O processo de territorialização epistemológica da Bioética de intervenção : por uma prática Bioética libertadora

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Bioética, 2015.Esse trabalho tem como finalidade descrever e analisar o processo de elaboração, surgimento, legitimação e propagação da teoria denominada Bioética de Intervenção. Conscientes da dimensão histórica, política e ideológica dessa proposição bioética, optamos por construir um texto na forma de registro historiográfico, com base numa hermenêutica crítica e dialógica capaz de comportar a pluralidade epistêmica que possa viabilizar a construção de um pluralismo bioético enraizado na realidade concreta da América Latina. Partimos do pressuposto de que a Bioética de Intervenção surgiu num contexto de contestação ao neoliberalismo e tendo a “periferia” como lugar de elaboração e enunciação de saber, se constitui numa proposta pluriversalmente aberta para as interações interepistêmicas com outros saberes que se colocam a serviço dos processos de construção das autonomias. Em seu horizonte está a libertação dos povos e dos grupos de pessoas oprimidas do Planeta, vítimas das injustas estruturas de poder que dão sustentação às relações de desigualdade historicamente construídas com base na conformação do Sistema-Mundo Capitalista. Com o propósito de contribuir com seu processo de consolidação epistemológica tecemos algumas considerações sobre o seu referencial teórico e apresentamos algumas sugestões objetivando a superação de algumas preocupações identificadas. Para evitar uma abordagem especista – dada sua forte vinculação aos direitos humanos –, estamos sugerindo a inclusão dos direitos da natureza dentro de seu arcabouço teórico. Como forma de insurgência contra a imposição da racionalidade ocidental pelas epistemologias dominantes propusemos a adoção de uma reflexão bioética interepistêmica e sentipensante na qual sentir e pensar (emoção e razão) interagem para produzir o conhecimento. Cuidando para que sua prática interventiva nunca ocorra de maneira intromissiva, desrespeitando o protagonismo e as autodeterminações dos sujeitos a quem se destina a ação bioética agregamos a perspectiva da interculturalidade crítica ao pluralismo bioético proposto pela Bioética de Intervenção. Considerando que o caráter político militante da Bioética de Intervenção implicará sempre no estabelecimento de relações com as instituições do Estado, refletimos sobre as tensões emanadas desse relacionamento e apresentamos a necessidade de refundação do Estado, buscando inspiração nas experiências recentes ocorridas na Bolívia e no Equador que resultaram na construção do Estado pluralista e inspirado pelo paradigma do Bom Viver.This work has as its purpose describing and analyzing the creation, emergence, legitimization, and propagation process of the theory named bioethics of intervention. Aware of the historical, political, and ideological dimension of this bioethics’ position, we have opted to write a text in the shape of a historiographical register, based in a hermeneutic critic and dialogical capable of comporting the epistemic plurality which may be able to build a bioethical pluralism rooted in the concrete Latin-American reality. We work on the assumption that bioethics of intervention arose in a context of contestation against neoliberalism and having the “periphery” as the place of creation and enunciation of knowledge, it constitutes itself on a proposal, which is plurally and universally open to the inter-epistemic interaction of other knowledge that are at service to the autonomy building processes. In its horizon, there can be found the liberation of the oppressed people and groups from the planet, victims of unjust power structures which give support to the disparity relations historically built based on the need to conform capitalist world-system. With the purpose to contribute with its epistemological consolidation, we have made some considerations about the theoretical referential and we have presented some suggestions objectifying the overcoming of some identified concerns. In order to avoid a speciesist approach –given its strong connection to human rights–, we are suggesting the inclusion of nature’s rights in its theoretical framework. As a way of insurgence against western rationality by the dominant epistemologies, we have proposed the adoption of an inter-epistemic and sentipensante bioethical reflection, in which to sense and to think (emotion and reason) interacts with one another to produce knowledge. Ensuring that its interventional practice never takes place in an authoritarian manner, disrespecting the protagonism and auto-determination from the subjects to whom is destined bioethics action, we aggregate the critical inter-culturally perspective against bioethical pluralism proposed by the bioethics of intervention. We consider that the militant character of bioethics of intervention will always imply in the establishments of relations with the State’s institutions; we have reflected on the tensions provided from such relationship and we have presented the need to refound the State, looking for inspiration in the recent experiences in Bolivia and Ecuador, which in its turn have resulted in the construction of a pluralist State inspired by the Good Living paradigm

Bioética de intervención, interculturalidad y no-colonialidad

The proposal of Intervention Bioethics (BI), which arose in the 1990s as a response to the Anglo-Saxon perspective of four universally presumed principles, which though necessary are insufficient in the Latin-American context, has continued its collective construction process. The article shows the common points between this proposal and Latin-American perspectives of inter-cultural and non-colonial issues. Simultaneously, the utilitarian perspective of John Stuart Mill opens the possibilities of approximation between utilitarianism and individual rights, ethically opposing positions for many authors. In addition, we show that BI has consonance with three Unesco declarations on culture, genetic heritage and human rights. All of these elements allow progress towards an epistemological statute of Intervention Bioethics, one of the more important proposals towards a Latin-American vision of this new interdisciplinary territory of knowledge.La propuesta de Bioética de Intervención (BI) surgida en los años 1990 como respuesta a la mirada anglosajona de la bioética centrada en cuatro principios pretendidamente universales - que aunque necesarios son insuficientes al contexto latinoamericano - ha continuado su proceso de construcción colectiva. El artículo muestra los puntos comunes entre esta propuesta y perspectivas regionales latinoamericanas acerca de interculturalidad y no-colonialidad. A partir de la mirada utilitarista de John Stuart Mill, abre posibilidades de aproximación entre el utilitarismo y los derechos individuales, posturas éticas contrarias para muchos autores. Igualmente, muestra como la BI está en consonancia con el contenido de las tres declaraciones de la Unesco en asuntos relacionados con la cultura, patrimonio genético y derechos humanos. Todos estos elementos permiten avanzar hacia un estatuto epistemológico para la Bioética de Intervención, una de las propuestas más difundidas en la contextualización latinoamericana de este territorio interdisciplinar del conocimiento

Educa(ações) indígenas: territórios de identidades e espaços de (re)existências do Povo Xukuru do Ororubá

Este artigo faz uma abordagem sobre a temática da educação indígena. É fruto das pesquisas realizadas ao longo do mestrado em educação contemporânea, na Universidade Federal de Pernambuco, e se propõe a analisar as interfaces existentes entre a educação Xukuru e a educação escolar do povo Xukuru do Ororubá enquanto territórios de identidades. A partir da vivência na área e a contribuição de alguns autores, constatamos que a escola serve de instrumento para o fortalecimento da identidade étnica, por isso é considerada um espaço de (re)existência, e a comunidade é a base para que essa educação aconteça, seja no espaço da sala de aula ou para além dele

Bioética, cultura e infanticídio em comunidades indígenas brasileiras : o caso Zuruahá

O artigo analisa a prática do infanticídio em comunidades indígenas brasileiras. Tomando como referência um caso específico envolvendo duas crianças do povo Zuruahá, focaliza o tema sob uma abordagem mais abrangente e discute como o infanticídio é interpretado em outros povos indígenas. Foram considerados, na discussão, os debates ocorridos durante a Audiência Pública realizada no Congresso Nacional Brasileiro, em dezembro de 2005, que analisou o tema, além de revisão bibliográfica. Diante dos posicionamentos assumidos naquela audiência, procurou-se identificar os problemas éticos e os dilemas morais, contextualizando-os e analisando-os à luz do respeito ao pluralismo cultural. A fim de contribuir com o debate, os autores analisam as possibilidades de intervenção nas práticas tradicionais de infanticídio, recusando qualquer opção que não esteja ancorada numa atitude de profundo respeito pela cultura de outros povos ou que não apresente condição de dialogar com indivíduos ou grupos com diferentes moralidades.This article analyzes the practice of infanticide in indigenous communities in Brazil. Taking as a reference point a specific case involving two children of the Zuruahá people, it takes a broader look at the issue and discusses how infanticide is understood among other indigenous peoples. A debate focusing specifically on this topic that took place during a public hearing held in the Brazilian National Congress in December 2005 has also been taken into consideration in this discussion. In view of the positions adopted as a result of the hearing, this paper seeks to identify the ethical problems and moral dilemmas relating to the subject, by putting them into context and analyzing them in the light of respect for cultural pluralism. Seeking to contribute to the debate, the authors analyze the possibilities for intervention in the traditional practices of infanticide, while rejecting those positions that are not anchored in an attitude of profound respect for other people's cultures or that do not create conditions for dialogue between individuals or groups with different moralities

Chemodectoma in a Dog

Background: The chemodectoma is a rare neoplasm that originates from chemoreceptors located mainly in the aortic body, and carotid body and sinus, and responsible for detecting variations in blood pH, oxygen pressure and carbon dioxide. Dogs of brachiocephalic breeds and aged between 7 and 15 years have greater propensity. A neoplasm involves infiltrative growth in the vessels at the heart base, which leads to Congestive Heart Failure (CHF). The definitive diagnosis is performed by histopathological and/or immunohistochemical examination. The aim was to report a case of chemiodectoma in a dog, showed the disease clinical characteristics.Case: A 13-year-old male undefined breed dog was examinated in the medical clinic of small animal of Veterinary Hospital, Federal Rural University of Pernambuco (UFRPE) with respiratory effort, hyporexia, and edema in face, cervical, ventral thorax and thoracic limbs, with thirty days evoluted. About physical examination, we observed cachexia, orthopneic position, cyanosis and edema with a positive Godet sign, as well as 8% dehydration degree. Thoracic auscultation presented mixed dyspnea and muffled heart sounds. Chest radiography detected an radiopacity increase in pulmonary section and metastatic neoplastic process associated with pleural and pericardial effusion. Fluid therapy with lactated ringer and posterior thoracentesis in the right hemithorax region was performed for greater respiratory comfort for the patient. Hematological count and biochemical profiles stated normochromic normocytic anemia, relative and absolute lymphopenia, thrombocytopenia, as well as increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The patient died after 12 hours when was submitted to necroscopic examination and histopathological evaluation. An infiltrative tumor of cardiac base was observed invading the light of the right atrium, obstructing the venous return, as well as a large thrombus located in the left ventricle and diffuse nodules in the lungs. Hydrothorax and hydroperitoneum were observed with serous fluid, with hepatic, renal and brain congestion, and duodenum hemorrhage. Histologically, the tumor was characterized as a chemodectoma with pulmonary metastasis.Discussion: Cardiac tumors are uncommon for canine population. A study sampled 729,265 dogs with observed incidence reaching 0.19%. The most common type is hemangiosarcoma with 69%, followed by chemiodectoma and lymphoma. Authors describe predisposed brachycephalic breeds such as Boxer, Boston Terrier and French Bulldog. In our case, the patient had elongated snout and undefined breed. Deregulation of chemoreceptors, which detect changes in pH and partial oxygen and carbon dioxide pressures, can result in hyperpnea and dyspnoea. Edema represents a deficit in venous return from the cranial and cervical regions, with consequent increase in hydrostatic pressure and liquid leakage into the thoracic cavity and subcutaneous tissue, thus inferring the Caudal Vena Cava Syndrome (CVCS). Tumors from the cardiac base, integrated with the large arteries insertion and adjacent to the atria, can cause pericardial effusion observed in this case. Chemodectomas are described as essentially benign tumors with low metastatic potential. In this case, pulmonary metastasis was detected. Surgical treatment is recommended when feasible. In this case, the patient had late veterinary care, in addition to the contraindication for surgery by the lung metastasis presence

Gastroesophageal Intussusception in Canine

Background: Gastroesophageal intussusception is characterized by the invagination of the stomach into the esophagus, with or without the involvementof adjacent organs such as the spleen, pancreas, and omentum. In dogs, this condition has no breed or sex predisposition. As it is an infrequent disease in routine veterinary medical practice, this study reports a case of gastroesophageal intussusception in a dog necropsied at the Veterinary Hospital of the Federal Rural University of Pernambuco (HOVET - UFRPE), Recife, Brazil.Case: The body of a 12-year-old black mixed breed male dog was sent to the Pathology Department (Necropsy Sector of the Federal Rural University of Pernambuco - UFRPE) for a necropsy. The animal had a previous 4-year history of recurrent emesis and limb weakness, primarily in the anterior limbs, that worsened in the previous months and progressed to death. No previous treatments were reported by the owner. On external examination, the animal had a low body score (cachectic), forelimb joints with great flexibility, congested oral and ocular mucous membranes, enophthalmos, and increased volume in the perianal region. At the opening of the thoracic cavity, the final third of the esophagus was dilated and gastroesophageal intussusception, edema, and pulmonary congestion were noted. In the abdominal cavity, there was hepatic and renal congestion and large intestine and rectal ampoule dilation, with a large amount of solid and retained feces (fecaloma), perianal hernia, and testicular neoformation. These findings were consistent with those observed in death caused by cardiorespiratory failure secondary to gastroesophageal intussusception.Discussion: The pathophysiology of gastroesophageal intussusception is still not elucidated and is probably multifactorial. This condition causes reverse gastric peristalsis associated with a sudden and sustained increase in abdominal pressure. Some probable predisposing factors for this pathological condition are esophageal motility disorders, lower esophageal sphincter dysfunction, and hiatal enlargement. In dogs, gastroesophageal intussusception is associated with increased intra-abdominal pressure owing to emesis or blunt trauma, negative intrathoracic pressure caused by respiratory, and previous esophageal diseases, especially megaesophagus. Partial or total obstruction caused by intussusception leads to circulatory disorders in the organs, especially decreased venous return. Persistence of this condition can lead to gastric necrosis and rupture followed by endotoxic (or septic) shock and release of inflammatory mediators that can cause cardiovascular and respiratory dysfunction and rapid death. Impaired circulation is macroscopically evident in several organs, characterized by mucosal, lung, liver, and kidney congestion, in addition to cardiac dilation and mitral valve endocardiosis. The occurrence of stomach invagination into the esophagus dilated in the final portion is characteristic of gastroesophageal intussusception. Moreover, death owing to cardiorespiratory failure is related to cardiac (dilatation and endocardiosis) and pulmonary (edema and congestion) involvement secondary to gastroesophageal intussusception. Since thispotentially fatal condition has a low incidence in small animals and often goes unnoticed by professionals, early and correct diagnosis along with surgical treatment are essential for a good prognosis and favorable progression

Pluralismo moral e direito à vida : apontamentos bioéticos sobre a prática do infanticídio em comunidades indígenas no Brasil

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2010.A partir do ano de 2005 o debate em torno do chamado “infanticídio indígena” passou a ocupar alguns espaços dentro da sociedade brasileira. Por não se tratar de um tema prioritário na agenda do movimento indígena, não houve inicialmente nenhum envolvimento por parte dos povos e organizações indígenas do país, até por que esses entendem tratar-se de um assunto privativo, de interesse interno de suas comunidades onde ocasionalmente o evento possa ocorrer, e dentro dessas comunidades ainda mais restrito a determinadas pessoas em decorrência da condição de gênero, relação de parentesco ou papel social que desempenham numa sociedade específica. O nosso interesse e envolvimento com o mesmo é conseqüência direta do longo tempo de atuação indigenista o que nos ajudou a identificar, a partir da maneira como a discussão estava sendo pautada, tratar-se de mais uma iniciativa a contribuir com a estratégia de criminalização dos povos indígenas, aumentando ainda mais o grau de preconceito e a discriminação da população não índia em relação a eles. Após perceber essa realidade, alguns segmentos do movimento indígena decidiram enfrentar o debate, o que também veio ocorrer com algumas entidades de apoio às lutas indígenas no Brasil. Somente então passaram a serem ouvidas algumas vozes discordantes do tratamento que vinha sendo dado pelos proponentes da campanha de combate ao “infanticídio indígena”. É nesse contexto que se situa nossa reflexão, com o intuito de contribuir para uma melhor compreensão do fenômeno e identificar possibilidades de diálogo, considerando como pressupostos a autonomia dos povos e o respeito às suas formas próprias de organização. A discussão bioética por nós desenvolvida ocorre na perspectiva de nosso engajamento tanto no campo indigenista como da bioética, a partir do paradigma da bioética de intervenção, uma corrente gestada no Brasil, tendo como laboratório principal a Cátedra UNESCO de Bioética da Universidade de Brasília - UnB. _______________________________________________________________________________ ABSTRACTSince the year 2005 the debate on the so-called "indigenous infanticide" has come to occupy some spaces within the Brazilian society. As it is not a priority issue on the agenda of the indigenous movement, there was initially no involvement by indigenous peoples and organizations of the country. Even more so, as in their understanding this is a private matter of internal concern to their communities where it occasionally may occur, and even within these communities the subject is restricted once more to certain people due to their condition of gender, family ties, or their role in that specific society. Our interest and involvement with this theme is a direct consequence of the long time that we have worked in the Indigenous sphere cause which has helped us identify, starting from the way the discussion was being guided, yet another initiative to contribute to the strategy of criminalization of indigenous peoples, further increasing the degree of prejudice and discrimination of the non-indigenous population in relation to them. After perceiving this reality, some segments of the indigenous movement decided to confront the debate, which also occurred with some entities that support the indigenous struggles in Brazil. Only then some dissenting voices began to be heard on the treatment which until then had been given by proponent groups of the discussion. It is in this context that our reflection is situated, with the purpose of contributing to a better understanding of "indigenous infanticide" and identify opportunities for dialogue, considering as a premise the autonomy of the indigenous peoples and the respect for their own forms of organization. The bioethics debate that we have developed takes place in the perspective of our commitment both in the indigenous as well as in the bioethics field, starting from the paradigm of the bioethics of intervention, a current that has been conceived of and developed in Brazil, with the UNESCO Chair of Bioethics at UNB as its main laboratory