Acessibilidade / Reportar erro

Representations of moral values in professional practice among dental students

Abstracts

The present qualitative study aimed to identify the moral values considered central to professional practice. For most students the subject of ethics is related to the rules, behavior, and principles imposed by society on all individuals, while morals, being more subjective, relate to the way human beings think and act on an individual level. The students identified respect, honesty and humility as the main moral values for professional practice. It was also noted that the representations of these values were wide-ranging and sometimes idealized. In this context, it is essential to rethink the way ethical education is taught within the academic process, given that democratic post-industrial societies require, now more than ever, ethical citizens who employ viable and humanizing working alternatives and are able to experience and promote the valorization of human values

Moral; Ethics; Professional practice


O presente estudo, de natureza qualitativa, objetivou identificar em estudantes de odontologia as representações de valores morais considerados centrais para o exercício profissional. Para a maioria deles, a ética relaciona-se com normas, condutas e princípios impostos pela sociedade a todos os indivíduos, enquanto a moral, por ser mais subjetiva, diz respeito à forma de pensar e agir do ser humano no plano individual. Elencaram respeito, honestidade e humildade como os principais valores morais para o exercício profissional. Constatou-se também que as representações elaboradas desses valores foram bastante amplas e, às vezes, idealizadas. Nesse contexto, torna-se imprescindível repensar a ética pedagógica adotada no processo de formação acadêmica, visto que as sociedades democráticas pós-industriais necessitam, mais do que nunca, de cidadãos éticos, que empreguem alternativas de trabalho viáveis e humanizadoras, capazes de vivenciar e de promover a realização dos valores humanos.

Moral; Ética; Prática profissional


El presente estudio, de naturaleza cualitativa, tiene como objetivo identificar las representaciones de los valores morales, consideradas fundamentales para el ejercicio profesional. Para la mayoría de los estudiantes, la ética se refiere a las normas, conductas y principios impuestos por la sociedad a todas las personas, mientras que la moral, por ser más subjetiva, refiere a la manera de pensar y actuar del ser humano de forma individual. Los estudiantes indicaron respeto, honestidad y humildad como los principales valores morales para el ejercicio profesional. Se observó también que las representaciones elaboradas de estos valores fueran bastante amplias y a veces idealizadas. En este contexto, es imprescindible repensar la educación ética adoptada en el proceso de formación académica, en vista que las sociedades post-industriales democráticas requieren, ahora más que nunca, ciudadanos éticos, que utilicen alternativas de trabajo viables y humanizadoras, capaces de vivenciar y promover la realización de los valores humanos.

Moral; Ética; Práctica profesional


Aprovação CEP CCS/UFPE 474.252/2012

Frequent and rapid transformations by which the world has been going through in all sectors of society bring about changes even in the relations among ethics, science and professional practice. These transformations may be questioned, and the scientific ideal of illustration, from the XVIII century, which advocated not a blind knowledge and dissociated of humans ends, but that controlled by the humans and used for the collective well-being may have become an inaugural mark. Scientific progress was seen as part of a complex evolution, in which, ethical, social and political factors acted jointly, before which science would find its place and its limits.

The progress of the future humanity was measured by the increase of justice, of morality, of equality in each country and among countries, and not for the isolated increase in scientific knowledge, able to dominate and destroy humanity. Thus, the scientific project formulated by the Enlightenment, and which it transmitted to its heirs, liberalism and socialism, did not aim at servitude. A counter-enlightenment modernity corrupted the project. Indeed, humanity would be much happier if Science, as a practice of power destined to produce social gentleness, if it had not been transformed in fetish, in a way of being considered neutral, intrinsically good and able to provide well-being to an increasingly larger number of individuals 1. Rouanet SP. Mal-estar na modernidade. São Paulo: Companhia das Letras; 2003..

In contrast with the scientific ideal of the Enlightenment, the current period, from the last quarter of the XXcentury, has characteristics predominant to the association between science and ethics, both used to serve the market. It is verified that what Science produces does not usually interests the humanity in general. Therefore, scientific and technical progress does not necessarily come with moral progress 2. Santos M. Por uma outra globalização do pensamento único à consciência universal. São Paulo: Record; 2009. , 3. Vásquez AS. Ética. 31ª ed. Rio de Janeiro: Civilização Brasileira; 2010..

Failure of the Enlightenment project led humans to a crisis of social and ethical values, unprecedented in history, that affects families, schools, public health, businesses, means of social communication, political activities and even the survival on the planet, in a rapid process of devastation. We live a moment marked by the relativism, indifference, misrepresentation of values, self-indulgence and apathy. This crisis on the capability of humans to exercise citizenship full of rights and duties is opposed to great scientific and technological progress achieved through the centuries, which, paradoxically, enable remarkable achievements, but cannot respond to the search for individual happiness or ensure peace among humans 1. Rouanet SP. Mal-estar na modernidade. São Paulo: Companhia das Letras; 2003. , 2. Santos M. Por uma outra globalização do pensamento único à consciência universal. São Paulo: Record; 2009. , 4. Pottker RS. Um estudo sobre o desenvolvimento moral da criança. Analecta. 2002;3(1):121-34.

. Finkler M, Calvo MC, Caetano JC, Ramos FRS. Um novo olhar bioético sobre as pesquisas odontológicas brasileiras. Ciênc Saúde Col. 2009;4(4):1.205-14.
- 6. Bauman Z. Ética pós-moderna. São Paulo: Paulus; 2010..

In the beginning of life in society, humans already perceived that it was necessary to establish a social organization to guide actions of each individual and also of the collectivity. This way of acting is called customs and/or culture of a people, and they are related to the mutual influence if values 3. Vásquez AS. Ética. 31ª ed. Rio de Janeiro: Civilização Brasileira; 2010., whose construction is related to affective projections of the individual on objects or people close to them 7. Piaget J. O juízo moral na criança. São Paulo: Summus; 1994..

Ethics established a deep relationship with values, however it is not limited to them. It may be considered as a reflexive principle that questions the basis and the validity of social values, which are manifested in the morality. As for the morality, it contains habits, customs and behaviors. And this is where attitudes are revealed and judged by the morality as correct or not. In this sense, ethics and morality, although distinct, are indissociable 3. Vásquez AS. Ética. 31ª ed. Rio de Janeiro: Civilização Brasileira; 2010. , 8. Lourenço O. Reflections on narrative approaches to moral development. Hum Dev. 1996;39(2):83-99.

. Rios TA. O que será da avaliação sem a ética? Cadernos Cenpec. 2007;2(3):45-52.
- 1010 . Silva LRC. A dimensão ética do ensino na docência universitária: concepções e manifestações na formação inicial de professores [dissertação]. Fortaleza: Universidade Estadual do Ceará; 2010..

Education for ethics

In several contemporary discussions, the concerns on courses taken by the society are always present. Among these issues, the relevant role of education as a reference of hope for a world that is more equitable, more dignified and harmonious is frequently included. Understanding education as a process whose objective is the humanization of education we should not exclude the task of trying to make it as one that guides its actions by ethical principles 1111 . Jares XR. Educar para a verdade e para a esperança: em tempos de globalização, guerra preventiva e terrorismos. Porto Alegre: Artmed; 2005.

12 . Carvalho V. Ética e valores na prática profissional em saúde: considerações filosóficas, pedagógicas e políticas. Rev Esc Enferm USP. 2011;45(2):1.797-802.
- 1313 . Razera JCC. O ensino de ciências entre a cultura do tédio e do sentido. Rev Ensaio. 2011;13(1):157-64..

In this sense, the education for citizenship and for life in a democratic society is not limited to the knowledge of laws and rules. The university, conscious of its formative and instructive role, cannot work with any value. It aims at an education for citizenship, its responsibility is in providing the students with the opportunity to Interact, reflexively and in practice, with universally desirable values and virtues and associated with justice, equality, citizenship, self-respect and to the respect in its great sense, aiming at the conscious search for happiness and for personal and collective well-being, such as advocated in the Universal Declaration of Human Rights 1414 . Organização das Nações Unidas. Declaração Universal dos Direitos Humanos. [Internet]. 1948 [acesso out 2014]. Disponível: http://www.unicef.org/brazil/pt/resources_10133.htm
http://www.unicef.org/brazil/pt/resource...
, even if these values are not extensive to each and every existing culture in the planet today 1515 . Araújo VAV. Cognição, afetividade e moralidade. Educ Pesqui. 2000;26(2):137-53..

In dentistry, ethics constitutes an important cause of concern, mainly due to the increasing number of professionals graduated in this area, and consequently, to the increased competition in the employment market. The absence of an adequate ethical professional formation and the increase in competitiveness are seen to drive the dentist to disregard the ethical dimension of the professional practice 1616 . Amorim AG, Souza ECF. Problemas éticos vivenciados por dentistas: dialogando com a bioética para ampliar o olhar sobre o cotidiano da prática profissional. Ciênc Saúde Col. 2010;15(3):869-78..

These ethical problems in the dental practice routinely occur and may involve aspects referring to the patient, to the organization of health care services, to the relationship with colleagues and to the society in general. Nevertheless, professionals are not always prepared to deal with ethical issues, which may lead them to experience ethical conflicts in the professional practice. Particularly for dentists, difficulties to resolve such conflicts are reinforced by the dental knowledge fragmented in disciplines and by the excessive technification of the dental work. This technicism is maintained mainly by the dental education, which usually ignores ethical, political, social and cultural dimensions inherent to health issues in general and particularly to the dental practice 1616 . Amorim AG, Souza ECF. Problemas éticos vivenciados por dentistas: dialogando com a bioética para ampliar o olhar sobre o cotidiano da prática profissional. Ciênc Saúde Col. 2010;15(3):869-78..

We main at launching on the employment market of dentists with a generalist, humanist, critical and reflexive formation, to act in all levels of attention to health, based on the technical and scientific rigor. Moreover, they should be able to do activities referring to the people’s oral health, guided by ethical-legal principles and by the understanding of the social, cultural and economic reality of their environment, guiding their action to transform the reality for the benefit of the society. One of the main issues in the process of professional formation is related to ethical dimension in this formation, because, for beyond the technical competence, the professional excellence requires ethical humanistic improvement of the students, turning to the development of a critical reflection of these students, mainly about themselves and the consequences of their actions on the others 5. Finkler M, Calvo MC, Caetano JC, Ramos FRS. Um novo olhar bioético sobre as pesquisas odontológicas brasileiras. Ciênc Saúde Col. 2009;4(4):1.205-14. , 1717 . Brasil. Conselho Nacional de Educação. Resolução CNE-CES nº 32, de 19 de fevereiro de 2002. Institui as diretrizes curriculares nacionais do curso de graduação em odontologia. Diário Oficial da União. mar 2002:seção 1, p. 10. , 1818 . Finkler M, Verdi MIM, Caetano JC, Ramos FRS. Formação profissional ética: um compromisso a partir das diretrizes curriculares? Trab Educ Saúde. 2010;8(3):449-62..

In this context, it is required an urgent reflection on the importance of the dentistry education to form new professionals, since, most of the times, it is based on practical activities carried out by students in clinics of the universities. In these clinics, the future professional learns, performs actions, learns conducts and acquires habits, making them into privileged places where not only for the learning of technical procedures, but also for the practice of ethical reflection on dentistry 5. Finkler M, Calvo MC, Caetano JC, Ramos FRS. Um novo olhar bioético sobre as pesquisas odontológicas brasileiras. Ciênc Saúde Col. 2009;4(4):1.205-14. , 1919 . Gonçalves ER, Verdi MIM. Os problemas éticos no atendimento a pacientes na clínica odontológica de ensino. Ciênc Saúde Coletiva. 2007;12(3):755-64..

Facing the need to discuss moral values and principles and clearly include them in educational projects of higher education, the present study has the purpose of identifying representations of moral values considered central for the professional practice between two groups of students regularly enrolled at the beginning of the professional cycle (from the 5th semester) and in the last semester of the dentistry course at “Universidade Federal de Pernambuco” (UFPE) (Federal University of Pernambuco).

Methods

The present study, of a qualitative nature, following the methodological guidelines of Minayo 2020 . Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. São Paulo: Hucitec; 2006., was approved by the Research Ethics Committee in human beings of UFPE and applied from November 2012 to March 2013 and all participants agreed to sign the free and informed consent form.

The methodology of Minayo 2020 . Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. São Paulo: Hucitec; 2006. takes into consideration three types of analytical methods – content analysis (influenced by the positivism), discourse analysis (influenced by the historical materialism, by the theory of discourse and by linguistics) and, mainly, the hermeneutic-dialectic analysis (influenced by philosophy and by social sciences) – and allows understanding the speech, the statement and the text as a simultaneous result of a social process and of knowledge, according to what was proposed by the German philosopher and sociologist Jürgen Habermas, of the Frankfurt School.

The sample comprised 14 students (28.6%) of 49 regularly enrolled in the 5th semester. This semester was selected to gather data because that is when students are introduced to the professional cycle, as it is designed in the new curriculum of the dentistry, and that was the first class following that new curriculum. The curricular reformulation that proposed this pedagogical change did bother to deepen the humanistic formation of the students. Regarding the old curriculum, 15 students (32.6%) were selected out of the 46 regularly enrolled in the 10th semester, that had already studied the mandatory disciplines of the course and, theoretically, they should present comprehensive knowledge on moral values considered central to the professional practice.

The definition of the number of individuals was not carried out based on a statistical sample, but through the technique of speech saturation 2121 . Bauer MW, AARTS B. A construção do corpus: um princípio para a coleta de dados qualitativos. In: Gaskell G, organizador. Pesquisa qualitativa com texto imagem e som: um manual prático. Petrópolis: Vozes; 2002.. Exclusion criteria were refusal to participate in the research, going down their enrolment and leaving the dentistry course during the period of data collection.

In order to obtain sociodemographic and economic variables of the students, a structured form was elaborated. Data obtained were tabulated and analyzed in the statistical program Epi Info, version 7.3.1.1. Regarding the methodological line adopted by the design and application of research, that is, the guidelines of Minayo 2020 . Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. São Paulo: Hucitec; 2006., it is possible to synthetize it in two phases – 1) construction of a tool for collecting information on the topic in question and 2) analysis of data collected – both described below.

The construction of the research tool occurred by elaborating a guide for the open interview, non-directive and carried out verbally, whose questions are explicit in the results. The period of data collection occurred from November 2012 to March 2013. A recorder was used to record verbal register of data obtained in the interviews that were carried out by a single researcher. In order to maintain the reliability of information, all questions answered were completely transcribed and reviewed by more than one researcher.

Concomitantly to interviews, non-verbal reactions of the participants such as behaviors, gesticulations, facial expressions, and customs were taken into consideration, due to their enriching character for the research.

After the transcription of the recorded interviews, information obtained was thoroughly read, synthetized and categorized in three central nuclei: 1) representations of the concepts of ethics and morality; 2) influence of the current society in the adoption of moral values; 3) representations of moral values considered essential for the professional practice. Then, these aspects were compared with previously selected theoretical references.

In the context of this study, representations should be understood as mental states that mediate the relationship between the individual and the environment, constituting the material of thought. They may be built by the direct contact with the world (primary representations) both by the capability of abstraction of human beings, that analyzes past events and makes projections about the future, that will allow the hypothetical-deductive reasoning, that is, secondary representations that need to be interpreted.

Result

Regarding sociodemographic variables, it was verified for interviewees of the 5th semester, they were mainly females (66.4%), aged from 19 to 21 years (80%), Brazilian (100%), from the city of Recife (63.4%) and lived with their parents (89%). For the 10th semester, most of the students were also females (55.7%), aged from 21 to 22 years (74%), Brazilian (100%), from the city of Recife (58.4%) and who lived with their parents (75%). As for the economic variable, it was verified that, for both groups, most did not have a paid job (92% and 66%, respectively) and, therefore, did not have a monthly individual income. Among those who had, it was about R$ 400.00, from monthly allowance, internship or monitoring/research grant.

In order to investigate the representations of moral values in dentistry students of the 5th semester (in the beginning of the professional cycle) and of the 10th semester (those completing the course), they were asked to present a concept of ethics and another one of morality. Because of the huge plurality of senses that both bring about in the imagination of the students, when it is impossible to present all concepts provided, and taking into account the similarity between concepts of ethics and of morality elaborated by the students of both semesters, the most frequent ones were selected. Thus, for most of them, ethics is related to “ideals”, “rules”, “norms”, “conducts”, “values” and “principles” imposed by the society to all individuals.

Next, it was possible to categorize, in similar frequencies, other representations of ethics: a) “a collective morality”; b) “laws and written codes”; c) “rules to practice the profession”; d) “depends on each person’s character” and; e) “it is what you do when everyone is looking”. It is also noteworthy, the fact that some students are not able to distinguish between the concept of ethics and of morality, because, according to them, both of them are very similar, as it is explained in the statement of a student from the 5th semester: “Ethics is to strictly follow the rules. To be a righteous, centered and moral person. But I do not know about morality. Everything is related. Morality is similar to ethics. It must be the same thing”.

Among the variety of representations that students produced on the concept of morality, the most common ones were characterized in three groups: 1) for most students, morality is related to “rules”, “norms”, “principles”, “customs” or “values” adopted individually (as explained by one of the students from the 10th semester: “Morality is intrinsic, individual, it is a way of being and acting of each person. It is what you are”); 2) some students conceptualized it as “laws”, “rules”, “norms”, “habits”, “customs” or “behaviors” imposed by the society to the people; 3) others talked about “appreciation of the profession and respect for professionals of the same area, however, at the individual level”.

Students were asked to list moral values they considered essential for the professional practice of dentistry. Among different values presented for both groups, the most emphasized ones, in a descending order, were “respect”, “honesty”, “humanization” and “humbleness”. The students were also presented with values of professional honesty, mutual respect, and social justice and they were asked to conceptualize each one of them. Regarding the representations of professional honesty, students of the 5thsemester associated the concept to: “not defrauding, not illuding, not deceiving in search of personal benefits rather than the patient’s health”; “being competent, responsible, humble and respectable”; “respecting and being able to put oneself on someone else’s shoes”. To these concepts, students of the 10th semester added: “clear professional-patient communication”.

As for mutual respect, students of both semesters responded that: “respect implies in reciprocity”; is it required “to respect the rights of the other, not exceeds the limits to deserve and have their respect”; people should “treat each other kindly, not depreciating themselves or the others”; it is important to “tolerate opinions and convictions of someone and expect them to do the same”; “it is giving to the others exactly what you want them to give you”.

Regarding social justice, students of the 5th semester reported this moral value as: “the creation of laws and rules by the society”; “everyone has the same rights in the society”. But students of the 10th semester responded that social justice represents: “justice that rules people”; “inequality among individuals”. It is also noteworthy the opinion of some students for whom the social justice is associated with the principle of equity, as it is observed as follows: “Social justice is to give more to those who need more and to give less to those who need less, and not to give the same for everyone”.

As for the qualities that a health professional need to have to be considered as an ethical reference, students of the 5th semester responded: “honesty”; “respect”; “being correct”; “humbleness”. Students of the 10th semester added: “acting according to ethics and morality”; “having character”; “having an adequate knowledge in his/her area of expertise in order to be able to practice their profession”.

Questioned about moral values that may be modified during the professional practice, students of both semesters mentioned: “honesty”; “respect”; “humbleness”; “humanization”. Others stated that all values undergo changes because the society is dynamic, as exemplified in the speech of a student from the 10th semester: “Information makes us change our thought, because we have prejudice to what is unknown; when it is known, everything changes, now you know it and may treat it in another way and end up changing everything regarding everything”.

Taking into account the moral development in the context of contemporaneity, students were asked whether characteristics of the current society influence the adoption of essential moral values to the professional practice. Students of both semesters responded affirmatively, emphasizing that “the overestimation of money and greed caused by consumerism”, “corruption”, “social disorder”, “competitiveness”, “unequal distribution of income” negatively interfere with the adherence to moral values.

Discussion

The relationship between ethics and science is one of the great challenges faced by humans since the second half of the XX century. People started to realize, in their everyday life, the significant deterioration of the physical and social environment, beside the astonishing and wonderful world of technology. Technological advancements in the areas of communication, transport, food, housing, health and leisure coexist with the ecological imbalance, misery, famine, unemployment, landless people, homeless people, ultimately, they coexist with all kinds of violence that destroys the dignity of those excluded from society 6. Bauman Z. Ética pós-moderna. São Paulo: Paulus; 2010..

Considering that there is no scientific and technological progress without a moral progress, it is just possible to talk about dentistry as the ethics of care if the professional is conscious of himself/herself and of the others, recognizing himself/herself as responsible for ethical values he/she adopts as an individual 9. Rios TA. O que será da avaliação sem a ética? Cadernos Cenpec. 2007;2(3):45-52. , 2222 . Chauí M. Convite à filosofia. São Paulo: Ática; 1994.

23 . Cardoso CM. Ciência e ética: alguns aspectos. Ciência Educ. 1998;5(1):1-16.
- 2424 . Candiotto C. Algumas aproximações entre a ética e o ensino superior. Rev Diálogo Educ. 2001;2(4):61-5..

Concepts of ethics and morality elaborated by students of the 5th and 10th semesters of their dentistry course were very similar. Therefore, a deeper level of reflection on ethics was not evident in both groups investigated. From the representations produced here, and because it is related to young people, it is likely to be the reason for the linearity found in the discourses analyzed extrapolates the scope of the changes made in the pedagogical proposal in the dentistry course, being justified by the characteristics of the current world. These characteristics have been analyzed by intellectuals such as Santos 2. Santos M. Por uma outra globalização do pensamento único à consciência universal. São Paulo: Record; 2009., Bauman 6. Bauman Z. Ética pós-moderna. São Paulo: Paulus; 2010., among others.

For most of the interviewees, ethics has the character of being mandatory and, therefore, it should be respected once it is imposed by the society with the purpose of organizing the coexistence of individuals and guiding the human behavior, prescribing limits, rules destined to influence decision making and individual attitudes. For the students, the adoption of ethical behaviors by individuals takes place more because of the fear of punishments or by the hope of receiving rewards that for the resulting feeling of well-being should be met. Consequently, cases of transgression require social punishment, because there are laws and ethical codes that determine how to live in a society and how to practice a profession. In this context, ethics may be compared to the deontology.

In this sense, according to La Taille 2525 . La Taille Y. Moral e ética: dimensões intelectuais e afetivas. Porto Alegre: Artmed; 2006., even heteronomous individuals are moral individuals, because they experience the sense of obligation. However, the contents that rule their morality are those that dominate their community. Only individuals who are morally autonomous elect the equity and the reciprocity as principles for their moral judgments and actions. They conceive morality as rules and principles that rule not only to relations among members that determine the society but also the relations among all human beings, that belong or not to your community.

As for the students’ interpretation of the concept of “morality”, most of them stated that it is a “personal issue”, guided by the individual acting conscientiously, since “some attitudes for a certain person do not have the same meaning as they do for another”. Therefore, for them, morality is what “each individual considers as right or wrong, regardless of what each phase considers as right”. For them, the moral perspective of individuals may be perceived in his/her positioning on the options of choice and of acts that rule interpersonal relations, and the morality is formed throughout life, influenced both by the parents and educators and by other members of the family and classmates.

It is worth mentioning the fact that, for them, there may be as many concepts of morality as individuals want to. On the one hand, it was verified a certain relativity of concepts of morality – which depend on the social and historical context analyzed –, on the other hand, it was not observed that the excessive relativization of morality would bring social chaos, since it would be impossible to organize and insure a healthier coexistence of individuals in society. Therefore, it is verified that elaborations about the idea of morality are paradoxical, since the student who managed to identify the relationship between morality with the introjection of values considered socially correct or wrong – which has the implicit idea that the moral behavior is related to the restriction of individual freedom –, but, contradictorily, do not realize that the unrestricted flexibility in moral may annihilate the very idea of morality and cause social savagery.

Among students who could not clearly distinguish between the concept of ethics and the concept of morality, by considering them as similar, we may observe that, whereas for one group ethics is a morality, but collective morality, for the other, it restricted to the individual, since it depends on each person’s character, but with the exception that it is advisable to “think, act and behave in public according to what the society considers right”, as it was stated by one of the interviewees from the 10th semester. Therefore, it is thought that for participants who thought that way, everything that is not socially accepted to be performed out of the public sphere, in case one wants to avoid criticism, judgments or punishments.

Even though, philosophers such as Comte-Sponville and Ferry 2626 . Comte-Sponville A, Ferry l. A sabedoria dos modernos. São Paulo: Martins Fontes; 1998. and Vásquez 3. Vásquez AS. Ética. 31ª ed. Rio de Janeiro: Civilização Brasileira; 2010. consider ethics and moral as distinct concepts, even if indivisible, it was observed that some interviewees could not distinguish between them. According to Silva 1010 . Silva LRC. A dimensão ética do ensino na docência universitária: concepções e manifestações na formação inicial de professores [dissertação]. Fortaleza: Universidade Estadual do Ceará; 2010., this proximity occurs by the original meanings of these words. As it is explained by Vásquez 3. Vásquez AS. Ética. 31ª ed. Rio de Janeiro: Civilização Brasileira; 2010., ethos, in Greek, does not refer only to nature (physis), but also to the social environment (domain of culture and customs) transformed by the individuals. On the other had, “morality”, from the Latin mos/mores, means custom(s), in the sense of group of norms or rules acquired by habit. Thus, both terms are associated not with a behavior corresponding to a certain natural disposition, but a behavior, which was acquired or conquered by habit.

In this study, it is argued that students, during their academic training, need to be confronted by ethical and moral concepts that postulate respect to human rights, value freedom, equality, solidarity, and reject intolerance or passive tolerance and point out the dialogue as a means to deal with moral conflicts.

In the impossibility of discussing all moral values considered central for the professional practice, according to the students’ perception, and considering that they did not manage to distinguish between desirable professional qualities and essential moral values for the dental practice, the study was restricted to the analysis of representations made on concepts of honesty, mutual respect and social justice. Honesty was conceptualized as a synonym of not lying, not defrauding or not deceiving. Mutual respect was related, in addition to the notion of limit (recognizing the rights of the other), to the need for reciprocity (“give to the other exactly what you would like him to give you”) and for tolerance (“tolerate someone’s opinions and convictions and expect the same from him/her”). Social justice was delimited between equality of rights and submission of laws and rules imposed by the society. Few students associated social justice with the principle of equity, as it may be observed in the following statement: “Social justice is to give more to those who need more and less to those who need less, and not to give the same to everyone”.

It was verified that students managed to identify values that should promote the good clinical practice in the health area. Nevertheless, except for honesty, the other values were conceptualized in a generic and imprecise way. Questioning to be carried out facing such plasticity consists of identifying strategies that will be adopted to choose values able to make the autonomous morality evident in modern societies, whose values acquired liquidity, as stated by Bauman 6. Bauman Z. Ética pós-moderna. São Paulo: Paulus; 2010..

As for mutual respect, according to Piaget 7. Piaget J. O juízo moral na criança. São Paulo: Summus; 1994., it is a fundamental feeling, which enables the acquisition of moral notions. It is a result of a dialectical relationship between feelings of love and fear to lose love, enabling individuals to see themselves as equal. Unilateral respect implies in inequality between the one who respects and the one that is respected. Mutual respect and solidarity among individuals, as opposed, lead to a feeling of justice.

For Piaget 7. Piaget J. O juízo moral na criança. São Paulo: Summus; 1994., in the heteronomous morality, the obedience goes ahead of the justice, and the notion of what is fair turns out to be mistaken for what is ordered or imposed by the seniors. The duties usually come promptly and finished, as requirements to be met. In the autonomous morality, justice represents a way of thinking and acting morally facing conflicts of interest or ethical dilemmas. Finally, justice is an ideal to be achieved.

Dentistry, as the ethics of care, needs to take into account the conception of justice as equity and recognition. In this sense, for Rawls 2727 . Rawls J. A theory of justice. Cambridge: Harvard University Press; 1971., there are two defining principles of a fair society: 1) fundamental equity among all members and 2) tolerance only to inequities that result in benefits for the society as a whole. Thus, the author aims at reconciling liberal principles of legal equality with the concern of limiting social inequalities, prioritizing the distributive principle.

Several authors, such as Taylor 2828 . Taylor C. Multiculturalism and the “politics of recognition”. Princeton: Princeton University Press; 1992. and Honneth 2929 . Honneth A. La lutte pour la reconnaissance. Paris: Éditions du CERF; 2000., will refute this social-liberal view of justice. Taylor 2828 . Taylor C. Multiculturalism and the “politics of recognition”. Princeton: Princeton University Press; 1992. argues that the primacy given by distributionist theories of the distribution of material goods, in the definition of a fair society, hides the fact that, several times, injustices are not of an economic nature, but of a moral nature. For Honneth 2929 . Honneth A. La lutte pour la reconnaissance. Paris: Éditions du CERF; 2000., recognizing the differences is the driving force that changes modern societies, and should be considered as the defining principle of a theory of justice. Therefore, when there is no recognition or when it is false, there is a struggle for recognition. Any experience of disrespect affects the feelings of honor and dignity of the individual as a member of the cultural community of values.

Fraser 3030 . Fraser N. Rethinking recognition. New Left Rev. 2000;3(7):107-20., when discussing the dichotomy among the valid criteria of justice in the contemporary world, argues that they need to account for both the social justice (related to distributional aspects) and for the symbolic justice (which involves recognizing the differences). This criticism will be resumed by the authors, following the example of Rorty 3131 . Rorty R. Achieving our country: leftist thought in twentieth-century America. Cambridge: Harvard University Press; 1998. and Bauman 6. Bauman Z. Ética pós-moderna. São Paulo: Paulus; 2010., so that today we see the establishment of a bipolar debate on valid justice criteria in the contemporary world: on the one hand, those that prioritize the equitable distribution of goods, and on the other hand, those that prioritize social recognition that others have or not in the society. Part of the current challenge consists of elaborating a wide concept of justice that may accommodate justifiable claims of social equality as for justifiable claims to recognize the difference.

Moreover, it is interesting to note that, for most students, any value that is considered fundamental for the professional practice may change over time of clinical practice. On the other hand, interviewees stated that, nowadays, “the overestimation of money and the greed caused by the consumerism”, “corruption”, “social disorder”, “competitiveness”, “income inequality” interfere with the adoption of more desirable values.

In this context, it is pertinent to reflect on the idea that contemporary societies, under the impact of globalization, tend to become societies with no limits, fluid and liquid 6. Bauman Z. Ética pós-moderna. São Paulo: Paulus; 2010.. These conditions bring consequences for the subjectivity of individuals and also for the nature of interpersonal relationships. On the other hand, the current society, supported by capitalist and neoliberal ideologies – pillars of the globalization process – based on the tyranny of information, on the greed for money and on the competitiveness, leads to confusions and reinforces the structural violence 2. Santos M. Por uma outra globalização do pensamento único à consciência universal. São Paulo: Record; 2009. , 3232 . Bauman Z. Modernidade líquida. Rio de Janeiro: Zahar; 2001. , 3333 . Haroche C. Maneiras de ser, maneiras de sentir do indivíduo hipermoderno. Ágora. 2004;7(2):221-34..

It is worth mentioning that the moral development of the student is the way to process the ethical dimension of the professional education 5. Finkler M, Calvo MC, Caetano JC, Ramos FRS. Um novo olhar bioético sobre as pesquisas odontológicas brasileiras. Ciênc Saúde Col. 2009;4(4):1.205-14. , 2020 . Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. São Paulo: Hucitec; 2006.. Educating for citizenship requires considering and acting intentionally on different dimensions, which constitute the human nature: bio-physiological, cognitive, affective and sociocultural 1515 . Araújo VAV. Cognição, afetividade e moralidade. Educ Pesqui. 2000;26(2):137-53.. Nevertheless, the unfortunate truth is that professors do not consider themselves as responsible for the moral development of their students. And that is probably because they have entered the higher education with virtually structured personalities. They are a “product” of the television, of the liberation of customs, of the parental permissiveness, among other factors 3434 . Rocha CB, Correia GCS. Ética na docência do ensino superior. Educare. 2006;(2):1-8..

Finals Considerations

Analysis of data obtained in the study allowed us to verify that most students were not able to accurately distinguish between ethics and moral concepts. Furthermore, their representations on questions investigated denote very little systematized or idealized elaborations in conceptual terms which, actually, it makes it difficult, in the dentistry practice, as an ethical care to the other. In addition, although it is about a group of students enrolled in the beginning or in the end of the professional cycle, it was not verified among those finishing the cycle, supposedly more prepared in terms of theory and practice, a deeper level of reflection on moral values which are socially more desirable for the ethical practice of a professional in the health area.

The distinction and adequate appropriation of concepts, particularly those of ethics and moral, in case of the participants in the study, are believed to help them to reflect better about adopting moral behaviors compatible with an adequate health professional practice, once they will be sufficiently trained to redesign and give a new meaning to their own concepts and actions. In fact, appropriately understanding the theoretical concept of ethics, for example, will result in the perception that it is not appropriate to excessively relativize the professional practice from a particular moral perception, without involving risk of compromising the personal and collective well-being.

Furthermore, considering that the moral behavior is not innate to human beings, that their learning is processed in phases that are intrinsically associated with the development of cognition and affection, it is desirable that any individual, when entering university, has already had, based on the previous development and school years, a discourse which is compatible with the acquisition of an autonomous morality. Nevertheless, asymmetrical interpersonal power relationships established in different social environments, following the example of the contemporary university, show that they still have not reached moral maturity.

In this context, it is essential that professor and students of the dentistry course of UFPE rethink the process of academic education adopted in the institution, considering both the pedagogical ethics as for different social educational and conceptual paradigms, seeking to improve them so that they provide humanized and feasible work alternatives. That process is essential, since post-industrial democratic societies, immersed in the economic globalization, need, more than ever, ethical citizens who act prudently, responsibly and committedly with human values.

Referências

  • 1
    Rouanet SP. Mal-estar na modernidade. São Paulo: Companhia das Letras; 2003.
  • 2
    Santos M. Por uma outra globalização do pensamento único à consciência universal. São Paulo: Record; 2009.
  • 3
    Vásquez AS. Ética. 31ª ed. Rio de Janeiro: Civilização Brasileira; 2010.
  • 4
    Pottker RS. Um estudo sobre o desenvolvimento moral da criança. Analecta. 2002;3(1):121-34.
  • 5
    Finkler M, Calvo MC, Caetano JC, Ramos FRS. Um novo olhar bioético sobre as pesquisas odontológicas brasileiras. Ciênc Saúde Col. 2009;4(4):1.205-14.
  • 6
    Bauman Z. Ética pós-moderna. São Paulo: Paulus; 2010.
  • 7
    Piaget J. O juízo moral na criança. São Paulo: Summus; 1994.
  • 8
    Lourenço O. Reflections on narrative approaches to moral development. Hum Dev. 1996;39(2):83-99.
  • 9
    Rios TA. O que será da avaliação sem a ética? Cadernos Cenpec. 2007;2(3):45-52.
  • 10
    Silva LRC. A dimensão ética do ensino na docência universitária: concepções e manifestações na formação inicial de professores [dissertação]. Fortaleza: Universidade Estadual do Ceará; 2010.
  • 11
    Jares XR. Educar para a verdade e para a esperança: em tempos de globalização, guerra preventiva e terrorismos. Porto Alegre: Artmed; 2005.
  • 12
    Carvalho V. Ética e valores na prática profissional em saúde: considerações filosóficas, pedagógicas e políticas. Rev Esc Enferm USP. 2011;45(2):1.797-802.
  • 13
    Razera JCC. O ensino de ciências entre a cultura do tédio e do sentido. Rev Ensaio. 2011;13(1):157-64.
  • 14
    Organização das Nações Unidas. Declaração Universal dos Direitos Humanos. [Internet]. 1948 [acesso out 2014]. Disponível: http://www.unicef.org/brazil/pt/resources_10133.htm
    » http://www.unicef.org/brazil/pt/resources_10133.htm
  • 15
    Araújo VAV. Cognição, afetividade e moralidade. Educ Pesqui. 2000;26(2):137-53.
  • 16
    Amorim AG, Souza ECF. Problemas éticos vivenciados por dentistas: dialogando com a bioética para ampliar o olhar sobre o cotidiano da prática profissional. Ciênc Saúde Col. 2010;15(3):869-78.
  • 17
    Brasil. Conselho Nacional de Educação. Resolução CNE-CES nº 32, de 19 de fevereiro de 2002. Institui as diretrizes curriculares nacionais do curso de graduação em odontologia. Diário Oficial da União. mar 2002:seção 1, p. 10.
  • 18
    Finkler M, Verdi MIM, Caetano JC, Ramos FRS. Formação profissional ética: um compromisso a partir das diretrizes curriculares? Trab Educ Saúde. 2010;8(3):449-62.
  • 19
    Gonçalves ER, Verdi MIM. Os problemas éticos no atendimento a pacientes na clínica odontológica de ensino. Ciênc Saúde Coletiva. 2007;12(3):755-64.
  • 20
    Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. São Paulo: Hucitec; 2006.
  • 21
    Bauer MW, AARTS B. A construção do corpus: um princípio para a coleta de dados qualitativos. In: Gaskell G, organizador. Pesquisa qualitativa com texto imagem e som: um manual prático. Petrópolis: Vozes; 2002.
  • 22
    Chauí M. Convite à filosofia. São Paulo: Ática; 1994.
  • 23
    Cardoso CM. Ciência e ética: alguns aspectos. Ciência Educ. 1998;5(1):1-16.
  • 24
    Candiotto C. Algumas aproximações entre a ética e o ensino superior. Rev Diálogo Educ. 2001;2(4):61-5.
  • 25
    La Taille Y. Moral e ética: dimensões intelectuais e afetivas. Porto Alegre: Artmed; 2006.
  • 26
    Comte-Sponville A, Ferry l. A sabedoria dos modernos. São Paulo: Martins Fontes; 1998.
  • 27
    Rawls J. A theory of justice. Cambridge: Harvard University Press; 1971.
  • 28
    Taylor C. Multiculturalism and the “politics of recognition”. Princeton: Princeton University Press; 1992.
  • 29
    Honneth A. La lutte pour la reconnaissance. Paris: Éditions du CERF; 2000.
  • 30
    Fraser N. Rethinking recognition. New Left Rev. 2000;3(7):107-20.
  • 31
    Rorty R. Achieving our country: leftist thought in twentieth-century America. Cambridge: Harvard University Press; 1998.
  • 32
    Bauman Z. Modernidade líquida. Rio de Janeiro: Zahar; 2001.
  • 33
    Haroche C. Maneiras de ser, maneiras de sentir do indivíduo hipermoderno. Ágora. 2004;7(2):221-34.
  • 34
    Rocha CB, Correia GCS. Ética na docência do ensino superior. Educare. 2006;(2):1-8.

Publication Dates

  • Publication in this collection
    Jan-Apr 2015

History

  • Received
    17 July 2014
  • Reviewed
    12 Jan 2015
  • Accepted
    9 Feb 2015
Conselho Federal de Medicina SGAS 915, lote 72, CEP 70390-150, Tel.: (55 61) 3445-5932, Fax: (55 61) 3346-7384 - Brasília - DF - Brazil
E-mail: bioetica@portalmedico.org.br