BIOETHICS, CULTURE AND INFANTICIDE IN BRAZILIAN INDIGENOUS COMMUNITIES 871 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 indi- vidual. We would add that autonomy is a concept related to freedom. Thus, if we accept that the indigenous moth- er’s values emanate from her culture/belief, the question arises: is she free to decide on her chil- dren’s fate, i.e., that one twin should be elimi- nated? Cultural traditions rooted in given cultures are not always easily accepted by others. An ex- ample is “clitoridectomy”, a tradition in some Af- rican 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. De- spite 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. Fermin Roland The morality of infanticide at the In the case discussed here, if ones chooses Schramm crossroads between moral pluralism physician’s autonomy as the priority (with the and human rights culture understanding that this helps define the full Escola Nacional de Saúde exercise of the human condition, without any Pública Sergio Arouca, The article Bioethics, Culture and Infanticide in tutelage), the conflict is resolved by hiding the Fundação Oswaldo Cruz, Brazilian Indigenous Communities: The Zuruahá Rio de Janeiro, Brasil. unborn child and subsequently isolating it from [email protected] Case defends the idea that the morality of infan- the village. ticide must be viewed in its specific cultural and Crucially, if the physician chose to perform social context, since in the case in question the the delivery and hide the infant, he would face newborn only begins to exist socially if the moth- ethical risks, doubts, and dilemmas. There would er accepts it, and if it has not only a biological life, definitely be a need for sedation (analgesia) of but a cultural identity, without which the new be- the mother, since transvaginal or caesarian deliv- ing would be no more than “a socially dead being” ery without her active participation could result (p. 856). Thus, based on this symbolic-imaginary in birthing complications. inscription, the actual practice of infanticide There would also be doubt about recording would be morally justified, considering that for information on the patient chart, and especial- the Zuruahá community, “If a child is born with ly about preserving secrecy, since information physical defects or without a father to protect it, would be shared by all the persons participating there is no reason to live because life would be ex- in the act of hiding one of the twins. cessively heavy for this child, for its family, and for Finally, the case highlights the possibility of its people” (p. 856). In short, infanticide among the debate on autonomy as a fundamental idea, the Zuruahá must be inscribed in the people’s as follows: “In deliberation pertaining to action, Weltanschauung, which includes moral norms we should not only examine the prudence of such that are distinct and different from others around action in order to know whether it is an appro- it. But, accepting the arguments that lend legiti- priate means for obtaining a desired end, but we macy to Zuruahá infanticide logically questions should determine whether it is intrinsically fair the “universal nature” of human rights, accord- and morally correct”. ing to which “infanticide is considered to be a crime against human rights” (p. 862), and one can assume “at first sight that it is imperative to be against it” (p. 862), but thereby running the Cad. Saúde Pública, Rio de Janeiro, 26(5):853-878, mai, 2010 872 Feitosa SF et al. risk “of imposing imperialistic and centralist logic of real attempts to find (on the symbolic level) under the pretext of ethics and law” (p. 862). agreements between conflicting actors and val- Obviously, the practice of infanticide is mor- ue systems, but presupposing that the conflict- ally controversial if one compares: (1) the set ing parties admit a priori that they wish to reach of values from the tradition that abolished it – an agreement (also known as a transcendental represented here by the National Campaign for condition in any dialogical confrontation); the Life and against Infanticide and the case of the principle of informed consent by all conflicted two Zuruahá infants removed from the village to parties, whom are morally and cognitively com- avoid their deaths and (2) the view of what we petent, and, I would add, the principles of char- could call contemporary morality, which is es- ity, which pressuposes that all the parties “are sentially secular, pluralist, and without canonic playing fair”. As the authors write, in this case “it morals accepted by all, represented here by the is essential to have the deepest possible knowledge defenders of Zuruahá identity and its practice of regarding the culture of the people with whom the infanticide in the name of respect for differences. dialogue will be established” and “prior manifes- At first glance, the two views appear antitheti- tation of interest in establishing this dialogue,” cal, since the former does not allow infanticide otherwise “the ethical debate will give way to the in any case, while the latter allows it in specific violence of the law of the strongest” (p. 863). The cases. However, taking a closer look, the latter Texan bioethicist Engelhardt Jr. summarized this is more subtle, since it appears to allow at least condition of moral agent in the contemporary, two types of stances towards the complexity of a secular, and pluralist world quite well, stating morally plural world. The first of these is respect that “there are no decisive secular arguments to for the prevailing value systems in the various establish that one concrete view of the moral life moral communities existing in society or coun- is better morally than its rivals, and since all have try – as in the case of Brazil, characterized among not converted to a single moral viewpoint, secular other things by a “a very wide diversity of Indian moral authority is the authority of consent (...) the peoples” and “many tribal groups that live with authority of the agreement of those who decide to minimal contact outside the group, or even in collaborate (...) without fundamental recourse to complete isolation, [maintaining] very little or force” 1 (p. 68). no relationship with Brazilian national society” In other words, the authors approach the ar- (p. 853) and in which traditional practices like guments for and against infanticide as it relates infanticide persist. not to societies which, as stated by Agamben, The main potential critique of this stance consider the “sacredness of life, which is invoked (respecting the differences and beliefs of the today as an absolutely fundamental human right various communities constituting a country) is in opposition to sovereign power [over life and that it results in a moral relativism which would death]” 2 (p. 91), but to communities in which, virtually rule out any possibility of shared values, as the authors contend, “[infanticide] has always such as those represented by human rights. As functioned as a means of birth control and even such, these rights are universally applicable and as a mechanism for adapting human life to ad- explicitly include the right to life and implicitly verse conditions of survival in certain hostile en- encompass the prohibition of infanticide. Moral vironments, especially under jungle conditions” relativism also implies the impossibility of even (p. 854). In the latter, there would be “good rea- valuing behaviors and thus leads to amorality. sons” for infanticide, such as “the mother’s in- However, moral pluralism is not necessarily a ability to devote the care and attention required synonym for moral relativism, since the former for yet another child; the newborn’s capacity or implies respect for cultural differences and their incapacity to survive within the physical and existing value systems, which is quite different socio-cultural environment into which he or she from amorality, which does not imply any respect was born; and the preference for one sex over the whatsoever. Indeed, the latter type of stance im- other” (p. 854). These reasons, with perhaps the plies establishing agreements in order to resolve exception of the third, may in fact be sustained by a moral conflict such as that posed by infanticide, the concept (central to evaluating the morality of as long as the moral agent external to the com- human practices) of “quality of life”. According to munity has sufficient understanding of (and re- Mori, this concept is the principal characteristic spect for) the values that allow infanticide, which of the bioethical paradigm, in which “morality can be viewed as a necessary condition for dia- is a social institution, consisting of values and logue to occur. This dialogical stance – defended norms which, in various historical circumstances, by the article’s authors – belongs to the field of guarantee (...) the necessary social coordination procedural