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Abstract

The interpretation of justice in the context of bioethics should not be restricted to the normative legal-juridical ﬁeld. On the contrary, since the time of conceptualization of global bioethics, incorporation of the reference framework of global justice to this broad context has required an appropriate conceptual opening and practical application to the modern world. The basis for this is the theory of universal human rights and its convergence with bioethics through the Universal Declaration on Bioethics and Human Rights (2005), which politicized the international bioethics agenda by expanding its applied thematic focus, i.e., the biomedical-biotechnological themes that previously were prioritized within traditional bioethics, to health-related, social, and environmental topics. The basis for these ideas is sustained by the need for global bioethics and global justice to serve as practical support instruments for social inclusion in a world in which socioeconomic disparities and inequalities of access to the minimum assets for digniﬁed human life to be developed continue to persist. In addition to analyzing the concepts of empowerment, liberation, and emancipation, this entry covers the need to bring (bio)ethics closer to politics and discusses the topic of equity and the interpretation of the environment as something precious that is everyone’s property, starting from the certainty that the natural resources of the planet are ﬁnite.

Introduction

When the word bioethics (bios + ethos) emerged formally in academic circles at the beginning of the 1970s, it brought in a clear global appeal in which the root bios was interpreted in the broad sense as “life”: biological, social, and environmental (Potter 1970). However, within a short time, due mainly to major conﬂicts that had arisen in different countries, especially in the United States, relating to abuses in the ﬁeld of clinical research and emerging moral conﬂicts in healthcare professionals’ relationships with their patients, its original meaning ended up being directed preferentially to the biomedical biotechnological ﬁeld. Thus, it was with this interpretation that bioethics became known worldwide in the 1980s and 1990s.

However, through the Fourth World Congress of Bioethics, promoted by the International Association of Bioethics (IAB) in Tokyo, Japan, in 1998, the globalization of bioethics came back into the center of international debates. The ofﬁcial theme chosen for this event was “Global Bioethics,” in an attempt to restore the original ideas.

Crucially, this viewpoint was deepened through the Sixth World Congress of Bioethics, which was held in Brasília, Brazil, in 2002, organized by the Brazilian Society of Bioethics, with 1400 speakers and participants from 62 countries. Its keynote slogan was “Bioethics: Power and Injustice.” The event in Brasília, following along the lines set out in Tokyo, politicized the international bioethics agenda by including social topics (poverty, social exclusion, etc.), health-related topics (the right to healthcare and essential medications, support for public healthcare services, etc.), and environmental topics (the right to clean water and pure air, preservation of the environment and biodiversity, etc.) in its scientiﬁc program. These subjects had, until then, only been dealt with secondarily by traditional biomedical bioethics (Garrafa and Pessini 2003).

Between the years 2003 and 2005, UNESCO (United Nations Educational, Scientiﬁc and Cultural Organization), through the International Bioethics Committee (IBC) and the Intergovernmental Bioethics Committee (IGBC), had the arduous task of developing the most important collective document so far constructed around the world in relation to bioethics: the Universal Declaration on Bioethics and Human Rights (UDBHR). After intense international discussions, this declaration, which contains 28 articles, of which 15 relate to “principles,” was adopted in Paris in October 2005, with signiﬁcant unanimous support among UNESCO’s then 191 member countries (UNESCO 2005).

Independent of the existence of the relationship between the events described above and the promulgation of the UDBHR, the proposal for conceptually and thematically expanded globalized bioethics with a political commitment to the acute differences between rich and poor nations around the planet, and their results and consequences, had already matured in many parts of the world. It is therefore precisely within this context that the concept of “global justice” will be developed.

Brief History: The Topic Of Justice As Part Of Global Bioethics

Since the beginnings of bioethics, the theme of justice has been studied through the concept of a “principle” and has been one of its pillars of theoretical and practical support. Together with the principles of autonomy, beneﬁcence, and non-harm, the “principle of justice” contributed toward disseminating and consolidating bioethics within the international context of the 1980s and 1990s. Since then, its interpretation, deepening, and application have been receiving attention from researchers in different parts of the world.

However, what was seen was that its basis was massively directed toward the individual sphere, to satisfy personal and private rights and, for example, to translate access to healthcare as an asset that could be purchased and used privately and never as a human right that would be conﬁgured universally from the time of an individual’s birth. Thus, the interpretation of justice as an international tool that also ought to be directed toward the public ﬁeld and correlated with the attributions and duties of the state and of institutions and governments of different countries, aimed toward collective rights, remained distant from the focus of bioethics.

The expression “global justice” in itself expresses the need for an approach differing from that which so far has been seen within the traditional context of bioethics, in which the topic of justice has been preferentially minimized in favor of autonomy, such that individuality practically suffocates collective notions and maximization of “me” leads “us” to an unequal secondary position. Thus panorama, taken together, ends up conﬁguring a state of ﬂagrantly preferential imbalance toward individual interests and private roots, in comparison with collective needs and the public and societal dimensions (Garrafa 2005a).

This tendency toward privileging individual and private issues to the detriment of collective and public interests was described long ago in the Belmont Report, a historical document produced within the speciﬁc sphere of ethics in clinical research between 1974 and 1978. It conferred the following basic characteristics to the principle of justice: “To each person an equal portion; To each person according to individual needs; To each person according to his or her efforts; To each person according to his or her social contribution; To each person according to merit” (Belmont Report 1978). To these ﬁve characteristics, a sixth one was immediately added: To each person according to the free exchanges of the market (Beauchamp and Childress 1979). All of these six statements have been used to direct the interpretation of justice in bioethics, in relation to private freedoms and needs, while remaining at a distance from the more acute problems relating, for example, to people’s rights of access to healthcare and to new technologies or the beneﬁts from scientiﬁc and technological development, which can be understood as social needs that form components of the ﬁeld of human rights and are naturally related to the topic of global justice.

Hence, the aim of this entry is to develop the idea of global justice starting from the reference framework of bioethics that is also global while also taking the reference point of the UDBHR, in which inclusion is translated as the right to beneﬁt from the scientiﬁc and technological developments seen in the modern world. To achieve this objective, the subject has been structured into distinct parts that have a relationship to each other. The ﬁrst part provides the basis for the concept of global justice and its relationships with global bioethics and human rights. The second part deals with the dimensions and ethical implications of this topic and positions bioethics as an instrument for supporting global justice through three approaches: the relationship between ethics and politics, the concept of equity, and the interpretation of the environment as everyone’s property. The third part starts from the in dissociable relationship that exists between global justice and social inclusion, taking the theoretical categories of people’s empowerment, liberation, and emancipation as the reference point, forming the basis for greater future equality.

Global Bioethics, Global Justice, And Human Rights

Until the beginning of the twenty-ﬁrst century, as stated earlier, the international bioethics agenda was directed as a priority toward biomedical and biotechnological themes, especially in relation to the resolution of the moral conﬂicts observed within the ﬁelds of clinical research and healthcare, which resulted from the relationships that researchers and sponsors of clinical research had with the subjects of this research and the relationships between healthcare professionals (doctors, nurses, dentists, psychologists, and so on) and their patients. With the approval of the UDBHR, the panorama changed, and topics that hitherto had been ignored became incorporated into the discussion. These included persistent collective socioeconomic and health-related macro issues that related mainly to populations that were less favored, which are well-known to form the majority of the world’s population.

In general terms, the “principle of justice” for bioethics that had traditionally been developed up to that time had a meaning similar to that of the ﬁeld of “health promotion” within the worldwide healthcare context of the 1950s to 1960s for what was then called “social medicine.” In other words, it was something that was distant, with indispensable presence, but hardly palpable from an applied point of view, which included all the problems that were not absorbed into the other categories of the preventive context that was followed at that time: speciﬁc protection, early diagnosis, damage limitation, and rehabilitation (or autonomy, beneficence, and non-harm, in the context of the present discussion), which were considered to be more important in day-to-day practice.

Thus, in the same way that, with the passage of time, a solid theoretical and operational basis was built up internationally for the ﬁeld of health promotion, it is indispensable today to rethink global justice in bioethics from other reference points that are more advanced, in relation to the simplistic direct contradictions represented by the conﬂicts between good and bad, fair and unfair, right and wrong, and, especially, inclusion and exclusion. For this reason, it is essential that these reference points should be expanded in relation to the notoriously individualistic Anglo-Saxon foundations, followed by the majority of the theoretical strands that have guided bioethics until today.

Even though respect for moral pluralism (which is clearly present and accepted within the contemporary cultural context) is one of the basic points defended by bioethics, this does not impede universally shared actions, such as use of the reference framework of human rights. Through the international standardization of these human rights that has been seen following the adoption of the UDBHR, the possibility for greater dialogue and construction of global consensuses has arisen, through building agreements with the singular contexts of each country or culture. Use of the concept of human rights enables the construction and defense of conciliatory and inclusive ethics that are based on a commitment toward universal expansion of protection for basic ethical assets in consonance with particular local and regional features (Oliveira 2011).

One of the purposes of the reﬂections in this entry is to seek to differentiate the vision of justice from the legal-juridical formalism that usually accompanies it, but without separating them. In this manner, it is sought to broaden and deepen the analogy that exists between bioethics and issues relating to human life in its widest meaning and to people’s universal right to digniﬁed public and collective healthcare and care within other sectors of the social sphere. The nature of the reference framework of justice, as a theoretical and practical category of bioethics directed toward universal human rights, is preferentially one of moral legitimation, rather than one of pure juridical legalism.

In this regard, before referring to obligations or duties, it is preferable that bioethics should allude to rights (social rights, citizens’ rights, rights of future generations, etc.), in seeking to (re)construct expanded ethics that are primarily public and collective, with a commitment to issues that are indispensable to digniﬁed survival of the needy majority of the population of the planet. After all, this was one of the reasons why bioethics was created and consolidated and now exists as a new ﬁeld of academic knowledge in order to make available new readings of persistent and emerging ethical problems seen in contemporary societies and to face up to these problems. Along this line of ideas, topics such as the relationship between ethics and politics, equity, environmental justice and people’s empowerment, liberation, and emancipation are incorporated into the body of the present analysis.

Bioethics relating to global justice can therefore be understood as ethics of knowledge not only applied to biomedical and biotechnological issues but also, above all, directed toward the present and future existence of humans, the environment, and the planet itself. This is therefore ethics with multi-, inter-, and trans disciplinary focus that makes it possible to connect current criticisms of events occurring today with the practices and experiences already developed by applied sciences, thereby ultimately aiming toward a better future for generations that are to come.

Thus, the conceptual proposal for developing this topic takes a particular view of justice that focuses especially on the political-social dimensions that historically were forgotten in the traditional approaches found in most academic texts published within bioethics internationally (Garrafa et al. 2005).

It also has to be stated clearly that in the new agenda drawn up again using the UDBHR, justice is brought closer to universal human rights and respect for human dignity and comes to have a truly central role, thereby requiring new interpretations. This new agenda stands out beyond “biotechnoscientiﬁc” issues that are governed by the unilateral interests of some industrialized nations, especially in the relationships between the sponsors of clinical research and the subjects of this research. The new conceptual reference framework for bioethics expands the importance of “justice,” and this is indispensable for enabling actions that show real commitment toward the different situations that relate to the quality of human life.

This differentiated concept of bioethics and justice has substantially expanded the ﬁeld of action of both ﬁelds, through oxygenating and politicizing them with the incorporation of topics of direct interest to the peripheral nations of the world, such as social inclusion, universality of people’s access to good-quality healthcare and essential medications, protection of biodiversity and the ecosystem, greater respect for environmental themes such as the right of access to potable water and pure air, combating violence at all levels, the right to literacy, sharing of the beneﬁts resulting from scientiﬁc and technological advances, and so on.

The achievements seen in today’s world, consequent to scientiﬁc and technological development, are very fragile from the point of view of the ethics of public and collective responsibility.

In the light of the profound contradictions that humanity (and countries) ﬁnds itself obliged to cope with, ethical rationality needs to start to move forward at the same rate as technological and scientiﬁc progress (Jonas 1990).

Summarizing what has been said so far, humanity is faced with the need to make changes in the ethical positions relating to public commitment and social responsibility. This does not necessarily mean dissolution of the existing values but, rather, their transformation. There is a tradition within western societies such that some hegemonic sectors of society unilaterally establish and determine individuals’ rights and the directions to be followed. This tradition, which is changing but still in proportions that are very slow and insufﬁcient, not only generates deep inequalities but also limits and places conditions on exercising these rights (both individually and collectively). Rights, which are a basic element of citizenship, should not be attributed to anyone; on the contrary, the ethical-political principle that governs the most elemental notion of rights is the one that stems from human existence itself: when a person is born, these rights are already established, and they need to be accessible and capable of material form, so that true citizenship is achieved.

Bioethics As An Instrument Supporting Global Justice

Starting from the reference framework of human rights, many elements can be used for conceptual and relational analysis between bioethics, global justice, and people and communities’ rights of access to a digniﬁed life with quality. To accompany the theoretical markers outlined here, three study reference points that contribute toward understanding this subject have been selected: ethics and politics, the topic of equity, and the environment as everyone’s property.

Ethics And Politics

The classical meaning of politics originates from the Greek word polis, which encompasses everything relating to the city and, consequently, everything that is urban, civil, public, and even sociable and social. In the modern era, the term has lost its original meaning and had been used to indicate an activity or set of activities that in some way relates to the state. Derived from this concept, the polis is sometimes a “subject,” when it refers to political acts such as removing and transferring resources from one sector of society to another, and sometimes an “object,” when it refers to political acts such as national defense or conquest of territory (Bobbio et al. 2004).

Through a broader conceptual framework, there are three classes of power: economic, ideological, and political, among which this last class is the subject of the present discussion. The concept of politics, taken as a form of human activity, is closely related to power. Power is deﬁned as a relationship between two individuals, in which one imposes his will on the other. Since domination over other people is not generally an end in itself, power as a type of relationship needs to be complemented with a deﬁnition of power as possession of the means that allow the desired effects to be achieved. Thus, political power is characterized as exclusive use of this force in relation to all of the groups that act within a given social context (Bobbio et al. 2004). This exclusivity results from a process that is developed in all organized societies, toward monopolization of power and use of means through which physical coercion can be exercised. In a form of counterpoint to this, the expression “empowerment” is particularly opportune, given that it refers to political themes that are also social, as will be dealt with later on.

The traits that provide humanity among the beings that are biologically recognized as human are the consequence of a collective process that takes material form through continual production and reproduction of meanings attributed to social practices. In this regard, the proposal to politicize bioethics, and its relationship with global justice, has a relationship with the assumption that politically committed social actions are those with the capacity to transform social praxis (Garrafa 2008).

Instead of diminishing the distance between rich and poor around the world, globalization of the world’s economy has further sharpened the contradictions, thereby accentuating the problems that already existed. In developing (peripheral) countries, the majority of the population continues to struggle to obtain the minimum conditions for survival and dignity. At the same time, the process of DE politicization of moral conﬂicts, irrespective of how severe they might be, has increased. Over the last decades of the twentieth century, ethics became used as a horizontal aseptic tool in many instances, and some currents within bioethics contributed toward this. It became capable of neutral readings and interpretations in relation to collective conﬂicts observed in populations that have been marginalized or socially excluded from the process of societal development (Garrafa 2008).

The strategy of marking out the discussion regarding social inclusion as a reference point on the agenda for discussions relating to global bioethics and global justice has contributed toward bringing it closer to politics. For socially inclusive bioethics to be effective, this requires not only willingness, persistence, and academic preparation among people interested in developing it but also a form of organized persistence and historical coherence, no matter whether they are students, healthcare workers, members of ethics committees, or researchers. The politicization of bioethics is a concrete manner of contributing toward constructing global social justice, given that in this context, bioethics is considered to be a new instrument: a new theoretical and methodological tool with sufﬁcient vigor and newness for it to have concrete action toward constructing citizenship and true democracy, in the work of expanding social inclusion.

Equity

The discussion on equity began to gain visibility in the western world around the middle of the twentieth century. Social movements, especially those that fought against racial and gender discrimination, were its main precursors. After a strong start in the 1950s and 1960s, its expression diminished somewhat in subsequent years. More recently, clad in new clothes, such discussions have been revived particularly through discussions within the ﬁelds of healthcare and distributive justice. This can, for example, be seen from meetings promoted by the World Health Organization in relation to reviewing the targets for the proposed program on “health for all by the year 2000,” during the last decades of the twentieth century, and more recently in relation to the new “health indicators for the millennium” and the “social determinants of health.” In these movements, the concept of equity has been vigorously taken up again and has become a keyword within the concept of quality of life.

Basically, equity signiﬁes a willingness to recognize each person’s rights equally, starting from their differences. Inequality occurs when equal and unequal people are dealt with equally and without distinction. Unequal people should be dealt with unequally, precisely to take into consideration the fact that they are unequal. In this case, justice is done not by attributing the same to all people as if everyone is equivalent to everyone else, but by dealing with people who are not equal in a differentiated manner (Rawls 1999).

Equality is the desired consequence of equity and equity is the starting point for equality. Equality can be achieved through recognizing the differences and diverse needs of social subjects. It is no longer a neutral ideological starting point that would tend to annul differences: it is the arrival point for social justice, which is the reference point for human rights in seeking better citizenship.

Thus, equity is the correct indicator for guiding the process of making ethical decisions, such as in relation to the topic of resource allocation (generally insufﬁcient) for public programs. Only through this indicator, which is associated with reference points for both individual and public responsibility and for justice, can the right to indispensable basic assets for daily human consumption be made to mean something. Equity, i.e., recognition of different needs for subjects that are also different, so that equal rights can be achieved, is the path for ethics applied toward attaining universal human rights, including the right to a digniﬁed life. Equity is a reference point that makes it possible to resolve a reasonable proportion of the distortions relating to distributive justice, through expanding the possibilities for life of signiﬁcant sectors of the population, along with the minimum assets for their survival.

Democracy signiﬁes giving the same starting point to everyone. However, the arrival point depends on each individual. In this regard, the concept of equity embedded within the concept of global justice discussed here relates to the notion that the state should provide compensatory mechanisms for people who historically have received smaller shares, so that these people have the same starting point as other people (equality) in order to compete fairly in seeking better conditions of survival and a digniﬁed life.

The Environment As Everyone’s Property

The reference point of human rights not only provides an argument for recognizing the collective right to equality and the rights of individuals and groups to equity but also incorporates the discourse of expanded citizenship, through which these rights are placed into differentiated positions in relation to the guarantees made by the state itself. Within this context, all human beings should be assured of the following: (a) ﬁrst-generation rights relating to recognition of the condition of a person, as the sole universal requirement for possessing rights, (b) second-generation rights signifying recognition of economic and social rights that are manifested within the material dimension of existence, and (c) third generation rights that relate mainly to the environment and preservation of natural resources.

With regard speciﬁcally to environmental issues, preservation and maintenance of natural resources for future generations is essential. The anthropocentric paradigm that gives rise to the positivist idea of development at any cost needs to be urgently replaced by the parameter of sustainability. In a certain manner, an analogy between environmental problems and the health disease process can be traced out. Just as health is mostly perceived when disease arises, the importance of preserving the environment is assessed when its deterioration is seen, with scarcity and lack of the natural resources necessary for maintaining and developing life itself.

In this regard, incorporation of the so-called diffuse rights relating to the theme of the environment, into the theoretical reference frameworks of bioethics and of global justice, becomes an imperative that determines the need to reassess priorities and reduce consumption that is necessary or unnecessary for the lives of people and populations. The need for such reductions affects all nation states. However, this is a form of asymmetry between different countries (and also between citizens), given that the richer segments are precisely the ones that consume and waste more resources. It cannot be justiﬁed that people in some countries should have daily per capita consumption of water or oil (natural resources of the planet that are ﬁnite and should be everyone’s property, i.e., belonging to humanity itself) that is much greater than that of others or that some countries produce emissions to the atmosphere of unsupportable amounts of harmful gases that are disproportionately greater than other countries’ emissions.

Caring for the environment needs to be addressed not only in the sense of preservation of biodiversity but also in the sense of being prudent with regard to interventions that might result in unsafe and/or unknown consequences for human survival and that of the planet. These actions form part of the complex context of preventive actions that can be disseminated from this concept of global justice, which in turn forms part of contemporary bioethics that is also protective, respectful, and inclusive toward the rights of future generations to the continuation of a healthy environment.

Global Justice And Social Inclusion

Given that global justice within bioethics is part of the context of universal human rights, studies on this also cannot leave aside examination of the topic of social inclusion. This is essential today, given the great number of people without access to the minimum assets relating to digniﬁed human survival, despite the increasing process of technological and scientiﬁc development and economic globalization. Social inclusion has received theoretical support through a variety of concepts and names over the course of time, with interpretations that have also differed. Some of these reference points have been seen to be very appropriate and others, less so. The justiﬁcations and arguments supporting the use of these reference points have been as important as the meanings of the themes and expressions chosen.

Studying social inclusion within the context of bioethics makes it possible to use a signiﬁcant number of expressions that are useful for better comprehension of the phenomenon in the light of global justice. For the purposes of the present text, only three of them that best ﬁt the line of reﬂections followed here will be used, namely, empowerment, liberation, and emancipation (Garrafa 2005b).

Empowerment

For empowerment to be conceptualized, the meaning of “power” ﬁrstly has to be deﬁned, particularly with regard to relationships, which might be gender, family, cultural, political, economic, or social relationships. This theoretical exercise also needs to take into account the relationship between the historical contexts within which each individual analyzes and defends his assertions regarding power. Power is something that is up to a certain point abstract and is continually wielded. It cannot be kept in any material place. Power is the capacity to have autonomy over one’s own life or, according to another interpretation, the capacity or strength to dominate, judge, sentence, and forgive. The etymology of the word “power” shows that its origin is from the Latin word “potere,” which means to deliberate on, order, exercise authority over, be sovereign, and have inﬂuence or strength over.

The concept of power goes beyond the political power imposed by the state, given that at each sphere of the state and social organization, power is present in a complex form and interpersonal manner. Power relationships can only exist when at least two subjects are present: the dominator and the dominated. This relationship is consolidated when these individuals accept their roles and reproduce the situation over time for their descendants, such that there is no break in the dominator’s supremacy and that the dominated party has subaltern status.

There are different concepts of power, such as the capacity for someone to impose his will on the behavior of another person or a force that has an inﬂuence over people’s conduct or the capacity to wield inﬂuence between people. Power is generally understood to be a situation in which one person has inﬂuence over another. What differentiates the practices of power is the process through which an individual is kept subjugated.

Because citizenship is something that is constructed and achieved through day-to-day action, the primary objective is to reach it through freedom of conscience and the will to participate in the construction process, whether this is through small initiatives or even at a national level. For this, a personal change in attitude is needed, in combination with knowledge about the rights to life, liberty, property, and equality of rights, i.e., civil, political, and social rights, and responsibility toward the common good. For there to be an effective process of transformation of ordinary subjects into subjects with rights (true citizens), education toward constructing this is needed, so that this citizen comprehends politics, social dynamics, education, healthcare, and the entire context of his community and state, with the ﬁnal objective of empowering this individual.

The expression “empowerment,” understood in the way it is today, originated in the 1970s. It stems from the idea of giving power to someone, i.e., giving freedom and information, so that the individual is able to participate in social life, thereby decentralizing power. In the Anglo-Saxon view, empowerment aims to change the positions of vulnerable groups through authorizing, enabling, and permitting their actions (Sen 2000).

Along this line of thought, the idea of empowering individuals who have become vulnerable through the historical processes and cultural characteristics of their societies cuts across the entire social sphere and provides interactions with the capacity to amplify voices within segments that are allied to the decision-making power, thereby promoting social inclusion (Freire 2001). The process of empowerment, understood thus, is based on organic links between different groups and segments and is what transforms a mere agglomeration of individuals into a society (Durkheim 1990).

The concept of empowerment in the context of global justice refers to the fact that the choices of social subjects cannot be marked only by a partial and stereotyped view of autonomy that circumscribes individual choice as an exercise in narcissism and anthropocentrism, thereby leading the thinking toward the issue of the power of one or other citizens in unequal worlds. Moreover, if inequality is constructed within social settings, i.e., within individuals’ education, surmounting this implies recognition of the unequivocal relationship between autonomy and responsibility. Autonomy is manifested not only in the capacity to contest a situation so as, at the same time, to address social morality, legal rules, and individuals’ needs and desires but also through recognition of the interconnections that exist between human beings and all other forms of life, along with the existential responsibility toward them.

Liberation

Comprehension of “liberation” can be compared with the idea of empowerment, through their closeness. However, this concept implies more than simple recognition of the existence of power. Liberation necessarily points toward the locus along which forces capable of obliging individuals to suffer subjection and weakness become established, which are manifested through incapacity to become free from such submission. With these poles deﬁned, as opposed to captivity or deprivation of the right to choice, liberation has the meaning of true exercising of autonomy. From this viewpoint, social subjects are eminently political players whose actions may either maintain or transform the status quo. Liberation, as a theoretical category, reveals positions of power and enables assumptions regarding positions taken in the balance of forces toward social inclusion (Freire 2001).

Its use in bioethics makes it possible to indicate the direction in which political participation should be conducted in order to ensure this freedom. The strength of the word “liberation” gives more visibility to the struggle of citizens who have achieved social inclusion, either in the context of healthcare and quality of life or in broader contexts such as the right to a clean environment, starting from becoming aware of the forces that oppress them and through concrete action to oppose these forces.

Authors who have studied the topic of liberation have correlated it directly with globalization and social exclusion. Within this context, the so-called ethics of liberation is not understood as mere statistical emancipation of single individuals, but as an active emancipatory process that forms part of a complex picture that incorporates material, corporal, and cultural issues, based on speciﬁc content, with a critically aware inﬂuence on realities. Differing from something of passive nature, the idea of liberation ethics is structured starting from individuals who are sociohistorical subjects, with memories of the past and projects and programs for future accomplishments, and who deﬁne their targets for transforming social realities with a focus on the victims of globalization at its sublevels of subjectivity: women on gender issues, blacks on racial issues, life on Earth in the light of environmental destruction, and so on (Dussel 2009).

For ethics of liberation, as a naturally integral part of bioethics for which there are global aims, the principles laid out are only complementary to liberating actions. However, together (in the case of bioethics, through the 15 principles that form part of the UDBHR), they clarify, explain, and deconstruct contrary arguments through developing the basis for the idea of liberation. Its theoretical normative capacity is not ambitious in the sense of resolving large problems, but it nonetheless fulﬁlls an important strategic function in people’s processes of learning critical awareness in the political and economic organization of emerging social movements within civil society.

It needs to be noted that, unlike the expression liberation, which is still insufﬁciently known and recognized at the global level, use of the word empowerment has reached greater acceptance such that it has in practice been incorporated into the social, juridical, and even health-related lexicon almost worldwide. Among other reasons for this, it has to be recognized that other than in the social sphere, the expression “liberation” is being used mainly in the ﬁelds of education (“liberation education”) and religion (“liberation theology”), with less mercantile appeal. In turn, the expression “empowerment” is generally directed toward the ﬁeld of economics, with high visibility in the contexts of the contemporary media and capitalism. Although use of both of these words (liberation and empowerment) has been made preferentially in favor of marginalized or excluded populations around the world, the appeal to economics is clearly much greater than to education at the historical moment through which humanity is currently passing.

Emancipation

The third expression included in this analysis is emancipation. An emancipated person cannot be anything other than a free person. An emancipated young adult, for example, is one who has acquired the status of the age of majority and has become responsible for his own acts. Emancipation signiﬁes privilege, independence, freedom, and standing on one’s own feet, which begins with liberation. Emancipated individuals have been able to suppress dependence, have attained self-mastery, and can ensure not only their survival but also especially their free choices in relation to the means of achieving this survival.

Power over oneself is what enables emancipation, thereby making the individual immune to the forces that seek his subjugation. Therefore, suppressing dependence is a precondition for attaining emancipation, and this is valid both for individuals and for the state. It is through this concept that the category “emancipation” is useful for global bioethics and speciﬁcally for studying global justice, i.e., as a tool or vehicle for directing the path toward empowerment and liberation.

On the other hand, emancipation has a meaning that is more juridical than sociopolitical, thus underscoring the legal capacity that an individual has for making decisions. Nonetheless, for the social inclusion inherent to emancipated citizens to be an effective reﬂection of autonomy, emancipation needs to be the fruit from achieving the right to make decisions and having the real possibility of exercising this right, therefore depending on this individual’s degree of empowerment and liberation. It cannot be the consequence of a mere concession, like a present offered without a ﬁght, which for this reason could equally be withdrawn at any time at the whim of those who conceded the gift.

In order to construct public global bioethics for citizens, governed by the reference framework of justice that is also global, social inclusion signiﬁes day-to-day action by real people. Its political dimension also needs to be worked on, as a process in which free and autonomous subjects link actions between each other and with their organizations and the state. Insofar as day-to-day actions guide choices not only as a function of personal desires but also with consideration of the entirety of material factors that surround people in the life of the society that they form a part of, such situations become inclusive and consequently provide greater symmetry with the purpose of ensuring digniﬁed existence for people and for the other forms of life on this planet.

Irrespective of the various connotations of the three expressions analyzed above in the context of global justice (empowerment, liberation, and emancipation), their use contributes toward better comprehension of the phenomenon of social inclusion as a dynamic process that needs to be built up and taken into practice, with the aim of establishing true citizenship.

Conclusion

The theoretical space and practice encompassed by the topic of global justice within the context of bioethics are broad and complex. The central idea that this entry has carried is the fact that bioethics is a multi-, inter-, and trans disciplinary ﬁeld of knowledge with an originally lay origin that is committed toward respect for moral plurality among individuals and peoples around the world, without distinction. In this regard, a conceptual approach with the capacity to provide inclusion of all these ingredients in the best way possible has become necessary, in order to characterize its real signiﬁcance in the twenty-ﬁrst century. The ethical-political context of justice and its relationship with the processes of social inclusion were therefore taken as the reference points for taking the ideas forward.

The basic elements of this entry were established starting from the relationship that existed and has now been consolidated between bioethics and human rights, which are important nutrients for strengthening the concept of global justice. The substantive expansion seen in the thematic agenda of bioethics in the twenty-ﬁrst century, subsequent to the adoption of UNESCO’s Universal Declaration on Bioethics and Human Rights in 2005, has also been taken into consideration. This event led to manifest politicization of bioethics and brought greater international weight to decisions that have been made in the name of global justice.

The right to a digniﬁed life for all people on the planet was the refrain that accompanied the presentation of ideas over the course of this entry, while respecting a certain thematic harmony, in which both the relationship between ethics and politics and the civic interpretation of the concept of equity were included. Furthermore, people’s and countries’ responsibilities toward the environment and the dramatic relationship between the future of the planet and the inexorable ﬁnitude of the Earth’s natural resources if waste continues to be produced at the same speed at which it is created today were addressed. Lastly, the slogan “the right to a digniﬁed life for all people” was developed from the deﬁnition of empowerment, liberation, and emancipation for individuals and peoples, which are themes that have direct relationships both with global justice and with human rights.

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