Bioethics as a science that studies the interrelation between life and the behavior of human beings, as well as institutions, poses several challenges for the medical practitioners and medicine in general. From the perspective of bioethics, a paradigm shift is proposed to adapt medical mission and vision according to the reality of the 21st century, where the threat of global warming and natural disasters is increasing affecting human health. In this complicated process, health institutions must adjust its aims and methods from bioethics, by correcting the mecanicist and economicist aspects that prevail and which are expressed in the increasing medicalization of social problems, but also by demedicalization processes. This paper shows the need to assume collective and individual ethics of responsibility and points out the main roads to fight against the socioenvironmental and health system disaster, in the framework of climate change.

Keyword: health, civilization, medical practitioners, medicalization, desmedicalization

The civilizational transition

This article aims to identify the theoretical and practical bioethical issues related to medical activity worldwide.

The methodology is considered from both a theoretical and operational definition of bioethics and its relationship with environmental ethics to derive its most significant theoretical and practical problems. At the same, it is about the significance of medicalization, which subordinates the medical codes to the big economic and political interests. As a consequence it appears dismedicalization as a way to overcome the current commercial paradigm. Lastly, bioethics is linked to the specific problems of the health system as a whole. In the civilizing crossroads, crucial ethical-moral problem have arose, taking into account that, given the bifacetic nature of today's world, society cannot shake this ambivalent substrate¹ covering all facets of human social life in contemporary world: this means strengthening theoretical models and practical actions that reinforce self-destructive pattern of life; or, on the other hand, it is necessary to situate ourselves in the framework of construction of an alternative life and production through models based on integrative of production and reproduction of human life together with nature, that is expressed in the whole health’s education system. And above all because these two dimensions that mark the fate of social organization and individuals, are subsumed to the market system of values especially economic, and based on the behavior looking with the aim of obtaining profits by itself, giving the meaning of social relationships, their material forms, human needs and also leads to socio-environmental degradation. This results in the fact that values ​​have become anti-values, enthroning over the values ​​of nature and human values, especially the right to achieve a healthy life. Likewise, the ongoing systemic structure generates a practice of justice in favor of the strong, while ownership becomes the right to appropriate the work of others and to destroy the ecosystems. Hence it needs to achieve redistributive justice.² Thus, the foundations of the established order have become their opposite, and freedom has been transformed into economic and social liberalism, provoking the enslavement of people; property has changed into the right of exploitation and justice is very far from the masses.

Humanization of the earth versus human naturalization

The human dominium extends to all land, but such humanization of the earth has a limit because as Heidegger warned, suppressing the sacred world, it has high costs and unpredictable negative impacts. Therefore, it can be said that as a consequence of climate change there is no environmental health.³ It follows that in today's world the quality of life is more important than the so-called standard of living, whose maximum aspiration is to approach the American way of life. This implies the emergence of virtue and frugality ethics.¹ But without social and natural security there is no human life, it means considering starting from universal values ​​beyond economic globalization. Therefore, the current ethics is a global one, but in the sense of achieving a positive globalization,¹ which is not simple commercial protectionism, but emancipate the local that in its sum truly explains the process of globalization; that is, it is a really protection for people, communities and natural ecosystems. But, beyond globalization, there are paths to build a new civilizatory order based on universal values ​​such as peace, food (bread), health, land.

"Wisdom is not concentrated in a single place but distributed over the whole face of the earth".⁴ Thus, all earthly localities generate knowledge and potentially constitute universal values; this breaks with the trap of a negative globalization because without the global, the local itself is a setback. In short, it is about arriving at global-local thinking. But not to fall into the extreme of a globalization without local development and even thought. However, in the motto of global thinking-acting locally, there is something negative, because it does not transformthe transnational power, first of all the distinction between biosphere and Gaia and between biosphere and humanosphere or biocentrism and antropocentrism. A central point is the existing one between health and environment, distinguishing environmental, social and personal health;⁵ for that reason it is necessary to take into account that in the life sciences, the biology, the social and the psychological are united (in a trans disciplinary vision).⁶ In sum, the ethics of the environment is an indispensable condition for the survival of man on earth. This isa really over-live, which means living beyond subsistence, "man does not live by bread alone". This is to go beyond the animalism that derives in the “economic animal” of Keynes and the political animal of Aristotle, it is therefore good living and the ethics of goodness, beyond ignorance and passion (Upanishads).

Therefore, bioethics requires a clear coordination between physical (and social) life and the quality of life of people as individuals and collectively. It is a global, planetary ethics (biosphere, Gaia), that in this context integrates human health into the biophysical networks that make life possible. In this sense, the life sciences represents the methodology of bioethics⁷ and make the ethics of the environment an indispensable condition for human survival and the realization of human rights. It must be added that, nowadays, human rights must be conceived as part of the rights of nature.⁸ And of course we must also incorporate the rights of the sick and dead people. A letter of the rights of the sick should include the right of the patient to life. What is needed is to draw a line with respect to the increasingly strong tendency to exercise the medical dictatorship that guarantees the interests of large companies in practice. That is the case of Transnational pharmaceutical chemical companies, which assert their economic benefit over the sick population, (and the achievement of a dignified death), which is seen as a captive market of "clients". Of course, easy access to healthcare is required, in geographical and economic terms but also that you have the right medical quality to achieve health and save thousands of human lives. This implies having all the reliable information, expedited, clear and reflecting the scientific medical advances. Consequently, it is essential to broaden the base of the science / ethics interrelation. It goes without saying that between these two aspects ethics should prevail over the cold and scientific decisions of medical science. Its goal is to heal pain-free and extend the healthy and useful life of the patient.

Ethics of responsibility

The starting point for the deconstruction of the current world and construction of the alternative is the ethical renovation which allows extending it to the recognition of the environmental dimension, beyond the Kantian golden rule² based on Christianity and its anthropocentric rationality. The latter assumes that nature has ceased to be sacred and has been desecrated by separating the gods fromnatura, where only the created nature (naturanaturata) is considered non-creative (naturanaturans).⁹ For its part, environmental ethics¹⁰ must be taking into account the environment as a complex reality beyond nature and mankind considered in isolation, to be placed in the perspective of a network of interconnections with their respective hinges in all its dimensions and directions; which only approaches the understanding of very general dynamics; so it is necessary to investigate in detail the concrete problems that currently affect the world nowadays.

A key to advance in this field is to recognize the real human impossibility of dominating nature, while the environment requires to be shaped by the hand of man governed by the principle of responsibility.⁸ On the other hand, given the inability of man to impose his course on the evolution of the earth, the task that remains is the control of the person and society as a whole.¹²

Extending ethics to all the dimensions that constitute the environment implies a corresponding vision of the cosmo-centric world³ which means to recognize diversity in the way of being, thinking and acting. Now, without detracting from its importance, generally speaking the economy is not understood without the existing imbrications with the other spheres of material and spiritual reality. In this framework, environmental ethics today is equivalent to what has been constituted as bioethics, incorporating problems of fundamental transcendence and in keeping with the expanded moral conscience, which requires to walk beyond the values ​​founded on the exploitation of the earth and the environment without considering the economic, social, environmental and moral damages of the parallel devastation that is inherent to the crisis of civilization that humanity is going through, with the peculiarity that overcoming this juncture implies gradual and radical changes towards another civilizational order whose foundation is the necessity to surpass the submission to the mother earth by means of new rules in the human relations. So it is necessary to understand that the definition of bioethics has to do with the interrelation of physical life and quality of human life, so that it does not fit with anti-humanist postulates but also without falling into the anthropocentrism, as in the phrase of Protagoras that "man is the measure of all things ".

It is clear that the prevailing-Christian and capitalist ethics¹³ can no longer be sustained in the face of the decline of the values ​​that are the axis of its existence. Here we must highlight the convergence between two major life processes: on the one hand, the evolution of organic nature and, secondly, human nature, which implies the clash or convergence between natural evolution and social development. Therefore, the latter is connected to the compatibility or not between the two mentioned processes. This supposes that social change is based on the evident incompatibility of the current order with its eco-social base, and for that reason the appearance of the anachronism of its structure with all the amount of concomitant setbacks (in front of the advances that are thus deserved). It is evident that these anachronisms have to be overcome if the material and spiritual evolution is to unfold for its next historical-natural phases. This is reflected in the social character of the capitalist system when it is shown how important is technological progress as the fundamental aspect of economic organization. But we should not singa victory for the above because parallel to the previous process is not less important the reproduction of backwardness (absolute and relative), along with eco-social regressions, is a case of slavery and servitude in the framework of today's society. All this is aggravated by the appearance of modern diseases, together with traditional diseases that supposedly would have been eradicated completely.

The new diseases include mental disorders that are essential to support the processes of destruction of daily life together with the social and ecological fabric. In these contexts “diseases of the earth” stand out. So the current world ethics implies understanding the diverse looks and legacies of different civilizations that are all amalgamated in the context of the civilizational transition. This implies the presence of an eco-social knot linked to the decadent order and the remains of other world in a situation where advanced nations no longer represent the future of the backward ones.

Medicalization and health of earth and human

Medicals and agronomists share the same goal: to teach how to cure the diseases of the earth and human being and the awareness of this fact. As health professionals, they are those who possess both the ethical virtues and the knowledge that will help the patient to overcome their illness (although the opposite also usually happens).

For this reason, the analogy between medicine and agronomy is underlying, trying to prevent, increase resilience and cure the body not in one part ("holistic" vision), although the threat of a vertical relationship ("powerful father") is also present.), paternalism, hence the importance of establishing and strengthening the ethical-medical-environmental codes. Antecedent in the subject discussed is the American author, Aldo Leopold,¹⁴ in his ethics of the land, who proposes: The correct thing is to act maintaining the biological integrity of the ecosystem (of the body mind or spirit), the incorrect thing : to attempt against the biological-cultural integrity.

This is the truly purpose in this era of earth crisis and increasingly serious environmental disasters; not only climate change but famines and others. Finally to cure is first of all to prevent. The former is of special importance given the presence of a holistic war; as a total war of the rich against the poor. In both the binomial science-humanity, appears as the central element in the arrival to a new paradigm. Hence it needs to use human thinking to ensure the responsible presence of man in promoting health, since health is not identical to not having diseases but rather aspires to the realization of fulfillment based on free will and the freedom to enjoy the "sacred garden", the paradise. Therefore, it is nothing other than the quality of his own life, in the aspiration to the fullness of health in being-thinking-acting-coexisting.

Patient/medical relationship

The medical patient relationship is crucial according to the different diseases and levels of the same, so if there is no good treatment, the rest is irrelevant. We must remember that according to Paracelsus the doctor is the one who cures, not the one who sells medicines; In addition, the real doctor looking for the patient. This requires the following aspects:

1. Informed consent. So long as you do not have to play with the health of the patient and you need to know exactly the state of your ailments, so it is not possible to justify any type of deception, even in the supposed benefit that the patients would have.
2. Also, we should know the treatment options even if they consist of totally opposite therapies.
3. The diagnosis of the patient must show their weaknesses as well as their bio-psycho-social strengths and trace the relevant forecasts with theoretical and empirical foundation.
4. Likewise, to propose the existing alternative treatments, especially in the face of iatrogenesis⁴ and secondary effects, with stratospheric costs, which does not exclude the use of lies and deception to enrich oneself at the expense of diseases and the death of the patient. Therefore, medicalization⁵ should be avoided and the side effects caused by the drugs that are being prescribed should be clarified.
5. It is recommended to ignore the tricksters who offer solutions for everything. This includes not only traditional healers, but on many occasions conventional doctors, who supposedly always have the prescription for any type of disease; and medicines that usually disturb the general functioning of the body-mind, causing anxiety and anxiety in the patient.
6. As a result of the above said, it is necessary to locate the origin of the diseases founded in the incompatibility with nature and society. Therefore, the meaning of different but complementary therapies in their diagnosis and prognosis must be doubled, so that laboratory analyzes are essential, as is taking into consideration the most diverse bio-psycho-social indicators and applying, whenever possible, different types of therapies in each case.
7. In addition, it is always present the verification of the free decision of the subject (individual and social) against the Hippocratic idea: sick = minor of age.
8. On the other hand its slogan is redeemable: "that your food be your medicine and your medicine your food").

¹From the point of view of an environmental ethics of virtue "nature is not merely an economic resource, but - what is most important - our greatest aesthetic, intellectual and spiritual resource. I think that a change in our conception of the good life would contribute to limit the destruction of the environment as much as the massive acceptance of the intrinsic value of nature can do.¹¹

⁴It is the process in which diseases are acquired as an unintentional effect of medical treatments.

⁵Peter Conrad¹⁶ defines medicalization as a process by which non-medical issues become defined and treated as medical problems, usually in terms of disorders and illnesses. This entails that a medical framework is used to think such problems and the medical discourse and practice have legitimacy over them.

²"Do not do to others what you do not want them to do to you".¹⁰

³Copernicus explained that in sidereal space there is not one center but several.¹⁵

Finally, the main issues concerning the relationship of bioethics with medicine framework can be summarized in the following:

1. Doctors and patients: it turns out to be a metaphor for the diseases that the land suffers and that the patients must understand as a doctor.
2. Understand that only two routes remain: medicalization versus demedicalization.⁶The path must conform to the principles of bioethics of responsibility.
3. Higher risk: disease to the healthy (excess of chemicals and / or agrochemicals).
4. Cure: need for a compatible path (not incompatible) with nature, given that the disease manifests a social and natural incompatibility.
5. Universal dialogues emerge as a means and end of bioethics concerning medicals practices with patients.

Dismedicalization refers to the opposite movement, meaning the process by which a medical problem becomes no longer defined and treated as medical in nature.¹⁶

⁶Medicalization refers to the expansion of medicine over more and more human and social problems, including the practice of selling drugs to the patient causing over consumption of them.

Broadening health studies and practice beyond the mechanical visualization of the medical sciences is an immediate and indispensable task. Therefore it is necessary to think about the epistemic transversality of bioethics in medicine, incorporating the social sciences and the humanities; this is the fundamental task from the medical educational point of view (interdisciplinary). Hence, it is fundamental to address the theoretical-practical dilemmas that are presented. And this from the perspective of the advent of transformations that lead to the struggle between globalization and its economism on the one hand, and the universal values ​​for life, freedom, justice, etc., on the other. At the same time, the other fundamental concern to renew the human and ecological project is to contribute to stop the devastation of the socio-ecosystems and natural ecosystems of the national territory including peoples’ health, in the context of climate change.¹² In the context of civilizatory changes (accelerated by climate change),¹² is attending to the main dilemma: commercial scientific paradigm or human one. And at this moment, it is necessary to understand the connection of the tasks of science and technology with the exacerbation of the predatory model of economic and socio-cultural life.

None.

Author declares that there is no conflicto of interest.

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