Mara de Sousa Freitas: "Health for all, a path, a horizon: bioethics"

7 April 2023 is World Health Day. This date marks the anniversary of the founding of the World Health Organization (WHO) in 1948, and this year, in addition to highlighting the importance of "achieving health for all", the celebration of WHO's 75th anniversary is an opportunity to remember the journey towards continuous improvement in public health and quality of life. This year's theme, Health for All, takes us back to the Ottawa Charter, adopted at the First International Conference on Health Promotion in November 1986. The search, as the charter states, "for a response to the growing expectations for a new public health" and for "health for all in the year 2000" - a persistent question, a path to be followed, a horizon to be attained.

On this horizon - achieving Health for All - what is the importance of bioethics?

Health is a complex construction shared and experienced by, for and with people. It concerns processes experienced and inserted in a singular life context, with multiple determinants requiring integrated and holistic responses. Health is materialised in the care that each person has for themselves and others; in the ability to exercise their autonomy and make choices, to be able to judge the data of a given situation or behaviour and know how to choose in their best interest, but also, whenever necessary, considering the common good, with independence, judgement and knowledge.

Health requires access, distribution and allocation of resources, and the sharing of rights, duties and responsibilities among citizens, civil society, health professionals, political leaders and actors. Health requires justice, equity, fairness, cooperation and solidarity. Creating more and better health for all is an expression of respect and responsibility for present and future generations, as it places care at the heart of human vulnerability.

Bioethics is therefore the necessary and urgent knowledge in the face of the multiple challenges and horizons for health. To acquire this horizon it is necessary "to learn to see beyond what is close, too close, not to look away, but to see better, in a wider set and in more current proportions" (1). Bioethics in the analysis of the issues raised by the development of new technologies applied to life and health sciences - but also in the ethical analysis of the multiple issues of management, practice, and strategic health planning, in Portugal - plays a core role, as it may contribute to solutions that effectively serve the needs of people and society, that (re)affirm human values and ethics as a "practical science" - it is urgent to see beyond what is near, it is urgent to think and act with (Bio)Ethics.

Bioethics is, in the original words, respect for "every living being, on principle as an end in itself (Fritz Jahr, 1927); It is the bridge to the future, based on a new wisdom, that of knowing how to use the (new) knowledge for the survival of man and for the best quality of life (Potter, 1971), so, on the path to this horizon, celebrated and acclaimed today - and so necessary - we need Bioethics and people trained in bioethics, we need to train people in this knowledge, cultivate science and research with social and scientific value, we need to promote good practices in health, the ethics of health and, in this way, renew the country, through excellence and by example.

As a corollary, I recall the words of Susan Sontag (2) on citizenship, she tells us that "everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place", thus, to achieve Health for All, the continuous improvement of public health and quality of life, it is necessary that this is an issue that concerns everyone and that everyone has an important role to play, "we must understand that we do not die because we are ill, we become ill because we are mortal" (Maurice Tubiana, 2000) (3).

(1) GADAMER, Hans-Georg, - O mistério da Saúde, O cuidado da saúde e a arte da medicina. Tradução de António Hall. Edições 70. 2002.

(2) SONTAG, Susan, – A doença como metáfora – A Sida e as suas Metáforas – Tradução de José Lima. Quentzal Editores. 2009.

(3) TUBIANA, Maurice, - História da Medicina e do Pensamento Médico, Lisboa. Teorema, 2000.

POTTER, Van Rensselaer - Bioethics: bridge to the future, 1971.