Brazilian Public Health System: an analysis through the bioethics of protection

Abstract

This study focuses on the theme of conflict among the three underlying moral and political principles in the Brazilian Public Health System (SUS), from the perspective of the bioethics of protection: the right to equality and comprehensiveness in health care, as well as universal access. We include this theme in the sphere of Public Health Bioethics, reviewing several previous studies on this issue with the aim of reflecting on whether the principles of the SUS are mutually consistent in their logic and compatible in practice, or on the contrary, whether they are logically contradictory and mutually exclusive. We consider this discussion relevant in light of the apparently increasing agreement in both the bioethical and health fields concerning the prima facie incompatibility between the guarantee of universal coverage on the one hand and comprehensive, equal access to services on the other, considering the reality of scarce resources, a problem that affects practically all health systems in the world, as by minor official funds as by major public demands. We thus approach what is considered the most controversial specific problem in so-called public bioethics, i.e., resource allocation in which public health guidelines determine that scarce resources should meet numerous and varied health demands at both the collective and individual levels.