“para premiar o penalizar la administración pública se idearon las elecciones: si un grupo (un partido, por ejemplo) o un candidato no cumple con lo que de él se espera, pues verá disminuida la posibilidad de ser elegido o reelegido. Por supuesto, no es este el «ungüento de la Magdalena» que salva de todos los males, dado que también puede generarlos, como es el caso, por ejemplo, de Bolsonaro en Brasil.

Otro mecanismo efectivo es el ejercicio del periodismo, ante cuyos ojos escrutadores no valen consignas ni buenas intenciones, sino resultados concretos. También son comunes las protestas populares como forma de presión, algunas de las cuales terminan en procesos loables, como la constituyente en Chile y la reciente elección del joven presidente de izquierda Gabriel Boric.

Sobre cualquiera de estas vías pesan en Cuba prohibiciones, lastres y estigmatizaciones que les impiden desarrollar la función social a la que están llamadas. La participación y el control popular son intrínsecos al socialismo, o deberían serlo. Entonces, la política y la administración pública no pueden ser materias ajenas a la ciudadanía, dado que tampoco le son ajenos los efectos nefastos de las malas estrategias.

En el camino de dejar la política en manos de un grupo selecto de «iluminados», hemos perdido la industria azucarera, la ganadería, la carne de cerdo y ahora vemos como nuestro dinero tiene menos valor que nunca, mientras en las tiendas en MLC —que no renuncian a sus ganancias en beneficio del pueblo, como se pide que hagan los empresarios y comerciantes privados— están muchas de las cosas que necesitamos para tener un mínimo de dignidad y confort.

Compete a cada uno de nosotros ser más ciudadanos y menos súbditos. Presenciando escenas como las del III Pleno y otras que demuestran esos dulces olvidos y simpáticos asombros, resuena en mis oídos el estribillo de la canción de José José que algunos chóferes de ómnibus se empeñan en no dejar morir: «lo que un día fue, no será». ¿Hasta cuándo vamos a permitirlo?

https://jovencuba.com/dia-fue-sera/amp/#comments

On a more fundamental level, though, paternalism fails to recognize the independent value of self-determination and the respect that people are entitled to as “choosing beings.” Because the traditional view leaves no room for self-determination as an essential aspect of each one welfare, it fails to treat humans as the moral equals by denying them the information they need to make informed decisions about their person. Without sufficient information upon which to base a judgment, an individual consent will not be informed, and in the absence of informed consent, their self-determination is effectively thwarted.

All the various tried and true forms of deceit—from outright lying to withholding information, to using technical jargon (“no need to worry; it is just a little market adjustment”)—undermine the status of the person as an autonomous agent. In the vast majority of cases, respecting those citizens autonomy by engaging their powers of deliberation, choice, and agency is not just consistent with the desire to benefit the people but is itself a means of doing so.

As a result, the importance of respect for autonomy is widely recognized in contemporary more advanced societies and can fairly be described as the cornerstone of contemporary social, economic and political ethics.

Placing respect for autonomy at the core of the relationship with the public represents the ideal of treating each of those actors as responsible moral agents capable of making decisions that will have a positive bearing on their lives.

This is based on the metaphor of a contract or covenant. Contrary to the paternalistic or Hippocratic model, the person served is the party within the “contractual” relationship charged with making critical value-laden decisions that will affect the overall direction of received service. The provider is responsible for presenting the available options to the person served and carrying out the details of the agreed-upon plan with professional expertise. Importantly, the provider retains his/her moral integrity within the contractual model and is not reduced to a mere “body mechanic” or “engineer” doing the bidding of their customers. Since a contractual relationship is a two-way street, the provider may decide to terminate the relationship if, for example, the person served makes unreasonable demands or is flagrantly non-compliant with approved plan.

So that there are at least two relevant consequences in this system:

  1. The primary responsibility of providers is to provide the people served with the information that they need in order to make the relevant decision.
  2. The idea that apart from serving as a knowledge resource, providers respect the autonomy of those persons by not interfering in the process of deliberation through which the they arrives at a final decision.

The way to prevent the values and priorities of those in the most powerful position from crowding out, or supplanting, the values of the community they were designated to serve. For the for autonomy, requires servants to be more than information delivery devices. They have to recognize the potential for abuse that is created by the functional inequalities that characterize their relationships with their served people. Providers have more knowledge than them but they too face challenging affective and intellectual barriers to decision making and no fewer institutional hurdles to governance.

Sweeping mistakes under the institutional rug can foster a perception of concealment and incubate resentment that may erode public trust and rob healthcare teams of their best chance to learn and improve. Profound social, psychological, and institutional hurdles to truth-telling can arise in almost any social environment.