Complex Bioethics and the COVID-19 Pandemic

Alterity and Otherness as a Necessary Framework for Thinking About New Social Relationships in a New Post-Pandemic World


In Brazil, the first identified case of the new coronavirus was traced to February 26, 2020, in the city of São Paulo, capital, and on March 17, 2020, the first death due to COVID-19 in Brazilian territory was recorded.[1] Since then, the number of cases in Brazil has increased significantly, as well as the number of deaths resulting from COVID-19[2], due to the damaging political decisions taken by the president of the republic and some state governors and mayors[3][4].

With the increase in the number of COVID-19 cases in Brazil, as well as the significant increase in the number of deaths, many bioethical issues are raised relevant to the local Brazilian context. This includes for example: scarce resource allocation criteria, in the sense what criteria to use to decide on the availability of an ICU vacancy for one patient over another; the justifications for mass testing for COVID-19; the criteria for the reopening of commercial activities; the integrity of scientific publications related to the COVID-19 pandemic; and also  the health of health professionals who are on the “front line” treating patients with COVID-19. For example, many regions of the country, during the epidemic are experiencing shortages of different kinds of supplies, including medicines, basic incomes to protect professionals, as well as  high technology devices, such as ventilators and others. This provides a very clear demonstration of the public health and social inequalities present in our country, generating and reflecting the vulnerability at many levels related to these regions where proper access to health care and justice are prejudiced or limited

With regard to this last topic, we would like to propose a reflection on “who takes care of the caregiver” based on the theoretical framework of Complex Bioethics that has been developed in the Brazil context.[5][6] Bioethics can be understood as a complex, interdisciplinary and shared reflection on the adequacy of actions involving life and living[7]. Among the theoretical references used in the approach of complex bioethics, we would like to deepen the issues related to the ethics of otherness by Emanuel Levinas, in the analysis of the relationship between health professionals and the care provided during the pandemic of COVID-19.

It is always important to return to the topic of Alterity and the otherness, especially in times of pandemics. Two situations deserve to be better discussed: the importance of the possibility of recognizing the face of the other and the need for reciprocal protection generated by interpersonal relationships. When health professionals have to use personal protective equipment necessary for their protection, that of other professionals and patients, they wear clothes that do not allow the differentiation of personal and professional characteristics, in addition to having their face, at least in part, covered. All of this leads, at least partially, to depersonalization.

It is especially the face that provides the possibility to recognize and be recognized for others. To hide the face with masks and facial protectors is to prevent this from happening. It is another person who is there, but who cannot be recognized. In many photos and reports there are professionals with their name and profession identified on the protective apron, in large letters written by the professionals themselves. The idea of ​​proposing the use of large size badges makes it possible to reverse this situation, at least partially, as long as the conditions to guarantee the safety of patients and professionals are maintained. Having the possibility to personally choose a photo for the badge is the beginning of a relationship: it is choosing how you want to be recognized. When making official documents, in many situations often the use of a photo is imposed, so that the person does not feel dequately represented. To be able to use previous personal photos, as has happened in the context of some of the  Brazilian health professional community as illustrated below,   is to recover good memories and to introduce into the troubled environment of the assistance, the possibility of sharing happy moments already lived. To be recognized by name and profession is to allow each one to be identified in their uniqueness. This possibility of seeing the face again, of a name being divulged and your profession identified  establishes the possibility of being recognized and of recognizing, of becoming a set of relationships with people that I identify. It is the presence of each one’s biography in the midst of a scenario that makes these relationships possible.


Alterity is also taking responsibility for the other and for oneself. It is from this responsible interaction between the self and the you, that the possibility arises of surpassing the individual , to create the we, the inclusive and shared collective. It is based on this relationship of co-responsibility that the justification for an action as simple as using face masks in all public places arises. The usual masks do not adequately protect the individual, but they effectively prevent contamination from others. In this way, by protecting the other, I am protecting myself. While there is important research still to be undertaken concerning whether the wearer of a facemask, whether professional or public, perceive that they are protecting themselves and/or others in Brazil and elsewhere, it is nonetheless this network of mutual shared protection that will enable ongoing social interaction. The more people wearing masks, the more people are being protected: it’s the opposite of contamination. Being selfish is not going to be effective, just being altruistic. Being co-responsible is the best answer: protecting each other and thus protecting yourself.

Non-neutrality towards the other, expressed through identification, recognition, mutual protection is the most appropriate response, it is the effectiveness of Alterity in the daily practice of each one of us. The vulnerability that affected everyone, made the words of the poet John Donne, in 1624, even more relevant, that no human being is an island, we are all part of a continent, recognizing that each death of someone, diminishes me as a person, for therefore, it is useless to ask who the bells are ringing for, as they ring for each one of us.


Lucas França Garcia. Is a sociologist. PhD in Medicine: Medical Sciences (Bioethics) at the Federal University of Rio Grande do Sul (UFRGS). Post-doctorate in Health Promotion at the Cesumar University of Maringá. Full Professor of Bioethics and Health Promotion at the Graduate Program in Health Promotion at the Cesumar University of Maringá (UniCesumar). Associate researcher at the Bioethics and Ethics in Science Research Laboratory of Hospital de Clínicas de Porto Alegre.

José Roberto Goldim. Is a biologist. PhD in Clinical Medicine from the Federal University of Rio Grande do Sul. Head of the Bioethics Division at Hospital de Clínicas de Porto Alegre. Full Professor of Bioethics at the School of Medicine of the Pontifical Catholic University of Rio Grande do Sul. Professor of the Graduate Program in Medicine: Medical Sciences at the Federal University of Rio Grande do Sul.

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[5] Complex Bioethics is one of the theoretical approaches developed in Latin America to address bioethical issues. Others approaches which origins could be determined to an endogenous origins could be accessed in the paper written by Garcia, L. F., Fernandes, M. S., Moreno, J. D., & Goldim, J. R. (2019). Mapping Bioethics in Latin America: History, Theoretical Models, and Scientific Output. Journal of Bioethical Inquiry, 16(3), 323–331.

[6] Goldim, J. R. (2009). [Complex bioethics: a comprehensive approach to decision making process]. Revista AMRIGS, 53(1), 58–63.

[7] Goldim JR. Bioética: origens e complexidade. Revista HCPA. 2006; 26:86-92.

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This publication was supported by a Wellcome Small Grant in Humanities and Social Science. Reference: 218699/Z/19/Z

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