Introduction

Bioethics is perceived as applied ethics, in other words, the place of interaction between ethical concern and a specific sphere of practice characterised by the prefix ‘bio’ (Ladrière, 2000). Thus, bioethics applies to dilemmas of value which arise in particular spheres of action in relation to the phenomenon of life, its manifestations and interactions. However, bioethics has not been sufficiently explored from the perspective of primary healthcare, where significant ethical conflicts and dilemmas occur. The variety and complexity of ethical dilemmas in primary healthcare derive from the continuous, bio-psychosocial interaction of the healthcare teams and the community, and they imply particular responsibilities of the state and of society as a whole.

Primary healthcare is the principal pathway to health services in public health systems and it interacts daily with individuals, families and communities. It is, to a great extent, the area in charge of promoting healthy life-styles, preventing illness and recovering the health of individuals (Zurro and Perez, 2000). The role of primary healthcare became evident in the World Health Organization's (WHO) international primary healthcare conference at Alma-Ata in 1978. At that meeting it was once more reiterated not only that health is the absence of disease, but that it encompasses the overall state of physical, psychological and social well-being of the individual, family and society (WHO, 1978). It implies promoting health through healthy life-styles, preventing diseases and accidents, maintaining people with chronic diseases, and rehabilitating their health when necessary. It is evident that this requires the collaboration and coordination of different sectors. Among them, primary healthcare has a relevant role, due to the closeness of its healthcare teams to the community, its institutions and organisations, its families and their life-styles, and to the continuous care provided by primary healthcare to each individuals throughout their life-cycle. This becomes most apparent in a family healthcare model (MINSAL, 1999a).