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Principle Features of Dental Ethics

*The doctor started the lecture by referring that the manual is the main source and the final reference for the material.

What is special about Dentistry?

Dentistry deals with human beings and this applies a big responsibility on you as a dentist, people come to dentists for help with some of their most pressing needs - pain relief and restoration of oral health and well-being. They allow dentists to see, touch and manipulate their bodies and disclose information about themselves ; that they dont want others to know, so gaining patient`s trust is part of your responsibility and it`s an important aspect and you always have to show the patient your competence.

Dentistry is recognized as aprofession;because a dentist employs his skills and knowledgeon a patient in order to earn living so it`s a commercial enterprisein the same time. So,, it`s a special profession because there`s a human part versus a commercial part Now, let`s discuss the commercial part: It means advertising to earn money. Some dentists may minimize their commitment to professionalism in order to increase their income, means that they may go too far in making aggressive advertising like some dentists compete to have their names the first when searching for dentists in Jordan on Google for example, or specializing in doingun-necessary cosmetic procedures, and this may end up affecting the reputation and the prestige of the dentist and the profession. Note that going too far in these activities and minimizing my commitment toward my professionalism is wrong and may affect the reputation not the activities theirselves.

*What is special about Dental Ethics?

It`s important for the dentist to know, plus it simplifies the core values of dentistry, such as: compassion,competence and autonomy 1-compassion: understanding and concern for another person`s distress, it`s essential for the practice of dentistry in order to deal with patient`s problems, patients may respond better if they feel that the dentist appreciates their concerns and is treating them rather than treating their illness only. 2-competence: means that you are qualified to do treatment. a lack of competence can have serious consequences for patients. *question: how to make sure that you are a qualified dentist that you can start treating patients? * Answer:if you are always updating your knowledge, not only your scientific knowledge but also technical and ethical knowledge then by time you`ll end up being qualified enough to do treatment. 3-Autonomy:self-determination. Dentists have been free to determine the standards of dental education and dental practice and this frees the dentists from government and corporate restrains on providing optimal treatment for patients. At the same time, there has been a widespreadacceptance by dentists worldwide of patientautonomy, which means that patients should be theultimate decision makers in matters that affectthemselves. Regarding autonomy;you must discuss the problem with the patient and have his opinion if necessary. For example: a patient having a class 2 cavity and you want to fill it after removing the caries, you can use amalgam or you can use composite but who decides this is the patient self-determination , but alsoyour role as a dentist to advice the patient by telling him for example that the composite have better chemical propertiesit will attach to the tooth structure and that it has the same color of the teeth, and after explaining everything you start doing what the patient wants.

Publicly proclaimed ethics: Another unique aspect about dental ethics, means that it`s international and public. *Principles of Ethics for the Dental profession: The primary duty of the dentist is to ensure the optimum oral health for the patient. However, the dentist has the right to decline treating a patient for example he never commits to an appointment, except in three cases: 1- emergency case 2-huminitarian reason 3- where the laws of the country dictate But as a dentist to protect yourself you have to tell the patient why you refuse to treat him, explain and discuss the reasons.

Should refer for advice and/or treatment any patient requiring a level of competence beyond that held. *for example if you see that you cant extract the third molar for a patient, refer him to another dentist maybe it`s a difficult case for you The needs of the patient are the overriding concern; he has the priority in our profession so the dentist as we said previously should refer any case that requires a level of dental competence higher than he possess. Must insure professional confidentiality of all information about patients and their treatments record patient`s information and provide security to these data so, the dentist must insure that all the staff respect patients confidentiality except where the laws of the country dictate otherwise. Must accept responsibility and utilize dental auxiliariesstrictly according to the law.

The dentist must accept full responsibility for all treatmentundertaken, and no treatment or service should bedelegated to a person who is not qualified or is not legallypermitted to undertake this. Must deal ethically in all aspects of professional life and adhere to rules of professional law Should continue to develop professional knowledge and skills. Should support oral health promotionthe dentist should participate in oral health education andshould support and promote accepted measures to improvethe oral health of the public. Should be respectful towards professional colleagues and staff. The dentist should behave towards all members of the oral health team in a professional manner and should be willingto assist colleagues professionally and maintain respect fordivergence of professional opinion. Should act in a manner which will enhance the prestigeand reputation of the profession. Who decides what isethical? A dentist can sometimes decide what is right and what is wrong , but he may face some new cases where he can`t tell if this is ethical or not and there is no direct principle to guide him so in this case we may look for some factors that may help affecting the ethical decision : 1- principles of FDI 2-religion may affect the ethics 3- may be influenced by family and friends and organizations 4-media may also affect ethics 5-different societies may have different ethical concerns 6-the law may affect the ethics

Do dental ethics change?

Yes, it changes from country to country. On advertising, for example, there is asignificant difference of opinion among nationaldental associations. Some associations forbid it butothers are neutral and still others accept it undercertain conditions. There can be little doubt that some aspects of dental ethics have changed over the years, until recentlydentists had the right and the duty to decide how Patients should be treated and there was noobligation to obtain the patients informed consent. In contrast, the U.K. General Dental Council nowadvises dentists that: It is a general legal and ethicalprinciple that you must get valid consent beforestarting treatment or physical investigation orproviding personal care for a patient. * consent: patient`s agreement on treatment. for example: you want to extract a third molar , you give a consent paper to the patient that this is a consideration for extraction of third molar , sometimes results in injury of the inferior alveolar nerve and this may result in paresthesia that may last for 6 months or one year, the patient must know everything about the operation and finally sign for the dentist to start the treatment process . so, this is the consent, and it`s one of the signs that ethics have changed, because in the past you always had to take the patient`s consent no matter what type of treatment youre going to do.

Another example is accountability.

What is accountability and why do ethics change according to it?

- It means the duty or the responsibility, that you`ll be judged or asked by.

* How does it affect/change dental ethics? In the past, at the beginning of the dental profession, dentists used to treat patients with no one asking them if is filling is right for example or if this is a right orthodontic treatment or extraction,a patient may really have a complain on your work but he will go to another dentist But nowadays,we have the Jordanian Dental Association, the patient may go to the association and make a complain and you`ll end up being judged by the association. Accountability change Dental ethics change Moreover, advances indental science and technology raise new ethical issues that cannot be answered by traditional dentalethics. Health informatics and electronic patient records. New technology new ethics so, as it`s mentioned, ethics change for patient`s benefit and according to studies of previous principles. *note: Remember, at the beginning the doctor said that FDI decides it`s principles according to the needs of the patient. So, we as dentist always need to know if this is ethical or non ethical, *For example, Doing a composite filling or amalgam filling for a patient who has arrested caries, is this ethical or non-ethical? -Ans.: non-ethical. Another Example: Your colleague working with you at the same organization, his is doing RCT treatment and his concern from treatment is gaining money, so he is faster than you, he is finishing RCT treatment in 30 minutes, his overriding concern is money over good work, you know this is un-ethical.

How do individuals decide what is Ethical? 2 ways: - Non Rational Approaches - Rational Approaches 1- Non-Rational Approaches: Obedience is" a common way of making ethicaldecisions, especially by children and those whowork within authoritarian structures (for example: the military, police, some religious organizations,many businesses) Imitation is similar to obedience in that itsubordinates ones judgment about right andwrong to that of another person, in this case: a role model. Morality consists in following theexample of the role model. This has been perhaps the most common way of learning dentalethics by aspiring dentists, with the role modelsbeing the senior dentists and the mode of morallearning being observation and assimilation of thevalues portrayed.

Feelings or desires a subjective approach to moraldecision-making and behavior. What is right iswhat feels right or satisfies ones desire; what iswrong is what feels wrong or frustrates ones desire. The measure of morality is to be found within each individual and of course can vary greatly from oneindividual to another and even within the sameindividual over time. Example: you are an orthodontist, and you have a case of endodontic treatment, you didnt practice endo since you were a student, so maybe you are thinking yes I can do this endo treatment for the patient but my feeling or my desire is not to do it because I havent done endo since 10 years, that`s what`s meant by feeling or desire.

 Intuition is an immediate perception of the rightway to act in a situation. It is similar to desire inthat it is entirely subjective; however, it differsbecause of its location in the mind rather than thewill. To that extent it comes closer to the rationalforms of ethical decision-making than do obedience, imitation, feeling and desire. However, it is neither systematic nor reflexive but directs moraldecisions through a simple flash of insight. Like feeling and desire, it can vary greatly from oneindividual to another and even within the sameindividual over time.

Habits a very efficient method of moral decision-making since there is no need to repeat asystematic decision-making process each time amoral issue arises similar to one that has been dealtwith previously. However, there are bad habits (lying for example) as well as good ones (truth-telling for example) moreover. Situations that appearsimilar may require significantly different decisions.As useful as habit is, therefore, one cannot place allones confidence in it. All these are non-rational approaches, and in general, we dont prefer non rational approaches because they may not guide us to the right decision, we prefer Rational Approaches. 2- Rational Approaches: As the study of morality, ethics recognizes theprevalence and usefulness of these non-rationalapproaches to decision-making and behavior.However, it is primarily concerned with rationalapproaches. Four such approaches are deontology,consequentialism, principlism and virtue ethics: Deontologyinvolves a search for well-foundedrules that can serve as the basis for making moraldecisions.

Consequentialism bases ethical decision-makingon an analysis of the likely consequences oroutcomes of different choices and actions. The rightaction is the one that produces the best outcomes.

for example: you want to extract a third molar , you have to think of the consequences of this action , you may injure the nerve plus if there was no pathology and the patient is not complaining about this 3rd molar in this case the best choice is to leave it. Principlism as its name implies, uses ethicalprinciples as the basis for making moral decisions. Itapplies these principles to particular cases or situations in order to determine what is the rightthing to do, taking into account both rules andconsequences like the FDI principles ** Four main USA principles ; Autonomy, Beneficence, Non-MaleficenceandJustice, have been identified as the most importantfor ethical decision making in health care. Virtue ethics focuses less on decision making andmore on the character of decision makers asreflected in their behavior. Virtuesthat are important for dentists include compassion, honesty,prudence, dedication and paternalism.

How to make sure that this Issue is ethical?

1. DECIDE Determine whether the issue at hand is an ethical one. Educate yourself about authoritative sources such asdental association codes of ethics and policies andconsult respected colleagues to see how dentistsgenerally deal with such issues. Consider alternative solutions in light of theprinciples and values they uphold and their likelyconsequences. Inform those whom your proposed solution willaffect and discuss it with them.

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2. ACD Assess Is it true? Is it accurate? Is it fair? Is it quality? Is it legal? Communicate Have you listened? Have you informed the patient? Have you explained outcomes? Have you presented alternatives? Decide Is now the best time? Is it within your ability? Is it in the best interests of the patient? Is it what you would want for yourself? Make your Decision and act on it, with sensitivity toothers affected. Evaluate your decision and be prepared to actdifferently in future. All in all, Ive tried my best to conclude points from the manual but as the dr. said you have to go back to it because it`s the final source of the material . Good Luck. -the required pages from the book are chapter one (22-41). *** Done by: GhadeerAfaneh

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