The term “critical bioethics” first appeared in the literature in an article by Parker ¹. In this work, Parker examined genetic screening protocols for breast cancer and used contemporary science philosophy to critique conventional bioethics. Parker highlighted how traditional bioethics often neglected contextual factors and diverse worldviews in ethical conflicts. At the time, she also established reflexivity as a core principle of critical bioethics, emphasizing the need for ongoing self-examination of normative commitments ¹.

Nine years later, Hedgecoe ² expanded on this concept by challenging the reasoning methods of “applied ethics”. He criticized the tendency to treat sociocultural factors as mere epiphenomena, irrelevant to the application of supposedly universal ethical principles. According to Hedgecoe ⁶ this reductionist approach undermined the validity of bioethics claims in debates over new technologies and their practical impact on decision-making. Citing DeVries and Conrad ³ he pointed to the American bioethics community’s neglect of issues like health financing and access to health services, noting that around 40 million Americans lacked health coverage.

Building on this critique, Hedgecoe ⁶ advocated for a deeper integration of bioethics with social sciences. He argued not only for the use of empirical methods from these sciences to inform ethical reasoning, but also for a more profound epistemological integration, capable of transforming the very characteristics of rationality of bioethics and surpassing the model of “applied ethics.”

The author outlined four inherent characteristics of critical bioethics: 1. Empirical grounding through the use of methods from the social sciences; 2. Theory challenging nature, particularly concerning the interaction between social sciences theories and bioethical deliberative models; 3. Reflexivity, as defined by ¹; and 4. Politely skepticism, proposing a stance of refusing to enter into disputes over different perspectives, while remaining sensitive to the complexity of justifying truths involving ethical issues in the field of health.

Hedgecoe ⁶ started from the notion of bioethics that has been considered, particularly prevalent among European and Latin American scholars. This view largely confines bioethics to biomedical ethics, diverging from the broader vision of the discipline’s founder, Potter (Potter, 1971), envisioned bioethics as encompassing environmental issues, global health, equitable access to scientific benefits, and the survival of humanity and nature.

Twine ⁷ supported the interdisciplinary and reflective nature of critical bioethics, echoing Hedgecoe ⁶ but criticized this author for adopting a reductionist approach. On this subject, Twine ⁷ remarked, “The contemporary narrowing of bioethics to a primary concern with the application of philosophical principles to medical ethics appears as both a confusing and unfortunate act of enclosure” (Twine ⁷ 287).

Ultimately, Twine ⁷ argued that critical bioethics requires expanding the “bio” component beyond the anthropocentric and ethnocentric constraints of convectional biomedical ethics. This reductionist perspective characteristic that drove conventional bioethics to remain in its uncritical analyses supported in theoretical categories like universalism and rationalism, inapplicable to people’s diversity and to environmental and global health problems.

Twine ⁷ highlighted the importance of critical bioethics by addressing the internal debates produced by theoretical perspectives that appeared in the specific field of bioethics, such as theories of feminist origin Rawlinson ¹⁹ and the perspectives that denounced and opposed what they called neocolonialism in Western ethics ²⁰.

More recently, Árnason ⁸ critically examined the constitutive elements of critical bioethics, according to the proposal by Hedgecoe Hedgecoe ⁶ proposing additional contents that he considered indispensable for its theoretical solidification. He began by recognizing that conventional bioethics, strictly based on moral philosophy, was given to three main types of errors: prematurity in critical analyses, an uncritical understanding of its own theoretical assumptions, and restrictive framing of bioethical issues.

Similar to Twine ⁷ Árnason ⁸ also challenged the narrow understanding of the bioethics field developed by Hedgecoe ⁶ (Hedgecoe, 2004), which focused solely on the critical assessment of biotechnologies with regard to their effects on individuals. For Ármason ⁸ empirical grounding was merely contribution of the social sciences to bioethics. Equally important was the foundation in well-established social theories, which enabled a “sociological imagination” (Árnason 2015, 162) to address ethical conflicts. This perspective allowed for the application of hermeneutics to understand the influences of ideologies and power relations in discourses on biotechnology. Arnasón also emphasized the importance of public spaces where normative deliberations are formulated and defended the need for dialogical practices grounded in communicative rationality, as referenced by Habermas ²¹.

For Árnason ⁸ one role of critical bioethics is to address the erosion of political and normative spaces concerning issues that threaten contemporary societies. It established four essential characteristics for critical bioethics to fulfill this role: 1. understanding the socio-cultural context of argument formulation and engaging with various positions on a specific ethical issue; 2. Maintaining critical awareness of the theoretical assumptions guiding analysis; 3. evaluating the broader social and global implications of biotechnologies in a reasoned manner; and 4. ensuring normative deliberations supported by free dialogical practices, communicative rationality, and attentiveness to power relations that might suppress arguments against hegemonic positions.

In Latin America and other peripheral regions, public health issues, particularly social vulnerability and inequalities in access to both new and established health technologies, remain central to bioethical concerns. In response, the region has developed theoretical models of counter-hegemonic bioethics ²² that reflect a geopolitically localized understanding of how contextual conditions, such as social vulnerability, impact access to technologies and other health goods ²³.

A model of critical bioethics aligned with the perspectives of Twine (Twine ⁷ and (Árnason, 2015) has emerged in the region. This model integrates theoretical assumptions and analytical categories from the Frankfurt Schools critical theory with decolonial studies, aiming to develop analyses, reflections, and normative propositions from a perspective specific to peripheral countries ^9,24-26.

In this model, the epistemic structure of critical bioethics consists of two components: an analytical component, which investigates the context, power dynamics, ideologies, and interests involved in a specific ethical conflict related to biotechnologies, and a prescriptive component, which proposes normative deliberations.

For example, in the analytical component, categories were derived from the seminal work of Horkheimer, who established the critical theory of the Frankfurt School in the early 1930s ²⁷. Horkheimer critiqued the traditional theory of science, inspired by Descartes and Newton, which portrayed scientist as neutral observers of the phenomena they studied. This traditional view excluded reflections and evaluations of the social consequences of scientific research.

In other words, science was initially guided by a traditional theory motivated by an ideology of domination over nature and other people. Based on this conclusion, Horkheimer proposed that critical theory should developed a science that transcends the dichotomy between factual truth and value- based truth.

Scientific investigation, whether of natural or socio-cultural phenomena, should be driven by values and interests related to the emancipation of human groups subjected to various forms of historical exclusion. These ideas would later align with the functions of science as conceived by the pioneering bioethics, Potter ¹⁸.

Other key aspect of the critical theory foundation to this model was Marcuses concept of the scientific-technological-industrial complex, ²⁸ 1991). This concept is crucial for understanding both the current model of production and distribution of biotechnologies, and the uncritical stance of conventional bioethics.

Marcuse ²⁸ demonstrated how the combination of traditional science, detached from moral considerations, and the instrumental rationality of economic and political powers led to the formation of an industrial scientific-technological complex. This system was closely linked to capitalist market interests, focusing on generating products primarily for commercial purposes, often disregarding their potential impacts on human health and the environment.

The emergence of this complex was fundamental to the development of modern industrial societies, where technologies began to exert a kind of fetishistic influence on citizens, a phenomenon that was then absorbed and normalized by the mass media. This process ultimately led citizens to adopt a conformist attitude toward their professional and civil practices and to engage uncritical consumption of technologies. Marcuse described such citizen as a “one-dimensional men” ²⁸

Other constituent elements of this articulation with the critical theory for the analytical component of bioethics came from a much more recent author, strongly influenced by critical theory: Robert Cox ²⁹. This author maintained that the process of globalization, consolidated in the last decades of the twentieth century, would have resulted in the internationalization of nation-states and in the formation of a dominant transnational civil society, as a result of the concentration of wealth.

It would then have a kind of global governance without government, which he called a ‘nebula”, that constituted a central feature of the world order. This order clearly favored groups that had instrumental control over three forces: 1. material capacities, represented by financial resources and means of production; 2. ideas, represented by inter-subjective notions that perpetuated habits, behaviors, and collective images that legitimized power, including their own scientific and moral ideas; and 3. institutions, including the various apparatus of central countries and international non-governmental bodies. These institutions were responsible for articulating ideas and material capacities with a view to stabilizing and perpetuating the world order.

For Cox ²⁹ individuals and groups were divided into three fundamental categories regarding their access to the benefits of the globalized world order: 1. the integrated, who are members of internationalized civil societies either by holding power or being favored by it; 2. the precarious, who have some access but face difficulties and deficiencies dependent on the fluctuations of the order; and 3. those who are unable to consume the products and are not even considered.

Ultimately, critical bioethics produced in Latin America could not avoid a geopolitically located perspective, given that biotechnologies are produced and distributed by central countries under norms developed within power dynamics that invariably favor the interests of those same countries. Hence, the model of colonial studies is important.

The concept of “coloniality” was developed by Peruvian sociologist Aníbal Quijano ¹⁰ in the late 1980s and early 1990s. Coloniality refers to the persistence of colonial logic structuring the relationship between central and peripheral countries regarding the exercise of power and the production of knowledge. It is seen as constitutive of modernity itself, as the notion of modernity itself, as the notion of modernity was built on the opposition between colonizers and colonized, with the former representing progress, innovation, development, and the center of the world, and the latter representing backwardness, archaicism, stagnation, and the periphery.

In this process, the notion of race became a central element, as the ‘civilized” European white person was considered the pinnacle of human evolution, in contrast to the perceived biological, mental, and moral inferiority of the colonized people, whether indigenous or African. The concept even justified Christian evangelization and the economic model based on the exploitation of resources and slave labor in the colonies.

Thus, categories intrinsic to European modern thought, such as “universality” and “rationality”, were developed in a colonial manner, with the European white person as the standard of universal and rational humanity. Similarly, notions of development and progress were framed by global norms that have operated since the beginning of colonization, ensuring the flow of raw materials from the periphery to the center and technological products from the center to the periphery. Currently, for authors like Quijano (Quijano, 2007), Mignolo (Mignolo, 2011), and Grosfoguel (Grosfoguel, 2002), coloniality represents the ongoing imposing of central countries’ power over peripheral countries.

Decoloniality, therefore, encompasses studies, thoughts, processes, and actions aimed to overcoming coloniality historically. In other words, it involves political, socioeconomic, ethical, and esthetic analyses and practices that challenge the colonial pillars of modernity. According to Mignolo (Mignolo, 2011), decoloniality represents both a political and epistemic project.

The articulation of the concepts presented thus far forms the theoretical framework underlying the analytical component of decolonial critical bioethics, integrating deeply with robust social theories, as supported by the authors of critical bioethics discussed (Parker ¹; Hedgecoe ⁶Twine, 2007; Árnason, 2015; Cunha and Lorenzo, 2014).

Next, this project will address the fundamentals for the prescriptive component of decolonial critical bioethics. Árnason (Árnason, 2015) highlighted the importance of a well-founded performance in public spaces where normative deliberations in bioethics are formulated. Armasón advocated for communicative rationality as ideal for conducting discussions from which normative deliberations are derived. Previously, however, the decolonial critical bioethics model had already proposed that discussions in public spaces typical of bioethics, such as research ethics committees, hospital bioethics committees, national and international bioethics commissions, and biosafety commissions, should be guided by parameters of communicative action (Cunha and Lorenzo, 2014; Lorenzo, 2012). This proposal is rooted in Habermas’ central work, Theory of Communicative Action (Habermas, 1981), where he defines and elaborates on the concept of communicative rationality.

In the Theory of Communicative Action (Habermas, 1981), Habermas establishes the foundation for a new form of rationality for social actions, known as communicative rationality. This form of rationality is intended to offer resistance to the purely instrumental rationality of economic and political powers. The practice of communicative rationality depends on the establishment of a communication community, formed by public, democratic spaces for discussion and the development of conditions for mutual understanding among social actors.

Therefore, an argument or norm has a hypothetical claim to validity when it can be justified rationally. A norm should seek a status analogous to truth; in other words, coherence between the action it directs and the nature of the social fact that it aims to regulate.

The three criteria that determine this claim to validity are: the truth of the proposition, the rightness of the actions prescribed, and the authenticity of the social actor. The first criterion requires that the norm, when addressing aspects of reality related to verifiable truths, be supported by scientific or statistical data, (constituting the empirical grounding of the proposal). The second criterion requires that norms be compatible with the socio-cultural context to ensure their compliance. Finally, the third criterion pertains to the subjective world of each participant in the normative deliberation and requires that each social actor be receptive to the rational strength of the arguments, without adhering to religious, ideological, or disciplinary dogmas, without being subjected to hierarchies, without hidden third-party interests, and without employing spurious language tactics such as induction, coercion, or deceit. When these three criteria are met, the proposed norm is likely to be accepted by all those involved in the social fact to be regulated.

Thus, decolonial critical bioethics is sociologically grounded for analytical practices from a perspective partly specific to peripheral countries in relation to the world order. It examines the contexts, ideologies, and powers ³¹ involved in the ethical issues related to the production and distribution of biotechnologies on a global scale. Regarding the operationalization of deliberative processes that define normative propositions, the model offers guidance based on communicative rationality, while being attentive to decolonial critiques concerning the potential ethnocentric understanding of rationality.

The analytical parameters of critical bioethics can be summarized in six statements:

1) International relations in the field of global health are understood as historical and geopolitical colonial processes that produce global hierarchies of politics, culture, morals, epistemics, aesthetics, class, gender, and race. This ensures control of the production and dissemination of knowledge by central countries and maintains a continuous flow of raw materials from the periphery to the center and industrialized products from to the center and industrialized products from the center to the periphery.

2) The world-system is structured by the instrumental control of three forces: a) material capacities; b) ideas, whether scientific, normative, or aesthetic; and c) national and international institutions responsible for articulating the action of the two previous forces, ideas and material capabilities.

3) The examination of the political quality of governance, the dependence of governmental and non-governmental institutions on the world-system, socioeconomic disparities, and access to health across countries must be understood as the results of these historically determined global hierarchies.

4) There is no ethical or ideological neutrality in science. Scientific interests are increasingly linked to economic interests and are driven by the formation of the industrial scientific-technological complex, which produces a naturalization of its results and favors an uncritical and unidimensional view of the world.

5) Ethical conflicts must be understood as social facts that can be transformed. The objective of decolonial critical bioethics is to identify the elements that generate the conflict and explore possible ways for its prevention or resolution.

6) The normative production process in public decision-making spaces, whether institutional, state, or non-governmental international, must be conducted based on communicative rationality.