Bioethics, Culture and Infanticide in Brazilian Indigenous Communities

Cad. Saúde Pública, Rio de Janeiro, 26(5):853-878, mai, 2010 Importantly, modern non-indigenous society views autonomy as a good to be preserved. A fair and just society morally preserves and sustains each person’s right to live as an autonomous individual. We would add that autonomy is a concept related to freedom. Thus, if we accept that the indigenous mother’s values emanate from her culture/belief, the question arises: is she free to decide on her children’s fate, i.e., that one twin should be eliminated? Cultural traditions rooted in given cultures are not always easily accepted by others. An example is “clitoridectomy”, a tradition in some African tribes. Based on values emanating from the culture/ belief of these tribes, this tradition allowed (and in some societies still allows) the excision of the clitoris in young girls in early puberty, by means of mutilating practices and with a high risk of morbidity and mortality. This extirpation was (or is) performed by women that traditionally detain the necessary practical knowledge. Despite respect for cultural traditions, the custom became the target of an international campaign of condemnation and disapproval when it came to the knowledge of people from elsewhere in the world. In the case discussed here, if ones chooses physician’s autonomy as the priority (with the understanding that this helps define the full exercise of the human condition, without any tutelage), the conflict is resolved by hiding the unborn child and subsequently isolating it from the village. Crucially, if the physician chose to perform the delivery and hide the infant, he would face ethical risks, doubts, and dilemmas. There would definitely be a need for sedation (analgesia) of the mother, since transvaginal or caesarian delivery without her active participation could result in birthing complications. There would also be doubt about recording information on the patient chart, and especially about preserving secrecy, since information would be shared by all the persons participating in the act of hiding one of the twins. Finally, the case highlights the possibility of the debate on autonomy as a fundamental idea, as follows: “In deliberation pertaining to action, we should not only examine the prudence of such action in order to know whether it is an appropriate means for obtaining a desired end, but we should determine whether it is intrinsically fair and morally correct”. Fermin Roland Schramm