INTRODUCTION

In March 2020, the World Health Organization (WHO) announced the pandemic of the new coronavirus (SARS-CoV-2), leading to the adoption of several measures in an attempt to reduce the contamination curve of the world’s population. One of them was the recommendation for social distancing, followed by social isolation, which, among other consequences, led to the need to interrupt activities in several sectors considered non-essential to society. Consequently, all educational institutions had their in-person classes suspended.

In Brazil, with the suspension of educational activities, the Ministry of Education (MEC) issued several ordinances, and the last one, N. 544, of June 17, 2020, authorized the replacement of disciplines that were taught in person by classes taught in digital environments, using information and communication technologies (ICTs) or other conventional means¹.

Undoubtedly, despite the fact that Emergency Remote Learning (ERL) and Distance Learning (DL) are already a reality for some Higher Education Institutions (HEIs), for countless others this has brought several challenges². Universities in the health area had to reinvent themselves in relation to the educational process and, almost simultaneously, they have discussed and implemented the best options to offer remote access and alleviate both social and digital exclusion, aggravated by the pandemic.

The discipline of Bioethics also had to reinvent itself, since, in person, it is characterized by dialogic discussions and is often approached through active methodologies strategies or moral practices. How can we adapt the virtual teaching of Bioethics in times of pandemic without aggravating the inequities? This question guided our research, which resulted in the following objective: to carry out a purposeful reflection on remote teaching in Bioethics in times of pandemic, from the perspective of education concerning values and social justice.

SOCIO-DIGITAL INCLUSION AND SOCIAL JUSTICE IN HIGHER EDUCATION IN TIMES OF PANDEMIC

The contemporary discussion of education aimed at citizenship and values cannot be separated from the debate on the inclusion of a cultural, racial, ethnic, gender and social diversity in the university. This citizenship education, based on democratic, egalitarian and equitable assumptions, envisions a fairer society with pedagogical and curricular choices linked to values ​​that are intrinsically related to the students’ moral education.

The interiorization of public universities and the implementation of the affirmative actions through the quota system brought changes to the socioeconomic profile of medical students, which cannot be ignored when planning online education during the pandemic. A good example of this situation is Universidade de Campinas (UNICAMP), which has, since 2005, implemented the Affirmative Action and Social Inclusion Program (Paais, Programa de Ação Afirmativa e Inclusão Social), aiming at the inclusion of high school students from public schools. Since 2018, the Institution has observed a higher percentage of admission of brown and black students from the public school network³. In 2019, in the medical course of the same institution, it was found that this percentage reached 85%, changing their socioeconomic profile, with a predominance of strata C1 and B27³. A study with medical students at Universidade Federal da Bahia (UFBA) showed that 66.4% self-declared black and brown, 44.4% studied most of high school in public schools and 17.6% declared having a family income up to 3 minimum wages⁴. At the Universidade Estadual de Londrina (UEL), an analysis of the socioeconomic profile from 2004 to 2012 concluded that the most often declared family income was 7 to 10 minimum wages⁵. However, in 2013, they recorded a greater number of new medical students with a family income of 1 to 3 minimum wages⁵. Similar data were found at Universidade Federal do Pará (UFPA), where 30.9% of the medical students declared a family income of 1 to 3 minimum wages and 3.9% up to 1 minimum wage⁶.

Also, according to the UNICAMP survey during the pandemic, it was observed that the majority (80%) of students accessed the classes via computer, notebook, or cell phone; that only 10% accessed classes exclusively by cell phone, and 10% accessed by tablet³. The main accessibility problems were: unstable internet connection and/or access exclusively via mobile networks; greater difficulty in following activities transmitted through web conferences and virtual meetings, as well as difficulties in accessing activities on digital platforms and image applications³.

These data, although not generalizable, do not exclude the relevance of observing these students who entered an elite course, and who cannot be ignored when planning an online education. Mainly in a period in which social inequalities lead to a demand for more equitable choices, especially in educational institutions which, at their origin, cannot be an additional cause of exclusion for groups that are already socially oppressed. In all of them, but especially the higher education ones (the object of our research), must be committed to establishing a culture of inclusion and legitimization of diversity, training for citizenship, in an attempt to minimize inequalities and increase inclusion.

Equality is not exclusively related to the distribution of goods among individuals (such as, for instance, distributing mobile devices to socially vulnerable students and concluding that this isolated action would be the solution for the issue of remote access to education); equality is closely associated with social relations and processes⁷. The individuals are members of different social groups, whose experiences and opportunities are influenced by their connections and how these people interact, observing how oppression impacts different social groups.

Our reflection, from the perspective of equality in online education, assumes that individuals who are part of privileged or oppressed groups have their teaching and learning opportunities influenced by this association with a social group. Their specificities and oppression mechanisms, which may arise in the pedagogical and curricular choices of educational institutions, must be taken into account.

EDUCATION CONCERNING VALUES AND THE TEACHING OF BIOETHICS

We start from the point of view of bioethics teaching that is built in Latin America in critical contexts of inequality and social exclusion, aimed at building knowledge and practices that join philosophy, social sciences, humanities and health.

The field of Bioethics⁸ encompasses the social, economic, cultural and environmental dimensions, where discussions of the most diverse realities are established, such as prejudices, exclusion, ecology, among others, which are traversed by moral conflicts. One of the current challenges of the teaching of Bioethics is to contextualize the moral conflicts that already exist and the ones that were enhanced due to the pandemic, aiming to contribute to the discussion and reflection on fundamental topics for our current reality.

For Puig, “the articulation of significant moral problems treated with the moral intelligence tools and guided by moral culture constitutes an excellent experience of learning moral and values”⁹. Therefore, one can autonomously face conflicts of value and controversies of unresolved issues that permeate the lives of individuals and groups in open, plural and democratic societies¹⁰.

Next, we will describe the skills that constitute the Moral Intelligence framework according to Puig^11),(12.

One of the purposeful reflections of this article is that these skills can be used as learning objectives in Bioethics disciplines and can be planned and stimulated in pedagogical strategies or in moral practices developed in the classroom, whether in-person or virtual ones.

Moral practices for Puig¹⁰ can be considered as: “an established course of cultural events that allows us to face significant, complex or conflicting situations from a moral point of view”. Also, according to the author, moral practice is a means of teaching and learning that problematizes usual life situations; it is a situation that has been though of and willing to learn in social practice¹⁰. Later, we will establish its correlation with ERL and DL. It should be noted that from Puig’s perspective, there is no possibility of moral construction without the presence of contextualized moral problems¹².

BIOETHICS TEACHING STRATEGIES IN A VIRTUAL ENVIRONMENT

With the pandemic, the entire discussion about ERL and DL, which would take decades, was accelerated due to its urgent attribute. This led the Ministry of Education (MEC) to authorize the replacement and adaptation of in-person disciplines into classes that use digital media, while the pandemic situation lasts¹.

Before continuing our purposeful reflection on the teaching of Bioethics in a virtual environment, one needs to differentiate between ERL and DL. The DL modality occurs when students and teachers are not together at the same time¹⁴. The term ERL, on the other hand, refers to the rapid change of panoramas, with different needs and limitations, and which involves a temporary change due to the crisis circumstances¹⁴. This teaching modality is considered to be remote because it requires a temporary geographic distance between students and teachers and was adopted at different levels of education by educational institutions around the world, so that school activities were not interrupted in the midst of the pandemic¹⁵.

As part of the reflexive proposition, we can use, in Bioethics disciplines, moral practices that are related to the following skills: self-knowledge, empathy, moral judgment, dialogical skills, critical understanding and self-regulation.

In ERL, virtual classes can take place in what is called synchronous time (which may follow the principles of in-person teaching), using video classes, lectures via web conferencing system (for example, Zoom, Google Meet, RPN, etc.), and chatrooms^15)-(17. On the other hand, DL activities can also occur asynchronously during the week in the virtual learning environment (VLE), such as: Moodle, Teleduc, Blackboard^15,17. It is of the utmost importance to emphasize that all activities, whether ERL or DL, must be prepared and planned, connecting the moral practice, the didactic contents and the desired learning objectives in order to facilitate moral training.

According to Maluf and Garrafa¹⁸, “one of the pedagogical difficulties for the development of Bioethics as a discipline is the construction of its contents, how it should be structured, how it should be defined in terms of mastering the theoretical-practical concepts and its objectives”.

Therefore, another purposeful reflection is an attempt to contextualize the didactic contents. For that purpose, we merged some suggestions of topics proposed by the Bioethics Core Curriculum (Programa de Base de Estudos sobre Bioética) developed by UNESCO¹⁹, by the Teaching and Research Group in Bioethics (GEPBio, Grupo de Ensino e Pesquisa em Bioética)²⁰, as well as other programs that we consider to be relevant for the discussion of the disciplines in Bioethics. As a result, in addition to the issues that have already been discussed in the curriculum, we also mention: human dignity; human rights; respect for human vulnerability and personal integrity; equality, equity and social justice and their direct relations with the following contents: race, gender, homeless population, indigenous population and quilombolas, slums, LGBT community, especially transgender people; research involving human beings; allocation of health resources; telemedicine; judicialization in health; environmental protection; the biosphere and biodiversity; basic sanitation^19),(20.

Some of the disciplines already held these discussions in their syllabuses; what is needed now is to discuss in medical courses how to advance the discussion for the insertion of the several spectra of human diversity - biological, subjective, ethnic-racial, gender, sexual orientation, socioeconomic, political, environmental, cultural, ethics - provided for in the National Curriculum Guidelines (NCGs)²¹. It is necessary to improve this debate on the social responsibility of medical schools, not only in this period of pandemic, but in the sense of promoting social justice to reduce inequities²¹. All these topics should be contextualized within the current moment, as well as adapt the discussions of content that already existed before the pandemic in the curricula, such as: the beginning and end of human life, principles of bioethics, secrecy and confidentiality, and professional relationship with the patient.

Added to these attempts to readjust the teaching-learning content and objectives, it is also necessary to discuss the socio-digital inclusion strategies with the teaching staff and the HEIs. It is noteworthy that these measures cannot be eventual and understood as a solution for the question of remote access to education; close and continuous monitoring of the students identified as being in a situation of social vulnerability is essential, so that they can be offered pedagogical, emotional, socioeconomic and digital support.

FINAL CONSIDERATIONS

The Covid-19 pandemic, due to its urgent nature, accelerated the inclusion of remote teaching in education, but, at the same time that it brought advances regarding the inclusion of information and communication technologies for the curricula in the health area, it also brought many uncertainties. For the discipline of Bioethics, it was no different, not only regarding education questions about socio-digital, economic and health inequalities, but also in learning, due to the loss of contact and face-to-face discussions, essential for the construction of moral personality. The challenge now is to incorporate the learning objectives consistent with moral practices and contents in Bioethics disciplines and maintain dialogical and participatory skills in the virtual environment.

We hope that our purposeful reflections can contribute to new considerations on the teaching of Bioethics, so that we can envision the exponentially increased bioethical problems and dilemmas in society at this time of pandemic, under the lens of social justice and, thus, assist the moral development of our students.