Interculturalism, bioethics perspectives, and human rights

Abstract

This paper aims to contribute to a deeper reflection on intercultural conflicts within the scope of bioethics, and to point out the problem of using human rights as a theoretical normative mediator of the conflicts in bioethics that bear elements of interculturalism. The methodological steps adopted in this inquiry were the analysis of the concept of intercultural conflict in bioethics, from the perception developed by Colectivo Amani; the study of human rights as tools of the culture of human beings, based on Bauman's theories; and the investigation of the tools that human rights offer so as to solve intercultural conflicts in bioethics. I conclude that intercultural bioethics must incorporate in its prescriptive and descriptive tasks, norms and institutions of human rights that ensure the participation and social integration of individuals from communities that are in cultural conflict. Such measures will act as instruments for the solution of intercultural conflicts.

Keywords:

• bioethics
• interculturalism
• human rights
• bioethics
• intercultural conflicts
• culture
• universalism

1. Introduction

Bioethics, in its path of theoretical, institutional, and normative construction, has not given emphasis to cultural conflicts, despite the countless conflict situations that involve cultural elements as sources of shock, controversy, and even wars, in the most varied regions of the planet. In Europe, for example, the relationship between Muslins and groups of the population from certain countries is notoriously tense. In addition, in Brazil, the existence of specific cultural communities, such as indigenous groups (Brazilian Institute of Geography and Statistics, 2013), gypsies (Brazil, 2013),¹ and quilombolas (Ministério do Desenvolvimento Social e Combate à Fome, Conselho Nacional de Assistência Social, 2013), generates cultural conflicts, including the ones related to bioethical themes.² Thus, I believe that bioethics, as applied ethics with a prescriptive characteristic, and directed toward conflict resolution in varied contexts, has to deal with the consequences resulting from the cross between different cultures, in the fields of medicine, life sciences, and technologies. This focus of bioethics on cultural conflicts is essential for the broadening of its range of influence. An intercultural perspective is an essential tool for dealing with conflicts between people or groups from different cultures and for the resolution of issues that emerge in the healthcare area, or in the scope of politics and public programs. In fact, Zambrano (2006) states that bioethics needs to introduce an intercultural perspective in its reflections and prescriptions, because it contributes to the insertion of bioethics into the social realm. It is also important to point out that bioethics, seen as theoretical and practical knowledge, has the human being as its axiological core, either in the contents of the Belmont Report (US Department of Health & Human Services, 2013) or of the Universal Declaration on Bioethics and Human Rights, adopted by UNESCO in 2005, consolidated in human dignity. Consequently, if bioethics, in its theoretical roots or prescriptive activities, fails to work on cultural clashes of people or groups, it will not consider an important feature of human experience, moving away from its role as applied ethics to real conflicts.

Hence, the aim of this paper is to contribute to the theoretical building of an intercultural bioethics perspective – IBP, seen as the part of bioethics based on intercultural perspectives to investigate the conflicts marked by the clash between different cultures. In fact, only its specific object, cultural conflicts, does not characterize IBP – those emerging between culturally different people or groups – but also for its normative aspect, as IBP is engaged in defending the respect among different cultures, surpassing the imperfections of ethnocentrism and cultural relativism, in search of equality (Aguilera Reija, Gómez Lara, Morollón Pardo, & Vicente Abad, 2009).

Hence, the IBP is characterized by the description of culture-based moral conflicts and due to its normative arguments defending the respect to cultures and human rights. With the intention to transpose its postulate to practical terms, IBP needs to use tools that ensure that ethnocentrism and cultural relativism do not permeate the process of decision-making in contexts of moral pluralism. On the other hand, these tools must strengthen interculturalism, whose premises consist of: (a) to refrain from analyzing other cultures from one's own cultural standards; (b) to seek equality among cultures; and (c) to promote a critical view regarding cultures, including facing some of their elements (Aguilera Reija et al., 2009). In this paper, these tools are human rights, which are norms of action universally shared, corresponding to human's true culture, as proposed by Bauman (2012).

The connection between human rights and IBP is part of my research, regarding the interface between bioethics and human rights. Hence, this paper is innovative, as it provides in-depth analyses of the introduction of the reference of human rights, a tool for culture-based conflict resolution, into an IBP.

In fact, bioethics does not neglect cultural diversity. However, cultural practices cannot become an excuse to justify any human rights violation, as prescribed in article 12 of the Universal Declaration on Bioethics and Human Rights (UNESCO, 2013a, 2013b). IBP should deal with this tension. If, on the one hand, adopting interculturalism as an attitude facing different cultural contexts implies respecting differentiated cultures and leads to equality among them, on the other hand, the incorporation of human rights as a theoretical normative reference carries ethical and legal barriers that cross all cultures. Therefore, we can infer that human rights are tools for establishing communication among different cultures. It can also be a normative guideline for bioethical evaluation regarding traditional practices; the aims of this paper are to contribute to further reflection regarding cultural conflicts within the scope of bioethics, and to approach the issue regarding the use of human rights as a theoretical normative reference to mediate conflicts in bioethics that present intercultural elements. In other words, when presuming that the encounter among cultures can cause dissents in bioethical themes, one may ask which instruments supplied by the human rights theoretical normative reference can be used to resolve such conflicts. The methodological steps adopted in this study were: (a) analysis of the concept of IBP and of cultural conflicts in bioethics, from the concept of culture and cultural conflicts developed by Aguilera Reija et al. (2009); (b) examination of human rights as instruments of human culture, based on the theory of Bauman (2012) regarding the concept of culture; and (c) analyses concerning the instruments that human rights offer for the resolution of cultural conflicts in bioethics, and the proposition to diligently investigate an IBP concept based on human rights.

2. Intercultural bioethics perspective: descriptive and normative perspective

The aim of this topic is to approach the concepts of culture adopted in this paper, the formulation of a proposal of IBP, and, finally, to delimit the notion of culture-based bioethical conflicts.

The study of IBP imposes a previous confrontation of the issue related to the concept of culture. Considering the scope of this study, I opted for discussing the theme from a single theoretical reference, which is by Bauman (2012). The theoretician initiates his approach regarding culture as a concept by recognizing the term's ambiguity due to the existence of numerous theoretical lines that historically start from the same term. According to Bauman (2012), there are three distinct concepts of culture that systematize its content and point out different aspects that constitute culture: (a) culture as a hierarchic concept; (b) culture as a distinguishing concept; and (c) the generic concept of culture. Considering the hierarchic concept, culture assigns a quality to a certain person, the “cultured” one, and it links to the following terms: “educated, polite, gracious, sophisticated” (Bauman, 2012). Culture as a distinguishing concept relates to the visible differences among the communities of people. The distinguishing concept is incompatible with the idea of cultural universes. The only universe that adjusts to such a concept is the one regarding human characteristics common for the species. According to Bauman (2012), plurality and singularity of cultures have become such a paradigm among anthropologists that it is a “fact”, and is exempt from the verification of its evidence. On the other hand, the distinguishing concept connects to the understanding of cultures as a “closed system of characteristics that distinguishes one community from another” (Bauman, 2012, p. 125). Consequently, if each culture constitutes an entity, closed, cohesive, and singular, the disagreement among cultures is seen as a shock between “distinct and coexistent cultural totalities”, the idea of “cultural shock” becomes an “evident truth” (Bauman, 2012, p. 125). Hence, the people who adopt the distinguishing concept of culture embrace the singularity of cultures and consider the mix among cultures something abnormal and condemnable (Bauman, 2012).

The generic concept of culture relates to the attributes shared by all members of the human species, distinguishing it from the animal species. This perspective sees culture as something typically human, and so it is a concept that encompasses universal human aspects. For example, man is the only animal that laughs, makes tools, and produces art and moral symbols. Thus, there is a set of elements of the human species that is universal and, for this reason, we characterize it as human culture. In this sense, human culture is unique, and cultures formed in different social, economic, and environmental contexts are part of the total. The understanding that despite specific traits of human groups, our species share basic needs supports the generic concept of culture. Thus, regardless of the idiosyncratic characteristics of groups of humans, it is true that language and the production of symbols is the “universal and basic core of human culture” (Bauman, 2012, p. 143).

This study adopts Bauman's (2012) concepts, both the distinguishing concept of culture and the generic concept. I understand that human communities possess specific cultures. However, such empirical understanding does not lead to the negation that there is a human culture, into which the specific cultures merge and in which they share their elements.

The study of IBP implies a previous distinction between non-normative and normative approaches in bioethics (Beauchamp, 2003). The non-normative and descriptive approach is about the factual description and explanations of behaviors and moral concepts. The normative approach focuses on basic principles that rule moral life and delimit standards of behavior that lead to actions (Beauchamp, 2003). Based on such a distinction, the IBP, from the non-normative point of view, has as the objective of study the description and the understanding of culture-based bioethical conflicts, analyzing distinct moral behaviors of different cultures and their disagreements. Hence, I anchored the descriptive IBP in the distinguishing concept of culture, that is, different communities present specific moralities, and it comes close to the idea of multiculturalism as a social phenomenon (Aguilera Reija et al., 2009). Under the normative perspective, IBP provides a system of moral principles and defends ways to accomplish its application (Beauchamp, 2003). Thus, it is based on interculturalism, as a “reference to the equal value of each culture” (Piacentini, 2008, p. 98), in the generic concept of culture. I subdivide the moral principles and guidelines that conduct IBP in principles of interculturalism – like the principles of intercultural dialogue and the equal value of cultures – and principles of human rights.

Beginning with descriptive IBP, the definition of conflict becomes an arduous task, as there are various approaches, such as the psych sociological and the sociological ones (Aguilera Reija et al., 2009). Under the light of the psych sociological aspect, the conflicts are the situations when its actors seek different goals, defend contradictory values, have opposing or distinct interests, or pursue simultaneously and competitively the same goal. Through the prism of the sociological approach, the sociology of the conflict defines it as a situation when irreconcilable or particular purposes and values among people coexist. Hence, a culture-based conflict, generally speaking, is a situation of divergence among people or groups of people from different cultures. The culture-based conflict is a situation explicitly marked by a cultural differentiation among the sides involved. In these cases, one has to pay close attention to cultural influence, as this element will intervene directly in the process of interaction and communication among the sides involved (Aguilera Reija et al., 2009). From the point of view of the IBP, a culture-based bioethical conflict is understood as a moral and divergent situation that involves sides from different cultures related to medicine, life sciences, and technologies when applied to human beings, according to the description of the object of bioethics pertaining to the Universal Declaration on Bioethics and Human Rights (UNESCO, 2013b).

Normative IBP is not only anchored by the fact of moral diversity, but it also has as guiding principles intercultural dialogue and the equal value of cultures, as well as human rights, which will be treated in Section 4. Regarding interculturalism, it surpasses ethnocentrism and cultural relativism. Ethnocentrism implies the approach of a culture from the perspective of our own culture, causing lack of understanding, paternalism, and different treatment among the sides involved in cultural conflicts (Aguilera Reija et al., 2009). Cultural relativism is the analysis of a culture taking into account only the internal assessment standards. It is a risk to abort any critical vision related to a certain culture in particular and to prevent rejecting certain traditional practices or to fight against them. According to cultural relativism, each traditional community must limit itself to its physical space (Souza Filho, 2007),³ keeping the possibility of encountering other cultures at bay (Aguilera Reija et al., 2009); and, finally, it endorses excluding or ethnocentric cultures. Hence, interculturalism seeks to supplant both, ethnocentrism and cultural relativism, advocating the dismantling of any idea of cultural superiority, supporting the principle of an equal value to all cultures, and thus limiting the ethnocentrism of the sides involved in the conflict (Zambrano, 2006). Following this line of thought, diatopic hermeneutics contributes to an encounter based on equality, as it proposes the use of the tools from a certain culture in order to understand another and to fill the gaps between two different cultures (Pannikar, 2004). To Santos (2004), diatopic hermeneutics seeks to broaden as much as possible the “awareness of a mutual incompleteness, by means of a dialogue that bears one foot in one culture and the other foot, in the other”. In other words, Santos talks about intercultural dialogue, which I will deal with later on in this paper.

Thus, regarding the principle of intercultural dialogue, it is important to point out that interculturality denotes “the construction of a space for collective participation among different cultures” (Krohling, 2010, p. 104), in which there will be an intercultural dialogue. In fact, Pannikar (2004) considers dialogue as a way to handle a culture-based conflict, which presupposes mutual opening towards the other person and the recognition of the cultures’ incompleteness. Intercultural dialogue “goes beyond the simple tolerance or formal respect” (Piacentini, 2008, p. 102). It also implies a cooperative attitude among the participants who truly search to come to an agreement (Eberhard, 2004). According to Pannikar (2004; see also Aguilera Reija et al., 2009), the search for “homeomorphic equivalents” integrates an intercultural dialogue. It implies that communication among people or groups from different cultures does not require only a literal translation of the language, but, most importantly, it seeks to create ways to promote the understanding of the symbols.⁴ These symbols expose a certain cosmovision by the other, searching for terms whose meanings get close to the meanings of the language from the other culture. Intercultural dialogue gives opportunity to an understanding among the sides involved in the conflict, by adopting an open posture in relation to what is different and by building bridges that connect interpretation schemes in order to reach shared symbols and meanings.

IBP, whose focus lies on culture-based conflicts, must reflect on them, give norms to them, and mediate these conflicts, through the instances of its institutional dimension, as it will be shown in Section 4. It requires the respect of the equality among cultures and an intercultural dialogue, with an equal and balanced participation of all the sides involved (Raymundo, 2011).

Now I will approach human rights as universal principles and norms, pursuant to human culture.

3. Universal human rights: aspects that constitute human culture

Currently, it is common for people to coexist with many cultures,⁵ not belonging to only one cultural community (Hall apud Tilio, 2013). Even traditional communities interact with those who do not integrate with these communities, which transmit and receive ideas concerning beliefs, values, customs, and other elements that form a culture. Thus, culture is an adaptation device. Cultures change historically. They are not something static, and the changes can come to enrich cultures (Aguilera Reija et al., 2009). Similarly, we can experience cultures in different ways. Members of a cultural community are never homogeneous. Each culture has its own multiple social identities. Since cultures change due to the influence of other cultures and their members share the cultural elements that form them in many different ways, it is evident that there is an inexorable opening of the cultures and of its members regarding external elements (Tilio, 2013). This opening provokes the incorporation of languages not originated in that culture.

Besides the distinguishing perspective of the cultures, there is the human culture that consists of aspects widely shared by members of the human species. Among these, there are moral norms, essential for social coexistence and that cross cultures, however, it does not imply the indistinct observance of these norms. Based on this understanding, this paper states that human rights, prescribed in international treaties, are behavioral norms shared simultaneously by different cultures, thus constituting the human culture. To support such thesis, this paper has two approaches: one is normative and talks about the theoretical basis to support and justify the universality of human rights. The second is through the descriptive prism, which demonstrates, by means of empirical statements, the global penetration of human rights. The first approach, of a normative aspect, resorts to the theoreticians who discourse on the universalism of human rights: Rorty (2001), Taylor (2001), Tesón (2001), Xiarong (2001), and Jullien (2010). This normative approach embraces three focuses: (a) the justification of human rights, universally shared; (b) human rights as behavioral norms; and (c) aspects concerning two types of arguments commonly used against the universality of human rights: authority and the conspiracy theory of human rights.

The second approach focuses on three aspects. They demonstrate the penetration of human rights into different cultural environments: (a) the ratification of international treaties on human rights; (b) the existence of national institutions of human rights in different areas of the globe; and (c) the importance of human rights to defend these rights in vulnerable groups from specific cultural communities.

3.1. Aspects of a normative nature

Regarding the justifying element of human rights, I have opted to base them on the human feelings that are common to all members of the species, and not on rationality. In fact, Rorty (2001) states that overcoming the concept of the other person as somebody “almost human” who does not deserve the same amount of respect and consideration implies searching for what we all have in common, our humanity. These are the elements that constitute human culture and whose importance is undeniable in order to integrate a person into our moral community. Thus, white people in relation to the black ones, men and women, Christians and Muslins, heterosexuals and homosexuals, despite their trivial differences, they all have something that joins them and makes them equal, allowing for the constitution of a moral community where everybody has the same intrinsic value. According to Rorty (2001), reaching this goal is only possible by means of affective upbringing, and not by the simple utilitarian calculation or the engagement in the process of public deliberation. By producing generations of kind, tolerant, confident, and respectful people, it will be possible to strengthen the culture of human rights. As an example, the approach regarding skinheads, who violate homosexuals’ rights, must take into consideration that they lack self-confidence and empathy. Lack of self-confidence because they think that being different is a threat to their perception of themselves and of their self-esteem. Moreover, empathy is the type of reaction that mobilizes us upon facing a situation of pain inflicted on the other person. Rorty (2001) stresses that the more scared and insecure people are, even from the point of view of the construction of their own subjectivity, the less prompted they will be to think about other people, who the aggressors do not immediately identify with. Finally, Rorty (2001) resorts to David Hume and states that empathy is the basis for moral capacity, not rationality. Hume's empathy, unlike that of common sense, can lead to compassion, making it possible to feel the effects of our actions on others (Guimarães, 2007). Like Rorty, Jullien places the basis of human rights in the scope of human culture and in the notion of an unconditional human being, transculturally shared. Such notion refers to the core of the human common sense, which consists of compassion towards the other, metaphorically expressed “in the arm that I extend to a child who is about to fall into a well”. This notion comes close to the feeling of empathy described by Rorty (2001). Therefore, human rights based on feelings that allow for a symmetrical look towards the other and towards what is clearly different. In this case, the person does not place him/herself in a superior or more important position. The violence against whoever is different is supported by the fact of some people failing to recognize other people as their equal, that is, people who also have a shared humanity.

Even if one disagrees with the basis of human rights, these rights, according to Taylor (2001), constitute a single path made of behavioral norms, despite the conforming values pertaining to each culture. This disagreement can result in certain cultural aspects, for instance, feelings of empathy range in different cultures. Hence, to build a common guideline of values that cross different cultures is really a task bound to failure, as the ways of expressing feelings and values are culturally varied. However, from the normative point of view, it is possible to share behavioral norms, such as sentencing people who practice genocide, murder, torture, rape, slavery, and mistreatment towards children (Taylor, 2001). Xiarong (2001) adds racism to this list. Therefore, we should not investigate the values that make these practices condemnable, because on a human rights perspective it is enough that these practices are illegal and morally rejected. Hence, we can see the distinction between behavioral norms and their underlying justifications. In this sense, Jullien (2010) points out that the universality of human rights is not theoretical, but operational, since it exists to intervene in practical situations, not becoming a true statement, but a resource. Therefore, we can assure that the feelings that anchor human rights express different values and beliefs, revealing that such rights are culturally shared norms of behavior, regardless of the elements that each culture uses to justify them.

From the point of view of the main arguments used against human rights on the part of those who defend cultural relativism, it is a great mistake to resort to the idea of imperialism or of Western hegemony. Such rights are freeing tools for their bearers, mainly to those from vulnerable groups, like indigenous people, women, people deprived of freedom, and children. In other words, human rights exist to protect people, not governments. We know that authoritarian governments in Asia, Africa, and Latin America reject vehemently the protection of human rights, under the allegation that these rights are external interferences in their sovereignties (Xiarong, 2001).

Tesón (2001) asks how one can justify the violation of human rights based on community purposes. The author gives an example when questioning the idea of accepting the discrimination against women in Islamic societies under the sole affirmation that it is a tradition, therefore revealing one of the arguments contrary to human rights, which is “it has always been like this” – a typical argument from an authority. Such a principle, heavily conservative, implies the assertion that cultural or religious traditions by themselves serve as an argument for keeping situations that violate human rights. Tesón (2001) affirms that, if a certain community has always adopted authoritarian practices, based on cultural or religious traditions, the fact of such traditions being cultural characteristics cannot be a moral justification for their perpetuation. In addition, Tesón (2001) points out another argument that is usually opposed to human rights, which is the so-called “human rights conspiracy theory”. According to such theory, human rights are a “Machiavellian creation”, formulated by Western culture to hinder the development of low or medium-income countries or to impose their culture on Eastern countries. It is the “Western weapon against the rest of the world” (Santos, 2004, p. 250). This theory fails by not being able to connect human rights with imperialist interests and to prove that the population from Eastern or poor countries, mainly from vulnerable groups, does not wish to receive the guarantees and benefits coming from human rights (Tesón, 2001). Confirming the argument regarding the inexistence between Western imperialist impositions on Eastern countries concerning human rights, Xiarong (2001) points out that Asian governors clip in their culture some aspects belonging to the Western world. By doing so, these governors move away from these aspects while accepting others, such as market capitalism and consumerism, and so getting rid of the “protection of the Asian values” theory.

3.2. Aspects of a pragmatic nature

The approach on the empirical aspects of universalism begins with the formal adhesion of the states to the instruments of human rights. Even when a state affirms that ratifying a treaty does not mean an effective implementation of human rights, the importance of such rights is undeniable, as they signal to the international community and, most importantly, to its citizens that the state recognizes the culture of human rights. Besides, victims of human rights violation can appeal to mechanisms pursuant to the Universal and the Regional Systems of Human Rights Protection. Another point is that such adhesion is voluntary. Hence, there is no coercion from the “imperialists or Western” states, obliging the other countries to adhere to the United Nations (UN) instruments of human rights. To give an example of the universal adherence of the states to human rights, we point out the number of states that have ratified UN treaties: the International Covenant on Civil and Political Rights (167 states); the International Covenant on Economic, Social and Cultural Rights (160 states); the Convention on the Elimination of All Forms of Discrimination against Women (187 states); the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (153 states); and the Convention on the Rights of the Child (193 states) (United Nations, 2013).

Another element of the empirical approach relates to the existence in the states of national human rights institutions. The UN defines them as central offices for the protection of human rights and as partners of the UN High Commissioner for Human Rights. The International Coordinating Committee of National Institutions for the Promotion and Protection of Human Rights instituted a Sub-committee on Accreditation, aiming to analyze and to review the petitions of accreditation from the human rights institutions sent by some states. In order for a human rights institution to be accredited, it has to follow the Principles of Paris, which set out the parameters required for the accreditation. Thus, according to the Principles of Paris and the Statute of the International Coordinating Committee, the institutions can receive status A, B, or C. Status A means that they are in accordance with the Principles of Paris; status B, not fully in accordance with such Principles; and status C implies that the institution does not meet the Principles of Paris. To illustrate the dissemination of the human rights culture in different parts of the globe, we have the following numbers: in Asia, there are 16 human rights institutions bearing status A. Some of these institutions are in India, Nepal, Jordan, Mongolia, Qatar, the Philippines, Korea, and Thailand. In Africa, there are 18 institutions bearing status A. Some of them are in Egypt, Morocco, Namibia, Nigeria, Senegal, Uganda, and Tanzania. In America, there are 15 institutions bearing status A. In Europe, 22 institutions with status A (Officer of the Higher Commission of the Human Rights, 2013). In fact, states with various cultures and religions, including the Islamic and Eastern countries, have human rights institutions that fully meet the Principles of Paris.

We conclude the empirical approach by showing the human rights relevance for vulnerable populations that form traditional communities. The indigenous communities in the Americas are petitioners of the Inter-American Commission on Human Rights, that is, they appeal to the mechanisms of protection of their human rights to make the states responsible for the violations practiced. For example, in the Inter-American Commission on Human Rights nowadays, there are nearly 58 petitions analyzed; 16 merit examinations; 7 friendly solutions in progress; and 14 cases sent to the Inter-American Court of Human Rights (Inter-American Commission on Human Rights, 2013). Therefore, it is evident that the indigenous people perceive human rights as instruments that are capable of validating their values, such as the right to the land and to a cultural identity. Since the 1980s, the Inter-American Commission on Human Rights (2013) has been systematically stating the rights of the indigenous people in its special newsletters and by means of case studies.

As an example of the incorporation of human rights by groups that defend vulnerable populations in Eastern countries, there was a public call held in 2011 by the Committee on the Elimination of All Forms of Discrimination against Women (2013) and the Committee on the Rights of the Child. This public call was regarding the presentation of subsidies related to harmful traditional practices that affect children and adolescents. As a result, a series of organizations from the civil society and individuals that defend human rights submitted subsidies related to this matter. Among the organizations and individuals that submitted subsidies to the assigned Committees, we point out the one from Pakistan, Guinaz Zahid (2013), which reports the existence of the Plan of Action for the Elimination of Harmful Traditional Practices Affecting the Health of Women and Children, presented in a regional seminar in Siri Lanka in 1994. In addition, it affirms that the 2010 Report from the Pakistani state identified 26 cases of marriages involving children; 557 cases of honor killings; as well as cases where women and girls are used for the attainment of justice between sides involved in conflicts. The Zambian organization, ZAS JPIC Committee (2013), affirms that a patriarchal society creates situations that subjected women to sexual and domestic violence, as the majority of women feel they are inferior to their husbands. The Committee reports that initiation rites encourage women's submission to their husbands, increasing the incidence of marriages and pregnancies at extremely early ages, which leads to the evasion of girls from schools. It informs that the “culture of silence” makes it difficult to identify and report on and resolve the cases of child abuse, incest, and violation. Finally, the Iwraw Asia Pacific organization (2013) states that cultural traits can subjugate and marginalize cultures and the identities of those who do not belong to the dominant social groups. It reports that the UNICEF (2013) actions that have involved various sectors of society, particularly women and girls, caused a change in the community conceptions about harmful practices and a wish to refute them. In sum, these reports show that non-governmental organizations in Asia are concerned with the use of the “traditional values” and the rhetoric defending the cultures to justify violations of the human rights of women and girls.

In this section of the paper, we sought to present the main challenges placed on the understanding that human rights are universal and form the human culture, despite recognizing that there is no global consensus related to values or ways of implementing human rights. Universality, unlike what Santos (2004) proposed, is not a specific issue pertaining to Western culture. It is a basic and core aspect to all vulnerable individuals, regardless of their culture. Women, children, indigenous people, and economically marginalized groups are holders of human rights and they can resort to these rights and demand measures from the states and the international organisms in order to accomplish these rights.

In the following section, the topic of human rights as behavior norms guiding IBPs will be approached.

4. IBP based on human rights

This section intends to contribute to the discussions on the development of an IBP based on human rights. This proposal assumes that human rights are not the only theoretical reference capable of dealing with culture-based moral conflicts. As Lorenzo (2011) advocates, ethical decisions in intercultural contexts can be based on the Habermas dialogue model. Even recognizing that in certain areas of contemporary philosophy there are suspicions concerning universalist claims (Aguilar, 2012), an IBP based on human rights starts from its universality and its transcultural acceptance. In this sense, human rights are the basis for a procedural and substantialist IBP (Cortina, 2005). The IBP, in its three dimensions – theoretical, institutional, and normative (Oliveira, 2011) – focuses on the institutional dimension, that is, the bioethical institutions that cooperate with those involved in moral conflicts, aiming to resolve them by means of intercultural dialogue. These institutions can resort to committees on ethics revision procedures, hospital ethics committees, and national bioethics committees (UNESCO, 2013b).

From the procedural point of view, one does not seek prescriptions of a concrete moral content, but the establishment of procedures that allow to legitimize or to take the legitimacy from procedural norms that guide the processes related to culture-based moral conflict resolution. Under the light of the substantialist perspective, IBP adopts shared norms of behavior (Cortina, 2005). Thus, under the procedural bias, human rights set out a series of norms. Those who participate in the decision-making process in concrete cases or in mediation of moral conflicts have to follow those norms by means of an intercultural dialogue. Hence, certain human rights must guide the activities performed by the bioethics institutions when the procedures aim to resolve culture-based moral conflicts. In fact, the cultural rights of the people involved, as defined in article 27 of the Universal Declaration of Human Rights, and in articles 13 and 15 of the International Covenant on Economic, Social and Cultural Rights, must be respected by all the concerning parties in the dialogue procedure. These rights establish that the people or groups involved in culture-based moral conflicts have the right to express themselves in their own language, and the right to choose and to perform their own cultural practices (UNESCO, 2013a). Cultural rights are essential to protect individuals that are part of minority groups, and these rights seek to allow these people to defend their lifestyles against the incursions of other communities, especially of the state (Donelly, 2003). I point out the right to participate in the decisions that concern and affect these people, the right not to be discriminated against, and the right to freedom of speech. The right to participate means that the people involved in the conflict can take part in the decision-making process or in the mediation. The right not to be discriminated against implies the respect of their beliefs, religion, values, and lifestyles. For example, Afro-Brazilian people have been discriminated against because of their “candomblé” practices (Shaeed, 2013), and this reflects on cultural and moral conflicts, as there are Afro-Brazilian patients who resort to this specific religious practice when they seek treatment for their illnesses, instead of looking for health facilities. The right to freedom of speech implies that the sides can freely express their ideas and cultural, philosophical, and religious concepts. A previous censorship in culture-based moral conflicts, established in ethnocentric behavior, can hinder an intercultural dialogue.

From the substantialist perspective, the norm that guides IBP based on human rights is article 12 of the Universal Declaration on Bioethics and Human Rights: The Principle of Respect to Cultural Diversity and Pluralism, which states that one must bear in mind the importance of cultural diversity and pluralism. However, these two elements cannot infringe human rights (UNESCO, 2013b). In fact, according to Beuchot (2005), human rights serve to delimit some cultural practices. However, one cannot forget that it is in an environment of respect to cultural differences and to other differences that human rights blossom. Resorting to the examples shown in this paper, we cannot tolerate under the excuse of being cultural practices some harmful practices to women and children, such as precocious and forced marriages, collective rapes as a form of justice among communities, and honor killings. One of the reasons is that certain cultural practices are clear examples of patriarchalism, asymmetrical power relations, discrimination against women, and subjugation of children. Hence, the committees of ethics revision procedures, the hospital ethics committees, and the national bioethics committees must have human rights as a background for the ethical analysis of the fairness and rightfulness of certain behaviors. Although one recognizes the importance of legitimate procedures for dialogues to make decisions resulting from an agreement between parties, all this anchored in human rights, it is clear that this is not enough. There are limits to the sides involved in culture-based moral conflicts, that is, some behaviors are not acceptable, since they get into conflict with human rights norms. Indeed, Brussino (2012) states that human rights supply criteria to delimit practices that are harmful to any human being, for example, torture and submission to cruel and degrading treatment, regardless of the cultural context where these practices exist.

In the resolution of culture-based moral conflicts, it is important to distinguish two types of conflict: conflict with human rights violation and conflict without human rights violation. In the first type of conflict, there is a moral disagreement about certain behaviors, however, are not characterized violate human rights situations. In the second case, in addition to moral disagreement, the practical object of dissent constitutes a human rights violation. The violation of human rights is a conduct perpetrated by the state, by act or omission, any breach in the international human rights treaties. The state has three human rights obligations: to respect, protect, and fulfill, so human rights violation presupposes the failure of one or more of these obligations. Such as in the case of respecting the state acts directly violating human rights; in the case of protecting the state fails to adopt protective measures of its population in order to prevent a breach of their human rights; and, finally, perform implies the adoption of policies and programs, administrative and legislative measures aiming to assure the rights of humans.

We recognize that there is some degree of subjectivity in the classification of a particular practice as a human rights violation or not. However, there are official pronunciations of the human rights bodies of the UN in this regard, for example, the Resolution adopted in December 2012 by urging all states to end female genital mutilation. Thus, there is global consensus, conformed in dialogical spaces in the UN, about what behaviors are human rights violations. Nevertheless, given that, conflicts can be analyzed on a case-by-case basis or abstractly. Bioethical commissions or committees responsible for such examination shall take into account international standards previously settled and the principle of maximum protection of human rights. Anyway, consideration about the presence or absence of human rights violation related to a specific conflict should precede the application of the tools of IBP, proposed in this article, because this definition will determine the subsequent path to deal with the bioethical cultural base conflict.

To illustrate a conflict without human rights violation, we use the example given by Lorenzo concerning the child of Toucan ethnicity who had been bitten by a jararaca snake and was hospitalized in a health facility in Manaus. At this facility, the child's father asked permission for a pajé to treat the child, according to the family's culture. As physicians denied the father's request, the father resorted to the law to have the child removed from the facility. The director of a hospital in the region suggested that the father let the child remain in the hospital, in the Intensive Care Unit, and receive the standard treatment together with the traditional ones performed by the pajé. The father accepted the director's suggestion and the child was then cured (Lorenzo, 2011). With this example, it is evident that there was a culture-based conflict regarding the child's treatment. However, it is clear that none of the involved parties violated the child's human rights.

On the other hand, in human rights violation conflicts, as in the case of infanticide among indigenous people and female genital mutilation, there is a violation of children and women's human rights, although the contexts of these practices are very different. In these cases, the Principle of Respect to Cultural Diversity and Pluralism is applied, according to which cultural diversity and pluralism cannot be used to justify human rights violations. Hence, I emphasize that we should reject such practices. However, the fact of perceiving them as human rights violations does not result in immediate cultural changes and does not impose intercultural measures that make these changes effective.

Thus, with respect to the resolution of culture-based moral conflicts by means of bioethics institutions, I support that there are two different types of procedures. Conflicts without human rights violation can be resolved by means of an intercultural dialogue, according to Habermas (Lorenzo, 2011). In addition, we can resolve it adopting human rights to guide the process of coming to an agreement between the parties involved. I propose the application of the right to express themselves in their language, the right to choose and to perform their own cultural practices, the right to participate in the decisions that concern and affect them, the right to not be discriminated against, and the right to freedom of speech. Human rights violation conflicts require measures of other natures, besides the fostering of intercultural dialogue, as there is a violation of the vulnerable groups’ human rights. However, I point out that such measures must respect the cultural rights of the people involved, besides the other rights mentioned above. It is important to state that choosing the suitable measures depends on checking if: (a) it is a traditional practice from a cultural minority; (b) if it is a traditional practice from a cultural and hegemonic majority. In the first case, we have to reject interventionist measures that do not respect the culture. An intercultural approach implies perceiving the culture analyzed in a clear way, not an ethnocentric one, eliminating the negative stereotypes and searching for a relationship based on empathy. Hence, strategies based on intercultural mediation (Aguilera Reija et al., 2009) are suitable to deal with such type of human rights violation conflicts. In the second case, when traditional practices reflect the inferior position that women and children hold in certain patriarchal societies, intercultural dialogue and intercultural mediation are not enough. Making use of the strategies set out by UNICEF (2013) to deal with female genital mutilation, we can adopt the following steps: (a) change in the national legislation to forbid this practice, without necessarily criminalizing it, but signaling the state's disapproval regarding it; (b) public campaigns; (c) empowerment of communities in order to debate the issue and to reach internal consensus; (d) inform communities about the consequences of this practice to health; (e) public declarations from members of the communities as a way to persuade them; and (f) engagement of religious and community leaders as key agents to cause the changes to happen.

Regarding the performance of bioethics institutions, it can be seen that the committees of ethics revision procedures and the hospital ethics committees usually deal with conflicts without human rights violation most of which regarding the relationship between the objects of a research and the researcher or the sponsor, and also the relationship between patients and healthcare professionals. National bioethics committees have to deal with human rights violation conflicts since they involve practices that violate the human rights of vulnerable groups.

Therefore, IBP deals with culture-based conflicts, with or without human rights violation. Consequently, the bioethics institutions that deal with such conflicting situations must bear in mind the different ways of working with these situations. However, human rights has guided their work, under either the procedural aspect or the substantialist one.

5. Conclusion

Culture-based moral conflicts are a reality in a large extent of the globe. Different cultures result in different practices in the areas of medicine, sanitation, and life sciences, which can lead to dissent concerning their morality. It is of utmost importance that bioethics, as ethics applied to moral issues, deals with such issues, which demonstrates its connection with the real world. The role of bioethics is relevant for obtaining order in social relations. Aiming to elaborate specific theoretical grounds to deal with culture-based moral conflicts, the IBP, besides focusing on moral disagreements among cultures, is guided by intercultural decision-making and mediation, the principle of cultural equality and intercultural dialogue, which implies the rejection of ethnocentrism and of cultural relativism. In addition, the theoretical normative reference of human rights plays an important role as the ethical guideline, both procedural and substantive, and as an element pertaining to human culture, whose essential role is to defend different cultures, mainly the ones from minority groups. Hence, human rights, being universal since all members of the human species are holders of these rights, become a unique instrument to defend vulnerable groups and to reject authoritarian governments and practices. Indigenous people make use of human rights in order to claim their rights before the Inter-American Commission on Human Rights. In addition, non-governmental organizations in countries where there are harmful traditional practices, like marriages involving children, female genital mutilation, and honor killings, claim their rights.

It is important to build a culture-based IBP founded on human rights due to their universal character and to their defending of vulnerable groups. Culture-based moral conflicts without human rights violation must be resolved by means of intercultural dialogue and mediation, guided by cultural rights, the right to participate, the right not to be discriminated against, and the right to freedom of speech. In the case of the culture-based moral human rights violation conflicts besides the human rights that guide intercultural dialogue and mediation, it is also necessary to make use of the principle of human rights prevalence, therefore rejecting arguments that denote authority regarding the predominance of cultural aspects over the rights of any individual. This individual has the right to not be subjected to torture, and to cruel, inhuman, or degrading treatment. Finally, there are strategies to resolve culture-based moral conflicts, regardless of their nature. I anchor these strategies in human rights and they presume that there is no hierarchy among cultures, and that it is an inexorable duty of the states to protect vulnerable groups, regardless of their cultural community.

Notes

1. “It is estimated that there is more than half a million gypsies in Brazil. According to data from the Research on Municipal Basic Information (Brazilian Institute of Geography and Statistics – IBGE) we can identified 291 gypsy camps in 2011. These camps are found in 21 Brazilian States.”

2. Beliefs, values, shared customs, behaviors, and devices, which people use when interacting with each other and transmit from one generation to the next by means of learning, constitute cultures (Aguilera Reija et al., 2009).

3. Cultural relativism can lead to the separation of worlds from cultural fundamentalism, which turns the “other” into an enemy, disqualifying and lowering the culture that this “other” is part.

4. People transmit culture by means of symbols and symbolic communication par excellence is the language.

5. Tilio points out “due to the effects of globalization, all the cultures in the world are in constant transformation and reconfiguration. We can identity traces of a culture in others, and one cannot determine to which culture those traces belong.”