ABSTRACT
El Poder Legislativo chileno propone una ley que elimine el timerosal como preservante de las vacunas parenterales del Programa Nacional de Inmunizaciones, proyecto que el Poder Ejecutivo se ha propuesto vetar. El mundo científico informa mayoritariamente que la sospecha de neurotoxicidad atribuida al timerosal es infundada. Pese a ello, las autoridades médicas han oscilado entre sostener que la precaución sugiere apoyar la ley y en otros momentos han manifestando que es más precautorio mantener los programas de vacunación actualmente vigentes. Estas contradicciones y oposiciones ilustran que materias que conciernen a la ciudadanía, requieren una reflexión bioética acabada sobre las políticas públicas sanitarias. Han quedado claro las deficiencias de la deliberación política y la falta de participación social en decisiones que, dado el grado de incertidumbre involucrada en temas como inmunización, requieren no sólo la inclusión de la ciudadanía sino el respeto de la autonomía individual para aceptar o rechazar la inclusión en los programas de vacunación propuestos por las políticas sanitarias. La participación ciudadana en nuestro país se ve severamente limitada por la falta de instrumentos sociales como el plebiscito, el ombudsman y, especialmente, la desidia en crear la Comisión Nacional de Bioética exigida por la Ley 20.120 de 2006, una de cuyas funciones más importantes es mediar deliberativamente entre legos, expertos y políticos en la generación de políticas sanitarias legitimadas por la participación ciudadana.
Chilean legislators have voted to ban vaccines preserved with thiomersal, an initiative that the Executive has vetoed. Most scientific evidence has dismissed the alleged toxicity of this substance, in accordance with the formal and publicly expressed opinion of local experts, and yet, medical authorities have issued contradictory statements. Some have argued that the principle of precaution suggests eliminating thiomersal preserved vaccines; others have declared that current vaccines should be maintained to protect the population. From the perspective of bioethics, this polemic is another example of the shortcoming of the deliberation process leading to controversial laws in lieu of including citizens in the discussion of regulations that harbor uncertainties, and respect for individual autonomy to accept or reject public immunization programs. The Chilean legal system has been unwilling to implement participatory democratic procedures like plebiscites or institutions such as the ombudsman. In 2006 a law was enacted that creates a National Commission of Bioethics, but successive governments have failed to create such a commission, which is an efficient social instrument to conduct deliberation on bioethical issues that require a balanced participation of the public, experts, and politicians.
Subject(s)
Humans , Bioethics , Preservatives, Pharmaceutical , Thimerosal , Mass Vaccination/ethics , Mass Vaccination/legislation & jurisprudence , Chile , Evidence-Based Medicine , Public Health , Public Policy , Immunization Programs/legislation & jurisprudence , Social ParticipationABSTRACT
O objetivo deste estudo é observar como vem se dando a relação entre a democracia participativa e representativa no Conselho Municipal de Saúde de Belo Horizonte (CMS/BH) desde a sua fundação em 1991 até 2010. A metodologia utilizada foi a análise das homologações e vetos do Executivo sobre as resoluções do conselho, com um aprofundamento no período entre 1997 e 2008. Os dados foram coletados no Arquivo de Resoluções e no site do CMS/BH. Os resultados foram relacionados ao mandato dos prefeitos e ao segmento dos presidentes do conselho. Os resultados demonstram que apenas uma resolução foi vetada pelo Executivo, mas 26% não apresentam registro de homologação, sendo que 41% destas apresentaram oposição dos gestores na votação. Espera-se que a realidade apresentada possa nos levar a reflexões quanto às práticas de poder, encorajando os conselheiros para a construção efetiva da democracia participativa neste espaço.
The scope of this study is to observe how the relationship between participative and representative democracy in Belo Horizonte's Municipal Health Council (Conselho Municipal de Saúde de Belo Horizonte - CMS/BH) has been developing since its foundation in 1991 through to 2010. The methodology applied involved the analysis of approvals and vetoes from the Executive power regarding the council's resolutions, with special emphasis on the period between 1997 and 2008. The data were collected from the Resolutions Archive and from the CMS/BH webpage. The results were related to each mayor's term and to the segment of the council's presidents. The results show that only one resolution was vetoed by the Executive power, however 26% of the resolutions do not show any record of ratification, whereby 41% of these faced opposition from the authorities in the voting process. It is hoped that the reality presented may lead to reflections regarding the exercise of power, encouraging the council members to effectively build participative democracy in this space.