The transformation of the medical ethos and the birth of bioethics in Colombia. A Foucauldian approach

Abstract

In the late 1960s and early 1970s bioethics was born in the USA and rapidly spread across the world. Bioethicists have traditionally argued that their discipline was the answer to the ethical challenges posed by the scientific and technological progress in biomedicine, although others have emphasised the abuses committed in biomedical human research and the dehumanisation of medicine. Notwithstanding the great excitement produced by the rise of the new field, its foundations, scope, and official historical accounts have been criticised. Calls to give bioethics better philosophical foundations –beyond the American principlism- and to broaden the field, particularly to include problems typical of the developing world such as poverty, exploitation and inequality have grown in the last twenty years. In Colombia, the idea that bioethics is an advocate of life, a discipline to protect life on earth from the dangers of an irresponsible scientific and technological advance as well as from a wrong model of development has been promoted by the Colombian bioethical establishment.

Drawing on the Foucauldian view on power and knowledge, this thesis analyses the connections between the flourishing of bioethics in Colombia and the implementation of a neoliberal healthcare system in the 1990s. The historiographies and hagiographies that have dominated the official history of bioethics in Colombia are criticised and, instead, a historical approach is offered. The central argument is that bioethics, and other discourses of surveillance of medical practice such as medical liability are part of the governmentalization of the Colombian medical ethos, and that bioethics has become a totalising, all-embracing field, constituting a form of power exercise over the biomedical scenario. Complementing the analysis, information from 27 semi-structured interviews is provided. Chapter one, the introductory chapter, discusses medicine as a contemporary cultural phenomenon and the birth of bioethics in the USA, while chapter two describes the elements of the Foucauldian toolkit that I use in the analysis. Chapters three and four critically approach the arrival and development of bioethics in Latin America and Colombia. Chapter five discusses the transformation of the Colombian medical ethos, describing the political transformation of the country in the 1990s and the healthcare reform. Chapters six and seven examine the discourses and practices around medical ethics in Colombia as well as how bioethics, medical practice, medical liability and biopolitically relevant legal decisions in the context of the new constitutional reality of the country became intertwined discourses.