Protect people who have become vulnerable and do not intervene where there is no need

Abstract

From the point of view of the bioethics of protection and the bioethics of public health, the State has the role of giving support to citizens who have become vulnerable, who do not present the objective and subjective conditions necessary for a satisfactory quality of life. Among the objective conditions are the capacity to satisfy legitimate needs and requirements (housing, education, access to healthcare services and basic freedoms). Among the subjective conditions is the cognitive and emotional competence to “look after oneself” and exercise one’s capabilities in an autonomous and responsible manner. The protective role that has traditionally been exercised by the State and been limited to giving support to people who have become vulnerable is gradually being replaced by another that is consistent with also intervening in spheres relating to personal care. This is known as having a state of exception in force, and it can be understood as a mechanism of mechanisms that is applied in principle to all individuals and population groups. In the case of healthcare, this is known as the medicalization of life, and it has the consequence of inverting the roles, since it tends to blame vulnerable people for their “unhealthy” behavior, instead of relying on controlling practices that might harm third parties or that may be requested. This situation can be summarized by the motto “healthcare is a duty of the citizen and a right of the State”. The tools of bioethics of protection may provide the means to deal with the moral and existential impasses that result from having this mechanism in force. Such impasses are the product of one-dimensional thinking that is incapable of taking complexity into account and living with the conflicting nature of contemporary democratic society.