quarta-feira, 28 de novembro de 2018

Desmontando falácias abortistas - Parte 2: Caça ao Embrião

Desmontando falácias abortistas - Parte 2: Caça ao Embrião



Mentirinha: “Essa valorização do feto humano é um exagero. Chegamos ao absurdo de impedir a realização de grandes descobertas científicas que poderiam curar os mais terríveis males que assolam a humanidade por causa de uma preocupação sem sentido com embriões que poderiam ser utilizados para pesquisas com células-tronco embrionárias.”

Talvez uma das mais impressionantes formas de defender o extermínio humano por meio do aborto seja justamente colocá-lo ao lado do progresso científico que arroga para si o papel de redentor da humanidade acometida por terríveis males. Para os abortistas, o aborto se transforma em uma necessidade para que haja mais pesquisas “redentoras”.

É um apelo muito mais emocional do que racional a uma solução parcial para uma das coisas mais assustadoras na vida humana: o sentimento de finitude, muitas vezes acompanhado pelo medo do desconhecido e do sofrimento que a morte traz. Com o intuito de combater a morte, eis que surge novamente a nossa campeã, a maravilhosa ciência, parteira de tantos milagres humanos, e agora também utilizadora de embriões.

No passado não tão distante, esperava-se que, com a conclusão do Projeto Genoma, o ser humano pudesse ser reprogramado e a caixa de Pandora fosse escancarada para que cientistas alcançassem todos os mais loucos sonhos. Isso não se realizou. Descobrimos muitas outras caixas de Pandora como a epigenética, que mistura os hábitos e a cultura humana no caldo genético e a proteômica.[1]

Embarcando na marola que sobrou da onda de esperanças destroçadas, onda esta advinda da ambição pelo domínio do destino humano por meio da genética, ainda surgem aqueles que sonham com a manipulação do ser humano por meio da terapia com células-tronco.

Eis que lá vêm os abortistas em busca da mais nova desculpa para seus lucrativos abortos: utilizar as células-tronco embrionárias, muito mais poderosas do que as células-tronco adultas, para promover soluções ainda mais espetaculares.

No Brasil, o Supremo Tribunal Federal, em seu ativismo, legislou sobre a matéria, anunciando a legalidade de se pesquisar com embriões humanos, para o desgosto dos defensores da vida. Também não agradaram por completo os próprios abortistas, já que há clara orientação para não se produzir novos embriões destinados à pesquisa.

Isso tudo apesar de não haver evidências de que células-tronco embrionárias de fato possuam grandes vantagens sobre o uso de células-tronco adultas.[2]E ainda há relatos de que as células-tronco embrionárias sejam de difícil controle, já que podem causar câncer em seus receptores, dado o altíssimo potencial que encerram.[3]Por outro lado, há um grande investimento em uma nova técnica que permite a transformação de células adultas em células-tronco, são as Células-Tronco Humanas Pluripotentes Induzidas, repletas de possibilidades e com menores entraves morais.[4]Esta última técnica, que nos pouparia de grandes dúvidas acerca da moralidade em se destruir embriões humanos para pesquisar, surge em um contexto no qual a pesquisa em embriões não foi estimulada. A criatividade humana encontrou um caminho mais ético, enfim, recusando o atalho oferecido por incautos pesquisadores.

Surgem também nos dias de hoje as acusações feitas pelos abortistas de que os defensores da vida humana são retrógrados, inimigos da boa ciência que salva milhões de vidas, saudosos de uma vida medieval – como se medieval fosse algum tipo de xingamento horrendo.

Em periódicos de altíssima circulação, esfregam na cara dos defensores da vida humana que hoje milhões de pessoas de todas as idades se beneficiam das vacinas. Segundo os abortistas, é preciso ser coerente e honrar o fato de que grande parte dessas vacinas foram produzidas com a ajuda de células fetais obtidas em abortos. O que esses iluminados escritores de editoriais de revistas cientificas famosas não falam é que se pode recorrer a células fetais de abortos espontâneos e que não há compromisso ético algum em permanecer fazendo algo questionável moralmente só porque se obteve algo de positivo de uma prática antiética realizada no passado. De forma análoga, pode-se perceber o grau de estupidez dessa linha de raciocínio ao se propor o absurdo de prosseguir com as práticas nazistas de experimentos monstruosos em seres humanos só porque, no passado, de forma criminosa, algum nazista hipoteticamente descobriu algo que nos beneficiaria no presente. Não faz o menor sentido.[5]

Aliás, já que falamos em analogias e raciocínios estúpidos, cabe lembrar outro exemplo vergonhoso da argumentação abortista: o argumento do terrível prédio em chamas (ou seria o terrível argumento do prédio em chamas?).

Alguns abortistas utilizariam a seguinte situação hipotética: imagine que você está em um prédio, em meio a um terrível incêndio. Você tem a chance de salvar uma menina de cinco anos ou doze embriões congelados. Você ousaria salvar os embriões?

Michael Sandel, que propôs essa situação, utiliza isso contra a ideia de equivalência moral entre embriões e pessoas já paridas em seu livro Contra a Perfeição. Seu argumento é de que, como as pessoas de regra salvariam a menina, conclui-se que as pessoas de fato não acreditam que embriões são seres humanos.[6]Eis um verdadeiro exemplo de non sequitur.

A resposta é dada por Yuval Levin, que argumenta contra a conclusão de que embriões deveriam ser apenas material bruto para pesquisas. 

Ele reproduz a analogia da seguinte forma: imagine que você está em um prédio em chamas com sua esposa e um estranho. Se tiver que escolher, obviamente escolherá sua esposa para salvar em detrimento do estranho (ou, pelo menos, espera-se que a escolha). Ninguém poderia culpar o homem que salvou a sua esposa e não a um estranho. Disso não se concluiria de forma alguma que o estranho, que não foi salvo, era apenas material bruto para queimar ou destruir. Tampouco se concluiria que poderíamos sair por aí pegando estranhos para arrancar-lhe os órgãos para pesquisa, certo?[7]

Segundo Levin,

O problema, em outras palavras, está na aplicação da lógica de um prédio em chamas – a lógica da triagem e da emergência – para a vida cotidiana. Nosso mundo não é um prédio em chamas. Argumentar a favor disso, como foi sugerido no caso de pesquisas médicas moralmente controversas, seria negar a legitimidade de praticamente todos os limites éticos e morais sobre a ação, se tal ação fosse direcionada à resolução de uma emergência. E se nossa natureza humana ou condição mortal em si é a emergência, logo qualquer ação – qualquer meio – seria moralmente permissível para estender nossas vidas.[8]

Falando de embriões e de pesquisas antiéticas, o anúncio recente de que cientistas chineses comemoram a criação de dois bebês humanos editados geneticamente pela técnica CRISPR para que sejam imunes ao vírus do HIV desperta preocupação até mesmo em grandes entusiastas dos grandes avanços tecnológicos e do Transumanismo, como Julian Savulescu, que afirma com correção que 

Se for verdade, esta experiência é monstruosa. Os embriões eram saudáveis, sem doenças conhecidas. A edição genética em si é experimental e ainda está associada a mutações indesejadas, capazes de causar problemas genéticos em etapas iniciais e posteriores da vida, inclusive o desenvolvimento de câncer. (...) Esta experiência expõe crianças normais e saudáveis aos riscos da edição genética em troca de nenhum benefício necessário real. (...) contradiz décadas de consenso ético e diretrizes sobre a proteção dos participantes humanos em testes de pesquisa. [Os bebês resultantes dos testes de He, pesquisador chinês formado nos EUA] estão sendo usados como cobaias genéticas. Isso é uma roleta russa genética.[9]


O que se vê, na linha de argumentação abortista em prol do pretenso avanço da ciência, é o risco real e imediato de uma profunda desumanização do homem, instrumentalizando-o em prol de um avanço científico de forma irresponsável e, portanto, antiética. Em troca da imoralidade, oferecem-nos maravilhosas expectativas.

Desde quando se justifica praticar um ato com altíssimo risco de ser antiético em prol de um hipotético avanço do conhecimento humano? Pois a dúvida moral em si mesma, como obrigatoriamente acontece no caso de um ato irreversível como a edição genética ou um aborto, já aponta imediatamente a sua falha ética. 

Por fim, usar embriões humanos em pesquisas é a instrumentalização irreversível e antiética de alguns seres humanos em prol de outros, é a desvalorização da vida humana ao afirmar que ela nada ou pouco tem de especial, é dar a cara a tapa para a velha crítica posta por George Orwell em seu romance A Revolução dos Bichos: Todos os animais são iguais, mas alguns animais são mais iguais que outros...[10]




Hélio Angotti Neto é médico formado pela Universidade Federal do Espírito Santo com Residência Médica em Oftalmologia e Doutorado em Ciências pela Faculdade de Medicina da Universidade de São Paulo. Atua como Professor e Coordenador do Curso de Medicina do Centro Universitário do Espírito Santo. É Presidente do Capítulo de História da Medicina da Sociedade Brasileira de Clínica Médica (Triênio 2017-2020), membro do Conselho Brasileiro de Oftalmologia e Delegado do Conselho Regional de Medicina do Espírito Santo em Colatina (2018-2023). Foi Global Scholar do Center for Bioethics and Human Dignityda Trinity International Universityem 2016 (Illinois, USA) e é Diretor Editorial da Mirabilia Medicinae, publicação em Humanidades Médicas sediada no Institut d’Estudis Medievalsda Universidad Autónoma de Barcelona. Publicou os livros: A Morte da Medicina; A Tradição da Medicina; Disbioética Volume 1: Reflexões acerca de uma estranha ética; Disbioética Volume 2: Novas Reflexões Sobre uma Ética Estranha; Disbioética Volume 3: O Extermínio do Amanhã; Arte Médica: De Hipócrates a Cristo; além de diversos capítulos de livros e artigos em Oftalmologia, Bioética, Política e Humanidades Médicas. Criador e Coordenador do Seminário de Filosofia Aplicada à Medicina. É Presbítero da 3ª Igreja Presbiteriana de Colatina. Casado com Joana e pai de Arthur, Heitor e André.


[1]FANU, James Le. The Rise and Fall of Modern Medicine. New York: Basic Books, 2012.
[2]PEREIRA, Lygia da Veiga. Células-Tronco. Promessas e Realidades. São Paulo: Moderna, 2013.
[3]AMARIGLIO, Ninette; et al. ‘Donor-Derived Brain Tumor Following Neural Stem Cell Transplantation in an Ataxia Telangiectasia Patient’. InPLoS Medicine, 6(2), 2009.
[4]LEVIN, Yuval. ‘What Happened to Bioethics’. InThe New Atlantis. A Journal of Technology and Society, vol. 56, 2018, p. 92-98.
[5]Recomendo a leitura de meu artigo “Tudo é bom motivo para matar um bebezinho”, publicado em: ANGOTTI NETO, Hélio. Disbioética Volume II: Novas reflexões sobre os rumos de uma ética estranha. Brasília, DF: Monergismo, 2018.
[6]SANDEL, Michael J. Contra a Perfeição. Ética na era da engenharia genética. Rio de Janeiro: Civilização Brasileira, 2013.
[7]LEVIN,op. cit., p. 93-94.
[8]Ibid., p. 94.
[9]LYI, Macarena Vidal. Cientistas chineses dizem ter criado os primeiros bebês geneticamente modificados. Os bebês, duas gêmeas, agora têm uma modificação que supostamente as protege contra o vírus da AIDS, segundo o geneticista He Jiankui. In:El PaísInternethttps://brasil.elpais.com/brasil/2018/11/26/ciencia/1543224768_174686.html?id_externo_rsoc=FB_BR_CM&fbclid=IwAR3DrSoMs3k7l-JcWbIcKzL5Ci2ozAne5BJgnI_uSZFiVgLo7LF7obAq50s
[10]ORWELL, George. A Revolução dos Bichos. Um conto de fadas. São Paulo: Companhia das Letras, 2007.

terça-feira, 27 de novembro de 2018

Was Hippocratic Medicine Authoritarian?

Was Hippocratic Medicine Authoritarian?
Author: Hélio Angotti Neto
KEYWORDS: Hippocrates, Medical Ethics, History of Medicine, Paternalism, Authoritarianism, Physician-Patient Relationship.


I. Introduction
Hippocratic Medicine became a taboo in our times. The Hippocratic tradition, rich and complex as it can be, receive accusations of irresponsibility toward social issues. In addition, physicians that worked or, allegedly, work under such an inspiration are seen as paternalists and authoritarians by many authors, professors, and even common folk. This article searches for an answer for the following questions: (1) Did the Hippocratic physicians of old were really paternalists in the strong sense of the term (all knowing and authoritarians, undermining the autonomy of the patient and their families)? (2) If not, how they practiced medicine considering their patients, their families and their colleagues?

II. Hippocrates and the authoritarian origins of medicine
The contemporary vision of Hippocratic ethical tradition is one of authoritarianism, paternalism, forceful beneficence and disrespectful stance, with an arrogance that cannot stand the autonomy of the patient. To some critics, the ancient model remained until very recently, perpetuating paternalism in some kind similar to a Dark Age of medical ethics, now enlightened by modern bioethics.
In a publication of the Regional Medical Council of São Paulo (Siqueira 2005, p.14) we can read:
(…) traditional medical ethics, as conceived in the Hippocratic model, has a strong paternalist appeal (…). Only in the sixties, medical ethical codes started to acknowledge the infirm as an autonomous agent.
Even in the probably most important book of bioethics in the world (Beauchamp & Childress 2013, p.1), they present the Hippocratic tradition as:
(…) not well equipped to address problems such as informed consent, privacy, access to health care, communal and public health responsibilities, and research involving humans subjects as these appeared in the modern context, and its paternalistic orientation  provoked resistance from advocates of patient’s rights.
The judgement of what was good for the patient, according to many critics, was an exclusivity of the physician, who reduced the patient to a complete vulnerable and dependent state (Cascais 2006, p. 1011). Only the physician retained the scientific knowledge; therefore, only he decided, without any concern for the patient’s will or participation (Ligiera 2005, p. 410-427).
This conception of an inadequate old medicine when someone evokes Hippocrates is commonplace in contemporary Academy. In the New England Journal of Medicine (Kapp 1999, p. 821), one can read that:
Gone are the days of medical paternalism, when arrogant health care professionals misused their power to force particular treatments on dependent patients who blindly trusted them.
This excerpt, from one of the most important medical journals in the world, is given as common knowledge, without any original text to justify it, and is referred directly by other authors (Silva & Nunes 2015, p.475) as proof for what they say in other article, as shown in the following excerpt:
Authority and responsibility, once an exclusive domain of the physician in medicine, are now shared with the patient, who is given, as a mentally and emotionally capable individual, the freedom to choose from several options. The risks and benefits related to those options should be explained in advance.
What, perhaps, was something accepted in the Academy with some valid justification is now reproduced inside the Academy itself without none, except for the repetition of many precious opinions.
Even if the justification for this authoritarian image of traditional medicine was adequate, the reproduction of such conclusion without adequate sources can turn common knowledge into prejudice. We fear that such can be the case with the Hippocratic moral tradition in medicine.
Resuming all the accusations:
(1)  Traditional Hippocratic physicians took for themselves all the authority and responsibility over the patient, disregarding patient’s autonomy to choose;
(2)  Physicians were arrogant and imposed their treatments on their patients;
(3)  Patients blindly trusted their physicians.
Searching in the Hippocratic originals, we will see if we can consider valid each one of these accusations. 
If the answer is positive - the accusations are valid and, therefore, just -, academic literature concerning Hippocrates is mostly right, and, perhaps, the accusations of romantic idealization directed to some defenders of Hippocratic tradition is adequate.
If the answer is negative, and the original texts of Hippocrates and philosophers of his time could deny the accusations, we can assume that a great historic injustice has been committed against traditional Hippocratic medicine. 
In addition, to assume that traditional Hippocratic medicine is not textually and systematically authoritarian is not the same as assuming that no physician was authoritarian, and vice-versa.
Considering the word “paternalist”, I will prefer, instead, the use of “authoritarian”, for the previous word carries a strong emotional rejection and can arise many wrong prejudices that will only confuse the exposition, and risk an incorrect interpretation, disregarding the many subtleties of the concept, varying from a strong to an weak form. The word “paternalism”, probably since the publication of the “Authoritarian Personality” (Adorno et al. 1950), became something almost as terrible as Nazi or sexist, and it could rightly be interpreted as a Hateful Labeling, a traditional eristic stratagem, according to Schopenhauer (2003). To use authoritarian, we want to approach paternalism in the strongest sense possible, as we seen in many accusations nowadays. 

III. The answer of the Hippocratic corpus and other classic texts
Accusation (1): Traditional Hippocratic physicians took for themselves all the authority and responsibility over the patient, disregarding patient’s autonomy to choose.
Many excerpts from the Hippocratic tradition completely deny this accusation.
I. Life is short, the Art long, opportunity fleeting, experiment treacherous, and judgment difficult. The physician must be ready, not only to do his duty himself, but also to secure the co-operation of the patient, of the attendants and of externals (Hippocrates & Heracleitus 1931).[1]
The first aphorism explicitly shows that the physician must search for the co-operation of other people, including the patient and his family. The good was not a duty only for the physician. It was something that should be accomplished by everyone surrounding the patient, and the patient himself.
LXIX. Such is my advice to the great mass of mankind, who of necessity live a haphazard life without the chance of neglecting everything to concentrate on taking care of their health. (Hippocrates & Heracleitus 1931).[2]
This passage shows that the Hippocratic writings were primarily educational instruments. Some of the Hippocratic authors expected that their writings could reach many hands and educate the “great mass of humanity”. To share knowledge hardly is compatible with an authoritarian accumulation of responsibility and power. Neither is compatible the understanding that the patient should co-operate: “The physician is the servant of the art. The patient must co-operate with the physician in combating the disease” (Hippocrates 1923a).[3]
This excerpt from Epidemics Ialso emphasizes the importance that the patient has in the therapeutic act, sharing responsibility with the Hippocratic doctor:“Do not hesitate to inquire of laymen, if thereby there seems likely to result any improvement in treatment” (Hippocrates 1923a).[4]
In the work Precepts, teamwork is remembered in the following situation:
VIII. So much for such recommendations. For remission and aggravation of a disease require respectively less or more medical assistance. A physician does not violate etiquette even if, being in difficulties on occasion over a patient and in the dark through inexperience, he should urge the calling in of others, in order to learn by consultation the truth about the case, and in order that there may be fellow-workers to afford abundant help. For when a diseased condition is stubborn and the evil grows, in the perplexity of the moment most things go wrong (Hippocrates 1923a).[5]
This clear prescription of humility and teamwork for the physician do not resemble an authoritarian, all-knowing, professional. In fact, it shows only a physician truly devoted to the patient’s good, ready to call for help if needed, be such help from other physicians, from the patient, or from their families. A very “contemporary” demand on medicine, indeed.
The disposition to educate the patient is clearly demonstrated. Why teach someone if not to expect an active role of the patient in the therapeutic act?
IX. A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit in his illnesses. (Hippocrates & Heracleitus 1931).[6]
The physician was rightly acknowledged as an authority in healthcare matters. The wise man urged everyone to heed physicians’ counsels. In the following passage, Plato shows that choosing to whom one should listen is a common happening:
7. Socrates. Come then, what used we to say about this? If a man is an athlete and makes that his business, does he pay attention to every man’s praise and blame and opinion or to those of one man only who is a physician or a trainer?
Crito. To those of one man only (Plato 1914).[7]
To choose a physician is not an imposition. It appears to be the most reasonable thing to do. However, the possibility of acting in an irrational way is not excluded. It is the patient who chooses, it is him who invites the physician to enter his house, under the vow of silence.
soc. And whether their mentor be poor or rich will make no difference to the Athenians when they deliberate for the health of the citizens; all that they require of their counsellor is that he be a physician (Plato 1927).[8]
The excerpt above, from Alcibiades I, shows that the ruling citizens of the Poliscalled physicians to listen to their counsels. Again, the physician act as an invited counselor, as the one who shows the way to achieve better health. The possibility of denying what the physician counsels is present, thus, the initiative of the patient or collectivity is present somehow.

Accusation (2): Physicians were arrogant and imposed their treatments on their patients.
One image comes to mind when I read some commentaries from nowadays bioethicists: an imposing and almost violent doctor forcing bad tasting medicine down the throats of helpless patients. This is a strong image, but false, at least when we appeal to ancient descriptions of medical-patient relationships. 
Someone can argue that the selection of Hippocratic works only is not sufficient, and more testimonies are necessary. However, even when those descriptions come from other sources than the Hippocratic writings, the aspects that were observed in Hippocratic texts are still present. In the work of Plato we can read:
str. Suppose a physician who has right knowledge of his profession does not persuade, but forces, his patient, whether man, woman, or child, to do the better thing, though it be contrary to the written precepts, what will such violence be called? The last name in the world to call it would be “unscientific and baneful error,” as the phrase is, would it not? And the patient so forced might rightly say anything else rather than that he had been treated in a baneful or unscientific way by the physicians who used force upon him.
y. soc. Very true (Plato 1925b).[9]
It may be surprising for some to see the expression violence linked to the disrespectful act against patient’s autonomy at that ancient period, but it is described as such in the work The statesmanfrom Plato. To describe this act of imposing treatment as violence presupposes the choice of the therapy by the patient before it starts as a parameter, it presupposes patient’s agreement. 

Accusation (3): Patients blindly trusted their physicians.
Patients appear to have a very active role in the medical-patient relationship, deciding if they would allow or not the physician to do his work, and even sometimes, distrusting the physician and denying treatment, which is something very far from  a blind-trusting patient. In the famous dialogue Gorgias, Plato describes a physician requiring help to persuade a patient.
Gorg. Ah yes, if you knew all, Socrates,—how it comprises in itself practically all powers at once! And I will tell you a striking proof of this: many and many a time have I gone with my brother or other doctors to visit one of their patients, and found him unwilling either to take medicine or submit to the surgeon’s knife or cautery; and when the doctor failed to persuade him I succeeded, by no other art than that of rhetoric (Plato 1925a).[10]
This passage of Gorgias reveals that patients could deny their physicians prescriptions, and shows a physician very different from the imposing figure described sometimes. The physician appears to ask compliance from the patient, knowing that he is an invited person, and has only the authority that the patient gives to him.
XII. On entering bear in mind your manner of sitting, reserve, arrangement of dress, decisive utterance, brevity of speech, composure, bedside manners, care, replies to objections, calm self-control to meet the troubles that occur, rebuke of disturbance, readiness to do what has to be done. In addition to these things be careful of your first preparation. Failing this, make no further mistake in the matters wherefrom instructions are given for readiness (Hippocrates 1923b).[11]
In this Hippocratic text, the physician deals with the possibility of objection from the patient. Again, an image very different from the accusation of docile patients, blindly trusting in their doctors.

IV. Conclusions and Discussion
There are many other references to the relation between physicians and patients or laypeople present in the works of ancient Greece physicians and philosophers, but for now, we believe these samples can answer our main questions.
(1) Did the Hippocratic physicians of old were authoritarian? 
After revising many ancient texts close to the time of Hippocrates, one cannot affirm that physicians were authoritarian because they followed Hippocratic morality. Therefore, the contemporary references to the authoritarianism – or very strong paternalism - of Hippocratic medicine should be better analyzed, and the true historical root of the authority problem ought to be searched. This conclusion does not affirm that no physician of old was authoritarian. Even today, in times of patient autonomy rising over other principles of action, one may encounter an authoritarian physician who has nothing of Hippocratic per se
(2) If not, how they practiced medicine considering their patients, their families and their colleagues?
Considering these original texts - a small but representative sample -, one can conclude that Hippocratic physicians were generally used to: (a) expect some collaboration from the patients and their families; (b) divide responsibility with other physicians and even layman, according to the situation; (c) try to convince their patients of the adequate treatment; (d) educate layman using written texts and, probably, oral learning; and (e) depend on their patients consent.
This historic frame differs much from the authoritarian figure evoked by many contemporary bioethicists and researches. Although the majority of the Academy appears to disavow traditional Hippocratic ethics, some researchers judge better the essential aspects of this tradition, and reach more equilibrated conclusions.
The great humanist physician, Pedro Laín Entralgo, for example, recognizes in his classic work “La Medicina Hipocrática” that the objectives of the Hippocratic physician included education of the patient, among many others.
As an expert in medicine and in the knowledge of human nature, the Hippocratic physician feels himself obligated to teach the profane. Primarily, to allow that this one, enlightened by the physician, could live in a more salutary way when healthy and could better help the physician when diseased.
 Second, because the physician’s experience could be greater and deeper if his patients received certain information about diseases and their treatments. 
Finally, because the formation of the learned man, thepaideia, demands the learning from those who truly knew, and the physician is, among all, the most qualified knower of the man’s physiology. The Hippocratic writer wants to intervene in the education of his people, especially of those citizens who, because of their social status in the polis, had the duty to possess culture” (Lain-Entralgo 1970).[12]
Actual researches, like Fabrice Joterrand, also examine the Hippocratic tradition with less prejudice, concluding that the Hippocratic Oath, for example, is a particularistic vision of the universal aspects of medical morality, and that can be used, even today, with some caution (Joterrand 2005).
Beier and Ianotti conclude, in a much adequate way, after analyzing many Hippocratic writings, that:
The Hippocratism is considered, not a few times, strongly paternalist, in the medical-patient relationship. However, after the close study of many passages in some Hippocratic works, one must admit the possibility that such paternalism was not strong, but moderate” (Beier & Ianotti 2010).[13]
It may be that the modern physician’s authoritarian character perceived by many patients, scholars and even physicians themselves is a product of Illuminist ideology, with its mechanicism and naturalism, in which the physician assumes the cold and powerful role of a technocrat. However, this hypothesis is to be discussed in another opportunity.
Concluding, the Hippocratic medical tradition cannot be termed as authoritarian – or strongly paternalist -, as many scholars affirm today. The Bioethics discourse may be influenced by some ideological biasin its judgement of past moral traditions, and Academy must review the way it refers to Hippocratic tradition if it wants to remain true to history and written legacies from the past. We should at least acknowledge the complexity and richness of the Hippocratic tradition and its developments in western civilization, avoiding simple generalizations that can undermine our capacity to understand our cultural roots. 
In a remarkable conference at the UNESCO International Symposium “Forms and Dynamics of Exclusion”, in Paris, 1997, the Brazilian philosopher Olavo de Carvalho remembered us that:
To reengage the dialogue with the past is to reconquer de sense of human unity. To try to reintegrate into humankind this or that group that remains today among the excluded and discriminated without revoking before the discrimination against all humanity that preceded us would be an insanity (Carvalho 1997).[14]
If we do not understand our past and find the universal connections that link human experiences along the centuries, we would hardly be prepared to face our present and our future.

Bibliography
Adorno T. W., Frenkel-Brunswik E., Levinson D. J., Sanford R. N. 1950. The authoritarian personality. New York: Harper and Row.
Beauchamp T. L., Childress J. F. 2013.Principles of Biomedical Ethics, Seventh Edition. New York, Oxford: Oxford University Press.
Beier M., Ianotti G. C. 2010. Paternalism and the hippocratic oath. Revista Brasileira de Saúde Materno Infantil 10(Supl. 2): S383-S389.
Carvalho O. 1997. O Futuro do Pensamento Brasileiro: Estudos sobre o nosso lugar no mundo, 2a. edição. Rio de Janeiro: Faculdade da Cidade Editora. 
Cascais A. F. 2006. A experimentação humana e a crise da auto regulação da biomedicina. Análise SocialXLI(181): 1011-1031.
Kapp M. B. 1999. The Practice of Autonomy: patients, doctors, and medical decisions [book review]. New England Journal of Medicine340(10): 821-822.
Hippocrates. 1923a. Ancient Medicine. Airs, Waters, Places. Epidemics 1 and 3. The Oath. Precepts. Nutriment.  Loeb Classical Library 147. Cambridge, MA: Harvard University Press.
Hippocrates and Heracleitus. 1931. Nature of Man. Regimen in Health. Humours. Aphorisms. Regimen 1-3. DreamsHeracleitus: On the Universe. Cambridge, MA: Harvard University Press.
Hippocrates. 1923b.Prognostic. Regimen in Acute Diseases. The Sacred Disease. The Art. Breaths. Law. Decorum. Physician (Ch. 1). Dentition. Loeb Classical Library 148. Cambridge, MA: Harvard University Press.
Plato. 1927. Charmides. Alcibiades I and II. Hipparchus. The Lovers. Theages. Minos. Epinomis. Loeb Classical Library 201. Cambridge, MA: Harvard University Press.
Plato. 1914. Euthyphro. Apology. Crito. Phaedo. Phaedrus.  Loeb Classical Library 36. Cambridge, MA: Harvard University Press.
Plato. 1925a. Lysis. Symposium. Gorgias.  Loeb Classical Library 166. Cambridge, MA: Harvard University Press.
Plato. 1925b. Statesman. Philebus. Ion.  Loeb Classical Library 164. Cambridge, MA: Harvard University Press.
Joterrand F. 2005.The Hippocratic Oath and Contemporary Medicine: Dialectic Between Past Ideals and Present Reality? Journal of Medicine and Philosophy30:107–128.
Lain-Entralgo P. 1970. La Medicina HipocráticaMadrid: Ediciones de la Revista del Occidente.
Ligiera W. R. 2005. Os princípios da bioética e os limites da atuação medica. Revista Ibero-Americana de Direito Público20: 410-427.
Schopenhauer A. 2003. Como Vencer um Debate Sem Precisar Ter Razão. Rio de Janeiro: Topbooks.
Siqueira J. E. 2005. Doente terminal. Cadernos de Bioética do CREMESP1.
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Hélio Angotti Neto is a Medical Doctor graduated at the Federal University of Espírito Santo, and has a Medical Residency in Ophthalmology and a PhD in Sciences from the Faculty of Medicine of the University of São Paulo. He acts as Professor and Coordinator of the Medicine Course of the University Center of Espírito Santo. He is President of the Chapter of History of Medicine of the Brazilian Society of Clinical Medicine (Triennium 2017-2020), member of the Brazilian Council of Ophthalmology and Delegate of the Regional Council of Medicine in the city of Colatina, at Espírito Santo, Brazil (2018-2023). He was a Global Scholar of the Center for Bioethics and Human Dignity of Trinity International University in 2016 (Illinois, USA) and is the Editorial Director of Mirabilia Medicinae, a publication in Medical Humanities hosted by the Institut d'Estudis Medievals of the Autonomous University of Barcelona. He published several books: The Death of Medicine; The Tradition of Medicine; Dysbioethics Volume 1: Reflections on a strange ethics; Dysbioethics Volume 2: New Reflections on a Strange Ethics; Dysbioethics Volume 3: The Extermination of Tomorrow; Medical Art: From Hippocrates to Christ; besides several chapters of books and articles in Ophthalmology, Bioethics, Politics and Medical Humanities. Creator and Coordinator of the Seminar of Philosophy Applied on Medicine. He is Presbyter of the 3rd Presbyterian Church of Colatina. Married to Joan and father to Arthur, Hector and Andrew.

[1]I. Ὁβίοςβραχύςἡδὲτέχνημακρήὁδὲ καιρὸςὀξύςἡδὲπεῖρασφαλερήἡδὲκρίσιςχαλεπήδεῖδὲοὐμόνονἑωυτὸνπαρέχειντὰδέονταποιέονταἀλλὰκαὶτὸννοσέοντα καὶτοὺςπαρεόνταςκαὶτὰἔξωθεν. Hippocrates, Heracleitus. Nature of Man. Regimen in Health. Humours. Aphorisms. Regimen 1-3. Dreams. Heracleitus: On the Universe. Translated by W. H. S. Jones. Loeb Classical Library 150. Cambridge, MA: Harvard University Press, 1931, p. 98-99.
[2]LXIX. Ταῦταμὲνπαραινέωτῷπλήθειτῶνἀνθρώπωνὁκόσοισινἐξἀνάγκηςεἰκῆτὸνβίονδιατελεῖνἐστίμηδ᾿ὑπάρχειαὐτοῖσιτῶνἄλλωνἀμελήσασιτῆςὑγιείηςἐπιμελεῖσθαι·Hippocrates, Heracleitus. Nature of Man. Regimen in Health. Humours. Aphorisms. Regimen 1-3. Dreams. Heracleitus: On the Universe. Translated by W. H. S. Jones. Loeb Classical Library 150. Cambridge, MA: Harvard University Press, 1931, p. 366-367.
[3]ἡτέχνηδιὰτριῶντὸνόσημακαὶὁνοσέωνκαὶὁἰητρός·ὁἰητρὸςὑπηρέτηςτῆςτέχνης·ὑπεναντιοῦσθαιτῷνοσήματιτὸννοσέοντα μετὰτοῦἰητροῦ.Hippocrates. Ancient Medicine. Airs, Waters, Places. Epidemics 1 and 3. The Oath. Precepts. Nutriment. Translated by W. H. S. Jones. Loeb Classical Library 147. Cambridge, MA: Harvard University Press, 1923, p. 146-147.
[4]μὴὀκνεῖνδὲπαρὰ ἰδιωτέωνἱστορεῖνἤντιδοκῇσυνοίσεινἐςκαιρὸνθεραπείης.Hippocrates. Ancient Medicine. Airs, Waters, Places. Epidemics 1 and 3. The Oath. Precepts. Nutriment. Translated by W. H. S. Jones. Loeb Classical Library 147. Cambridge, MA: Harvard University Press, 1923, p. 312-313.
[5]VIII. Περὶσημασίηςτοιαύτηςἅλιςἔστω·ἄνεσιςγὰρκαὶἐπίτασιςνοσέοντοςἐπινέμησινἰητρικὴνκέχρηνταιοὐκἀσχήμων δέοὐδ᾿ἤντιςἰητρὸςστενοχωρέωντῷπαρεόντι ἐπίτινινοσέοντικαὶἐπισκοτεόμενοςτῇἀπειρίῃκελεύῃκαὶἑτέρουςἐσάγεινεἵνεκατοῦἐκκοινολογίηςἱστορῆσαιτὰπερὶτὸννοσέοντακαὶσυνεργοὺςγενέσθαιἐςεὐπορίηνβοηθήσιοςἐνγὰρκακοπαθείηςπαρεδρίῃἐπιτείνοντοςτοῦπάθεοςδι᾿10ἀπορίηντὰπλεῖσταἐκκλίνουσιτῷπαρέοντι. Hippocrates. Ancient Medicine. Airs, Waters, Places. Epidemics 1 and 3. The Oath. Precepts. Nutriment. Translated by W. H. S. Jones. Loeb Classical Library 147. Cambridge, MA: Harvard University Press, 1923, p. 312-313.
[6]IX. Ἄνδραδὲ χρήὅς ἐστισυνετόςλογισάμενονὅτιτοῖσινἀνθρώποισιπλείστουἄξιόνἐστινὑγιείηἐπίστασθαιἐκ τῆςἑωυτοῦγνώμηςἐντῇσινούσοισινὠφελεῖσθαι. Hippocrates, Heracleitus. Nature of Man. Regimen in Health. Humours. Aphorisms. Regimen 1-3. Dreams. Heracleitus: On the Universe. Translated by W. H. S. Jones. Loeb Classical Library 150. Cambridge, MA: Harvard University Press, 1931, p. 58-59.
[7]7. ΣΩΚΡΑΤΗΣΦέρεδήπῶςαὖτὰτοιαῦτα Bἐλέγετογυμναζόμενοςἀνὴρκαὶτοῦτοπράττωνπότερονπαντὸςἀνδρὸςἐπαίνῳκαὶψόγῳκαὶδόξῃτὸννοῦνπροσέχειἢἑνὸςμόνουἐκείνουὃςἄντυγχάνῃἰατρὸςἢπαιδοτρίβηςὤν;
ΚΡΙΤΩΝἙνὸςμόνου.
Plato. Euthyphro. Apology. Crito. Phaedo. Phaedrus. Translated by Harold North Fowler. Loeb Classical Library 36. Cambridge, MA: Harvard University Press, 1914, p. 162-165.
[8]ΣΩἈλλ᾿ἐάντεπένηςἐάντεπλούσιοςᾖὁπαραινῶνοὐδὲνδιοίσειἈθηναίοιςὅτανπερὶτῶν ἐντῇπόλειβουλεύωνταιπῶςἂνὑγιαίνοιενἀλλὰζητοῦσινἰατρὸνεἶναιτὸνσύμβουλον.Plato. Charmides. Alcibiades I and II. Hipparchus. The Lovers. Theages. Minos. Epinomis. Translated by W. R. M. Lamb. Loeb Classical Library 201. Cambridge, MA: Harvard University Press, 1927, p. 110-111.
[9]ΞΕἌντιςἄραμὴπείθωντὸνἰατρευόμενονἔχωνδὲὀρθῶςτὴντέχνηνπαρὰτὰγεγραμμένατὸβέλτιονἀναγκάζῃδρᾶνπαῖδαἤτιναἄνδραἢκαὶγυναῖκατίτοὔνοματῆςβίαςἔσταιταύτηςἆρ᾿οὐπᾶνμᾶλλονἢτὸπαρὰτὴντέχνηνλεγόμενονἁμάρτημαCτὸνοσῶδεςκαὶπάνταὀρθῶςεἰπεῖνἔστιπρότεροντῷβιασθέντιπερὶτὸτοιοῦτονπλὴνὅτινοσώδηκαὶἄτεχναπέπονθενὑπὸτῶνβιασαμένωνἰατρῶν;
ΝΕΣΩἈληθέσταταλέγεις.
Plato. Statesman. Philebus. Ion. Translated by Harold North Fowler, W. R. M. Lamb. Loeb Classical Library 164. Cambridge, MA: Harvard University Press, 1925, p. 140-141.
[10]ΓΟΡΓΕἰπάνταγεεἰδείηςΣώκρατεςὅτιὡςἔποςεἰπεῖνἁπάσαςτὰςδυνάμειςσυλλαβοῦσαὑφ᾿ Bαὑτῇἔχειμέγαδέσοιτεκμήριονἐρῶ·πολλάκιςγὰρἤδηἔγωγεμετὰτοῦἀδελφοῦκαὶμετὰτῶνἄλλωνἰατρῶνεἰσελθὼνπαράτινατῶνκαμνόντωνοὐχὶἐθέλονταφάρμακονπιεῖντεμεῖνκαῦσαιπαρασχεῖντῷἰατρῷοὐδυναμένουτοῦἰατροῦπεῖσαιἐγὼἔπεισαοὐκἄλλῃτέχνῃτῇῥητορικῇ. Plato. Lysis. Symposium. Gorgias. Translated by W. R. M. Lamb. Loeb Classical Library 166. Cambridge, MA: Harvard University Press, 1925, p. 290-291.
[11]XII. Ἐνδὲτῇἐσόδῳμεμνῆσθαικαὶκαθέδρηςκαὶκαταστολῆςπεριστολῆςἀνακυριώσιοςβραχυλογίηςἀταρακτοποιησίηςπροσεδρίηςἐπιμελείηςἀντιλέξιοςπρὸςτὰἀπαντώμεναπρὸςτοὺςὄχλουςτοὺςἐπιγινομένουςεὐσταθείηςτῆςἐνἑωυτῷπρὸςτοὺςθορύβουςἐπιπλήξιοςπρὸςτὰςὑπουργίαςἑτοιμασίηςἐπὶτούτοισιμέμνησοπαρασκευῆςτῆςπρώτης·εἰδὲμήτὰκατ᾿ἄλλαἀδιάπτωτονἐξὧνπαραγγέλλεταιἐς ἑτοιμασίην.Hippocrates. Prognostic. Regimen in Acute Diseases. The Sacred Disease. The Art. Breaths. Law. Decorum. Physician (Ch. 1). Dentition. Translated by W. H. S. Jones. Loeb Classical Library 148. Cambridge, MA: Harvard University Press, 1923, p. 294-295.
[12]Como experto en medicina y en el conocimiento de la naturaliza humana, el médico hipocrático se siente en el deber de enseñar al profano (idiotes, dèmótés). Ante todo, para que éste, así ilustrado, viva de un modo más salubre cuando está sano y colabore mejor con el médico cuando llegue a enfermar.
En segundo lugar, porque la experiência del médico podrá ser más amplia y profunda si sus pacientes han recibido cierta información acerca de las enfermedades y su tratamiento.
Y por fin, porque la formación del hombre culto, la paideia, exige aprender de los que real y verdaderamente saben, y el médico es, entre todos ellos, el más calificado conocedor de la physiología del hombre. El tratadista hipocrático quiere intervenir en la educación de su pueblo, y muy especialmente en la de los ciudadanos que por su situación social en la polis tienen el deber de la cultura.
Lain-Entralgo, P. La Medicina Hipocrática. Madrid, Sp: Ediciones de la Revista del Occidente, 1970, p. 367.
[13]Não poucas vezes, considera-se que o hipocratismo se assenta sobre um paternalismo forte na relação médico-paciente. Entretanto, o estudo atento de passagens diversas em alguns dos livros do CH, levam a possibilidade de se admitir que esse paternalismo não era forte, mas moderado. Beier M; Ianotti GC. Paternalism and the hippocratic oath. Revista Brasileira de Saúde Materno Infantil, Recife, 10 (Supl. 2): S383-S389 dez, 2010.
[14]Reencontrar o diálogo com o passado é reconquistar o sentido da unidade da espécie humana, e seria loucura pretender reintegrar na humanidade este ou aquele grupo que estejam hoje entre os excluídos e os discriminados, sem antes revogar a discriminação de toda a humanidade que nos precedeu. “Les plus exclus des exclus: Le Silence des morts comme modèle des vivants defendus de parler”, Conferece at the UNESCO International Symposium “Forms and Dynamics of Exclusion, Paris, June 22-26, 1997. In: Olavo de Carvalho, O Futuro do Pensamento Brasileiro: Estudos sobre o nosso lugar no mundo, 2a. edição, Rio de Janeiro, Faculdade da Cidade Editora, 1997, pp. 82-111. Internethttp://www.olavodecarvalho.org/textos/mais_excluidos.htm#nota1