1. Introduction

Global bioethics can be defined as a sub discipline of bioethics that was created and developed by the biochemist, oncologist and researcher Van Rensselaer ^{Potter, in 1988}, from his work Global bioethics. Building on the Leopold legacy, as a result of his reflections already expressed in his main work Bioethics: Bridge to the future, in 1971. In both works, Potter reflects on the need to create a new discipline that applies ethical principles to the new advances in technology, with the aim of avoiding harmful effects on the environment; that is, he proposes the creation of a transdiscipline aimed at guaranteeing human life, based on a dignified survival in an optimal environment, to which future generations would be entitled ⁽¹⁾.

Concern about the disappearance of the human species and the destruction of the environment was not in vain. The 1980s marked a brutal escalation of pressure between the two protagonists of the Cold War, the United States and the Soviet Union, which ended with the fall of the Berlin Wall in 1989 and of the Communist bloc in 1991, thus reviving the ephemeral global hope for a world without conflict. At the same time, seeing the imminent triumph of the Allied bloc, the presidents of the United States and Great Britain (Ronald Reagan and Margaret Thatcher) laid the foundations for neoliberal economic policies as a result of the Atlantic Charter (1941) and the Bretton Woods Agreements (1944), which led to the creation of such important international institutions as the International Monetary Fund, the World Bank (1946) and, later, the World Trade Organization (1995).

These agreements, aimed at the implementation of liberal principles in the domestic economies of the countries, starting with the United States, put an end to the conquests and guarantees of social and labor human rights achieved by factory workers as a result of the struggles carried out by previous generations.

For its part, in Latin America, the implementation of the Reagan doctrine justified the political and economic support to military coups in Central and South American countries, generated with the aim of avoiding their potential support to communism in the context of the Cold War. As a result of these geopolitical maneuvers, a regime of systematic violation of human rights was established through policies of State terrorism. Guatemala, Chile, Argentina, Panama, Bolivia, among others, suffered cruel dictatorships followed by long civil wars, the wounds of which have yet to heal.

A documented example of this historical moment is the case of Nicaragua and the United States (military and paramilitary activities against the Nicaraguan government).¹ In this interesting process, Nicaragua denounced the United States before the International Court of Justice for violating international law by supporting with resources the armed opposition (the contras) in their war against the democratic Nicaraguan government. During the maneuvers, in addition to thousands of deaths, fundamental structures of the State were destroyed (ports and other various means of land communication), leaving the country in a situation of technical and social development setback.

The panorama of global violence that characterizes this decade does not exclude the effects of weapons and the escalation of arms and technology on nature and its resources. The effects of sustaining a war economy, in addition to new technological discoveries applied to monoculture productions, were disastrous. Practices such as the nuclear tests on the Mururoa atoll (1966 and 1996); the Chernobyl nuclear accident (1986); the leakage of 45 tons of toxic gas in a pesticide factory of the US company Union Carbide, in Bhopal (India), which caused the death of more than 30,000 people in 1984. These are some of the events that highlighted the self-destructive capacity of human beings and its consequences for nature. To this must be added the discovery of the hole in the ozone layer in Antarctica; the indiscriminate use of pesticides; the beginning of the use of genetically modified plants and animals, etc. All these actions and their consequences were beginning to damage the health of the most vulnerable populations on the planet.

These are some of the historical events that put researchers, social actors and the population in general on alert and concerned about the survival of the human species. The unstoppable degradation of the environment, coupled with rapid technological advances, all of them without an ethical control that would allow adequate reflection on the harmful effects of these actions, both for the individual and for Nature, highlighted the need to design and apply a series of principles that would serve as a guide for decision-making aimed at protecting Nature and, therefore, the survival of individuals and societies based on a common value: dignity.

In this context, it is necessary to highlight a key moment: the proclamation of the Earth Charter. In 1987, the United Nations World Commission on Environment and Development was created, which called for the drafting of a Charter that would include the fundamental principles for sustainable development, an initiative that has become a worldwide movement to date.²

Another important initiative for global bioethics started in the 1980s was the request to the United Nations for the Declaration on the Rights of Future Generations (2). In spite of the obvious obstacles encountered by its promoter, the French marine scientist Jaques Cousteau, a timid declaration was finally approved, the result of more than ten years of work and development.

These two milestones seem very distant; however, after analyzing the current panorama, marked by a global pandemic that has accentuated pre-existing inequalities, the continuous warnings from the United Nations about the alarming environmental degradation and the normalization of violence, national and international, that is generating insensitivity towards its victims; all these circumstances have brought to light two realities: global bioethics must evolve as other systems have done (scientific, economic or human rights) and, secondly, this evolution must be based on a transdisciplinary construction that creates new concepts, based on principles and constructions aimed at providing solutions to the global problems facing humanity.

2. Background

Van Rensselaer Potter, in the title page of his book Global bioethics. Building on the Leopold legacy⁽³⁾, defines the concept of «global bioethics» as Biology combined with diverse humanistic knowledge, forging a science that sets a system of medical an environmental priorities for acceptable survival; that is, as «biology combined with diverse humanistic knowledge, shaping a science that develops a system of medical and environmental principles for acceptable survival».

Although some criticisms could be made of this work -such as its simplicity in the reading of social problems, since it is based solely on biological arguments that are quite imprecise when applied to a complex being (such as the person), who lives in a global village during one of the most difficult periods in human history ³-, it is nevertheless possible to extract several important reflections as a guide for action in today’s world for the discipline called «global bioethics».

The first is that ethical values cannot be separated from biological facts, but neither can they be separated from medical, political and economic facts. In a period in which ethics has been vilified for the sake of the magnification of reasonableness, the analysis of history and its consequences in the human family show us that the rational is not always the most reasonable. For this reason it is necessary to inquire into the process by which ethical values can be present in decision making that affects life, human and natural, holistically. Thus, as Potter argues, what is demanded of each generation is an ethical theory that is not a mere rationalization of prejudice or a physiological discourse so abstract as to be irrelevant to solving the practical problems facing humanity⁽³⁾.

Ethics applied to life or, to be precise, to the survival of life in a broad sense is the field of study of bioethics; however, since its creation it has taken on its own inertia, applying itself to biomedical and clinical activities. This approach was adopted, developed and defended by the obstetrician André E. Hellegers, who founded the Kennedy Institute of Bioethics at Georgetown University (1971), where, for the first time, an academic development of bioethics as a discipline took place. From the work done by Hellegers in 1978, the first encyclopedia of bioethics defined by Warren Reich was published. From these developments, the definition of bioethics was agreed upon as the systematic study of human behavior in the area of life and health sciences, examined in the light of values and moral principles⁽⁴⁾.

According to these publications, bioethics was thought to be incardinated in the areas of health sciences, focusing its implications on technological advances such as human in vitro fertilization, manipulation of human embryos, cloning, abortion, among other issues, as well as on encouraging the reflection on the consequences that these biotechnological developments would have on human life, dignity and survival.

With the aim of guiding the decisions to be taken in the biomedical field on these issues, the bioethicists T. L. Beauchamp and J. F. Childress proposed a system of principles applicable to the constant challenges that the development of biotechnologies imposed on bioethics, which to this day serve as a guide for the resolution of bioethical dilemmas. These principles are four: autonomy, beneficence, non-maleficence and justice. They were established within the current called principlism, considered as one of the sub-currents of utilitarianism, together with contractualism and prima facie deontology.

The first principle that of autonomy, refers to the duty to respect the capacity of people in making decisions about their own life and integrity based on the requirements of reasonableness and information. Secondly, the principle of beneficence refers to the duty of medical personnel and healthcare structures to act in the patient’s best interest. The parallel principle to beneficence, nonmaleficence, is oriented to the duty of healthcare actors to avoid harming the patient and, in the event of harm to the person, it must be of a lesser magnitude and proportional to the benefit to be achieved by the harmful action. Finally, the principle of justice is limited to establishing parameters for the equitable distribution of risks, harm and benefits in the healthcare area.

Parallel to the principlist current, others emerged, such as the personalist, utilitarian, liberalist and sociobiological currents, from which a hierarchy of principles was generated to guide the actions of healthcare and/or research personnel in cases of real ethical conflicts. However, if we analyze the resolution of conflicts or dilemmas in the field of global bioethics, we can see that these tools are not optimal for unraveling complex problems that put life at risk, from a broad and global perspective. Therefore, as a first approach to this branch of bioethics, we will briefly review its history.

Potter, already considered the father of bioethics in the English field, criticized, in his work Global Bioethics (1988), that Joseph and Rose Kennedy Center for the Study of Human Reproduction and Bioethics of Georgetown University used the term «and Bioethics» in its name, omitting the origin of the term and limiting its scope to its development in medical bioethics committees working in Bioethics Centers in the clinical area, dealing with the problems of life and death that are still controversial today. Thus, bioethics had been limited to its development within the medical, clinical or biotechnological research area, a trend that was criticized by the father of bioethics in his lecture on the occasion of the 66th Annual Meeting of the American Cancer Association (1975) ⁽⁵⁾.

With the focus on medical options, the fact that Bioethics had been proposed to combine human values with ecological facts was forgotten by many: the ethics of how far to exercise technological options in the exploitations of the environment was not associated with the term bioethics.⁴

The reality and the research activities carried out in universities show us that the two aspects are not in dispute; on the contrary, they are complementary and feed off each other in their common goal of achieving a dignified life for present and future generations in a common home that is cared for and respected. However, while for clinical bioethics there is a wide range of clear values and principles for the resolution of ethical conflicts, can the same be said of global bioethics?

3. Are the principles of clinical bioethics applicable to global bioethics?

Analyzing the origin of the interests involved in the conflicts of global bioethics, i.e., those that involve not only individuals, but also society, nature and even future generations, can hardly be solved on the basis of the principles of clinical bioethics, since the latter is developed on the basis of the relationship between two or more subjects (individuals) in the process of the medical or research act. However, when the bioethical conflict identifies a group of people (a collectivity) or a non-human living being, such as nature, with its flora, fauna and natural resources, the principles set out above have no meaning whatsoever.

Therefore, principlist bioethics, although it helps to clarify obscure points and to bring order to moral language, as well as to the construction of normative systems that allow overcoming fallacies and logical errors ⁽⁶⁾, manifests an undeniable Anglo-Saxon approach to reality, considered by several branches of bioethics (such as the so-called bioethics of intervention, the bioethics of protection, or the bioethics of protection or the bioethics of bioethics), protection bioethics or human rights bioethics) as incapable of shedding light on the needs of developing countries or even for the poor populations of developed countries ⁽⁷⁾, where the principle of justice and equality require greater commitment and significance.

In a world of limited resources, the good living of all is incompatible with the better living of some. It is not possible to make them compatible, not even by referring to J. S. Mill’s statement that the foundation of all happiness is not to expect more from life than life can give⁽⁶⁾. In the face of scarce resources, the excess of one is sustained by the lack of the other.

In this sense, accepting the interrelation between the destruction of the environment in relation to the progressive degradation of societies and the integrity of individuals, as is done from integral ecology, would provide the optimal transdisciplinary approach for the solution of the dilemmas of global bioethics: environment and natural resources, poverty, inequality, interculturality, among others, where the interest to be analyzed is not divisible.

Therefore, part of the task at hand will be the transformation of the principles of bioethics from a collective approach to the persons and natural assets in need of protection by global bioethics. This challenge is not only necessary for bioethics, but it is still a pending issue in the guarantee of human rights, which is why it is possible to make use of its developments and experiences. In this sense, this paper proposes and justifies the existence of four subjects of interest for global bioethics: the individual, society, nature and future generations.

4. Areas of interest in global bioethics

As mentioned above, the subjects of interest for medical bioethics are the person (physician/researcher/patient). However, people, being beings in relationship, cannot remain oblivious to what happens to their fellow human beings and to the environment in which they are situated; this is what global bioethics realizes and therefore it is important to understand and attend to the person in his or her social dimension and in his or her relationship with the environment. However, the panorama of global bioethics is more complex, since it involves other entities or subjects whose protection must be manifest: human communities or societies, nature and future generations. Therefore, one of the proposals of this paper is to recall the interest of providing protection and care to these three entities from Global Bioethics, without neglecting the person, for the reasons that will be developed below. However, before starting the argument about the need to consider these subjects of interest, what is meant by such category will be specified.

The term interest comes from the Latin interesse, which means «to be interested, to matter». Consequently, the subjects of interest in global bioethics would be understood as those subjects or realities «that matter». Consequently, because of their importance for the dignified survival of the human family and the common home, they must be protected. Considering the levels of importance to contribute to the protection of the dignity of the person, it has been determined that the areas of interest should be: people, communities, nature and future generations. In this sense, if the necessary protection of these subjects is agreed upon, Global Bioethics would be forced to overcome the handicap of the individualistic vision of its traditional approach to consciously enter the collective vision, since only in this way will it be able to solve dilemmas that exceed the individual.

In current practice, there are conflicts involving interests that cannot be divided in proportion to the impact on individuals; in these cases we are talking about collective interests. As an example, referring to the right to personal freedom, to integrity, to freedom of thought and conscience, can be thought of in individual terms; however, if we try to calculate the interest that corresponds to each person, for example, the right to a healthy environment, or to Peace, or to the conservation of ecosystems, in these cases, the difficulty in determining the plot of common interest is highlighted ⁽⁵⁾. Moreover, even social substrates marked with some kind of discrimination would limit protection (such as nationality, whether legal residence requirements are met, whether tax burdens are complied with, among others). For example, this is the case of the contamination of a spring with which migrants and undocumented migrants in transit quench their thirst. In this case, it would be more appropriate to defend the spring per se, because it is valuable in itself, but also for the work it does in providing water to all those who need it. Therefore, if we analyze the ethics of the activities that pollute that source, we must start from the analysis of the damage to the natural good itself, as a area of direct interest, but also to all mankind as a area of indirect interest, since anyone should have the possibility of quenching their thirst in the spring; even future generations should also be entitled to such interest.

For this reason, this legitimate prerogative of any person to have access to water from a spring is called collective or supraindividual interest. The category of diffuse interests has even been established, which refers to those whose beneficiaries are not identifiable, such as future generations.

The defense of individual, collective and diffuse interests has been developed in the field of law; however, this concern has not yet crystallized in the field of Global Bioethics developed by Anglo-Saxon authors, such as Ten Have. After making an analogy of Ada Pellegrini Grinover’s studies on public and private interests in the international legal sphere, the academy makes a critique that highlights the ineptitude of the traditional normative (legal and bioethical) paths for the solution of conflicts or dilemmas in the protection of transindividual rights and duties; that is, those located between the public interest and the private interest, these being common in a globalized society ⁽⁸⁾.

Along the same lines, Kazuo Watanas explains that the traditional strategy that normative systems have had for the resolution of controversies has been built from the liberal vision, where the individual perspective is preponderant ⁽⁹⁾. However, this atomized perspective has fragmented conflicts, preventing their integral approach and, therefore, the design of a holistic, ethical solution in accordance with fundamental rights.

In conclusion, according to Antonio Gidi, supra-individual rights or interests do not belong to a specific person, but to an amorphous, fluid and flexible community with a social identity. They are not the addition (sum) of individual rights ⁽¹⁰⁾, but the adaptation of the required positioning is qualitative; that is, transindividual interests (they go beyond the individual vision) have a marked social dimension, as they are common to a collectivity of persons or to society in general. For example, the interest in conserving the Amazon rainforest does not only come from the communities that live there, nor even from the states in whose territory it is located; this is an example of transindividual and diffuse interest, since it involves the human family as a whole, the ecological system itself and future generations, who should have the possibility of enjoying this resource in the same conditions as we do (or better). Therefore, diffuse interests are involved with the protection of collective needs synthetically referred to the quality of life and the environment.

5. A proposal of principles applicable to global bioethics

In order to achieve the greatest protection of the areas of interest, it is essential to bear in mind that global bioethics is not a discipline separate from the rest of the disciplines; that is, there are other disciplines that can contribute to the fulfillment of the common objectives based on an interdisciplinary methodology. Therefore, before referring to the proposed principles, a distinction will be made between system, value and principle, since there is a need to establish coordination between systems, principles and values that allow the protection of life in a broad sense.

6. Conclusion

Global Bioethics has been a discipline that, from its beginnings, has been oriented towards the protection of the person and the environment so that the survival of the human species and future generations could be guaranteed. For this reason, because the protection of the person, society, Nature and future generations is important for Global Bioethics, as an interdisciplinary discipline oriented to the survival and protection of human dignity, the tools used in the solution of conflicts and dilemmas that may arise must be optimal for this purpose.

Consequently, the coordination and cooperation between the principles of law and the ethical principles of bioethics is proposed, so that they can be adapted to resolve global bioethical conflicts. Within this cooperation, two tests are presented, the proportionality weighting test and the reasonableness test, as an adequate way for the resolution and argumentation of global bioethical conflicts, where the people and the areas of interest are involved.