Perspective Chapter: Teaching Bioethics through Critical Pedagogy

Abstract

This investigation is focused on critical pedagogy for the teaching of bioethics. The objective is to design a course where ethical dilemmas of various topics are raised, to be analyzed with bioethical principles and legal bases, through a model that allows systematizing the various situations in three stages: 1 - approach; 2 - assessment of the case; and 3 - conclusions and implications. Throughout several semesters, the results showed that the model worked to achieve a bioethical opinion, integrating all the analyzed aspects of the dilemmas raised. This achievement was evaluated through the students’ perceptions, applying strategies framed in critical reflection. The analysis of results included both the grades and the information obtained in the critical reflections of the students. The evidence highlights a good management of bioethical analysis, a lot of motivation and participation and conceptual changes, which can possibly promote the achievement of critical learning.

1. Introduction

Actually, many people talk about value crisis, part of which includes the excessive use of scientific and technological advances without considering their environmental and social impacts. This crisis is reflected in educational institutions where dishonest behaviors are observed, such as copies in evaluations, non-repayment of what is borrowed, plagiarism in work, and so on [1, 2].

This crisis establishes an urgency of dialog between scientific knowledge and human values. In 1970, Van Rensselaer Potter (considered the father of bioethics) proposed this dialog through bioethics, which represents a space for articulated reflection on a scale of values ​​and for making responsible decisions about related problems with biological life, the environment, and the developments of science [1, 3]. For Potter, bioethics is a new discipline that represents the bridge between classical ethics and the life sciences [4, 5].

It is important to note that bioethics has its roots in philosophy [6], where two perspectives are found: first, the perspective of materialist bioethics [7] and second, the perspective of the personalist [8], whose center is the good of the person [6]. These two perspectives have led to the derivation of various currents, among them Principlism [9], Personalism with anthropological foundation [6], Utilitarianism, and Materialist Functionalism [7].

The important thing about these currents is the pluralism that implies the incorporation of bioethics as a topic in research. For this reason, it is necessary to reach agreements at the level of the scientific community in order to ensure respect and promotion of human rights, which represent the limit and guiding criteria for such agreements [9]. In this regard, codes composed of statements that establish guidelines for bioethics in its various applications have been proposed.

Although it seemed that bioethics focused on the area of ​​health, today bioethics is taken up again in a broader concept, as defined by Pessina (Professor of Bioethics at the University of Sacro Cuore in Milan), as “critical awareness of technological civilization,” and Postigo, who considers bioethics as the systematic and interdisciplinary study of the ethical implications of human actions on all kinds of life to determine a possible solution for man and future generations [6]. Currently, bioethics represents a way of doing ethics, as indicated by various authors and many codes, as in the Code of Ethics for Life of the Ministry of Science and Technology of the Bolivarian Republic of Venezuela [10].

Regarding the issues that can be addressed in bioethics, they are organized into two groups. The first group refers to the topics of medicine and health areas such as dentistry and nursing; and the second group addresses a wide range of issues, all related to human life and in the context of nature [1, 11].

In all the themes, aspects related to values and ethics are included, and that is why, for UNESCO, scientific and technological development cannot be separated from ethical reflection. In this regard, Article 23 of the Universal Declaration on Bioethics and Human Rights [12] states as objective “to promote the principles of the Declaration through education and public information programs that train citizens at all levels and without distinction in understanding the bioethical implications of science and technology” [6].

This principle must be guaranteed by the States, through the educational institutions that are responsible for compliance with this article [11, 13], since the question that as educators we must ask ourselves is what kind of people and of citizens we want to form? The answer justifies the inclusion of a training program in bioethics in the curriculum of all faculties [2]. In addition, it represents a change in terms of the objective of education, which should be to train citizens to have their own opinion that allows them to participate in the social debate in an informed manner and in the promotion of public policies.

This is the case in all areas of life, but in the field of bioethics, it is especially important and complex, since in order to propose and promote normative, ethical, political, and legal guidelines, not only a particularly responsible attitude but also a double knowledge is required: the scientific-technical (which implies a previous work of diffusion and disclosure by those who work directly on the problems) and the argumentative. The challenge of bioethics is to propose a common framework of values ​​that, at the same time, is respectful of the differences between individuals, their values, their principles, and their models of life [13].

From the point of view of pedagogy, it is suggested that bioethics should be taught from elementary school to high school, not only as a complement within traditional classes but also as a separate subject that should have two emphases: a social one which, supported by workshops, booklets, banners, and intense dissemination work, is interested in issues such as hygiene, sustainable development, and those related to the environment in general. The other emphasis of the course must be the development in the student of tools to learn respect, responsibility, and love. “Strengthen self-love, respect for others and love for nature.” In this type of teacher-student problem, several questions arise about the field of action and relevance for bioethics of the problems raised. A list of actions of a transgressive nature can be appreciated, explainable from the way in which values ​​, the rules of conduct, goodness or badness in the actions, as well as the rules and manuals of behavior and coexistence are understood [14].

Regarding the responsibility of the states, the Bolivarian Republic of Venezuela, in the first “Socialist Plan of the Nation” (2007–2013) [15], considers bioethics as a transversal axis; in fact, one of the objectives is “[m]ainstreaming the teaching of ethics,” which allows us to infer the importance of bioethics in the training of citizens capable of making decisions in the face of scientific and technological advances, which implies designing proposals for classrooms to promote this training [16].

Given the aforementioned information, the authors of this research considered the proposal and implementation of a bioethics course at the Pedagogical Institute of Caracas (IPC) of the Experimental University Pedagogic Libertador (UPEL). The model for the design and implementation of the course was the one proposed by Müller de González and Szczurek in 1989, who presented a model in the application of Instructional Development [cited in 17] and whose phases included: diagnosis of needs, design of the solution, simulation or implementation, and, finally, the evaluation of the implementation.

2. Bioethics course for teachers

2.1 Phase 1. Diagnosis of needs

Following the model, Partida, Alvarado, and Ochoa de Toledo published phases 1 and 2 of the proposal in 2017 [17]. For phase 1, the elements that were considered to establish the need for a bioethics course included: first, teaching experience in the Science, Technology and Society (CTS) course, a course administered by prof. Marlene Ochoa de Toledo; CTS is a subject that allows the contextualization of the contents, which is why the positive and negative impacts of science and technology are pointed out; prof. Marlene observed that when ethical aspects were touched on, the only perspective of the arguments was that of personal values, since the students had no other tools. That is the reason why it is needed to provide tools to future teachers regarding the analysis of bioethical dilemmas, in order to provide elements that contribute to the objectivity of the arguments.

Second, article 23 of the Universal Declaration on Bioethics and Human Rights has as its main objective the promotion of the principles of the declaration through educational programs in order to train citizens in the bioethical implications of science and technology [13]; in this regard, Venezuelan government policies in the Organic Law of Education [18], in article 33, point to “bioethics as a guiding principle of university education,” and the Socialist Plan of the Nation (2007–2013) [15] supports this inclusion in Venezuelan education and goes further when it proposes the mainstreaming of bioethics in education; furthermore, since 2011, there has been the Code of Ethics for Life of the Ministry of Science and Technology of the Bolivarian Republic of Venezuela [10].

For this reason, at the IPC-UPEL, these remarks were raised as a justification for the opening of a Bioethics course for future biology teachers and later for the specialty of chemistry as well.

2.2 Phase 2. Solution design

Once the need was established, the next step was the design of the bioethics course for students specializing in biology and chemistry, which corresponds to phase 2 of the Instructional Development Model. Although the idea for the future is to implement bioethics in all specialties, the researchers started with these specialties since they included the students who also took the CTS course, which made the population accessible to the researchers.

The objectives set for the course were the following:

1. Establish the importance of advances in science and technology in solving social problems.

2. Value the responsibility of the human person in the rational use of science and technology.

3. Value life.

4. Solve ethical dilemmas on different issues: violence against women, child abuse, biological weapons, use of animals, religions, organ transplants, stem cells, euthanasia, abortion, medically assisted procreation, and so on.

5. Resolve ethical dilemmas that arise in the classroom and/or school institutions.

These objectives are framed within the education in values. According to Chaparro [19], the education in values consists of awakening the creative potential of the human being, helping him to equip himself with his own capacities, and forging in him attitudes of tolerance and understanding, which allow or help him to develop himself in relation and with respect to others.

In order to fulfill the proposed objectives, critical pedagogy was selected for the teaching methodology. In this sense, first, the importance of communication for the teaching and learning processes was taken into account; for many authors, the communication process is multidisciplinary and transdisciplinary [20]. One of the representatives of communication studies is Mario Kaplún, who points out that the educator becomes the companion and guide to provide tools that allow the student to build their own structures of meaning [21], so they can make their own decisions and thus “learns to learn” [22].

The communication process in bioethics must start from critical pedagogy, which seeks the development of critical and reflective skills of students, contributing knowledge and culture that are significant for the student [23, 24]. The representatives of this current are: Peter McLaren (Canadian), Henry Giroux (American), and Paulo Freire (Brazilian) [23]. McLaren points out that the knowledge to be imparted must be important, relevant, and critical in order to promote transformation [25]. For his part, Giroux points out that education must be committed, critical, and revolutionary to allow critical development; Thus, the students will be able to be citizens concerned with facing social issues and be willing to extend the meaning; in addition, he points out the role of the teacher as a guide in the process [25, 26, 27].

Regarding the different bioethical approaches to address the discussion of ethical dilemmas, the course follows the principlism current. Principlism is a resource that bioethics took from the philosophy based on human-centered orientations. Such guidelines facilitate ethical reflection on scientific facts and their impact on humanity, considering that they are applicable to society [28], especially in analyzing the impact of scientific and technological advances [4]. The principles were established in the Universal Declaration on Bioethics and Human Rights [12]; for the purposes of the principlist approach, we worked with the four principles indicated by Beauchamp and Childress [9], which were: autonomy, beneficence, non-maleficence, and justice; but for the proposed bioethics course, two principles, that are found in the Code of Ethics for Life of the Bolivarian Republic of Venezuela [10], were also included: responsibility and precaution. The principles are used to promote respect for everyday life and human differences, with which students can get involved in caring for life [1, 29].

The management of such principles in the classroom favors the formulation, articulation, and resolution of ethical dilemmas, thereby promoting a culture of respect for life in everyday life and respect for human differences without being discriminated against, since there are no absolute truths [1].

The next point that was taken into account for the design of the course was related to the methodology of critical pedagogy and the didactic strategies that could be included, that is, how to teach bioethics. In this case, it was important to define the role of the teacher, since he should be distinguished by encouraging debate and respecting different opinions; this is because for bioethical dilemmas, there may be more than one solution. That is why the transdisciplinary approach to the situation is so important to reflect on the values ​​involved. Only in this way can it be expected that scientific knowledge can be modified into ethical knowledge [16].

Regarding the methodologies, the following are included: competency model [30]; learning of bioethics based on problems (ABBP) [31]; case-study approach [32]; humanist-integral approach, which considers that it is important to know the anthropological and philosophical bases that will allow decisions to be made about good or bad behavior. This includes knowing the importance of laws (a legal aspect that does not always go hand in hand with ethics) and religions for a comprehensive vision of the case [32, 33]. It is important to point out that regardless of the selected methodology, the main emphasis for a correct participation in bioethics issues rests on the process and on the role of the teacher as a guide and learning partner [22].

Once the methodology was established, the selection of the different strategies for the course was made, among which were included: debates, master classes, seminars, case studies, group presentations, text and film debates, and symposiums and conferences (Caramico, Zaher and Rosito, [cited by 33].

Regarding the analysis of bioethical cases, it is a strategy implemented by Schmidt [34] as a way to systematize information, analysis, and comparison of different points of view, prioritizing life and protecting the most vulnerable. The same author proposes a model focused on the moral decision process, which is what allows the person to appropriate moral knowledge through a series of intentional operations. Starting from the proposed model, Partida, Alvarado, and Ochoa de Toledo designed an adaptation of it for strictly pedagogical purposes while maintaining the objective of the method [17].

The strategy is managed through critical incidents, which are cases with certain meanings that will create a conflict with the thinking or behavior of the students (real cases are handled in the bioethics course). The incident leads to a disorienting dilemma that facilitates a teacher-led discussion, in which all participants argue their opinions, producing a consensual response [35].

Steps for critically reflecting on cases during classroom discussion include:

• Describe the event or case, that is, a consideration of reality.

• Make an objective observation of what is described, considering the emotions that accompany such events (which puts beliefs, values, ideas, and even behaviors at stake) through dialog.

• Consider alternative and potential answers until finding the appropriate answer, which will often change previous structures through the debate. It implies a reassessment of the original event [1, 35, 36, 37].

Although accepting moral pluralism is important, it is not that any proposal is acceptable or valid; it must be evaluated to determine if it is supported by consistent arguments to be used in a public debate in which prejudices must be refuted with reasons. In this regard, it is important to clarify that all people are respectable, but this is not the case with opinions [13].

The guided discussion of cases is based on the pedagogical point of view, in problem-based learning. Among the skills that are enhanced with this methodology, the ability to identify and solve problems, making decisions, communication and personal interaction, working in a team, developing critical thinking and permanent self-learning, evaluation and self-assessment, among others, have been described. For this reason, the student is responsible for their learning, while the teacher becomes the facilitator of the process through the revitalization of the work and the motivation to achieve the objectives [38]. The strategy implies a less leading role for teachers but one that is necessary to lead debates and help reach a consensual response.

Regarding the evaluation, it becomes a constructive process that allows assessing cognitive, specific procedural, and attitudinal curricular aspects, where each student is capable of reflecting on their own performance. In the short term, this type of evaluation produces a strengthening of group work, while in the long term, it allows the acquisition of skills by students [38].

The second strategy of the critical pedagogy used is: reflection, which can be considered a reflective writing. It is not exactly a diary, but it is reflective because in it the student evaluates himself, with which he is aware of what he learns. As a guide, students are given points to include: what I liked, what I have learned, conception changes, what I have not learned, what I did not like, and recommendations; self-assessment is evidenced by pointing out the knowledge acquired and the changes in conception, which represents an important element to consider in critical learning [25, 26, 35].

This information allows the self-assessment of the student based on what has been learned and the changes in conception. For the teacher’s purposes, the information could be corrected in terms of wrong conceptual aspects; in this case, attention to students is personalized. The other aspects included in the reflection allow to know the perception of the students about the subject, the speakers, and the dynamics of the class; all that information represents valuable inputs for the organization of the course. For each topic selected and discussed in class, students must reflect under the aforementioned parameters. At the end of the course, they are asked for a free, undirected reflection, which represents a free writing about the impressions of the completed course, the learning achieved, and any other aspect of interest.

Both the debates for the analysis of cases and the reflections meet the objectives of critical learning insofar as they imply critical reflection and demonstrate the existence of critical thinking that links the theoretical concept with daily practice and their experiences [25, 26, 35].

In addition to the aforementioned strategies, other strategies are included for the proposed bioethics course.

Third, presentations by teachers are handled for the introduction, for the theoretical foundations, and for a specific topic of interest for the course. Likewise, exhibitions by invited teachers are handled for specific topics. Finally, the group exposition of a specific subject previously selected is handled. In all presentations of specific topics, they must include the conceptual aspects, the dilemmas that arise in that topic, case examples, the legal aspects related to the topic, and the bioethical principles for the discussion of cases. In this sense, the presentations are made under established parameters, in order to guarantee the necessary information to address the cases.

The fourth strategy is the bioethical analysis of a film previously selected by each group. The exhibition has its guidelines:

• You must include a brief summary of the film as the rest of your classmates may not know the film.

• It must raise the dilemma under analysis since several dilemmas can arise in a film.

• Analysis of the dilemma;

• Participation of the rest of the group for comments.

In a publication by Luco, Quer, and Beca [39], positive results were reported regarding the inclusion of forum cinema for bioethical discussion. In this case, the cinema was not handled as a forum but as a presentation. What is relevant in this activity is the selection of the film whose analysis seeks to improve, deepen, and apply knowledge to other contexts.

The proposal for the course in terms of its objectives and content was presented to the Curriculum Unit of the Pedagogical Institute of Caracas, which approved the course as an in-depth elective for biology students. Subsequently, in 2012, the course was also approved for future chemistry teachers. In this way, phases 1 and 2 of the Muller de González and Szczurek Technological Development model [40] were completed.

Subsequently, in a second publication, the researchers present steps 3 and 4 that correspond to the validation and evaluation of the application of the proposal, in this case, of the course [41]. For validation, the results of the pilot test of the course are included. Then, based on the results obtained, adjustments are made for the implementation of the course. For the evaluation phase of the application, the qualitative results of the course are presented in light of the perceptions of the students and the analysis of their opinions.

2.3 Phase 3. Validation of the proposal

2.3.1 Method

For purposes of validation of the proposal corresponding to phase 3 of the Müller de González and Szczurek model of 1989 [40], the course was applied as a pilot test in the 2009-I semester. It only had five biology participants (total population of the bioethics course), so the total population was used to gather information that would allow adjustments to the proposal for future applications. The pilot test included the following strategies: exhibitions, film discussions, case analysis, and critical reflections.

2.3.2 Results

For the case and film analysis activities, the methodological protocol based on the Ludwig Schmidt model [34] was used. This author proposes a model that allows to systematize and interpret the various situations in: dilemma, bioethical situation (which includes facts, actors, scenarios, relationships, central idea), intention (correct or incorrect), and act (adequate or inadequate). The facts lead to a holistic assessment (technical, legal, social, and personal), and the intention and the act lead to an ethical assessment. The central idea leads to the beginning. The holistic assessment, the ethical assessment, and the central idea imply criteria that lead to objective and/or subjective norms that lead to the opinion or bioethical opinion, which finally leads to a proposal for improvement.

Since the pilot test, the authors noted some flaws in the analyses, such as its brevity, and the little inclusion of legal aspects. In subsequent applications of the course, a complete analysis of the dilemma was achieved, but when giving the bioethical opinion that resolved the dilemma, that opinion did not include the arguments indicated in the analysis. Therefore, the fundamental aspect that was the resolution of the dilemma was almost limited to giving the possible solution without the support of the arguments. In other cases, the dilemma was not raised.

Based on the flaws detected, Ludwig’s design is modified in a pedagogical model proposed by Partida, Alvarado, and Ochoa de Toledo [17] in which the following steps are established:

1. Presentation of the case: refers to the description of the facts. This point must include:

   • Actors: are the individuals directly or indirectly involved in the problematic situation.

   • Setting: is the place (country, region, locality, and/or environment) where the events take place.

   • Relationship: it is the relationship between those involved in the problematic situation.

According to the scheme, the next aspect to include is the dilemma. This is a question that leads to two options (or more), which must be answered in the bioethical opinion. In a problematic situation, there may be multiple dilemmas; for didactic purposes, it is recommended to choose only one for the analysis.

1. Analysis of the case. Three aspects are included:

   • Personal assessment: it is the direct opinion that the spectator(s) has about the problematic situation. If there are several participants for the analysis, each one must give their contribution. In this assessment, there can be many discrepancies because it is related to religious aspects and personal values.

   • Legal framework: represented by laws, decrees, agreements, codes, oaths, and regulations in force in relation to the case. In all cases, the article(s) directly related to the situation must be mentioned.

   • Bioethical principles: the bioethical principles related to the case will be named and explained. The principles analyzed are the six included in the Code of Ethics for Life [10]: autonomy, beneficence, non-maleficence, justice, responsibility, and precaution.

Bioethical opinion: the case analyses are done in groups, as if they are included in a bioethical committee: This is where the deliberation should take place and where everyone should participate. Here, there are different visions: one, the personal vision; second, the legal framework, which may be in contradiction with some principles. Historical background can be included in the deliberation, that is, previous cases similar to the one presented that can serve as a guide for the solution. Therefore, the deliberation process is essential. In the end, there will be a consensual answer to the dilemma, whose support are arguments taken from the analysis.

Proposal for improvements: in this regard, the committee can give suggestions and/or recommendations in order to minimize risks and/or harm in future similar cases.

The model presented here does not assume a predetermined solution. Each committee is free to resolve the dilemma according to the discussion based on the analysis. Not all groups arrive at the same answer, but in each group, the answer is the consensus of the members. In this way, it can be concluded that for a dilemma, there may be different solutions and that the solution given to the case will depend on the committee. There is no correct answer, since the answer includes the personal aspect that varies from group to group. It also reinforces the fact that the answers must be based on solid arguments that include the legal framework and bioethical principles. That is, although principlism is handled, it is not enough to argue. The legal framework is another important pillar to give the answer to the dilemma. The model was designed for pedagogical practice and was applied in phase 4 of the evaluation of the implementation of the proposal.

During the course, the evaluation strategies included: case analysis, presentations by the students, reflection on each of the topics covered, and a final reflection on the course. The evaluation was formative in terms of the fact that the student had the opportunity to improve reflections and analyses of cases and summative in the case of presentations. Finally, they were asked for the final reflection about the course.

The qualitative aspects resulting from the different strategies include:

1. In the reflections of each topic, students place a lot of information about what they learned, which facilitates self-assessment by the student and evaluation by the teacher. Likewise, in these reflections, the students point out the need to raise legal aspects and the importance of respecting opinion diversity. Conception changes are included in specific topics.

2. The different presentations made by the students allowed them to broaden the vision about the treated topic since they believed that bioethics was only for the health area. They thought that more time was needed for the presentations and more depth was required to address various aspects. They recommended the use of videos to make them more dynamic.

3. The students elaborated the case analyses; one student even managed to establish her own model. However, they pointed out maleficence as a bioethical principle, which indicates the confusion between an act and a bioethical principle. And in the case of bioethical opinion, on several occasions, it was very concise apart from the fact that they did not handle the arguments they made in the analyses.

4. In the final reflection, they considered that bioethics was the best course for the integration and analysis of knowledge and that it should be implemented as a code of human conduct in all specialties. They pointed out the importance of the course in learning to respect the diversity of opinions.

5. Finally, regarding the content, two students indicated that they thought it was another subject to complete credits, but in reality, it is a course that offers tools for the analysis of dilemmas and for the treatment of human resources.

6. For the purposes of the course as a pilot test, the results were very satisfactory, since the proposed objectives were achieved, despite the fact that the sample was very small; in addition, the fulfillment of assignments and how they were understood were reflected in the grades obtained; however, there were difficulties in differentiating personal assessment, legal aspects, and bioethical principles with which the bioethical opinion should be argued. In the analysis of the dilemma, the principles did not appear; they placed them in the possible solution of the dilemma without discriminating which were the ones that corresponded.

7. The pilot test of the course allowed to evaluate the use of the planned strategies and the development and responsibility of the students. In addition, it offered the opportunity to see the aspects that could be improved in the final implementation of the course, such as the approach to ethical dilemmas and the establishment of guidelines for student presentations.

2.4 Phase 4. Evaluation of the implementation of the proposal

2.4.1 Method

The research is a qualitative study and is part of the interpretive paradigm because it is intended to collect information from students for subsequent analysis and interpretation of the reality of the bioethics course. This is a quasi-experimental study, applied to intact sections of the bioethics course at the Pedagogical Institute of Caracas.

For data processing and analysis, the Continuous Comparison Method (MCC) proposed by Glaser and Strauss [42] and Straus and Corbin [43] was used. The investigation culminates with reflection on the findings obtained. The first step, after organizing the documents, was to tabulate the information; from this, we proceeded to categorize, and later, the corresponding analysis was made, supporting the findings obtained in the theoretical references.

The semesters in which the course was taught included from 2011 to 1 to 2016-I, and the group of students was made up of the entire population of future biology and chemistry teachers taking the course of bioethics. For evaluation purposes, parameters that should be included for each activity were considered: thus, the presentations should include both the conceptual and bioethical aspects, linked to a problem; the cases had to follow the guidelines of the pedagogical model for the analysis of bioethical cases, according to Partida, Alvarado, and Ochoa [17]; reflections should include aspects such as what I learned, conception changes, what I liked, and recommendations for presenting the topic. Depending on the aspects considered, the score was assigned to the activity, to comply with the evaluation as an academic requirement. Likewise, in the first semesters of application of the course (2011-I to 2012-I), a survey about the expectations of the course was applied. The collected material was organized by semester and by activity to facilitate data processing.

2.4.2 Collection and analysis of perceptions

The analysis was made according to the elements considered for the evaluation of the course and the initial survey.

2.4.2.1 Survey for bioethics students 2011-I, 2011-II, and 2012 II (n = 51) with questions about the expectations of the course, what they had thought up to that moment (they had been in the course for three weeks), if they considered it an important or necessary subject, and if they would recommend it.

The results were the following: in terms of expectations, they were diverse; in the first semester of application of the survey, there was a total ignorance about its content and usefulness. But from the second semester of application of the survey, expectations of the course appeared regarding the objectives, the bioethical cases, the legal framework, and the ethics present in all aspects of life. These remarks included the comments and experiences of classmates who had already taken the subject.

Regarding what they thought of the course, they pointed out that it was an important subject for personal development and growth; They also suggested that it made them think of cases in the environment, that it changed the vision of scientists and their research, that it led itself to debate and discussion, that it taught bioethical analysis with the inclusion of legal aspects. They also pointed out that the first classes gave the theoretical support to argue a position in bioethical cases and the importance of the legal framework.

In another question, the students answered that it should be a required course not only for biology and chemistry but also for all specialties, for all universities, and for all public, because it taught legal aspects that we should all know; it is a course that helps to create awareness with which our society can be improved.

Finally, they pointed out that they would recommend a bioethics course or workshop for students and the general public.

This instrument was only applied in the initial semesters, since, due to its novelty, there were many expectations and erroneous information about the course. It seemed interesting to collect these impressions and thus compare what they thought at the end of the course, through the final reflection. To the same extent that the course was applied, the probability of indicating erroneous expectations decreased; even an increase in enrollment was noted, so the survey was no longer passed.

2.4.2.2 Strategies handled in class. Bioethics course: 2011–2016 semesters.

The information about the strategies was collected through participant observation in the classes and through the assignments that the teacher evaluated (case analysis, reflections, presentations).

1. Case analysis

   One of the biggest concerns that arose in the first application of the course was carrying out the case analysis. This led Partida, Alvarado, and Ochoa de Toledo to design a pedagogical model for the analysis of bioethical dilemmas [17]. Since the use of the model from 2012, the problems of the bioethical analysis began to be corrected, giving greater weight to the opinion. The model is based on the humanist-integral approach since both the philosophical assessment represented by the principles and the legal framework are handled according to the context of the case presented; likewise, religious aspects are considered as part of personal assessment [32].

2. Other strategies

   The result of the different strategies was very satisfactory, as stated by the students themselves. They expressed that it was excellent to use various experts in the course; they liked the diversity of topics; on some occasions, the students were taken to an expotatoo (tattoo artist event), to be more in touch with reality and thus be able to analyze cases related to the topic. The bioethical analysis of films gave them another way of seeing real and fictional situations. Many commented on the use of the blog that was opened for bioethics students where they could freely contribute their ideas and opinions. In summary, the strategies managed by the teachers, according to the students, represent a way of feeling like protagonists in the class, generating learning through better group interactions, and support what has been proposed by various authors such as Orozco [16]. These perceptions were obtained from the final reflections of the course.

3. Aspects indicated in the reflections

   The reflections include both the ones they made by theme and the final reflection. As for the final reflection, it was totally open, and there, they could talk about the course, the strategies, and the teachers. A variety of information was extracted from there, and the most important was that students considered that there should be reflections in all subjects in order to express and self-evaluate. All the material was tabulated and organized into categories that included: their perception in relation to the course, acquired learning, bioethics as a discipline, the role of the teacher, and recommendations for the course according to the students.

   1. In relation to the bioethics course

      Some important aspects noted include that the course makes it possible to establish a connection between the real world and the academic world; in addition, it is integrative of various disciplines; it motivates debate and analysis; it helps us to change by making us aware of all the aspects that make up our day to day; it is easy to understand and carry, since real cases are handled, cases we believe far from our environment; it addresses questions that we have ever been asked but not from the perspective of ethics, making possible the maturity of critical thinking, which can be transferred to all areas, including education. It allows the expression of diverse opinions and to put yourself in the place of others and learn from their experiences. In this sense, the course modifies personal behaviors, concepts, points of view, and paradigms, and furthermore, it encourages getting a good grade and not just getting the minimum passing grade.

      The course allows creating social awareness of the transformative action of education and the leading and determining role played by the teacher, which supports critical pedagogy according to Deeley, Giroux, and Torres [25, 26, 35].

   2. Learning acquired in the course

      Most of the students expressed in their reflections some specific comments that included learning about values and how they influence human decisions; being able to compare the first bioethical analyses with the last ones allowed them to see their growth in terms of carrying them out and the importance of considering bioethical principles and the legal framework. They also pointed out the knowledge about bioethics committees and the role they play in the present institutions. In addition, the approach to various topics through real cases led them to understand that there were not two extremes or two shades but that there were nuances, which helped them for their teaching role and their personal growth; a fundamental point of learning in the course is the performance of bioethical analyses.

   3. Bioethics as a discipline

      In the final reflections, the students placed a lot of emphasis on bioethics as a discipline. Thus, for example, they defined it as the study of all the characteristic problems of the human species and the space for critical discussion of them, which allows the development of new strategies for addressing cases in the pedagogical field. Bioethics helps to educate beyond procedural and theoretical content; in this sense, it supports education from a holistic perspective of teaching, especially in the case of scientific areas.

      Finally, some pointed out that if there were more bioethics courses, they would take them all because of the experience gained. Also, they pointed out that they must be the propagators of bioethics in their classrooms and social circles.

   4. Teacher

      One of the most outstanding aspects in the reflections of the students was the fundamental role of the teacher for this type of course. They pointed out that the teacher must not only master the theoretical aspect of the course but also have the ability to use tools and resources, in addition to being open and communicative (these characteristics are indicated from the experience with the teachers of the grade). It is the teacher who can guide the change, so that they can become sensitive to the situations and achieve the improvement that as humans we must achieve, as stated by Kaplún (El NACIONAl, 2016) [21].

   5. Recommendations for the course according to the students

      Based on the reflections, a brief summary of the recommendations made by the students for the course was made. It could be noted that although they gave suggestions for new strategies, in general terms, the students aspired to a course of bioethics beyond the semester. Among the recommendations given by students are:

      • The topics presented should be part of the race to make teachers more tolerant, to avoid placing labels that lead to discrimination, and to prepare them for many cases that arise in their field of work. Furthermore, it should be for all audiences, and in the case of the educational field, it should begin at the basic level as part of the citizen training process to make it more humane with respect to the planet and coexistence with all human beings.

      • Research areas in bioethics and projects in the area could be proposed to continue the work of this discipline and affirm the immense learning that it left in the students.

      • The course could be closed with a free case proposed by each student (real or fictitious). Workshops and dramatizations could be included.

3. Conclusions

1. Bioethics as a course can contribute to managing the humanistic part along with scientific and technological advances, training professionals as citizens capable of making reasoned decisions that seek to cause the least possible harm. As long as critical pedagogy is handled, this type of course allows training people by making them more tolerant and respectful of different ideas, through learning based on discussion and debate. That is, the subject includes attitudinal content by involving students in situations and reflecting on their possible solutions, content aimed at training rather than information, in accordance with what was stated by Deeley, Giroux, and Torres [25, 26, 35].

2. The case analysis model was designed for pedagogical practice. The results showed that the model worked to achieve a bioethical opinion, integrating all the aspects analyzed and thus responding to the dilemma. The presented method can be adopted in the pedagogical practice of any level, especially if it is thought that bioethics should be incorporated from primary education.

3. The process of deliberation and argumentation of the final answer helped to achieve the objective of the course, in terms of awareness about the responsibilities toward life and the environment; in fact, students felt capable of transferring the analyses to any situation of daily life; many commented on how the news impacted them, which they hardly even read before, and how they automatically analyzed it from the perspective of bioethics. In many cases, they involved family and friends in their arguments, with which the learning acquired passed to the phase of social diffusion.

4. The perceptions of the students allow us to confirm that the use of critical pedagogy is fundamental for this type of course, since they can become aware that the personal vision is not the one that leads to the best answer; therefore, there is a conflict between the answer and what is believed. This can lead to being more flexible to different options, respecting other opinions, and changing toward a professional who is more committed to their social environment [25, 26, 35].

As a conclusion of this work, it can be said that the implementation of the course has been highly satisfactory, in light of what was expressed in the reflections of the students about it. The objective of the course has been fulfilled by incorporating bioethics in the teaching of future teachers in a significant way, since they can transfer what they have learned to other situations, including concrete experiences of their lives.

4. Final recommendations

The experience of the course in each semester makes the authors think of some recommendations:

1. Continue with the application of this pedagogical method, for bioethical analysis, with the purpose of expanding the sample that supports the model.

2. Continue the opening of topics within the course, since the students state that they have new needs in terms of bioethics in pedagogical practice, in research, and in labor practice. These needs support the fact that bioethics must be understood with broader criteria than those that originally defined it. In this regard, the president of the Latin American Federation of Bioethics Institutions (FELAIBE) summarizes the different ways of seeing bioethics:

• As interdisciplinary knowledge, which has been researched and disseminated in institutes and bioethics centers;

• As an academic discipline, which, in fact, has been taught in many universities around the world in undergraduate, postgraduate, and even high schools;

• As an instrument, which has been applied in consultancies, in government commissions and international organizations, and in clinical and non-clinical committees; and.

• As a global movement in favor of life and its environment and in defense and promotion of the survival of humanity and planet earth [44].

The last point summarizes the reason for the existence of a bioethics course; hence, the vision of education must be its management as a transversal axis at all levels of education. Although it is true that at UPEL-IPC, the course is optional for future biology and chemistry teachers, the course should be required for all specialties.

It can be evidenced that the course promotes changes in students. However, the scope of this study does not allow us to know if these changes last in the long term in them, since it is unknown if critical learning is considered in other courses. Changes can be promoted with only one course, but they can be diluted if there are no reinforcements where reality can be involved as part of the learning and the ethical aspects involved. However, the fact that post-course products are generated leads us to think that it goes beyond learning for a semester. Hence, we suggest workshops for teachers so that everyone can apply strategies that consolidate the changes promoted by bioethics.

The application of the course has been very satisfactory for the teachers, because, although we think that bioethics still has a long way to go, at least the importance of the discipline for the training of our teachers and researchers has begun to be considered. For now, there are few products, but it is expected that new contributions will continue to be added in the future, since there are seminars on bioethics in the master’s degree in teaching biology; a course on bioethics in elementary education was opened, and the bioethical aspects of research are now a requirement according to the new research regulations of the IPC-UPEL. The highest aspiration is that bioethics be a required course for all university specialties and that little by little this discipline can be mainstreamed through the new university curriculum.