Ethics in Dentistry 2024-2025 PDF

HORUS UNIVERSITY FACULTY OF DENTISTRY Ethics in Dentistry Code: OPED 213 By Prof. Reham Mohamed Abdallah Level 2. Semester 1 1  ‫جامعة ح...

HORUS UNIVERSITY FACULTY OF DENTISTRY Ethics in Dentistry Code: OPED 213 By Prof. Reham Mohamed Abdallah Level 2. Semester 1 1  ‫جامعة حورس‬-‫رؤية كلية طب األسنان‬ ‫التميز والريادة في مجال طب األسنان محليا ً وإقليميا ً ودوليا ً من حيث التعليم والبحث العلمي وخدمة‬ ‫المجتمع‬ Vision of the Faculty of Dentistry - Horus University Excellence and leadership in the field of dentistry locally, regionally and internationally in terms of education, scientific research and community service. ‫جامعة حورس‬-‫رسالة كلية طب األسنان‬ ‫إعداد خريجين مؤهلين بالمعرفة النظرية والمهارات العمليه والسلوكيات اإلنسانية التي تمكنهم من‬ ‫المنافسه في سوق العمل ونقل المعرفة من خالل إجراء الدراسات والبحوث العلمية وتقديم الخدمات‬.‫المجتمعيه المتميزه للمواطنين‬ Mission of the Faculty of Dentistry - Horus University Preparing qualified graduates with theoretical knowledge, practical skills and human behaviors that enable them to compete in the labor market and transfer knowledge through conducting studies and scientific research and providing distinguished community services to citizens. 2 Intended Learning Outcomes of Course (ILOs) By the end of this course, the student should be able to a. Knowledge and understanding: 1. Recognize the meaning of ethics, dental ethics and Hippocratic oath. 2. Identify the difference in meaning between the terms of profession, professional and professionalism. 3. List the ethical principles. 4. Recognize paternalism and autonomy. 5. Describe different approaches in decision making. 6. Recall the dentist-patient relationship. 7. Restate duties of the dentist towards patient, his colleagues and public 8. Discuss unethical behaviors of practicing dental profession. 9. Describe standards of Nuremberg code 10.Report the research ethics. b. Intellectual skills 1. Categorize the meaning of dental ethics term. 2. Differentiate between profession, professional and professionalism. 3. Analyze different approaches in decision making. 4. Compare the dentist and patient attitudes in both paternalism and autonomy. 5. Compare the rules of the dentist towards the patient, other dentists and the whole community. 6. Analyze the models of dentist-patient relationship. 7. Appraise the unethical behaviors done by the dentist. 8. Distinguish the standards of Nuremberg code. 9. Estimate properly the research ethics. d. General and transferrable skills 1. Utilize information technology. 2. Develop capability of giving scientific based comments 3. Manage ethical attitude in dental practice and develop professional responsibility. 4. Manage time efficiently. 3  ETHICS The word ethics is derived from Greek word “ethos” meaning custom or character. ‫عاده او عرف‬ It is used interchangeably with moral which is derived from Latin word mores meaning “customs or habits”. DEFINITION Ethics is the philosophy of human conduct. (‫(السلوك البشري‬or A way of stating and evaluating principles by which problems of behavior can be solved. )‫(طريقه لصياغه وتقييم مبادئ لحل مشاكل السلوك بها‬ 4  Ethics is concerned with standards (‫ )معايير او مقاييس‬judging whether actions are right or wrong. DENTAL ETHICS Dental ethics simply means moral duties (‫ )الواجبات األخالقية‬and obligations )‫ )االلتزامات‬of the dentists towards the patients, professional colleagues and to the society. Ethics deals with the choices we make and our actions in relation to those choices WHAT IS A “PROFESSION”? It is an occupation (‫ )مهنه او وظيفه‬involving long and specialized preparation on the level of higher education and governed by a special code of ethics. WHAT IS A “PROFESSIONAL”? A professional is a member of a profession. (‫)عضو في المهنة‬ The charge as a dentist is to be a professional. On receiving the degree in dentistry, the person officially became a participant in a profession. 5  A participant is not necessarily to be a professional. Four qualities (‫ )صفات‬have been attributed to those who practice a profession: 1. A professional has respect for human beings. 2. A professional is competent. (‫)مؤهل او مختص او كفؤ‬ 3. A professional has integrity. (‫)نزاهة او أمانه‬ 4. A professional’s primary concern is service, not profit. (‫)منفعة‬ So, a professional is concerned about conduct. A professional is ethical. WHAT IS “PROFESSIONALISM”? Professionalism extends ethics to include the conduct (‫)تصرف او اداره‬, that characterize a professional or a profession. Or Quality of conduct (‫ )جوده االداء‬by use of superior knowledge, skill, and judgment, to the benefit of another, prior to any consideration of self- interest. Example of exam question 1. All is true about a professional except a. A professional has respect for human beings. b. A professional is competent. c. A professional has integrity. d. A professional lies on patients. 6 HISTORY HIPPOCRATIC OATH )‫(حلف او قسم أبقراط‬ It is the first ethical standards )‫ )المعايير األخالقية‬given by Hippocrates, the father of medicine, in the 4th century BC (before crest). “Prescribe principles for the good of my patients according to my ability and my judgment and never do harm to anyone”. ETHICAL PRINCIPLES 1. To do no harm [ non-maleficence ] ‫عدم االيذاء‬ 2. To do good [ beneficence ] ‫االحسان‬ 3. Respect the person ‫احترام الشخص‬ 4.Justice ‫عدالة‬ 5.Veracity or truthfulness ‫المصداقية‬ 6.Confidentiality ‫السرية‬ 7  I. TO DO NO HARM (NON-MALEFICENCE) Actions of the dentist should not harm the patients in anyway. IATROGENIC DISEASES-DOCTOR INDUCED ILLNESS 1. Use of unsterilized instruments. ‫ طبيب يسبب المرض‬- ‫امراض عالجيه المنشأ‬ 2. Iatrogenic diseases (underfilling, overfilling etc). 3. Doing procedures beyond his competency. (‫)اعلى من كفاءه الطبيب‬ 8 II. TO DO GOOD (BENEFICENCE) A dentist should act in the best interest of the patient. (‫)العمل في مصلحه المريض‬ In the process of treating a patient what has to be weighed are the consequences of treatment versus no treatment, e.g.: questionable dental caries. Attempts to maximize the benefits and minimize harm. Plan for a treatment only if necessary. Should always think about the welfare of the patient. Example of exam question The action of not harming the patients is related to 1. Confidentiality principle 2. Autonomy principle 3. Non-maleficence principle 4. Beneficence principle 9  III. RESPECT THE PERSON This incorporates at least two other ethical principles 1. AUTONOMY (SELF GOVERNMENT OR THE CONDITION OF BEING AUTONOMOUS) It is the principle that states that dentist respect patients right to make decisions of the treatment plan. )‫( يحترم حق المرضى في اتخاذ القرار في خطه العالج‬ Dentists usually try to direct the patient towards a particular mode of treatment by stressing only over the advantages rather than mentioning disadvantages. Respect patient's right to make decisions. Don’t force decisions on patients. In case of minors, parents or guardians (‫ )وصي‬can grant the consent for care. 10  Paternalism is to act as a father (or parent) (an action limiting a person's liberty). In dentistry, it is the dentist’s responsibility to determine the decision-making for the patient’s own benefit. Paternalism in health care can take the form of withholding information (‫)حجب المعلومات‬, restricting choices (‫)حصر الخيارات‬. 11 Example of exam questions The principle of respecting patients' right to make decisions concerning the treatment plan is termed 1. Paternalism 2. Truthfulness 3. Justice 4. Autonomy 2. INFORMED CONSENT It is an essential component of a patient’s right to autonomy (Adequate information, with adequate understanding). It is the first stated and the largest principle of the Nuremberg code. The Nuremberg code identified four attributes without which consent cannot be considered valid. Consent must be – Voluntary (‫)بإرادة المريض‬ – Legally competent (‫)يفي بالغرض من الناحيةالقانونية‬ – Informed (‫)تم اعالم المريض مسبقا‬ – Comprehending (‫)شامل‬ Consent is a two-step process Firstly, information is presented to the patient by doctor Secondly, the patient understands and based upon this understanding either agrees or refuses to undergo the treatment. 12 It includes a description of: 1. Procedures to be carried out. 2. Risks of the treatment. 3. Expected benefits from the treatment. 4. A statement that the patient has understood the procedure and is willing to undergo the treatment. 5. The signature of the patient and of a witness. 13 Example of exam question All of the following are important attributes for the informed consent except 1. Informed 2. Legally competent 3. Against patient well being 4. Comprehensive IV. JUSTICE (FAIRNESS) It means providing equal treatment to all without any prejudice. (‫)انحياز‬ Principle of justice is to protect the weak and to ensure equality in rights and benefits, for both groups and individuals. Violation of justice (‫)انتهاك العدالة‬ It occurs by discrimination (‫ )التمييز‬between patients based on caste (‫)الطبقةاالجتماعية‬, creed (‫)العقيدة‬, socioeconomic status (‫ )الحالةاالجتماعية‬and health condition (‫)الحالةالصحية‬. Dentists should treat their patients by: Providing a quality service.(‫)تقديم جوده في الخدمة‬ Assessing a reasonable fee.(‫)تقدير قيمه اتعاب مناسبه‬ Attending to the patient in time of need (‫)الحضور للمريض في وقت الحاجه‬ 14  Gaining an informed consent Maintaining confidentiality (‫)االحتفاظ بالسرية‬ Example of exam question The dentist should achieve the justice principle towards the patients through 1. Discrimination between patients based on socioeconomic status. 2. Disclosing secrets of the patient to public. 3. Lying on the patient about the treatment plan. 4. Equality in rights and benefits. V. TRUTHFULNESS OR VERACITY The patient - doctor relationship is based on mutual trust. (‫)الثقةالمتبادلة‬ Lying shows disrespect (‫ )عدم االحترام‬to the patient. Patient expects the dentist to give true information about treatment and prognosis. 15  Don’t: Hide treatment failures. Give false information. Studies on terminally ill patients had shown that the physicians should withhold (‫ )يحجب‬bad news when they believed it would upset (‫ )تزعج‬the patient. It is an example for Hippocratic paternalism; that the doctor knows the best. Nowadays, in certain areas, there is a reversal (‫ )عكس‬of this concept. VI. CONFIDENTIALITY (‫)السرية او الخصوصية‬ Health is a sensitive issue. Hippocratic Oath “What I may see or hear in the course of treatment or even outside of treatment related to the life of men…, I will keep to myself”.(‫)احتفظ بها لنفسي‬ The patient has right to expect that all records related to their care will be treated as confidential. Disclose (‫ )يكشف‬only if it benefits the patient (with consent). 16  Avoid - Gossiping (‫ )النميمة‬about the patient as this breaks the bond of trust between dental professional and patient. Example of exam question Gossiping about the patient destroys one of the ethical principles which is 1. Autonomy 2. Confidentiality 3. Truthfulness 4. Justice 17 HOW DO INDIVIDUALS DECIDE WHAT IS ETHICAL? Two approaches are used in decision making; rational and non- rational. NON-RATIONAL APPROACH )‫)نهج غير عقالني‬ OBEDIENCE )‫(الطاعه‬ Making ethical decision by following the rules or instructions of those in authority)‫(سلطه‬, whether or not you agree with. Examples on this as during dealing with children or those who work in the military organizations )‫(المؤسسات العسكريه‬. IMITATION )‫(تقليد أومحاكاه‬ Making ethical decision by following a role model)‫ (قدوه‬being the senior dentists for example. FEELING OR DESIRE It is a subjective approach )‫ (نهج ذاتي‬to moral decision making. Making ethical decision by following the person’s desire or feeling towards right or wrong things. It can vary greatly from individual to another, and even within the same individual over time. 18  INTUITION )‫(البديهه‬ It is an immediate perception )‫ (إدراك فوري‬of the right way to act in a situation. It is similar to desire in that it is entirely subjective )‫(ذاتي‬. Like feeling and desire, it can vary greatly from individual to another, and even within the same individual over time HABIT Decision making depends on previous decisions had been taken before and related to previous similar situations. However, there are bad habits as well as good ones. Moreover, situations that appear similar may require significantly different decisions. RATIONAL APPROACH )‫)نهج عقالني‬ DEONTOLOGY )‫(علم األخالق‬ Decision making depends on fundamental rules )‫ (القواعد األساسيه‬to be used as a basis for making moral decisions. An example of these rules is treating all people as equals. CONSEQUENTIALISM )‫(التبعيه‬ Decision making depends on the choice that produces the best outcomes )‫(النتائج‬. 19  It depends on analysis of the consequences or outcomes of different choices. However, Disagreement usually occurs in determining which outcomes to be used in evaluating the decision. PRINCIPLISM )‫(المبدأ‬ Ethical principles are used as the basis for making moral decisions. Respect for autonomy, beneficence, non-maleficence and justice, are considered the most important principles for ethical decision making in health care. VIRTUE ETHICS )‫(األخالق الفضيله‬ Focuses less on decision making and more on the behavior of decision makers. Examples of important virtues of dentists are compassion, )‫(التعاطف‬ honesty )‫ (الصدق‬and dedication )‫(التفاني‬. Dentists with these virtues can make good decisions and apply them in a good way. However, virtuous dentists may make wrong decisions. 20 Note: None of these approaches was able to win universal approval as each one has both strengths and weaknesses. Also, individuals vary in their preference to a certain approach over another. Principlism is the most helpful for making clinical ethical decision at the chairside. Example of exam question Decision making depending on the choice that produces the best outcomes represents a rational approach which is….. 1. Virtue ethics 2. Consequentialism 3. Intuition 4. Deontology 21  EHICAL RULES FOR DENTISTS Duties of dentist towards patients Duties of dentist towards one another Duties of dentist towards the public A. DUTIES OF DENTIST TOWARDS PATIENTS 1. Dentists should be polite)‫)مهذب‬, sympathetic (‫)متعاطف‬, friendly and helpful. 2. Respect time of his appointments. 3. Should not permit considerations (‫ )اعتبارات‬of religion, nationality, race (‫)الساللة‬, or social standing (‫ )المكانةاالجتماعية‬to affect his duties and treatment. 4. Keep knowledge updated and search for new for better treatment of patient. 5. Maintain accurate medical reports of patients. 6. Keep patients’ information as confidential. 22  DOCTOR-PATIENT RELATIONSHIP MODELS 1. Guide model 2. Agent model 3. Commercial model 4. Interactive model GUIDE MODEL (‫)نموذج المرشد‬ The relationship is based on dentist's expertise (‫ )خبره‬and the patient's lack of it. Patient does not participate (‫ )ال يشارك‬in dental decisions. Dentist is the judge of the patient's needs. )‫(يحكم على احتياجات المريض‬ 23 AGENT MODEL (‫)نموذج العميل‬ All dental decisions are made by patient. Dentist provides service for patient choices. COMMERCIAL MODEL (‫)النموذج التجاري‬ Dentist has something to sell and the patient may or may not want to buy it. Principles of "market place" are applied. Patient's need for care is not the direct determinant of the dentist's actions. Dentist and patient are on equal ground. INTERACTIVE MODEL (‫)نموذج تفاعلي‬ Dentist and patient are equal partners. (‫)شركاء متساويين‬ Preservation and maximization of patient autonomy. Dentist enhances patient's decision making capacity. (‫)يحفز قدره المريض في اتخاذ القرار‬ Dentist participates with his expertise into the decision-making process. (‫)يساهم بخبرته في اتخاز القرار‬ 24 B. DUTIES OF DENTIST TOWARDS ONE ANOTHER 1. Every dentist should be proud (‫ )فخور‬of his / her colleagues and should not under estimate (‫ )يقلل من قيمه‬them with words or act. 2. If a dentist treated a patient of another dentist and found that the patient is suffering from previous faulty restoration His duty is to correct the treatment at once with few comments to avoid bad reflection on his colleague. 3. When the dentist asked his colleague to take care of his patient, during his sickness or absence Mutual arrangement (‫)ترتيب متبادل‬ should be made. C.DUTIES OF DENTIST TOWARDS THE PUBLIC 1. Dentist should take leadership roles in the communities on matters related to dental health. 2. To participate in community affairs (‫)الشئون المجتمعية‬. 3. Educate the public in promotion of health (‫)تحسين الصحة‬. 4. To provide for public needs/welfare. 5. To follow community laws. 25 Example of exam question The participation of the dentist in community affairs in one of his duties towards 1. His colleagues 2. Public 3. Patient 4. Himself UNETHICAL PRACTICESS 1. Practicing by unregistered persons employed by the dentist. 2. Signing a certificate issued for untrue and misleading reasons.( ‫توقيع‬ ‫)شهادات اصدرت ألسباب غير حقيقيه ومضلله‬ 3. Allowing or accepting commission. (‫)يسمح او يقبل بالعمولة‬ 4. Dentists advertising whether directly or indirectly for the purpose of obtaining patients or his own professional advantage. 5. Use of forged diplomas.(‫)زائف‬ 26 6. Undercharging to attract patients. (‫)اسعار اقل الجتذاب المرضى‬ 7. Practice without a dental qualification. (‫)يمارس بدون المؤهالت‬ 8. Use of Dentist’s name that is no longer practicing (can continue only for 1 year). 9. A dentist practicing medicine. 10.A dentist’s clinic termed as hospital. 11.Use of terms like tooth puller, Denture maker etc. 12.Not informing patients about change of ownership or address. 13.Performing unnecessary services for gaining money. (‫)تحقيق مكاسب ماديه‬ 14.Obtaining money from patients who may carry a particular insurance. 27 Example of exam question Describe the following behaviors as ethical or unethical 1. Dentist practicing without a dental qualification. (Unethical) 2. The patient - doctor relationship is based on mutual trust. (Ethical) 3. Dentist accepts commission. (Unethical) 4. Dentist is attending to the patient in time of need. (Ethical) NEED FOR RESEARCH ETHICS “Many prominent medical researchers in the 19th and 20th centuries performed experiments (‫ )اجرو تجارب‬on patients without their consent (‫ )موافقه‬and with little if any concern for the patients well-being” )‫(مصلحه المريض‬ NAZI EXPERIMENTS Testing with infectious diseases Killing High altitude experiments Experimental surgery Traumatic experimentation Pharmacological experiments 28  NUREMBERG TRIAL The Nuremberg Code is the most important document in the history of the ethics of medical research. The Code was formulated in 1947, in Nuremberg, Germany, by American judges sitting in judgment of Nazi doctors ( ‫قضاه أمريكيين تواجدوا في محاكمه‬ ‫ )االطباء النازيين‬accused of conducting murderous human experiments in the concentration camps. (‫)متهمين بممارسه تجارب انسانيه قاتله في معسكرات االعتقال‬ 29  NUREMBERG CODE Briefly, the 10 standards of the Nuremberg code are as follows: 1. Volunteers freely consent to participate 2. Researchers fully inform volunteers concerning the study 3. Risks associated with the study are reduced where possible 4. Researchers are responsible for protecting participants against harms. 5. Participants can withdraw from the study at any time 6. Qualified researchers perform the study. 7. Termination of the study if adverse effects occur. 8. Society should benefit from study findings. 9. Research on humans, should be based on previous animal experimentation. 30 10. A research study should never begin if there is a reason to believe that death or injury may result. DECLARATION OF HELSINKI (‫)اعالن اوتصريح‬ It is a set of ethical principles for medical research involving human subject developed by world medical association (WMA) in 1964and its subsequent amendments. (‫(تعديالت‬ It provides guidance to physicians and other participants in medical research involving human subjects. WHISTLE- BLOWING Whistle- blower is someone who informs people in authority or the public that an individual or an organization is doing something unethical or illegal. The expression comes from the world of sport, where a referee blows a whistle to signal an infraction of the rules. 31  So, whistle blowers have to disclose information about unethical research to the authorities (for example, lying to research subjects or fabricating data). CONFLICT OF INTEREST )‫(تضارب المصالح‬ A conflict of interest is a set of conditions in which professional judgment concerning a primary interest (such as a patient’s welfare or the validity of the research) tends to be excessively influenced by a secondary interest (such as financial gain). )‫(الربح المادى‬ CONCLUSION Healthcare is not a business. Hence, adherence to a code of ethics is important for the continued trust of the society in dentistry. Ethics is not a rule or cannot be forced on anyone. It has to be self-cultivated. 32