only on the Research Ethics Committees (CEP), which already number around 450 throughout Brazil. These Research Ethics Committees involve the participation of more than 6,000 professionals, and all of them report to the National Research Ethics Committee (CONEP), created in 1996 and linked to the Ministry of Health. Professor Hossne (1927-2016), one of the pioneers and authority of bioethics in Brazil, states that “the approach of bioethics means a step forward for the country, as it is an instrument of social control that represents society”, and that bioethics, with “committees, which bring together professionals with unusual training”, should open fields of action in all areas of knowledge [59].

Starting Points and the Common Core

But we can ask whether there is currently the profession of bioethicist. And the answer may be that, as a regulated, clear and defined profession, no. In practice, however, there are those who deal with bioethics, exercising as an academic and/or advisory activity. Based on the examples of several other words ending in “ista”, (such as nutritionist, electrician, ophthalmologist), it can be said that an ethicist is a specialist in ethics and a bioethicist would be a specialist in bioethics. The fact of not being an “expert” in bioethics or ethics does not mean that you cannot participate in related activities, since bioethics (and ethics) due to its original characteristics affects and should involve any person, layperson or “expert”. The Participation in bioethical activities is certainly a necessary condition for a bioethicist, but it is not a sufficient condition for being an ethicist or bioethicist. There are other indispensable conditions that both must fulfill in order to do so. What conditions are these? In the case of ethics, the specialist (ethicist) is supposed to be a philosopher trained in ethics. And in the case of bioethics, shouldn’t the specialist (bioethicist) necessarily be a philosopher specialized in ethics and/or bioethics? If bioethics is pluralistic, multidisciplinary, interdisciplinary and transdisciplinary, would it be possible to be one only for philosophers, that is, trained in philosophy? From the considerations made so far, above all, it seems that, taking into account the field of activity and the characteristics of bioethics, it is inconceivable that only a Philosopher (graduated in philosophy) can become a bioethicist professional.

Thus, one can reach bioethics with the aim of becoming a bioethicist, starting from any area of human knowledge that makes possible the necessary conditions to seek and acquire a multidisciplinary, interdisciplinary and transdisciplinary formation, mainly in relation to the areas of human sciences, health sciences, life sciences and/or environmental sciences.

Therefore, from wherever you start, you can, with more or less difficulty, reach bioethics. One of the fundamental things is that the postulant has a sufficient basic formation that allows taking him/her to the interdisciplinarity of dialogue, deliberation and decision. The starting point will allow the development of a specific profile of bioethicist: biologist, jurist, doctor, theologian, philosopher, engineer, etc. Likewise, everyone’s vision will be, in many ways, different. In fact, different views and a common core are part of the essence of bioethics, and it is indispensable for bioethicists. The fact, however, that a pure physician or pure philosopher simply discusses laws about phenomena in the areas covered by bioethics does not make them bioethicists. It is indispensable in both (and in opposite directions) the reasonable development of its bases, with interdisciplinary potentials, which include and integrate areas of technical- scientific knowledge (biology, medicine, etc.) and areas of humanistic and cultural knowledge (philosophy, theology, sociology, etc.) together with a common core. Also, in addition to interdisciplinary training in bioethics, for the bioethicist it is essential that the training obtained is properly used for the proper exercise of bioethical option.

Domain of Basic Knowledge

The first requirement is the mastery of basic knowledge in the humanities and biological areas in order to allow the future bioethicist a safe incursion into the two mentioned fields and growth on several fronts. These fronts will allow you to open, at every opportunity, new horizons and new perspectives, show willingness for new incursions of anxieties and reflections, questioning, evaluations, reformulations and constant improvements, if and when necessary.

Profile

The second requirement is to have the profile, behavior and attitudes that are minimally compatible with ethics. Although there is no specific profile for the bioethicist, the future bioethicist must possess and develop a critical sense, starting with a constant self-assessment, excluding, as far as possible, bad character and weakness of will.

Character

The third requirement that is considered important is the character and behavior of the bioethicist. This is because the individual, who lies, defames, slanders, curses will not be a bioethicist. Even admitting that one cannot demand honesty and integrity from everyone, for example, one must demand from the bioethicist at least minimally serious, honest, correct, civilized, upstanding behavior and at least compatible with good customs. From an ethical point of view, the use or application of knowledge under inappropriate conduct is extremely dangerous. Bioethics emerged precisely as a movement against the inappropriate use of scientific and medical knowledge. In this sense, for example, requiring only the skills and technical skills of a doctor, and authorizing him to use a melee weapon, strongly cutting, to remove organs and tissues from a patient, is reckless and risky. Likewise, requiring only the technical knowledge and communication skills of a lawyer, and authorizing him to make decisions in the face of a highly vulnerable patient, is also risky and reckless. In both exemplary cases, there could be a “bioethicist” who, even with good scientific background, was capable of ethically inappropriate conduct and/or behavior, is to incur risks.

Freedom of Choice And Operation

Bioethical activity has as its objective the equation of the values in demand, and this presupposes an option and implies a decision with responsibility. Faced with the natural “anguish” of choosing, it is much easier to give in to the desire to escape the responsibility of thinking, discussing and choosing, hiding behind laws and rule codes. Illustrating this thought, Kant’s text “Was ist Aufklärung?” [60], as well as Sartre’s “Being and Nothingness” [61]. Thus, a fourth condition for exercising the profession of bioethics is the freedom to operate, to play its role as such.

No Prejudice or Minimal Preconception/ Prejudice

Equally important is the other condition: non-prejudice or minimal prejudice. When carrying out a reflection, be it bioethical, philosophical or of another nature, it is essential that each actor, before making an option and decision, gets rid of prejudices, concepts already formed a priori, and prior to reflection and dialogue themselves on the conflicting topics. Wittgenstein, in at least two moments, and in certain contexts, warned that this task is perhaps the most difficult thing to do: The first says: “Nothing is more difficult than being faced with concepts without prejudice. (And this is the main difficulty of philosophy)” [62] and the second: “(…) Nothing is more difficult than considering concepts without preconceptions because preconception is a form of understanding and to renounce it when precisely so much important to us resides there” [63]. It should be noted that difficulty is not synonymous with impossibility.

Humility to Respect the Opinions and Positions of Others

The idea that it is possible to know all the information on a given topic is outdated. After the exorcization of “Laplace’s demon” by Werner Heisemberg, the principle of uncertainty and indeterminacy was accepted and extended to any and all processes, in order to admit that not only the processes change as they can change their own way of changing [64]. There was a definitive change in scientific discussions, but there was not the expected counterpart of humility from most scientists, philosophers and other professionals involved with the generation and application of knowledge, so that Hans Jonas went so far as to state that “humility would be necessary as an antidote to today’s noisy technological arrogance” [65]. In bioethics, specifically, some degree of empathy and humility are essential ingredients for respecting the opinions and positions of others, as well as the consequent greatness to change an option that is judged to be wrong or inadequate.

Ferrer and Alvarez exemplify this conditional aspect: Precisely because of the power he possesses, it is important that, in the clinical encounter, the physician has the intellectual humility to recognize the limits of his knowledge and admit his arrogance when he does not know. Knowing when to say “I don’t know,” and having the courage to do so, is a virtue advised in sources as different as the Babylonian Talmud and the writings of Galileo, which reveals a person’s character [66].

In this way, the characteristics listed together with the six conditions presented above, indicate the way and direction in which bioethics should go in order to claim and ensure its own field of knowledge and reflection within ethics [67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92].

Thus, to become a bioethicist, at least five basic conditions must be met and as we have seen, the first condition to be fulfilled is the mastery of the basic knowledge of the common core. But we could ask about the process that the postulant must follow to acquire such domain. That is, how should this education, training or teaching of bioethics happen?

Starting, first, from a positive response regarding the teaching of bioethics, it can be said that it is a matter of offering information and transmitting the basic knowledge involved in the field of bioethics. But starting, secondly, from another positive answer, it can be said that, in the insufficiency of this teaching, there is an education, a training commitment assumed by the opting, which goes beyond the transmission of knowledge, and which enables the future bioethicist to admire, enrich and build their own training process in bioethics. Thus, bioethics provides the instruments and conditions and the future bioethicist must develop and give consistency to this process.

As for the questions about what to teach and how to teach, this will depend on the training base that the future bioethicist has, as well as the common core that each and every one must master to start the process of specific training in bioethics. The syllabus of all these subjects can be created at the discretion of the professor in charge and must be guided with the objective of acting in the face of the contextual problem of bioethics.