Public policies, bioethics, and old age


Fernando Lolas Stepke, Lecturer at Universidad de Chile, Director of the Interdisciplinary Center for Bioethics, Academician from the Chilean Academy of Language, Correspondent of the Spanish Royal Academy, Honorary Academic Member of the Chilean Academy of Medicine.

Translated by Natalia Tranchino

The public space is that segment of the social sphere that goes beyond interpersonal relations. The “one-on-one” becomes “everyone”, according to Paul Ricoeur, so that the ties resulting from friendships or the personal obligations are transferred to a space governed by the principles of impartiality and equitable distribution. They are summarized into the imperative of justice, the greatest virtue of social institutions.

There is an essential teleological dimension in the ethics of the public, which is the striving for coexistence and for a life of peace. However, the good life of a community takes shape through deontological directives, which entail duties, and are the foundations for rights. In the social context, people are “subjects of law” as long as they recognize their obligations and accept the penalties for their wrongdoings. This broad concept of imputability, or capacity to receive action attribution, turns into responsibilities: the “responsibility of”, the “responsibility before” and the “responsibility for”. The concept of responsibility, thus bursting into multiple meanings, becomes the main requirement of human life in society.

We are not only required to be responsible of our own actions. Also, there is responsibility towards other people, the environment, our coexistence, our future. Nothing illustrates better the extraordinary breadth of the concept of responsibility than the work of Hans Jonas, who extends it over time, to future generations, to scientific development and its consequences. Thus, the core of this concern moves from the individual sphere into the collective one, from present to future, from our contemporaries to those generations that will come after us.

Perhaps the essential element in a bioethical concept of public policy is that of being responsible.

This means: making sure that the institutions that establish it and promote it are fair and sustainable.

It is precisely that social space in which the individual interests and the groups complement each other and give all the participants the feeling that duties and rights are balanced. Thus justice, a virtue according to Aristotle and predicate of the good republic according to Plato, acquires in the post Kantian and contractualist version of Rawls a condition that today prevails as essential, which is that of being attribute of a democratic society. This contractualist dimension stresses the deliberations and processes that will lead to something being good because it is just and not necessarily to being just because it is good.  What is good for some might not be good for others, and what some consider as an end, others will consider it as a means. The virtue of a public policy is not only that it is agreed upon by the participants, but to be legitimate and, therefore, fair. Justice is not something owned only by virtuous individuals, but a characteristic of the whole of the society. In this sense the law, expression of the general will, is the one that commands, prohibits and allows when accepted by those who are to live under its empire. Legitimacy is not the same as legality. In law and public policy it is the text that is accepted—and not the text that prevails—the one that interests. It is the text built up by custom, by traditional use, by the pre-reflective and general morality of the set. This ensures its sustainability with sound arguments as it lingers for generations.

When these reflections are applied to the temporary course of human life, it is advisable to remember that this one is more biography than biology. Indeed, chronological time is not as significant as lived time. Among people, this time is indicated for being, essentially, a narration: the narration of ourselves. For that reason we say that human time is “narrated time”.

Narratives can be done in first, second and third person. To live and to age are personal and non-transferable experiences; the quality of life is entirely subjective. Another element that constitutes our own life is what our significant ones, relatives and friends can say about it thus helping to configure the self; that way of being that changes while keeping our identity. Finally, life configures itself by virtue of what social institutions (and public policies) prescribe and outlaw, sanction or prohibit.


Discourses on old age as a vital stage and of aging as a process do not always agree. Likewise, individual narratives (what we believe we are), the dialogic ones (what acquaintances tell me) and the public ones (what is stated by the third person of the universal text of the law) hardly agree with each other. To be and to seem, as Baltazar Gracian stated, are permanent dimensions. His saying was “try to be what you wish to seem”; what you wish to seem before your own eyes and of others.

The analysis appeals to three dichotomies: rational versus emotional, voluntary versus obligatory and positive (additional to the natural thing) versus remedial or compensatory (which restores the natural thing).

All public policies must appeal to what is considered reasonable and at the same time be emotionally acceptable, to distinguish what is obligation from what is individual will and, finally, to discern that which is considered essential (as natural) from what can be qualitative (as luxurious). In these times governed by the “medicine of desire”, people do not want to be only healthy. They want to be more beautiful, more intelligent, be happier, and live longer. The “economy of desire” not only suggests to have the basic things, but to have advantages. On the other hand, the “policy of desire” requires not only minimum conduct but fullness of sense in social practices, transparency when making decisions, and respect for diversities.

No public policy, although properly agreed and freely accepted, can guarantee universal health and happiness. The utilitarian argument of giving the maximum to the greater number ends up sacrificing some for the benefit of others. What is indeed possible to expect from a public policy that is bioethically informed is that it offers the space, means and resources so that everyone makes their own living in coexistence and satisfaction with one another. This construction is, ultimately, the narrative that people make of themselves by listening to their own voice and that of their loved ones; the voice of the anonymous community in which they live.

Aging in an equitable society requires that these narratives come near each other. It is necessary that what each one believes to be satisfactory in the narration of their biography agrees with the opinion of those who are close to them and with what is dictated by the prescriptions of the law. When this is achieved, if ever achieved, it could be said that life becomes completely human in its variations and changes and also in death, which is its universal end. Limitations are accepted, benefits are thanked for, and hope is encouraged. All of these are conditions for a life that is not only livable, but which is also a good and fair life.

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